Characteristics and risk factors of nasal mucosal pressure injury in intensive care units

Abstract

Aims and objectives: This study aimed to understand the risk factors that contribute to medical device-related (MDR) nasal mucosal membrane pressure injuries (MM PI) in ICU patients.

Background: ICU patients require substantial tube-based life support such as oxygen tubes, tracheal intubation and indwelling gastric tubes. As a result, there is an increased risk of PI occurrence; however, few studies have assessed the risk factors associated with nasal mucosal MDR-MMPI in ICU patients.

Design: A cross-sectional study design was performed.

Methods: From January 2019 to June 2020, data from 912 patients treated in the ICU of a tertiary first-class a hospital in China were collected. The occurrence of PI of the nasal mucosa was obtained by nasopharyngoscope when replacing the nasal catheter fixation patch every day. The study methods were followed by the STROBE guidelines.

Results: The incidence of nasal mucosal MDR-MM PI was 10.9%. The degree of nasal mucosal MM PI was mainly grade 1 (62cases, 62.6%), and no grade 4 were observed. The columella (58 cases, 58.6%) was the most common site of nasal mucosal MM PI followed by the anterior septum (18 cases, 18.2%). A high patient APACHE-Ⅱ score, the disturbance of consciousness, a history of diabetes, days of gastric tube indwelling, hypoproteinemia, fever (T > 37.5℃) and the use of vasoconstrictors were identified as significant influencing factors of nasal MM PI in ICU patients (p < .05).

Conclusions: A high APACHE-Ⅱ score, disturbance of consciousness, history of diabetes, days of gastric tube indwelling, hypoproteinemia, fever (T > 37.5℃) and use of vasoconstrictive drugs were risk factors for nasal mucosal MDR-MM PI in ICU patients. This study informs on the risk factors of nasal mucosal MM PI that will allow medical support staff to carry out key interventional measures to prevent nasal mucosal MM PI.

Relevance to clinical practice: This study illustrates the characteristics and risk factors of nasal mucosal pressure injury in intensive care units, potentially contributing to the prevention of the incidence of nasal mucosal MDR-PI in ICU patients.

Keywords: ICU; mucosal membrane pressure injury; nasal mucosa; risk factors.