• Sonia O Labeau, Elsa Afonso, Julie Benbenishty, Bronagh Blackwood, Carole Boulanger, Stephen J Brett, Silvia Calvino-Gunther, Wendy Chaboyer, Fiona Coyer, Mieke Deschepper, Guy François, Patrick M Honore, Radmilo Jankovic, Ashish K Khanna, Mireia Llaurado-Serra, Frances Lin, Louise Rose, Francesca Rubulotta, Leif Saager, Ged Williams, Stijn I Blot, DecubICUs Study Team, and European Society of Intensive Care Medicine (ESICM) Trials Group Collaborators.
• Nursing Department, Faculty of Education, Health and Social Work, HOGENT University of Applied Sciences and Arts, Ghent, Belgium.
• Intensive Care Med. 2021 Feb 1; 47 (2): 160169160-169.

PurposeIntensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients.MethodsInternational 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis.ResultsData from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9-27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6-16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score < 19, ICU stay > 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2-1.8), stage II (OR 1.6; 95% CI 1.4-1.9), and stage III or worse (OR 2.8; 95% CI 2.3-3.3).ConclusionPressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat.

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