중환자실 기관 삽관 환자에서 물리적, 생리적 특성과 구강점막 욕창의 상관성

Abstract

Purpose This study was conducted to examine the incidence of oral mucosa pressure ulcers (PUs) in patients in intensive care unit (ICU) and the relationship between mechanical and physiological variables in the on set of PUs.

Method A prospective, observational, and descriptive study design was used. Patients who were older than 18 years with endotracheal tube insertion from an ICU in a secondary hospital in Busan, South Korea, were recruited in the study. The data of 80 patient-days were included. Patient assessments and medical record reviews were conducted to collect data regarding mechanical and physiological variables. Nonparametric univariate analyses were performed using Chi-square test or Fisher exact test and independent t-test or Mann–Whitney U tests and Spearman rank order analysis.

Results The incidence rates of oral mucosa PUs were 17.3% in the lower jaw and 6.2% in the upper jaw. Significant relationships were observed between the lower oral mucosa PU stage and restraint use (r = 0.30, p = .008), level of consciousness(r=0.31, p = .005), steroid use (r = 0.33, p = .003), creatinine level (r=−0.24, p = .029), Pseudomonas aeruginosa (r = 0.25, p = .028), and Streptococcus pneumoniae (r = 0.22, p = .046). Upper oral mucosa PU stage was related to restraint use (r = 0.43, p < .001), steroid use (r = 0.24, p = .031), vasopressor use (r = −0.23, p = .042), serum albumin (r = −0.22, p = .046), and number of P. aeruginosa (r = 0.45, p < .001) and Streptococcus aureus (r = −0.24, p = .033) in the oral cavity.

Conclusion Mechanical factors, such as bite-block or airway use, restraint use, and duration of ventilator use were not related to the stage of oral mucosa PUs. Multiple hematological variables, such as creatinine and serum albumin, bacteria, such as P. aeruginosa, S. aureus, and S. pneumoniae in the oral cavity, were related to the stage of oral mucosa PUs. Further investigation is required to prevent oral mucosa PUs induced by mechanical and physiological factors.