Avaliação do impacto de um protocolo de prevenção de lesão por pressão nos desfechos clínicos de pacientes internados na unidade de terapia intensiva: ensaio clínico randomizado

Abstract

Introduction: considered one of the main adverse events (AEs) related to assistance in health services, pressure ulcers (PI) may result from the long stay of patients in Intensive Care Units (ICU). Nursing care for patients at risk of PI is still based on the individual knowledge of nurses. For the rise of this care, it is necessary to program a nursing care supported by a process based on scientific evidence. In turn, the PI prevention protocol is a scientific instrument, validated to conduct the actions of the nursing process. Objective: to evaluate the impact of implementing a protocol for the prevention of pressure injuries in intensive care unit patients. Method: this is an open-label randomized and controlled clinical trial (open trial). We analyzed 139 patients admitted to the ICU between February 2021 and November 2021, evaluated using the revised Cubbin & Jackson (C&J) scale, followed by the analysis of inclusion criteria: age equal to or greater than 18 years, length of admission to the care units critical < 24h, not having LP at the time of the first evaluation. Patients randomized to the intervention group (IG) received actions that make up the PI prevention protocol and patients in the control group (CG) received routine care at the unit under study. These patients, allocated in the CG and IG, were systematically followed up for a period of 10 days in the ICU. Results: 92 patients were randomized, divided into CG (46 patients) and GI (46 patients). During the 10 days of applicability of the project, 35 (38.05%) patients developed PI, 9 (19.57%) patients from GI vs. 26 (56.52%) patients from CG, [19.57% (9) GI with LP vs 56.52% (26) GC with LP]. As for the staging and classification of LP, the extent of damage caused to the tissues of the 35 patients who developed LP was evaluated; 24 patients developed LP G2, 9 were allocated in GI vs 15 in CG; 11 patients had LP G3, all belonging to the CG, no patient in GI had LP G3. Length of hospital stay (IUT) in CG vs IG (30.5 days vs 23 days), Length of stay in ICU (ICUI) in CG vs IG (20 days vs 17.5 days). The daily assessment of the NAS showed that during the 10 days of application of the PI prevention protocol, there was no impact on the workload of the nursing team when comparing the CG vs IG. Conclusion: the pressure injury prevention protocol proposed in this study reduced the incidence of PI in patients and did not increase the nursing workload.