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anemia, critical care, hospital-acquired pressure injury, ICU, mechanical ventilation, pressure injury, pressure ulcer, vasopressin



  1. Alderden, Jenny PhD, APRN, CCRN, CCNS
  2. Cadavero, Allen PhD, RN, WOCN, CCRN
  3. Zhao, Yunchuan "Lucy" PhD, RN
  4. Dougherty, Desiree MBS, BSN, RN, CCRN, TCRN
  5. Jung, Se-Hee MS, RN
  6. Yap, Tracey L. PhD, RN, WCC, CNE, FGSA, FAAN


OBJECTIVE: To identify factors associated with subsequent hospital-acquired pressure injury (HAPrI) formation among patients in surgical and cardiovascular surgical ICUs with an initial HAPrI.


METHODS: Patients admitted to a level 1 trauma center and academic medical center in the Western US between 2014 and 2018 were eligible for this retrospective cohort study. Inclusion criteria were development of an HAPrI stage 2 or above, age older than 18 years, the use of mechanical ventilation for at least 24 hours, and documentation of a risk-based HAPrI-prevention plan including repositioning at least every 2 hours. The primary outcome measure was development of a second, subsequent HAPrI stage 2 or higher. Potential predictor variables included demographic factors, shock, Charleston comorbidity score, blood gas and laboratory values, surgical factors, vasopressor infusions, levels of sedation or agitation, Braden Scale scores, and nursing skin assessment data.


RESULTS: The final sample consisted of 226 patients. Among those, 77 (34%) developed a second HAPrI. Independent risk factors for subsequent HAPrI formation were decreased hemoglobin (odds ratio, 0.71; 95% confidence interval [CI], 0.53-0.92; P < .000), vasopressin infusion (odds ratio, 2.20; 95% CI, 1.17-4.26; P = .02), and longer length of stay in the ICU (odds ratio, 1.01; 95% CI, 1.00-1.02; P = .009).


CONCLUSIONS: Patients with an HAPrI are at high risk of subsequent HAPrI development. Anemia, vasopressin infusion, and longer ICU stays are independent risk factors for repeat HAPrI formation.