Risk Factors for Pressure Injury in Mechanically Ventilated Patients in Emergency Intensive Care Units: A Prospective Observational Study

Abstract

Background: High incidence of pressure injury (PI) in emergency intensive care units (EICUs) persists; however, research on its prevention remains limited. Aim: This study aimed to identify the risk factors for PI in mechanically ventilated patients in EICUs. Study Design: This prospective observational study included 120 mechanically ventilated EICU patients from December 18, 2023, to February 17, 2024. Patients were followed up from EICU admission until EICU discharge, and PI incidence was recorded based on the electronic medical records. Data on general, disease-related and PI-related characteristics were collected and analysed using descriptive statistics, chi-squared tests, independent t-tests and logistic regression. Results: Of the 120 mechanically ventilated patients, 55 (45.8%) had pressure injuries at EICU admission. During the EICU stay, 49 (40.8%) had persistent injuries, 18 (15.0%) developed new injuries, 6 (5.0%) healed completely, and 47 (39.2%) remained injury-free—indicating a total injury burden of 63.3%. In multivariate analysis, longer duration of mechanical ventilation (odds ratio [OR] per day: 1.16, 95% confidence interval [CI]: 1.02–1.32), higher sacral interface pressure (OR per 1 mmHg: 1.81, 95% CI: 1.40–2.32) and higher occipital interface pressure (OR per 1 mmHg: 1.24, 95% CI: 1.03–1.50) were associated with increased risk of PI. Conversely, higher body mass index (OR per 1 kg/m2: 0.84, 95% CI: 0.72–0.98) and higher serum albumin levels (OR per 1 g/dL: 0.26, 95% CI: 0.10–0.66) were associated with decreased risk. Conclusions: EICU nurses should closely monitor high-risk patients and implement targeted preventive strategies based on identified risk factors. Relevance to Clinical Practice: Early detection of high-risk patients is essential to reduce the incidence of pressure injuries in mechanically ventilated EICU patients. Critical care nurses should proactively evaluate patients upon admission—particularly those with poor nutritional status or elevated interface pressure—and promptly implement targeted interventions, such as pressure redistribution, individualised repositioning and nutritional support.