Characteristics and Associated Factors of Pressure Injury Development in Adult Intensive Care Unit Patients after Prone Invasive Ventilation: A Study based on the MIMIC-IV Database
DOI:
https://doi.org/10.54097/7g0rg442Keywords:
Pressure Injury, Prone Position, Invasive Mechanical Ventilation, Intensive Care Unit, MIMICAbstract
Objective: To describe the documentation characteristics of pressure injuries in adult intensive care unit (ICU) patients receiving invasive mechanical ventilation following prone positioning, and to analyze associated factors. Methods: A retrospective cohort study was conducted using the MIMIC-IV v3.1 database, including adult patients admitted to the ICU for the first time who received invasive mechanical ventilation and had documented prone positioning. The index event was defined as the first recorded instance of prone positioning, and patients with prior documentation of pressure injury before this event were excluded. Multivariable logistic regression was used to analyze risk factors, and a 24-hour landmark analysis was performed to examine the association between the intensity of early nursing documentation during prone positioning and subsequent documentation of pressure injury. Results: A total of 297 patients were included, of whom 102 developed new pressure injury documentation following their first prone positioning episode, yielding an incidence of 34.34%. The model constructed from pre-index-event variables showed limited discriminatory ability (C-statistic = 0.594), and none of the candidate variables reached statistical significance. The 24-hour landmark analysis revealed that the number of nursing documentation entries within 24 hours after initial prone positioning was significantly associated with new pressure injury documentation beyond 24 hours (OR = 2.42, 95% CI: 1.39–4.19, P = 0.002). Conclusion: New pressure injury documentation is relatively common among adult ICU patients on invasive mechanical ventilation after prone positioning, and early nursing documentation intensity is associated with subsequent pressure injury documentation. Clinically, more intensive skin assessment and monitoring of high-risk pressure areas in prone patients are warranted, along with more standardized nursing documentation practices.
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