Korean J Intern Med.  2022 Nov;37(6):1186-1194. 10.3904/kjim.2021.546.

Neuromuscular blocking agents and opioids are major risk factors for developing pressure injuries in patients in the intensive care unit

• Lee SY
• Oh DK
• Hong SB
• Lim CM
• Huh JW

• KMID: 2535984
• DOI: http://doi.org/10.3904/kjim.2021.546

Abstract

Background/Aims
Patients in the intensive care unit (ICU) are at high risk for developing pressure injuries, which can cause severe complications and even increase the mortality risk. Therefore, prevention of pressure injuries is most important. In this study, we investigated the risk factors of pressure injury development in patients admitted to the ICU.
Methods
We retrospectively analyzed patients ages > 18 years admitted to the medical ICU in a tertiary hospital between January and December 2019. We collected patient baseline characteristics, medications received, mechanical ventilation or hemodialysis use, laboratory findings, and date of pressure injury onset and characteristics.
Results
We analyzed 666 patients who did not have pressure injuries at ICU admission. Pressure injuries developed in 102 patients (15%). The risk of pressure injury development increased as the administration days for neuromuscular blocking agents (NMBAs; odds ratio [OR], 1.138; p = 0.019) and opioids (OR, 1.084; p = 0.028) increased, and if the patient had problem with friction and shear (OR, 2.203; p = 0.011).
Conclusions
The prolonged use of NMBAs and opioids can increase the risk of pressure injury development. Because these medications are associated with immobilization, using both should be minimized and patient early mobilization should be promoted. Among the Braden subscales, “friction and shear” was associated with the development of pressure injuries in ICU patients.

Keyword

Pressure injury; Intensive care units; Neuromuscular blocking agents; Analgesics; opioid; Immobilization