Intensive Crit Care Nurs. 2025 Nov 22;93:104278. doi: 10.1016/j.iccn.2025.104278. Online ahead of print.
BACKGROUND: Intraoperative Acquired Pressure Injury (IAPI) is a common complications in cardiac surgery, with reported incidence rates of 14.3-30%. Conventional pressure redistribution methods have limited effectiveness during lengthy procedures. This study evaluated the efficacy of intermittent pneumatic compression (IPC) cushions in preventing sacrococcygeal IAPI in cardiac surgery patients and developed a predictive nomogram for risk assessment.
METHODS: In this prospective, single-center randomized controlled trial, patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) were randomized to receive either IPC cushion (n = 94) or standard gel pad (n = 95). The primary outcome was the incidence of sacrococcygeal IAPI. Secondary outcomes included intraoperative changes in regional tissue oxygen saturation (rSO2) and postoperative skin temperature differentials (ΔT). Risk factors were identified through logistic regression analysis, and a predictive nomogram was constructed and validated.
RESULTS: The IAPI incidence was significantly lower in the IPC group compared to the control group (3.19 % vs. 18.95 %, P = 0.001). The IPC group demonstrated higher sacrococcygeal rSO2 values during CPB and rewarming phases (P < 0.05). Postoperative sacrococcygeal ΔT was significantly lower in the IPC group [0.0 (-0.1, 0.1) vs 0.3 (-0.3, 0.5); P = 0.001]. Multivariate logistic regression identified lower preoperative sacrococcygeal rSO2 (OR = 0.94, 95 % CI: 0.90-0.98), absence of IPC intervention (OR = 0.06, 95 % CI: 0.01-0.28), and diabetes mellitus (OR = 7.98, 95 % CI: 2.20-29.01) as independent risk factors for IAPI. The nomogram demonstrated excellent discrimination (AUC = 0.857, 95 % CI: 0.776-0.937) and calibration (χ2 = 1.09, P = 0.997).
CONCLUSION: IPC cushions effectively reduce IAPI incidence during cardiac surgery by improving sacrococcygeal tissue perfusion. Skin temperature differentials correlate with IAPI risk and may serve as early indicators for prevention. The validated predictive nomogram offers a practical tool for risk assessment and targeted preventive strategies in clinical practice.
IMPLICATIONS FOR CLINICAL PRACTICE: This study introduced an innovative application of IPC for preventing intraoperative IAPI in cardiac surgery patients, demonstrating its effectiveness in lowering the incidence of IAPI.
PubMed:41275621 | DOI:10.1016/j.iccn.2025.104278