Pressure ulcer incidence and risk factors in ventilated intensive care patients Francisco Manzano MD a, ⁎ , Maria José Navarro RN b , Delphine Roldán RN a , Maria Angeles Moral RN c , Isabel Leyva RN a , Carmen Guerrero RN d , Maria Angustias Sanchez RN e , Manuel Colmenero MD a , Enrique Fernández-Mondejar MD b, ⁎ Granada UPP Group 1 a Intensive Care Unit, Hospital General (University Hospital Virgen de las Nieves), Granada, Spain b Intensive Care Unit, Hospital de Traumatología (University Hospital Virgen de las Nieves), Granada, Spain c Intensive Care Unit, San Cecilio University Hospital, Granada, Spain d Intensive Care Unit, Motril Hospital, Granada, Spain e Intensive Care Unit, Baza Hospital, Granada, Spain Keywords: Pressure ulcers; Incidence; Risk factor; Mechanical ventilation; Intensive care unit Abstract Purpose: The aim of this study was to determine the incidence of pressure ulcers (PUs) in ventilated patients in all intensive care units (ICUs) in Granada (Spain) and identify risk factors for their development. Materials and Methods: A prospective cohort study in 9 medical-surgical ICUs was conducted. Two hundred ninety-nine patients with more than 24 hours on mechanical ventilation (MV) were enrolled during 2 periods in a 5-month study. Pressure ulcers of patients were measured according to the European Pressure Ulcer Advisory Panel. Results: Of the 299 patients initially enrolled, 47 (16%) developed PUs of at least grade II severity. The incidence density of PUs was 13.4 cases per 1000 patient-days of ICU stay and 19.6 cases per 1000 patient- days on MV. Logistic regression identified first-day respiratory sequential organ failure assessment (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.026-2.360; P = .037), fourth-day cardiovascular sequential organ failure assessment (OR, 1.33; 95% CI, 1.066-1.664; P = .012), age (OR, 1.042; 95% CI, 1.013-1.072; P = .004), winter period (OR, 4.60; 95% CI, 1.99-10.59; P b .001), and length of MV before PUs (OR, 1.042; 95% CI, 1.005-1.080; P = .024) as significant independent predictors of PU development. Conclusions: Among other factors previously known in ventilated patients, duration of MV and winter period were identified as risk factors for PUs. © 2010 Elsevier Inc. All rights reserved. ⁎ Corresponding authors. Francisco Manzano is to be contacted at Intensive Care Unit, Virgen de las Nieves University Hospital, 18014 Granada, Spain. Tel.: +34 958020125; fax: +34 958020134. Enrique Fernández Mondéjar, Intensive Care Unit, Virgen de las Nieves University Hospital, 18013 Granada. Spain. Tel.: +34 958021630; fax: +34 958021634. E-mail addresses: fmanzano@mailpersonal.com (F. Manzano), enrique.fernandez.mondejar.sspa@juntadeandalucia.es (E. Fernández-Mondejar). 1 See Appendix A. 0883-9441/$ – see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.jcrc.2009.09.002 Journal of Critical Care (2010) 25, 469–476