Preventing pressure ulcers by assessment of the microcirculation in tissue exposed to pressure

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Fältnamn	Indikatorer	Metadata
000		06177nam a2200541 4500
001		oai:DiVA.org:liu-109960
003		SwePub
008		140829s2014 \| \|\|\|\|\|\|\|\|\|\|\|000 \|\|eng\|
020		a 9789175193175q print
024	7	a https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-1099602 URI
024	7	a https://doi.org/10.3384/diss.diva-1099602 DOI
040		a (SwePub)liu
041		a engb eng
042		9 SwePub
072	7	a vet2 swepub-contenttype
072	7	a dok2 swepub-publicationtype
100	1	a Bergstrand, Sara,d 1978-u Linköpings universitet,Avdelningen för omvårdnad,Hälsouniversitetet4 aut0 (Swepub:liu)sarbe56
245	1 0	a Preventing pressure ulcers by assessment of the microcirculation in tissue exposed to pressure
264		c 2014-08-29
264	1	a Linköping :b Linköping University Electronic Press,c 2014
300		a 80 s.
338		a electronic2 rdacarrier
490	0	a Linköping University Medical Dissertations,x 0345-0082 ;v 1407
520		a The overall aim of this thesis was to combine optical methods into a system with the ability to simultaneously measure blood flow changes at different tissue depths. The goal of such a system was to reveal vascular mechanisms relevant to pressure ulcer etiology under clinically relevant conditions and in relation to the evaluation of pressure-redistribution support surfaces.This thesis consists of four quantitative, cross-sectional studies measuring blood flow responses before, during, and after pressure exposure of the sacral tissue. Two optical methods – photoplethysmography and laser Doppler flowmetry – were combined in a newly developed system that has the ability to discriminate blood flows at different tissue depths. Studies I and II explored blood flow responses at different depths in 17 individuals. In Study I the blood flow was related to tissue thickness and tissue compression during pressure exposure of ≥ 220 mmHg. In Study II, the sacral tissue was loaded with 37.5 mmHg and 50.0 mmHg, and the variation in blood flow was measured. Studies III and IV included 42 healthy individuals < 65 years, 38 healthy individuals ≥ 65 years, and 35 patients ≥ 65 years. Study III included between-subject comparisons of blood flow and pressure between individuals in the three study groups lying in supine positions on a standard hospital mattress. Study IV added within-subject comparisons while the individual was lying on four different types of mattress. The studies explored the vascular phenomena pressure-induced vasodilation (PIV) and reactive hyperemia (RH).The most common blood flow response to tissue exposure in this thesis was PIV, although a decrease in blood flow (a lack of PIV) was observed in some individuals. The patients tended to have higher interface pressure during pressure exposure than the healthy groups but no differences in blood flow responses were seen. Our results showed that pressure levels that are normally considered to be harmless could have a significant effect on the microcirculation in different tissue structures. Differences in individual blood flow responses in terms of PIV and RH were seen, and a larger proportion of individuals lacked these responses in the deeper tissue structures compared to more superficial tissue structures.This thesis identified PIV and RH that are important vascular mechanisms for pressure ulcer development and revealed for the first time that PIV and RH are present at different depths under clinically relevant conditions. The thesis also identified a population of individuals not previously identified who lack both PIV and RH and seem to be particularly vulnerable to pressure exposure. Further, this thesis has added a new perspective to the microcirculation in pressure ulcer etiology in terms of blood flow regulation and endothelial function that are anchored in clinically relevant studies. Finally, the evaluation of pressureredistribution support surfaces in terms of mean blood flow during and after tissue exposure was shown to be unfeasible, but the assessment of PIV and RH could provide a new possibility for measuring individual physiological responses that are known to be related to pressure ulcer development.
650	7	a MEDICIN OCH HÄLSOVETENSKAPx Hälsovetenskapx Omvårdnad0 (SwePub)303052 hsv//swe
650	7	a MEDICAL AND HEALTH SCIENCESx Health Sciencesx Nursing0 (SwePub)303052 hsv//eng
650	7	a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicin0 (SwePub)3022 hsv//swe
650	7	a MEDICAL AND HEALTH SCIENCESx Clinical Medicine0 (SwePub)3022 hsv//eng
653		a Pressure ulcer
653		a photoplethysmography
653		a laser Doppler flowmetry
653		a non-invasive
653		a tissue blood flow
653		a reactive hyperemia
653		a pressure-induced vasodilation
653		a interface pressure
653		a risk assessment
700	1	a Lindgren, Margareta,c Dr.u Linköpings universitet,Avdelningen för omvårdnad,Hälsouniversitetet4 ths0 (Swepub:liu)marli73
700	1	a Ek, Anna-Christina,c Professor emeritau Östergötlands Läns Landsting,Linköpings universitet,Avdelningen för omvårdnad,Hälsouniversitetet,Akutkliniken4 ths0 (Swepub:liu)annek27
700	1	a Engström, Maria,c Dr.u Linköpings universitet,Avdelningen för radiologiska vetenskaper,Centrum för medicinsk bildvetenskap och visualisering, CMIV,Hälsouniversitetet4 ths0 (Swepub:liu)maren21
700	1	a Lindberg, Lars-Göran,c Dr.u Linköpings universitet,Institutionen för medicinsk teknik,Tekniska högskolan4 ths0 (Swepub:liu)larli69
700	1	a Huss, Fredrik,c Docentu Uppsala Universitet, Akademiska sjukhuset, Uppsala4 opn
710	2	a Linköpings universitetb Avdelningen för omvårdnad4 org
856	4	u https://liu.diva-portal.org/smash/get/diva2:741881/FULLTEXT01.pdfx primaryx Raw objecty fulltext
856	4	u https://liu.diva-portal.org/smash/get/diva2:741881/COVER01.pdfy cover
856	4	u http://liu.diva-portal.org/smash/get/diva2:741881/FULLTEXT01
856	4 8	u https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-109960
856	4 8	u https://doi.org/10.3384/diss.diva-109960

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