# Risk Factors for the Development of Pressure Injury in the Heel Area in Critically Ill Patients

## TL;DR

This study identifies risk factors like poor blood flow and certain medications that increase the chance of heel pressure injuries in critically ill patients.

## Contribution

The study highlights the role of distal perfusion dysfunction and catecholamine use as significant risk factors for heel pressure injuries in ICU patients.

## Key findings

- Catecholamine infusion is strongly associated with heel pressure injuries (p < 0.001, r = 0.45).
- Low ABI (PAD) values increase the risk of heel pressure injuries by about fivefold (OR = 5.10).
- Low creatinine levels are a strong predictor of heel pressure injuries (OR = 8.75).

## Abstract

Background/Objectives: Pressure injuries on the heels of critically ill patients occurring during hospitalization are a global problem. Risk factors include comorbidities, distal perfusion disorders, multiple organ failure, pharmacotherapy, and immobilization associated with mechanical ventilation. These factors affect microperfusion quality in the heels. The presence of friction, shear, and compressive forces contributes directly to local tissue hypoxia and secondary tissue destruction in the heels. This study aimed to assess the impact of risk factors on the development of pressure injuries on the heels of patients in intensive care. Methods: A prospective observational study using controlled observation and assessment was conducted on 120 patients treated in the Department of Anesthesiology and Intensive Care. The initial risk assessment for pressure injuries was conducted within 24 h of admission to the ward, with a follow-up assessment conducted between five and ten days after admission. Data were collected using a scientific research protocol consisting of three parts (A, B, and C). Part A contained sociodemographic data, selected biochemical results, an ankle-brachial index assessment, and a pressure injury risk assessment using the Braden scale within the first 24 h of admission. Parts B and C involved re-evaluating selected biochemical parameters and assessing areas particularly vulnerable to pressure injury development. Statistical analysis was performed using IBM SPSS Statistics v. 21. Results: It was shown that the high risk of pressure injuries in the heel area in critically ill patients is dependent on catecholamine infusion (p < 0.001, r = 0.45) and distal perfusion dysfunction, which is assessed using the ankle-brachial index (ABI-PAD) (p = 0.026, r = 0.23). The ABI (PAD) index is an important factor in the development of pressure ulcers associated with peripheral artery disease, which is associated with an approximately fivefold increase in the likelihood of heel pressure injuries compared to patients with normal ABI values (OR = 5.10, 95% CI: 1.56–16.65, p = 0.007). A correlation was demonstrated between CRP values (chi-square = 5.795, df = 1, p = 0.016) and creatinine levels (chi-square = 7.512, degrees of freedom = 2, p = 0.023, r = 0.25) and the occurrence of pressure ulcers in the heels of critically ill patients. It was shown that the strongest prognostic factor for the occurrence of heel pressure injury was a below-normal creatinine level (OR = 8.75, 95% CI: 1.20–64.13, p = 0.033). Conclusions: Distal perfusion disorders resulting from circulatory failure and low peripheral perfusion increase the risk of pressure ulcer development in critically ill patients. The use of catecholamines to stabilize the circulatory system increases the risk of pressure ulcers on the heels of critically ill patients. Specific pharmacotherapy and invasive medical procedures may contribute to the development of pressure ulcers regardless of the level of pressure ulcer prevention.