Incidence of, and factors associated with, oral mucous membrane medical device-related pressure injury in critically ill patients with orotracheal intubation: a prospective cohort study
- PMID: 40527564
- PMCID: PMC12182116
- DOI: 10.1136/bmjopen-2024-098114
Incidence of, and factors associated with, oral mucous membrane medical device-related pressure injury in critically ill patients with orotracheal intubation: a prospective cohort study
Abstract
Objectives: This study aimed to investigate the incidence of oral mucous membrane medical device-related pressure injury (MDR-MM PI) and identify its risk factors in critically ill patients undergoing orotracheal intubation, guided by the conceptual framework of pressure injury development. The findings aim to inform effective preventive strategies in intensive care settings.
Design: Prospective cohort study.
Setting: General intensive care unit (ICU) of a tertiary care hospital in China.
Participants: Patients aged ≥18 years who underwent oral endotracheal intubation were included between July 2023 and July 2024. Exclusion criteria were (1) existing oral mucosal injuries before intubation, (2) radiotherapy-induced oral mucositis, (3) patients undergoing oral surgery and (4) intubation duration of less than 24 hours. A total of 420 patients met the criteria and were included in the final analysis.
Outcomes: The outcomes included the incidence of oral MDR-MM PI, the time to oral MDR-MM PI occurrence and the identification of risk factors using multivariate Cox regression analysis.
Results: Among the 420 patients, 43.10% (n=181) developed oral MDR-MM PI, with Stage I accounting for 38.67% and Stage II for 61.33%. The lower lip (38.67%) and upper lip (38.12%) were the most common injury sites. The median time to oral MDR-MM PI occurrence was 8 days (95% CI: 7.134 to 8.866). Significant risk factors identified through multivariate Cox regression included sepsis (HR=2.090, 95% CI: 1.273 to 3.431), lower platelet (PLT) counts (HR=0.997, 95% CI: 0.995 to 0.999) and use of hard bite blocks (HR=1.553, 95% CI: 1.082 to 2.230). Probiotics showed a protective effect (HR=0.632, 95% CI: 0.468 to 0.854, p<0.05).
Conclusions: Critically ill patients undergoing orotracheal intubation in ICUs are at high risk of developing oral MDR-MM PI, with a median onset time of 8 days. Risk factors such as sepsis, low PLT counts and hard bite blocks were identified, while probiotics were found to have a protective effect. These findings highlight the need for targeted preventive strategies to reduce oral MDR-MM PI incidence in ICU settings.
Keywords: Adult intensive & critical care; Nursing Care; Prevalence; Risk Factors.
© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.
Conflict of interest statement
Competing interests: None declared.
Figures
Similar articles
-
Characteristics and Risk Factors of Oral Endotracheal Tube-Related Mucous Membrane Pressure Injury in Intensive Care Units.Nurs Crit Care. 2025 Jul;30(4):e70090. doi: 10.1111/nicc.70090. Nurs Crit Care. 2025. PMID: 40506056
-
Effectiveness of haloperidol prophylaxis in critically ill patients with a high risk of delirium: a systematic review.JBI Database System Rev Implement Rep. 2017 May;15(5):1440-1472. doi: 10.11124/JBISRIR-2017-003391. JBI Database System Rev Implement Rep. 2017. PMID: 28498176
-
Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia.Cochrane Database Syst Rev. 2016 Oct 25;10(10):CD008367. doi: 10.1002/14651858.CD008367.pub3. Cochrane Database Syst Rev. 2016. Update in: Cochrane Database Syst Rev. 2020 Dec 24;12:CD008367. doi: 10.1002/14651858.CD008367.pub4. PMID: 27778318 Free PMC article. Updated.
-
Oxygenation during the apnoeic phase preceding intubation in adults in prehospital, emergency department, intensive care and operating theatre environments.Cochrane Database Syst Rev. 2023 Aug 2;8(8):CD013558. doi: 10.1002/14651858.CD013558.pub2. Cochrane Database Syst Rev. 2023. PMID: 37531462 Free PMC article.
-
The effectiveness of interventions to meet family needs of critically ill patients in an adult intensive care unit: a systematic review update.JBI Database System Rev Implement Rep. 2016 Mar;14(3):181-234. doi: 10.11124/JBISRIR-2016-2477. JBI Database System Rev Implement Rep. 2016. PMID: 27532144
References
-
- National Pressure Ulcer Advisory Panel (NPUAP) European Pressure Ulcer Advisory Panel (EPUAP) Pan Pacific Pressure Injury Alliance (PPPIA) Emily Haesler; 2019. Prevention and treatment of pressure ulcers/injuries: clinical practice guideline (Emily Haesler, ed.)
MeSH terms
LinkOut - more resources
Full Text Sources
Medical
Research Materials
Miscellaneous