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The trial addresses a focused issue and uses a targeted population. The study population constitutes of patients of critically ill patients who had been placed on mechanical ventilation (Manzano et al., 2014). The study compared two interventions concerning patient repositioning in the prevention of pressure ulcers. The study focused on evaluating the effectiveness of patient repositioning at two or four hours.
The study is focused in terms of the research outcomes that are considered. The study incorporated findings related to the development of pressure ulcers as well as the nursing workload related to repositioning. The study also goes ahead to include device-related events such as the intubation of patients.
Patients were randomly assigned to the different repositioning schedules. The patients were enrolled within twenty-four hours and forty-eight hours from the time when mechanical ventilation was initiated. Patient allocation into the repositioning schedules was done randomly and in the ratio of 1:1. Manzano et al. (2014) state that the allocation was concealed through the use of pre-numbered envelopes that were opaque.
The study personnel and evaluators were blinded. The patients and the nursing staff were not blinded. It was impossible to blind the nurses and the patients due to the need to ensure that the turning schedule was maintained.
The patients, who were allocated into the two schedules, bore several similarities at the start of the trial as evidenced in the baseline characteristics. There was just a difference of one year in the mean age of the patients in the two groups. The difference in terms of the number of males and females included in the two schedules was negligible. The two-hour group consisted of 109 males and 56 females while the four-hour group consisted of 110 males and 54 females (Manzano et al., 2014). The patient groups had similar social class characteristics. The groups were treated equally from the experimental intervention.
All the patients who entered the trial were properly accounted for at the conclusion. The trial was carried out to a conclusion as the patients were not exposed to any harm. Patient analysis was done in the assigned groups with an intention to treat.
The outcomes measured various results. The primary outcome that was measured included the occurrence of a new grade-two pressure ulcer at any anatomic site. The secondary outcomes included the rate of implementing the assigned schedules, the mortality rate at the hospital as well as the ICU, the duration of the mechanical ventilation, and the duration of stay in the ICU.
The study defines the primary outcome very clearly. In the study, the primary outcome was the development of a new grade-two ulcer. The grade-two ulcer in the study is described as a blister or an abrasion based on the guidelines for determining pressure ulcers developed by the European Pressure Ulcer Advisory Panel.
Among the patients that were put on the four-hour schedule, 13.4% developed new grade-two pressure ulcers while only 10.3% of those in the four-hour schedule developed pressure ulcers (Manzano et al., 2014). The rate of implementing the assigned schedules was twenty-one minutes per patient for the two-hour schedule and eleven minutes per patient for the four-hour group. There was no significant difference in the mortality rate at the hospital or the ICU. There was no change in the duration spent on mechanical ventilation or the length of stay in the ICU.
The study employed a confidence limit of 95% in assessing all the outcome measures that were under investigation. The confidence level applied in the study was statistically significant given the population under study.
The results of the study can be applied to the local content. The demographics of the patients admitted to the local hospitals are similar to that of the patients included in the study. The local ICU wards have a significant number of patients. A number of the patients in the ICU require mechanical ventilation during their care. It is important that the nurses establish an appropriate repositioning schedule to help prevent the development of new pressure ulcers among hospitalized patients. The results of the new study are also significant in the identification of new research areas to enable the improvement of patient care locally (Manzano et al., 2014).
The study focuses on important clinical outcomes related to the management of patients with an aim of preventing pressure ulcers. The study clearly stipulates the need to conduct the study given the high incidences of pressure ulcers among ICU patients. The study specifies that there is a lack of literature that compares the different repositioning schedules that are applied to prevent the development of pressure ulcers (Manzano et al., 2014). The study also states there is a lack of sufficient data on the risks involved in the repositioning of ICU patients.
The benefits of evaluating the available repositioning schedules are worth the harms and costs involved in the study. The establishment of an efficient repositioning schedule is critical in guiding the allocation of resources when managing patients under mechanical ventilation. Successful prevention of pressure ulcers among hospitalized patients is critical in reducing healthcare costs and related litigations.
Reference List
Manzano, F, Colmenero, M, Pe´rez-Pe´rez, AM, Rolda´n, D, Jime´nez-Quintana, M, Man˜as, MR, Sa´nchez-Moya, MA, Guerrero, C, Moral-Marfil, MA, Sa´nchez-Cantalejo, E & Ferna´ndez-Monde´jar, E 2014, ‘Comparison of two repositioning schedules for the prevention of pressure ulcers in patients on mechanical ventilation with alternating pressure air mattresses’, Intensive Care Medicine, vol.40, pp.1679-1687.
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