Yap Submits Subcontract Application to Study Pressure Injuries

Tracey Yap, associate professor, and her team have submitted their subcontract application entitled "A Paradigm Shift in Severe Pressure Injury Etiology." This Department of Defense (DOD) proposal with the University of Utah requests funding for a two-year period with a start date of September 1, 2020. 

The FY20 PRMRP Topic Area of this application is pressure injuries (PrI), formerly called pressure ulcers (before that, decubitus ulcers, and before that, “bedsores”). Hospital-acquired pressure injuries (HAPrI) are twice as common in intensive care unit (ICU) patients for reasons which are poorly understood. PrI are commonly believed to be caused from the “outside-in” due to prolonged and intense pressure against the skin resulting in capillary occlusion and eventual tissue necrosis. However, prevention protocols aimed at relieving external pressure, while relatively effective in reducing the incidence of superficial PrIs (stage 2), are much less effective in decreasing the incidence of severe PrI (Stages 3&4, Deep Tissue, and Unstageable). We therefore assume that current prevention strategies for Stage 2 PI fail to mitigate additional or alternative risk factors among patients with severe PrI.

The central hypothesis is that severe PrIs are resistant to current prevention protocols because their etiology includes an “inside-out” development process triggered by vascular hypo-perfusion (hypotension, hypoxemia, anemia, hypo-albuminemia, vasopressor infusion), not at the capillary level, but at the level of named arteries and/or veins which follow a specific anatomical distribution (sometimes called “angiosomes”). The primary objective of this study is to advance our understanding of contributing risk factors, hemodynamic thresholds, and the anatomical distribution of superficial versus severe PrIs to inform the next generation of ICU PrI prevention protocols. If they are correct, the next step will be to develop refined PrI prevention protocols for the ICU setting. This study will compare risk factor profiles and anatomical distribution for superficial vs. severe PrI using dynamic real-world, critical care data (EHR, and granular, time-stamped, hemodynamic data) from a large hospital system.