Pressure ulcers are areas of tissue necrosis in patients who are forced to maintain a sedentary lifestyle. Their appearance not only causes additional suffering to the patient, but can also cause the development of severe complications and even death of a person. What to do if you or your loved ones have a similar problem?
This article is an aid for those who want to know all about bedsores: what they arise from, how to suspect their appearance in time, how they can affect human health and whether it is possible to die from pressure sores. We will also touch on the question of what modern methods of their prevention and treatment exist.
The author of the article: doctor Klimov
Table of contents:
What is bedsores?
The heavy operations demanding long observance of a bed rest. Injuries that permanently (or permanently) limit patient mobility. The expressed exhaustion connected with any disease or with life situations. Comatose states in which a person can be unconscious for days, months and even years. Situations in which there may be pressure sores on the body, not so little.
Pressure relief occurs in 15-20% of patients treated in hospitals: these are the data presented in the document of the Ministry of Health of the Russian Federation “The protocol for the management of patients. The bedsores (2002). The protocol also states that this complication significantly increases the cost of treating patients, as the patient’s stay in the hospital increases, additional drugs, care products, etc. are required.
“It is also necessary to take into account non-material costs: severe physical and moral suffering experienced by the patient,” the report states. At the same time, as the drafters report, “adequate prevention of bedsores can prevent their development in patients at risk in more than 80% of cases“!
So, bedsores – what is it? This is the necrosis (necrosis) of soft tissues and skin that occurs in a person who is stationary for a long time. Surgeons often characterize these lesions as “necrotic ulcers resulting from pressure” (
The most common places for the formation of bedsores are areas of the body where there is little adipose tissue (fiber), which softens the pressure. Therefore, the more pronounced the exhaustion of the patient, the higher the risk of developing this problem. Also, the places of their occurrence depend on the patient’s position – lying on his back, on his side, sitting.
According to the data presented in the Protocol for the management of patients, the most common places for the onset of bedsores are the thoracic spine, the sacrum, the greater twirls of the femur, the heels, elbows, and auricles.
Also, the places of possible formation of bedsores – the back of the head, shoulder blades, ankles, toes. That is, the protruding parts of the body in which the adipose tissue is small or it is practically absent (especially during exhaustion), in contact with solid surfaces on which the patient lies or sits.
In addition, the possible places of occurrence of bedsores are areas where the skin and plaster bandage, splint, corset, orthopedic apparatus, poorly fitted prosthesis, which exert constant pressure on the skin and deep-lying tissues, causing their damage, occur.
For example, with such an injury as a fracture of the femoral neck, often occurring in old age, in which patients are long-term (months or even years) bedridden, the formation of pressure sores in the area of the sacrum and buttocks, as well as in places of pressure of the plaster cast, often begins.
Even the pressure of catheters used to inject drugs in vessels for a long time, as well as urethral catheters that are used to remove urine from the urethra or bladder, can lead to the formation of bedsores. Such damages are of small size, however, they can cause infection of the infection and development of inflammatory processes in the tissues, as well as blood infection.
What do bedsores look like? It depends on the stage of their development. The Protocol for the management of patients refers to four stages of the process. At the very beginning (stage 1), only redness on the skin can be seen, which does not disappear immediately after the cessation of pressure. Only the upper layer of the skin (epidermis) is involved in the process, there is no damage to the skin. At stage 2, there is already a violation of the integrity of the skin associated with the death (necrosis) of skin cells, affecting the upper and deep layers of the skin (epidermis and dermis).
When it comes to stage 3, a pressure sore – this is quite a deep ulcer, penetrating the subcutaneous tissue and reaching the muscle layer. In stage 4, there is necrosis (death) of cells of all soft tissues – skin, cellulose, muscles. The lesion resembles not so much an ulcer as a deep cavity in which tendons and bones can be seen. More information about the stages, types and classification of bedsores can be found in this article.
To understand what bedsores are, you can look at the pictures:
Stage 1 – noticeable persistent redness of the skin without damaging it and the formation of an ulcer.
Stage 2 – here we see characteristic bedsores in bedridden patients – in the photo it is noticeable that the damage affects the upper layers of the skin.
Stage 3 – bedsore, shown in the photo, is characterized by the presence of an ulcer with a deep skin lesion, but not affecting muscle tissue.
Stage 4 – deep defeat of all layers of soft tissues (skin, subcutaneous tissue, muscles) with the formation of a cavity. Such bedsores often occur on the back and in the area of the buttocks.
Thus, pressure sores – this is, in fact, an open wound (especially in stages 3-4). Given that they most often develop in debilitated patients, the risk of attaching an infection of the skin and soft tissues in such patients is very high. Such complications in people in the hospital are often caused by the so-called nosocomial infection: certain microorganisms (staphylococcus, Pseudomonas aeruginosa, E. coli, etc.), which, as a rule, have a low sensitivity to antibiotics.
The accession of the infection significantly complicates the treatment of pressure sores: long-lasting ulcers form, there is a risk of serious complications such as osteomyelitis (inflammation of the bone tissue), blood infection (sepsis), which significantly increase the likelihood of death.
Therefore, in the Protocol for the management of patients with bedsores, special attention is recommended to be paid to the prevention of such complications: timely diagnose joining suppurative soft tissue diseases. The signs that need to be paid attention to the timely detection of infections are the appearance of pus in the wound, the development of swelling of its edges, and complaints of pain in the affected area.
However, even if such signs as suppuration, swelling of soft tissues, indicating that inflammation of soft tissues develops, are not detected during the inspection of a pressure sore, doctors are advised to regularly carry out a so-called bacteriological examination. It lies in the fact that a liquid is taken from the ulcer or cavity (a smear or puncture with a syringe), and the resulting material is placed (“seeded”) on nutrient media, ensuring the growth of microbes. This method allows to detect pathogens of infectious processes in time and take measures against the development of inflammation.
What causes bedsores?
The name “bedsore”, derived from the word “lie”, as well as the Latin term decubitus (dekubitus), denoting this lesion, derived from the word decumbere, which means “to lie”, does not reflect the current understanding of the causes of this phenomenon. Because:
- first, similar problems are observed in sedentary patients;
- secondly, a long stay in immobility (sitting or lying) is only one of the reasons for their formation.
Thus, in spite of the fact that the definition of “bedsores” is still used in medicine, it is necessary to take into account various factors (other than directly “lying”) that lead to their occurrence in order to apply effective methods of their prevention and treatment.
So, what are the causes of pressure sores?
Pressure (squeezing) of tissues
The life of every cell in the body is maintained thanks to the nutrients and oxygen that come to it along with the blood flow through the smallest vessels – capillaries. In addition, blood and lymphatic vessels are discharged from the cells of the products of their vital activity and dead cells.
How do bedsores start? When a person remains stationary for some time, in areas of the body (primarily in places where there is a minimal layer of muscle and adipose tissue between the bone tissue and skin), the capillaries and nerves that regulate metabolism are in contact with the hard surface. substances in the tissues. As a result, cells begin to suffer from nutrient and oxygen deficiencies.
Also, due to the clamping of blood and lymphatic vessels, the removal of processed substances from cells is disturbed, they begin to accumulate, negatively affecting the state of healthy cells, which also begin to die. At first, these changes are reversible and disappear without any consequences when pressure stops. If, however, not to take measures in time, there is a massive cell death.
In a person lying on his back, pressure in the region of the neck, sacrum, heels and buttocks, on average, is about 60 mm Hg. Art. It can increase due to the large body weight of the patient, the additional weight of clothes, blankets and reach 70 mm Hg. Art. Therefore, in these areas, pressure sores can occur after two hours of the patient’s immobility. That is why it is recommended to change the position of the body in patients unable to move independently, every 2 hours.
When the patient lies on his stomach, the greatest pressure is about 50 mm Hg. Art. – Exposed chest and knees. Therefore, for the occurrence of damage in these places requires more time (3 hours or more), however, there may be an increase in pressure due to the large weight of the patient and additional factors (weight of blankets, clothes, etc.).
Shift (displacement) of tissues
How are bedsores associated with shearing? As indicated in his works
The development of internal (exogenous) bedsores is often associated with the displacement of tissues. These are situations when Massive death of muscle cells, due to impaired oxygen and nutrients, occurs when the skin is externally intact. Constriction of nerve fibers leads to a decrease in sensitivity at the sites of development of these complications, which also complicates timely diagnosis. Therefore, in such situations, soft tissue infection may join more quickly, which adversely affects the general condition of the patient, and may cause blood infection (sepsis) and death of the patient.
Folds on bed linen, coarse clothing, seams on linen, buttons, etc. — all this causes friction, as a result of which the protective layer of the skin is “exfoliated” and damage occurs. Pressure ulcers, which were formed as a result of friction, are more often observed in the elbows, heels, knees, shoulder blades, buttocks, depending on the position of the patient.
Also, trauma to the skin and deep tissues associated with friction may occur. with the wrong technique of changing bed linen, when the sheets are “pulled out” from under the patient lying motionless. Violation of the integrity of the skin threatens the accession of infectious processes.
Increased skin moisture is one of the most important factors contributing to the formation of pressure sores. It can be associated with intense sweat removal, which can be caused both by an unfavorable microclimate in the room where the patient is located (dry, hot air) and by internal problems (inflammatory processes accompanied by fever, impaired sweating, etc.).
Also the cause of increased humidity, leading to the occurrence of pressure sores, may be incontinence of urine and feces, especially when non-compliance with the rules of patient care. Constant wetting of the skin leads to its soaking with moisture and swelling (the term “maceration” is used in medicine), the bonds between the cells of the first superficial and then deeper layers are broken.
Increased moisture increases the friction of the skin on the surface, increases the “grip” of the skin with them, which increases the likelihood of microtraumas. Gradually, the skin exudes, cracks and abrasions appear on it, it begins to exfoliate. In the case of incontinence of feces and urine, irritation caused by the acids contained in these physiological fluids joins the skin due to moisture.
External and internal risk factors for the development of bedsores
When we talk about such a problem as pressure sores, their causes can be associated not only with the direct impact of friction, pressure, tissue shear and moisture on the skin. An important role in their development is played by the conditions in which the patient is located and the characteristics of caring for him (external factors), and the state of the body (immunity) and the presence of various diseases (internal factors).
For example, the highest risk of bedsores exists in patients with severe injuries of the spine and spinal cord – the probability of their development with improper care is up to 95% (
Therefore, pressure sores that occur in patients with injuries of the nervous system are called neurotrophic (“trophic” means “nutrition” in Latin). Also, according to various data, the probability of accession of sepsis (blood infection) in such patients is from 25 to 50%.
The Protocol of the Ministry of Health for the management of patients with bedsores, identify the following risk factors for their development:
Internal risk factors (related to the patient’s condition)
- General exhaustion (associated with both malnutrition and impaired metabolic processes in the body)
- Brain and spinal cord injuries
- Obesity (due to excess weight, body pressure on the surface increases, metabolic and hormonal disorders increase the risk of developing infectious complications)
- Anemia (anemia)
- Dehydration. It may be associated with both insufficient fluid intake and its increased losses.
- Low blood pressure
- Acute and chronic infectious diseases accompanied by fever
- Long stay of the patient unconscious, coma
- Mental disorders resulting in inability to exercise self-care
- Fecal and / or urine incontinence
- Diabetes mellitus (due to vascular lesions and suppression of immunity and the ability of tissues to recover)
- Vascular disease, atherosclerosis, vascular damage associated with smoking, etc.
- Heart failure (diseases in which the heart does not cope with its work, swelling occurs in the tissues)
- Older age (the older the patient, the higher the risk of developing pressure sores)
External risk factors (associated with external influences)
- Disorders of hygienic care of a sedentary or lying patient
- The use of synthetic underwear that prevents access of oxygen to the skin, contributing to an increase in sweating.
- Wrong technique of moving the patient in bed
- The presence of folds on bedding, crumbs in bed, etc.
- The presence of fixing material on the patient’s body: tires, plaster cast
Microvibration resource shortage as a factor in the development of pressure sores
The bedsores – from what they are formed? In addition to the above direct causes of their development, such as pressure, friction, displacement of tissues and humidity, as well as risk factors that create the conditions for their formation, the shortage of the microvibration resource of body tissues is very important. What it is? It is known that in order to sustain life we constantly need resources such as air, food, water and heat. However, in order for each cell to fulfill its function qualitatively (due to which health is maintained), it is necessary that the body maintains a sufficient level of microvibration.
Microvibration is the result of the reduction of millions of muscle cells of the body, which are observed even at rest and during sleep, the body spends a huge amount of energy on maintaining it. Famous physicist
A sufficient level of microvibration is necessary for the normal functioning of the blood vessels responsible for providing each cell with nutrients and oxygen, that is, when the microvibration is deficient, the nutrition of the tissues is disturbed. In addition, the ability of the organism to remove and recycle (utilize) damaged cells and harmful substances (slags, poisons) depends on the provision of this resource.
Even in a relatively healthy person, cell death constantly occurs in the body, both as a result of natural causes and as a result of the action of damaging factors. The more damaged cells in the body, the worse the immunity, the lower the ability of tissues to recover (regeneration). Lymphatic and circulatory systems, as well as bone marrow, spinal cord, liver, and kidneys are responsible for the disposal of damaged cells. The work of all these organs and systems is closely related to the level of microvibration. This means that the more pronounced its deficiency, the more damaged cells accumulate in the body, which negatively affects all its functions.
What does the level of microvibration depend on? First of all, from the human motor activity. Walking, running, swimming, charging – any movement nourishes the body with a valuable resource. However, today even many healthy people lack microvibration due to lack of movement: sedentary work, hours spent in front of a TV or computer, car trips instead of walks – all this creates conditions for a shortage of resources and creates prerequisites for the development of diseases.
If we consider from this position, what is a pressure sore in a person who is forced to lead a sedentary lifestyle due to illness or injury, it becomes clear that reducing the level of microvibration plays an important, perhaps the key role in the development of this phenomenon! According to
In addition, over time, a person without physical activity, there is a decrease in muscle mass, which leads to a further decrease in the level of microvibration.
How does the lack of this resource lead to the development of pressure sores? First of all, the blood vessels suffer, because of which the nutrition of the tissues is disturbed, including skin cells and muscle fibers, and their ability to regenerate is impaired. A decrease in the level of microvibration also affects the work of the lymphatic system and other organs responsible for the utilization of damaged cells. The situation is aggravated by the fact that in lying patients the cells of the skin and soft tissues of the cells die not only due to natural causes (physiological process of tissue renewal, the completion of the normal life cycle of each cell), but also under the influence of the factors we mentioned above: pressure, friction and so forth
Thus, an increased load falls on the lymphatic system in such a situation, while it suffers from a deficiency of microvibration and cannot cope with the increased workload. All this leads to the rapid accumulation of damaged cells and increases the risk of bedsores. As indicated
Also, microvibration deficiency is one of the reasons for the increased risk of bedsores in older people.
Thus, considering such a problem as bedsores, we see that this phenomenon is associated not only with the influence of external factors and various diseases of the patient, but also with a decrease in the microvibrational background in the human body, forced to lead a sedentary lifestyle. And, therefore, one of the most important tasks in the prevention and treatment of bedsores is to increase the level of microvibration. But how to do this, if a person is deprived of the ability to actively move? The way out in this situation is vibroacoustic therapy. On how she can help in the situation with bedsores, we will discuss below.
What are dangerous bedsores?
The phenomenon of bedsores adversely affects the general condition of the patient. The symptoms of the underlying disease, which led to a restriction of the mobility of a person, are joined by pain from ulcers on the body, which further limits the mobility of the patient. And this, in turn, can lead to the development of lesions in new areas of the body.
What are dangerous bedsores in bedridden patients? First of all, by the addition of infection. Immunity weakened by the disease, a sharp decrease in the level of microvibration, the accumulation of damaged cells – all this creates favorable conditions for the development of inflammatory processes in the skin and soft tissues caused by various pathogens.
Often, the patients themselves and their relatives have a question: is it possible to die from pressure sores? It is necessary to understand that life-threatening is not so much the ulcers themselves, arising from a sedentary lifestyle, but the complications that infection of the affected area leads to. What diseases can occur as a result of infection? Here are just some of them:
- Cellulitis – purulent inflammation of the subcutaneous fatty tissue, which tends to spread rapidly to the surrounding tissue.
- Osteomyelitis – involvement in the inflammatory process of bone tissue. Often there is a lesion of the bones of the head, heel bones, and the head of the femur, which can lead to its destruction and disability of the patient.
- Purulent arthritis – inflammation of the joints and ligaments.
- Purulent fusion of the vascular wall: with involvement of the vascular wall into the inflammatory process, on the one hand, bleeding may occur (especially dangerous when large vessels are affected, for example, femoral arteries), and, on the other hand, the infection can penetrate into the bloodstream and lightning fast spread throughout the body.
- Sepsis (blood poisoning) is the most serious complication of bedsores. Bacteria that cause inflammation are spread throughout the body, affecting vital organs: heart, brain, kidneys, etc. According to various sources, the mortality from blood poisoning is from 50 to 70%.
Thus, answering the question of how many a person with bedsores can live, the doctors explain that the prognosis depends on the severity of the underlying disease and on the severity of infectious complications of this phenomenon. Diseases of the brain and spinal cord, severe vascular disorders, advanced age, low microvibration background – all these factors that increase the risk of accession and the rapid spread of infection throughout the body. This increases the probability of death of the patient.
Also, the answer to the question “how many people live with bedsores?” Depends on how quickly measures were taken for their timely treatment. If the defect of the skin and soft tissues was detected at an early stage, if proper treatment was carried out, the risk of serious complications and death is minimized. When it comes to patients with severe lesions, complex support of the body is important, aimed at improving the blood supply to tissues and
If serious defects with already developed infectious complications are found, it is very important to start treatment with antibiotics and surgical treatment in time to reduce the chance of damage to the surrounding tissues and the development of sepsis.
Symptoms and signs
When a problem such as bedsores, a description of the signs and symptoms of their occurrence depends on the stage of the process:
The initial stage of the doctors is called stage of circulatory disorders (
If measures are not taken to stop the pressure, the skin becomes cold to the touch, edematous.
Bubbles appear indicating a detachment of the upper layer of the skin (epidermis). The patient himself may notice an increase in the sensitivity of the skin in the affected area, a slight soreness, or, alternatively, a feeling of numbness, which is associated with compression of the nerve endings.
In the absence of adequate measures to prevent further development of the process, begins stage of necrotic changes and suppuration, massive death of skin cells and deep-lying tissues, the addition of infection. The first signs of the passage of bedsores to this stage can be seen in the photographs: if external factors (pressure, friction) play a leading role in the development of injuries, external (exogenous) or dry necrosis often develops, in which the tissues shrink and “mummify”. In this situation, damage to the skin and deep-lying tissues has clear boundaries, the wound is dry and, as a rule, shallow. The general condition of the patient with such lesions, most often, does not suffer.
If the leading role is played by internal factors (first of all, we are talking about lesions of the nervous system: injuries of the brain and spinal cord, strokes, brain tumors) leading to malnutrition of tissues, endogenous (internal) necrosis develops. In this case, there is a massive death of soft tissue cells – muscles, subcutaneous fat, infection quickly joins. Doctors say that in this situation bedsore develops by type moist gangrene with progressive necrosis of surrounding tissues. This means that the damage (ulcer) that occurs at the site of the bedsore can quickly increase in size, affecting all new areas.
When such bedsores occur, symptoms such as the discharge of fetid fluid, pus from a wound, and swelling of surrounding tissues are observed. The ulcer has great depth, and tendons and bones can be seen in it.
Due to the accession of the infection, the general condition of the patient suffers: there may be a rise in temperature up to 39-40 ° C, chills, impaired consciousness, delusions, palpitations, decreased blood pressure, an increase in the liver.
According to the professor
With the prevailing external causes and a fairly prosperous general condition of the patient, necrotic changes develop more slowly – several days, a week. If we are talking about patients with lesions of the brain, spinal cord, cell death can begin as early as 20-24 hours after the first signs of a pressure ulcer appear with the rapid addition of infectious lesions of soft tissues.
Diagnosis of pressure sores
In most cases, for the diagnosis of pressure sores, especially in the early stages, it is enough to inspect the site of injury. Congestion in characteristic areas of the body exposed to pressure in patients with limited mobility, desquamation of the upper layers of the skin, detection of an ulcer defect: most often, the data obtained during the examination is sufficient to establish the diagnosis and determine the stage of the process. However, in some cases, when it comes to deep lesions, it may be necessary to perform an ultrasound of soft tissues.
What is soft tissue ultrasound? This is an ultrasound examination, which allows to obtain information about the state of deep-lying tissues, the extent of the damage which cannot be assessed during a routine examination: subcutaneous fatty tissue, muscles, tendons, ligaments, joints. This study is particularly relevant when it comes to purulent complications of pressure sores. As well as the development of lesions in patients with injuries of the nervous system, when changes on the skin surface may be minimal, and the main changes are hidden in the deep-lying layers.
In addition, to assess the condition of a patient with pressure sores, especially when joining infectious complications, laboratory tests (complete blood count, allowing to detect the severity of the bacterial process, biochemical blood count, urinalysis, etc.), as well as other examinations aimed to identify the involvement of other organs in the inflammatory process.
What kind of doctor to refer to for bedsores? Surgeons deal with the treatment of severe lesions: after examining and examining a patient, they decide on the need for surgery, determine the tactics of the patient. If pressure sores occur in a patient undergoing treatment at home, it is necessary to call the attending physician (therapist), who will decide whether to refer the patient to the surgical department of the hospital, or (at the initial stages of the process) give recommendations for patient care.
What to do to prevent bedsores in a bed patient?
Bedsore prevention is a complex process that should include:
- Competent care for a patient with movement limitations.
- Informing relatives caring for the sick about how to detect lesions in the initial stage and what measures need to be taken.
- It is necessary to organize proper nutrition, allowing the patient to provide the patient with all the necessary components for the full operation of each cell.
- Competent treatment of the underlying disease, the appointment of drugs that improve the blood supply to tissues, etc. For more on this, see the articles “Prevention of pressure sores” and “Effective remedy for bedsores at home”.
Vibroacoustic therapy or phoning is one of the most effective methods for the prevention and treatment of bedsores. The use of medical devices Vitafon allows you to saturate the body with a healing microvibration resource. This will have a beneficial effect on the state of the vessels, will lead to an improvement in the nutrition of the skin and muscle cells in the area of the bedsore.
Vibroacoustic therapy is a powerful support for the lymphatic system and other organs responsible for the utilization (elimination) of damaged cells, which is one of the most urgent tasks in the treatment and prevention of bedsores. Getting rid of the ballast of damaged cells, achieved through the use of the apparatus of the Vitafon, has a beneficial effect on the work of the immune system, and contributes to the prevention of infectious complications.
Especially for patients who are forced to lead a sedentary lifestyle, a vibroacoustic mattress, which is part of the Vitafon-2 medical device, was developed. It consists of 8 vibraphones at once, which make it possible to completely cover the area of bedsores and nearby tissues with vibro-acoustic effects. The automatic mode of operation of the device does not require human participation for a long time (up to 14 hours), while vibrating phones are turned on and off according to a predetermined program (for 3 minutes every 24 minutes), providing continuous and metered effects.
- the excretion of harmful substances (slags) and dead cells is activated;
- the work of the nervous system is improved (which is especially important for the prevention of pressure sores in patients with injuries of the brain and spinal cord);
- the problem area is saturated with blood, oxygen and nutrients;
- immunity is strengthened, which is important to prevent the development of infectious complications;
- recovery (regenerative) processes in all tissues and organs, including the skin and muscles, are improved.
In fact, the use of vibro-acoustic therapy is the only way to generate a sufficient level of microvibrational background in patients who are unable to replenish this resource independently with the help of movement. Activation of metabolic processes, maintaining immunity, improving blood supply to tissues, creating favorable conditions for regeneration of skin and muscles are all effective methods for preventing and treating bedsores, which are achieved through the use of vibro-acoustic therapy.