Exploring tissue reperfusion in two body positions and varied load periods in critically ill patients. (EXTREME II Pressure Study)

Study Procedures 1. Patient suitability will need to be confirmed on the day of data collection with the registered nurse (RN) assigned to the patient, Clinical Nurse Consultant (CNC), the team leader (usually the CNC), Clinical Co-ordinator (CC) and medical staff member allocated to the patient. A suitable time for data collection will be co-ordinated with relevant staff members of the ICU department 2. When the patient is scheduled for repositioning the bedside nurse will set up the laser Doppler perfusion monitor (LDPM) equipment at the patient bedside. For data collection the patient will be positioned either on their back (supine semi-recumbent position) or side (lateral quarter turn position), as per the routine ICU repositioning schedule. If the patient has been lying on their back, the research nurse and ICU team will position the patient on their side and data collect on the greater trochanter first or vice versa. The research nurse will talk to the patient and ICU team through the data collection process. 3. The research nurse will tape the LDPM to the surface of the sacrum (when positioned on the back) or greater trochanter (when positioned on the side). 4. Once the LDPM is in place a baseline recording will be taken to record the patients normal tissue perfusion (before loading with pressure). 5. After a stable baseline is recorded, the ICU team will complete the repositioning by turning the patient on their back or side. 6. Once the patient is lying in position and the LDPM recording has started, the research nurse will monitor the LDPM recording and the bedside nurse will continue with the patient cares as normal. The patient will remain in the position for 2.5-hours. 7. After 2.5-hours, the patient will be due for repositioning. The research nurse and ICU team will reposition the patient to offload the LDPM and the tissue reperfusion measurements will be recorded. The reperfusion time will be recorded for approximately 10 minutes. The patient’s body weight will be supported with pillows for comfort for the duration of this time. 8. Once data collection has been completed for the first position the above process will be repeated for the second position. The second position will be recorded for a total of 4-hours. 9. After data collection, the patients routine repositioning will continue for the duration of their stay in ICU; the study will only record tissue reperfusion with the LDPM on one occasion. 10. The research nurse will follow up with skin assessments 3-4 times per week to check for PI development until 20 skin checks have been completed or the patient has been discharged from hospital, whichever occurs first. As the data collection is expected to take 7-8 hours and the study only has one LDPM device the study will only be data collecting a maximum of one patient per day. The eligible patient for the data collection will be the most suitable patient in the ICU that meets study criteria. All patient routine cares will be conducted as normal during this time. If the patients’ health situation changes or they need to be moved from the position during data collection, the data collection will then be ceased as the patients care needs come first. Data collection is only conducted if deemed appropriate by the bedside nurse, Clinical Nurse Consultant and ICU medical team. The data collection form will be used to document the data and prompt the nurse to check pillow placement and bed angles are set to the guidelines in the study procedures