Objectives: This is a prospective cohort study to determine the incidence and causes of respiratory medical device- related pressure ulcers (MDRPU) in children admitted to a pediatric intensive care unit.
Methods: This study was conducted on 184 children who were admitted to the pediatric intensive care unit at P University Hospital in City Y from April 2016 to January 2017 and used respiratory medical devices. electronic medical record was used to collect the general and clinical characteristics of these children, and questionnaire forms were used to directly observe and collect data regarding the application of respiratory medical devices and MDRPU-related characteristics. SPSS software was used to analyze the collected data with a t-test and χ²-test.
Result: 1) The results showed that, MDRPU occurred in 13.0% of the subjects. A comparison of the general characteristics indicated that there were differences in the disease characteristics (χ²=4.089, p=.043), length of stay in an intensive care unit (t=-4.492, p<.001), and mechanical ventilator adaptation period (t=-3.82, p=.001).
2) Among the subjects with an occurrence of MDRPU, the stage of decubitus ulcer formation was as follows: 61.9% were at Stage I, 3.9% were at the suspected deep tissue injury stage, 34.6% had mucosal pressure ulcers. The respiratory medical devices that led to MDRPU were an endotracheal tube (34.6%), a cotton twill tape to secure an endotracheal tube (15.4%), high flow nasal cannula (34.6%), a nasal cannula (7.7%), and a percutaneous pulse oxysensor (7.7%).
3) Differences in the occurrence of MDRPU based on the characteristics of the adjustment of respiratory medical devices were compared separately among the endotracheal tube, high flow nasal cannula, nasal cannula, and oxysensor. The results show that in 92.2% of the subjects, MDRPUs were not caused by an endotracheal tube; however, in 7.8% of them, MDRPUs developed because of the tube. When the results of MDRPU application characteristics pertaining to the endotracheal tube were compared, a statistical significance between the occurrence and non-occurrence groups was found at the site of the fixed application (χ²=17.015, p<.001), in edema (χ²=23.811, p=.006), with the use of a bite block (χ²=19.309, p<.001) and adhesive tape (χ²=18.427, p<.001), in skin dryness (χ²=35.233, p<.001), and adhesive strength (χ²=24.308, p<.001).
4) The high flow nasal cannula was responsible for the occurrence of MDRPUs in 9.0% of the subjects but not in 91.0% of the subjects. With regards to the high flow nasal cannula, the comparison among the MDRPU application characteristics revealed a statistical significance between the occurrence and non-occurrence groups, in the presence of skin dryness (χ²=5.954, p=.034), fixation in touch with nostrils (χ²=16.840, p<.001); fixation in contact with the columella nasi (χ²=10.117, p=.004); and immobility after fixation (χ²=23.944, p<.001).
5) The results showed that the nasal cannula was responsible for MDRPUs occurring in 2.2% of the subjects and not in 97.8% of the subjects. There was no statistical significance between the occurrence and non-occurrence groups associated with the nasal cannula.
6) The results indicated that due to an oxysensor, MDRPUs did not occur in 98.9% of the subjects, while 1.1% had MDRPUs. There was no statistical significance between the occurrence and non-occurrence groups related to the oxysensor.
Conclusions: According to the results obtained, the occurrence of MDRPU increased when the duration of stay in an intensive care unit and duration of ventilator adjustment was high, an endotracheal tube was inserted and a bite block or cotton tape was used to secure the tube, the tube was secured to an edematous and moist surface, and a high flow nasal cannula came in contact with the skin or an edematous skin surface. Consequently, when a medical device is secured to the skin, it should not be fixed firmly. If necessary, an inspection and observation should take place frequently. In addition, when the skin integrity is compromised, such as by excessive moisture or edema of the skin, it is helpful to monitor the application site of the medical devices. The development of pertinent nursing interventions related to this matter is required.

Key words: pressure ulcers, intensive care units, pediatric