Risk factors for development of medical device-related pressure ulcers associated with nasotracheal intubation in pediatric patients.

OBJECTIVE

Risk factor analyses of medical device-related pressure ulcers associated with nasotracheal intubation in pediatric patients remain limited. Therefore, this clinical study aimed to identify the potential risk factors of nasal pressure injuries (NPI) caused by nasotracheal intubation.

METHODS

We conducted a retrospective observational cohort study of critically ill children who underwent mechanical ventilation via nasotracheal intubation at a single tertiary care center in Japan. Demographic data and device-related factors were analyzed using multivariate logistic regression.

RESULTS

Pediatric patients who received mechanical ventilation via nasotracheal intubation were included. Of the 3015 patients, 642 who were receiving nasotracheal intubation were analyzed. In total, 75 (12 %) patients developed NPI. Based on the univariate analysis, younger age (20 vs. 36 median months; p = 0.0042), longer length of pediatric intensive care unit stay (5 vs. 4 median days; p = 0.0035), trisomy 21 (5 % vs. 0.4 %; p < 0.001), cyanotic congenital heart disease (28 % vs. 4 %; p < 0.001), and post-living donor liver transplantation (LDLT) status (12 % vs. 2 %; p < 0.001) were significantly associated with NPI. Among these factors, trisomy 21, cyanotic congenital heart disease, and post-LDLT remained significantly associated with NPI in the multivariate analysis.

CONCLUSIONS

Trisomy 21, cyanotic congenital heart disease, and post-LDLT are risk factors of NPI in pediatric patients receiving nasotracheal intubation.

IMPLICATIONS TO PRACTICE: These findings underscore the critical role of pediatric nursing in implementing tailored prevention strategies-such as routine skin assessments, meticulous device fixation, and interdisciplinary collaboration-to reduce the risk of nasal pressure injuries in high-risk pediatric populations.