Risk factors and preventive strategies for pressure injury and medical device-related pressure injury in ICU patients receiving invasive mechanical ventilation: A scoping review.

OBJECTIVES

Adult ICU patients receiving invasive mechanical ventilation (IMV) are at risk of pressure injury (PI) and medical device-related pressure injury (MDRPI) due to immobility, impaired perfusion, and device contact. This scoping review synthesized evidence on PI and MDRPI risk factors and preventive strategies.

METHODS

This scoping review followed the Arksey and O'Malley framework and PRISMA-ScR guidelines. Five databases (PubMed, CINAHL, Scopus, MEDLINE, ScienceDirect) were searched from inception to April 2026. Studies of adult ICU patients receiving IMV reporting PI, MDRPI, risk factors, or preventive strategies were eligible.

RESULTS

Forty-two studies from 14 countries (2009-2026) were included. PI incidence ranged from 10.3 to 36.3% (up to 88.7% when prone-positioned); MDRPI (oral mucosal injury) ranged from 25.9 to 43.1% (80.1% with a broader erythema criterion). Cutaneous PI mainly affected the sacrum, heels, occiput, face, and thorax (generally Stage 1-2); oral mucosal MDRPI, assessed using heterogeneous severity criteria, was typically mild-to-moderate. Onset was commonly reported on days 3-9. PI risk factors included immobility, impaired perfusion, vasopressor therapy, and poor nutrition; MDRPI risk factors involved prolonged intubation and device exposure. Preventive strategies included device repositioning, securement adjustment, device-contact protection, and oral care.

CONCLUSIONS

Prolonged mechanical loading and reduced tissue tolerance are intensified by immobility, sedation, hemodynamic instability, impaired perfusion, vasopressor use, and device exposure. Early-stage cutaneous PI and mild-to-moderate mucosal MDRPI were more commonly reported than severe cutaneous and mucosal injuries; given the descriptive, non-comparative evidence, this cannot be attributed to preventive effectiveness. Early monitoring may be important for detecting early-stage injury and identifying progression toward more severe injury.

IMPLICATIONS FOR CLINICAL PRACTICE: Prevention should combine pressure redistribution with tolerance-based repositioning, skin monitoring, device securement, device-contact protection, and oral mucosal care. An exploratory, hypothesis-generating observation is that the first 10 days of ICU stay may be a high-risk period, requiring prospective validation.