Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-19T17:50:22.726Z Has data issue: false hasContentIssue false

Aetiology of pressure sores

Published online by Cambridge University Press:  17 November 2008

MR Bliss*
Affiliation:
Homerton Hospital, London, UK
*
MR Bliss, Consultant Physician in Medicine for the Elderly, Homerton Hospital, Homerton Row, London E9 6SR, UK.

Abstract

Image of the first page of this content. For PDF version, please use the ‘Save PDF’ preceeding this image.'
Type
Rehabilitation
Copyright
Copyright © Cambridge University Press 1993

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Lowthian, P.Preventing pressure sores. Nurs Mirror 1985; 160: 1820.Google ScholarPubMed
2Kaminski, MV, Pinchcofsky-Devin, G.Nutritional management of decubitus ulcers in the elderly. Decubitus 1989; 2(4): 2030.Google ScholarPubMed
3Norton, D, McLaren, R., Exon, Smith AN.An investigation of geriatric nursing problems in hospital. Edinburgh: Churchill Livingstone, 1975.Google Scholar
4Jordan, MM. Report on pressure sores in the elderly. Further information from the survey of the patient community of the Greater Glasgow Healthboard Area, 1976.Google Scholar
5Chow, WW, Odell, EI.Deformations and stresses in soft body tissues of a sitting person. J Biomech Eng 1978; 100: 7987.CrossRefGoogle Scholar
6Scales, JT. Pathogenesis of pressure sores. In: Bader, DL ed. Pressure sores: clinical practice and scientific approach. Basingstoke: Macmillan, 1990; 1526.CrossRefGoogle Scholar
7Catell, M.The physiological effects of pressure. Cambridge Philosophic Society Reviews 1936; 11: 441–75.CrossRefGoogle Scholar
8Neumark, DW.Deformation, not pressure, is the prime cause of pressure sores. Care Sci Pract 1981; 1: 4143.Google Scholar
9Kosiak, M.Etiology of decubitus ulcers. Arch Phys Med Rehabil 1961; 42: 1929.Google ScholarPubMed
10Bennett, L, Lee, BY. Pressure versus shear in pressure sore causation. In: Lee, BY ed. Chronic ulcers of the skin. New York: McGraw-Hill, 1985; 3956.Google Scholar
11Bennett, L, Lee, BY.Vertical shear existance in animal pressure threshold experiments. Decubitus 1988; 1(1): 1824.Google ScholarPubMed
12Scales, JT.Pressure sore prevention. Care Sci Pract 1982; 1(2): 917.Google Scholar
13Bennett, L, Kavner, D, Lee, BY, Trainer, FA.Shear vs pressure as causative factors in skin blood flow occlusion. Arch Phys Med Rehabil 1979; 60: 309–14.Google ScholarPubMed
14Ek, AC, Lewis, DH, Zetterqvist, H, Svensson, PG.Skin blood flow in an area of risk for pressure sore. Scand J Rehabil Med 1984; 16: 8589.CrossRefGoogle Scholar
15Bennett, L, Lee, BX.Vertical shear existance in animal threshold experiments. Decubitus 1988; 1(1): 1824.Google ScholarPubMed
16Bliss, MR.Acute pressure area care: Sir James Paget's legacy. Lancet 1992; 339: 221–23.CrossRefGoogle Scholar
17Kosiak, M.Etiology and pathology of ischaemic ulcers. Arch Phys Med Rehabil 1959; 40: 6269.Google Scholar
18Vermillion, C.Operating room acquired pressure ulcers. Decubitus 1990; 3(1): 2630.Google ScholarPubMed
19Graves, DJ.Stage 1 in ebony complexion. Decubitus 1990; 3(4): 4.Google Scholar
20Barton, A, Barton, M.The management and prevention of pressure sores. London: Faber & Faber, 1981.Google Scholar
21Lindan, O, Greenway, RM., Piazza, JM.Pressure distribution on the surface of the human body, evaluation in lying and sitting positions using a bed of springs and nails. Arch Phys Med Rehabil 1965; 46: 378–85.Google Scholar
22Swearingen, TJ, Wheelwright, CD., Garner, JD.An analysis of sitting areas and pressure in man. Oklahoma: Civil Aviation Agency, Aeronautical Center, 1962.Google Scholar
23Ferguson-Pell, MW, Bell, F., Evans, JH. Interface pressure sensors: existing devices, their suitability and limitations. In: Kenedi, RM., Cowden, JM., Scales, JT. eds. Bedsore biomechanics. London: Macmillan, 1976: 189–97.Google Scholar
24Bennett, L., Kavner, D, Lee, BY, Trainer, FS, Lewis, JM.Skin stress and blood flow in sitting paraplegic patients. Arch Phys Med Rehabil 1984; 65: 186–90.Google ScholarPubMed
25Kosiak, M, Kubicek, WG, Olson, M, Danze, JD, Kottke, FJ.Evaluation of pressure as a factor in the production of ischial ulcers. Arch Phys Med Rehabil 1958; 39: 623–28.Google ScholarPubMed
26Bliss, MR, McLaren, R, Exton, Smith AN.Mattresses for preventing pressure sores in geriatric patients. Monthly Bull Ministry Health 1966; 25: 238–68.Google ScholarPubMed
27Grant, LJInterface pressure measurement between a patient and a support surface. Care: the British Journal of Rehabilitation and Tissue Viability 1985; 1: 79.Google Scholar
28Bader, DLInterface pressure measurement. Care Sci Pract 1982; 1(3): 2224.Google Scholar
29Bader, DLPressure mapping at the interface. Care Sci Pract 1984; 3(2): 6769.Google Scholar
30Reswick, JB, Rogers, JE. Experience at Rancho Los Amigos Hospital with devices and techniques to prevent pressure sores. In: Kenedi, RM., Cowden, JM., Scales, JT. eds. Bedsore biomechanics. London: Macmillan, 1976; 301–10.Google Scholar
31Bauman, JH, Brand, PW.Measurement of pressure between foot and shoe. Lancet 1963; 1: 629–32.CrossRefGoogle ScholarPubMed
32Wytch, R, Neil, G, Kalisse, C.Skin orthosis interface pressure transducers: a review. Care Sci Pract 1989; 7(4): 100104Google Scholar
33Cochran, GVB. Measurement of pressure and other environmental factors at the patient-cushion interface. In: Lee, BY. ed. Chronic ulcers of the skin. New York: McGraw-Hill, 1985: 2337.Google Scholar
34Krouskop, TA, Garber, SL.Interface pressure confusion. Decubitus 1989; 2(3): 8.Google ScholarPubMed
35Groth, KE.Klinische Beobactungen und experimentelle Studien über die Entstehung des Dekubitus. Acta Chirurgica Scand 1942; 87 (suppl 76).Google Scholar
36Husain, T.An experimental study of some pressure effects on tissues with reference to the bedsore problem. J Pathol Bacterial 1953; 66: 347–58.CrossRefGoogle Scholar
37Bennett, L.Transferring load to flesh. Part V. Experimental work. Bull Prothetics Res 1973; 10(19): 88103.Google Scholar
38Daniel, RK, Priest, DL, Wheatley, DC.Etiologic factors in pressure sores: an experimental model. Arch Phys Med Rehabil 1981; 62: 492–98.Google ScholarPubMed
39Le, KM, Madsen, BL, Barth, PW, Ksander, GA, Angell, JB, Vistnes, LM.An in depth look at pressure sores using monolithic silicon pressure sensors. Plastic Reconstructive Surg 1984; 74: 745–54.CrossRefGoogle Scholar
40Conner, LM, Clack, JW.In vivo (CT scan) comparison of vertical shear in human tissue caused by various support surfaces. Decubitus 1993: 6(2): 2028.Google ScholarPubMed
41Clark, M, Rowland, BR, Wood, HA, Crow, RA.Measurement of soft tissue thickness over the sacrum of elderly hospital patients using B-mode ultrasound. J Biomed Eng 1989; 11: 200202.CrossRefGoogle ScholarPubMed
42Reger, SI., McGovern, TF., Chung, KC. Biomechanics of tissue distortion and stiffness by magnetic resonance imaging. In: Bader, DL. ed. Pressure sores: clinical practice and scientific approach. BasingstokeMacmillan, 1990: 177–90.CrossRefGoogle Scholar
43Sangeorzan, BJ, Harrington, RM, Wyss, CR, Czerniecki, JM, Matsen, III FA.Circulatory and mechanical response of skin to loading. J Orthop Res 1989; 7: 425–31.CrossRefGoogle ScholarPubMed
44Reddy, NR. Effects of mechanical stresses on lymph and interstitial fluid flows. In: Bader, DL ed. Pressure sores: clinical practice and scientific approach. Basingstoke: Macmillan, 1990: 203–20.CrossRefGoogle Scholar
45Dorrington, KL.Skin turgor: do we understand the sign? Lancet 1981; 1: 264–66.CrossRefGoogle Scholar
46Daly, CH, Chimoskey, JE, Holloway, GA, Kennedy, D. The effect of pressure loading on the blood flow rate in human skin. In: Kennedi, RM, Cowden, JM, Scales, JT eds. Bedsore biomechanics. London: Macmillan, 1976: 6977.Google Scholar
47Pye, G, Bowker, P.Skin temperature as an indicator of stress in soft tissue. Eng Med 1976; 5(3): 5860.CrossRefGoogle ScholarPubMed
48Rithalia, S, Edwards, J, Gonsakorale, M.An evaluation of three methods used for comparing patient support surfaces. J Tissue Viability 1992; 2(2): 68.CrossRefGoogle Scholar
49Porter, JM, Swain, ID.Non-invasive measurement of limb and digit blood flow. Care Sci Pract 1990; 8(1): 711.Google Scholar
50Holloway, GA, Tolentino, G, De, Lateur BJ. Cutaneous blood flow responses to wheelchair cushion pressure loading measured by laser Doppler flometry. In: Lee, BY ed. Chronic ulcers of the skin. New York: McGraw-Hill, 1985: 5766.Google Scholar
51Schubert, V, Fagrell, B.Local skin pressure and its effects on the microcirculation as evaluated by laser Doppler fluxmetry. Clin Physiol 1989; 9: 535–45.CrossRefGoogle ScholarPubMed
52Jonsson, TK, Jensen, JA, Goodson, III WH, West, JM, Hunt, TK.Assessment of perfusion in postoperative patients using tissue oxygen measurements. BrJ Surg 1987; 74: 263–67.CrossRefGoogle ScholarPubMed
53Bader, DL, Gant, CA.Changes in transcutaneous oxygen tension as a result of prolonged pressures at the sacrum. Clin Physics Physiol Measurement 1988; 9: 3340.CrossRefGoogle ScholarPubMed
54Bader, DL, White, SH, Burge, PD.Monitoring soft tissue viability during orthopaedic surgical procedures. J Bone Joint Surg 1990; 72B: 164.Google Scholar
55Bader, DL.Tissue viability measurement. J Tissue Viability 1992; 2: 39.Google Scholar
56Polliack, A, Taylor, R, Bader, DL. The analysis of sweat during soft tissue breakdown following pressure ischaemia. J Rehabil Res Dev (in press).Google Scholar
57Hoyman, K, Gruber, N.A case study of interdepartmental cooperation. Decubitus 1992; 5(6): 12.Google Scholar
58Brooks, B, Duncan, GW.Effects of pressure on tissues. Arch Surg 1940; XI: 696709.CrossRefGoogle Scholar
59Johnson, HM, Swan, TH, Weigand, GE.In what positions do healthy people sleep? JAMA 1930; 94: 2058–62.CrossRefGoogle Scholar
60Barbenel, JC. Movement studies during sleep. In: Bader, DL ed. Pressure sores: clinical practice and scientific approach, Basingstoke: Macmillan, 1990: 249–60.CrossRefGoogle Scholar
61Exton, Smith AN, Sherwin, RW.The prevention of pressure sores: significance of spontaneous bodily movements. Lancet 1961; ii: 1124–26.CrossRefGoogle Scholar
62Bar, CA, Lloyd, S, Pathy, MS, Chawla, JC.A system to monitor gross positional changes in recumbent patients. Care Sci Pract 1983; 2: 47.Google Scholar
63Wheatley, DC, Berme, N, Ferguson-Pell, MW.A low profile load transducor for monitoring movement during sleep. Exp Mech 1982; 20: 1921.CrossRefGoogle Scholar
64Nicholson, PW, Leeman, AL, O'Neill, CJA, Dobbs, SM, Deshmukh, AA, Denham, MJ.Pressure sores: effect of Parkinson's disease and cognitive function on spontaneous movement in bed. Age Ageing 1988; 17: 111–15.CrossRefGoogle ScholarPubMed
65Bader, DL, Hawken, MB. Ischial pressure distribution under the seated person. In: Bader, DL ed. Pressure sores: clinical practice and scientific approach. Basingstoke: Macmillan, 1990: 223–33.CrossRefGoogle Scholar
66Rogers, MA.Living with paraplegia. London: Faber & Faber, 1986: 4663.Google Scholar
67Barbenel, JC, Jordan, MM, Nicol, SM, Clark, MO.Incidence of pressure sores in the Greater Glasgow Health Board Area. Lancet 1977; ii: 548–50.CrossRefGoogle Scholar
68David, J.The size of the problem of pressure sores. Care Sci Pract 1981; 1(1): 1013.Google Scholar
69Nyquist, R, Hawthorn, PJ.The prevalence of pressure sores within an area health authority. J Adv Nurs 1987; 12: 183–87.CrossRefGoogle ScholarPubMed
70Richardson, RR, Meyer, PR.Prevalence and incidence of pressure sores in acute spinal cord injuries. Paraplegia 1981; 19: 235–47.Google ScholarPubMed
71Guttmann, L. The prevention and treatment of pressure sores. In: Kenedi, RM, Cowden, JM, Scales, JT eds. Bedsore biomechanics. London: Macmillan, 1976: 153–59.Google Scholar
72Edmonds, ME.The diabetic foot. Med Int 1989; 65: 2708–12.Google Scholar
73Raney, JP.A comparison of the prevalence of pressure sores in hospitalised ALS and MS patients. Decubitus 1989; 2(2): 4849.Google ScholarPubMed
74Cochrane, G. The severely disabled. In: Bader, DL ed. Pressure sores: clinical practice and scientific approach. Basingstoke: Macmillan, 1990: 8196.CrossRefGoogle Scholar
75Braden, BJ, Bergstrom, N.Clinical utility of the Braden scale for predicting pressure sore risk. Decubitus 1989; 2(3):4451.Google ScholarPubMed
76Piloian, BB.Defining characteristics of the nursing diagnosis ‘high risk for impaired skin integrity’. Decubitus 1992; 5(5): 3247.Google ScholarPubMed
77Schubert, V, Fagrell, B.Postocclusive reaction hyperemia and thermal response in the skin microcirculation of subjects with spinal cord injury. Scand J Rehabil Med 1991; 23: 3340.CrossRefGoogle Scholar
78Bannister, R. Introduction and classification. In: Bannister, R ed. Autonomic failure. A text book of clinical disorders of the autonomic nervous system, second edition. Oxford: Oxford University Press, 1988: 120.Google Scholar
79Roy, CS, Graham, Brown J.The blood pressure and its variations in the arterioles, capillaries and smaller veins. J Physiol 1879; ii: 323–59.Google Scholar
80Lewis, T, Grant, R.Reactive hyperaemia. Heart 19251926; XII: 73120.Google Scholar
81Goldblatt, H.Observations upon reactive hyperaemia. Heart 19251926; XII: 281–94.Google Scholar
82Spittle, CSN, Stears, A, Michel, CC.The effects of venous congestion on the magnitude and time course of reactive hyperaemia in the human forearm. J Physiol 1990; 432: 13P.Google Scholar
83Michel, CC, Gillott, H. Microvascular mechanisms in stasis and ischaemia. In: Bader, DL ed. Pressure sores: clinical practice and scientific approach. Basingstoke: Macmillan, 1990: 153–63.CrossRefGoogle Scholar
84Lewis, MJ.Endothelium derived relaxing factor. Curr Op Cardiol 1986; 1: 832–36.CrossRefGoogle Scholar
85Walker, BR, Williams, BC.Corticosteroids and vascular tone: mapping the messenger maze. Clin Sci 1992; 82: 597605.CrossRefGoogle ScholarPubMed
86Petty, RG, Pearson, JR.Endothelium – the axis of vascular health and disease. JR Coll Phys Lond 1989; 23: 92102.Google ScholarPubMed
87Guyton, AC ed. Muscle blood flow during exercise; cerebral, splanchnic and skin blood flows. In: Guyton, AC.Textbook of medical physiology. Washington: WB Saunders, 1981: 344–56.Google Scholar
88Friman, G, Hamrin, E.Changes of reactive hyperaemia after clinical bedrest for seven days. Upsala J Med Sci 1976; 81: 7983.CrossRefGoogle ScholarPubMed
89Guyton, AC. Local control of blood flow by the tissues, and nervous and humoral regulation. In: Guyton, AC ed. Textbook of medical physiology. Washington: WB Saunders, 1981: 232–45.Google Scholar
90Bogie, KM, Nuseibeh, I, Bader, DL.Transcutaneous gas tensions in the sacrum during the acute phase of spinal cord injury. Eng Med 1992; 206: 16.CrossRefGoogle ScholarPubMed
91Charcot, JM.Lectures on diseases of the nervous system. London: New Sydenham Society, 1877.Google Scholar
92Munro, D.Care of the back following spinal cord injuries – a consideration of bedsores. N Engl J Med 1940; 223: 391–98.CrossRefGoogle Scholar
93Paget, J.Clinical lecture on bedsores. Students Hospital Gazette (London) 1873; 1: 144–46.Google Scholar
94Barton, AA, Barton, M.The inhibition of decubitus ulceration with ACTH. J Pathol Bacteriol 1968; 96: 345–51.CrossRefGoogle ScholarPubMed
95Nicholl, PA, Webb, RL.Vascular patterns and active vasomotion as determiners of flow through minute vessels. Angiology 1955; 6: 291308.CrossRefGoogle Scholar
96Munro, D.Thoracic and lumbosacral cord injuries; a study of 40 cases. JAMA 1943; 122: 1055–63.CrossRefGoogle Scholar
97Berger, JC.Surgical treatment of decubitus ulcers. Plastic Reconstructive Surg 1957; 20: 206–17.CrossRefGoogle ScholarPubMed
98Yeoman, MP, Hardy, AG.The pathology and treatment of pressure sores in paraplegics. Br J Plastic Surg 19541955; 7: 179–92.CrossRefGoogle ScholarPubMed
99Constantian, MB, Jackson, HS. Factors affecting pressure ulcer development. In: Constantian, MB ed. Pressure ulcers: principles and techniques of management. Boston: Little Brown, 1980: 143–48.Google Scholar
100Bader, DL.The recovery characteristics of soft tissues following repeated loading. J Rehabil Rex Dev 1990; 27: 141–50.CrossRefGoogle ScholarPubMed
101Bennett, L, Lee, BY.Paraplegic pressure sore frequency versus circulation measurements. J Rehabil Res Dev 1990; 27: 115–26.CrossRefGoogle ScholarPubMed
102Reichlin, S.Molecular basis of the metabolic changes in trauma and sepsis. Hosp Update 1991; 17: 628.Google Scholar
103Walmsley, D, Wiles, PG.Impaired hyperaemic response to skin microtrauma in diabetes is associated with retinopathy. Clin Sci 1988; 74 (suppl 18): 2425p.CrossRefGoogle Scholar
104Lowe, GDO.Blood rheology in arterial disease. Clin Sci 1986; 71: 137–46.CrossRefGoogle ScholarPubMed
105Unsworth, J.Picture quiz. Rheumatology 1989; 1: 13.Google Scholar
106Shah, AM.Vascular endothelium. Br J Hosp Med 1992; 48: 540–49.Google ScholarPubMed
107Brady, AJB, Williams, FM, Williams, TJ.Inflammatory injury in myocardial ischaemia. Clin Sci 1992; 83: 511–18.CrossRefGoogle ScholarPubMed
108Trumble, HC.The skin tolerance for pressure and pressure sores. Med J Aust 1930; ii: 724–26.CrossRefGoogle Scholar
109Jones, JR. Physiology of the cord-injured patient: anesthetic considerations. In: Constantian, MB ed. Pressure ulcers: principles and techniques of management. Boston: Little Brown, 1980: 4145.Google Scholar
110Schubert, V.Hypotension as a risk factor for the development of pressure sores in elderly subjects. Age Ageing 1991; 20: 255–61.CrossRefGoogle ScholarPubMed
111Barton, AA. Pressure sores. In: Barbenel, JC, Forbes, CD, Lowe, GDO eds. Pressure sores. London: Macmillan, 1983: 5357.CrossRefGoogle Scholar
112Versluysen, M.How elderly patients with femoral neck fracture develop pressure sores in hospital. Br Med J 1986; 292: 1311–13.CrossRefGoogle Scholar
113Dealey, C.Pressure sores: the result of bad nursing? Br J Nurs 1992; 1: 748.CrossRefGoogle ScholarPubMed
114Waterlow, J.The Waterlow card for the prevention and management of pressure sores: towards a pocket policy. Care Sci Pract 1988; 6(1): 812.Google Scholar
115Barratt, E.A review of risk assessment methods. Care Sci Pract 1988; 6(2): 4952.Google Scholar
116Gosnell, DJ.Pressure sore risk assessment: a critique. Part I: the Gosnell scale. Decubitus 1989; 2(3): 3238.Google ScholarPubMed
117Guttmann, L.The problem of treatment of pressure sores in spinal paraplegics. Br J Plastic Surg 1955; 7: 196213.CrossRefGoogle Scholar
118Freeman, BS.Treatment of bedsores in paraplegic patients. Surgery 1947; 21: 668–74.Google ScholarPubMed
119Mulholland, JH, Tui, C, Wright, AM, Vinci, V, Shafiroff, B.Protein metabolism in bed sores. Ann Surg 1943; 118: 1015–23.CrossRefGoogle ScholarPubMed
120Bateman, FTA.Silicone barrier cream in prevention of bedsores. Br Med J 1956; i: 554–55.CrossRefGoogle Scholar
121Matheson, AT, Lipschitz, R.The nature and treatment of trophic pressure sores. S Afr Med J 1956; 30: 1129–32.Google Scholar
122Langston, R.The use of testosterone in debility states. J Plastic Reconstructive Surg 1952; 9: 543–46.CrossRefGoogle ScholarPubMed
123Fox, TA, Apfelbach, GL.Prevention and treatment of decubitus in fractures. JAMA 1940; 115: 1438–39.CrossRefGoogle Scholar
124Freeman, L. Clinical forms of gangrene: bedsores or decubitus. In: Keen, WW ed. Surgery. Its principles and practice. Philadelphia: WB Saunders, 1906, 333–38.Google Scholar
125Loeper, J, Rameix, P.Le probleme des escarres et leur traitment chez le sujet age. Semaine des Hopitaux de Paris 1960; 10: 635–38.Google Scholar
126Barton, AA. MD Thesis. London: University of London, 1970.Google Scholar
127Animal management Vetinary Department of the War Office, 1933.Google Scholar
128Wiles, PG, Grant, PJ, Jones, RG, Knibbs, AV, Hampton, IFG.Lowered skin blood flow at exhaustion. Lancet 1986; ii: 295.CrossRefGoogle Scholar
129Larsson, PT, Hjemdahl, P, Olsson, G, Egberg, N, Hornstra, G.Altered platelet function during mental stress and adrenaline infusions in humans: evidence for an increased aggregability in vivo as measured by filtragometry. Clin Sci 1989; 76: 369–76.CrossRefGoogle ScholarPubMed
130Eisenhofer, G, Lambie, DG, Johnson, RH.Beta-adrenoceptor responsiveness and plasma catecholamines as determinants of cardiovascular reactivity to mental stress. Clin Sci 1985; 69: 483–93.CrossRefGoogle ScholarPubMed
131Boyd, GW.On stress, disease and evolution. Hobart: University of Tasmania, 1989.Google Scholar
132Anonymous. Endotoxin bound and gagged [Editorial]. Lancer 1991; 337: 588–90.CrossRefGoogle Scholar
133Clowes, GHA.The metabolic response to trauma. Med Int 1987; 2: 1561–66.Google Scholar
134Faist, E, Baue, AE, Dittmer, H, Heberer, G.Multiple organ failure in polytrauma patients. J Trauma 1983; 23: 775–87.CrossRefGoogle ScholarPubMed
135Glavis, C, Barbour, S.Pressure ulcer prevention in critical care: state of the art. AACN Clinical Issues 1990; 1: 602–13.Google ScholarPubMed
136Malone, C.Intensive pressures. Nurs Times 1992; 88: 5764.Google ScholarPubMed
137Gendron, FG.Unexplained patient burns: investigating iatrogenic injuries. California: Quest Publishing Company, 1988.Google Scholar
138Green, T, Manara, AR, Park, GR.Dermatological conditions in the intensive care unit. Hosp Update 1989; 15: 367–76.Google Scholar
139Glauser, MP, Zanetti, G, Baumgartner, J-D, Cohen, J.Septic shock: pathogenesis: Lancet 1991; 338: 732–36.CrossRefGoogle ScholarPubMed
140Chernow, B.Role of mediators in the pathogenesis of shock and multiple organ failure. Br J Hosp Med 1991; 46 (Critical Care '91 Abstracts Supplement); 2223.Google Scholar
141Bennett, ED.Regional blood flow. Br J Hosp Med 1991; 46 (Critical Care '91 Abstracts Supplement); 25.Google Scholar
142Tortora, GJ, Anagnostakos, NP. Metabolism. In: Tortora, GJ, Anagnostakos, NP eds. Principles of anatomy and physiology. New York: Harper & Row, 1981: 645–66.Google Scholar
143Helliwell, TR, Griffiths, RD, Cookley, JH et al. Necrosis of muscle in critically ill patients. Br J Hosp Med 1989; 42: 140.Google Scholar
144Cohen, J.Septicaemia. Med Int 1992; 104: 4361–67.Google Scholar
145McLelland, P, Yaqoob, M, Raines, G et al. Clinical, bacteriological and humoral detenuinants of sepsis. Clin Sci 1992; 83 (suppl 27); 14.CrossRefGoogle Scholar
146Eckman, KL.The prevalence of dermal ulcers among persons who have died. Decubitus 1989; 2(2): 3640.Google ScholarPubMed
147Hanson, D, Langemo, DK, Olson, B et al. The prevalence and incidence of pressure ulcers in the hospice setting: analysis of two methodologies. Am J Hospice Palliat Care 1991; 5: 1822.CrossRefGoogle Scholar
148Bliss, MR, Silver, JR. Pressure sores. In: Monk, BE, Graham, Brown RAC, Sarkany, I eds. Skin disorders in the elderly. Oxford: Blackwell, 1988: 97112.Google Scholar
149Blaylock, B.Pressure ulcers: a review. Dermatol Nurs 1990; 2: 278–82.Google ScholarPubMed
150Ishii, T, Hosoda, Y, Maeda, K.Cause of death in the extreme aged – a pathologic survey of 5106 persons 80 years old and over. Age Ageing 1980; 9: 8189.CrossRefGoogle ScholarPubMed
151Singer, M, Screaton, G, McNally, T, Mackie, I, Machin, S, Cohen, S. Clotting of continuous haemofiltration circuits in critically ill patients may be related to low levels of antithrombin III rather than heparin clearance. London, Royal College of Physicians: Medical Research Society Winter Meeting, 1992: 6.CrossRefGoogle Scholar
152Morrell, MT, Dunnill, MS.The postmortem incidence of pulmonary embolism in a hospital population. Br J Surg 1968; 55: 347–52.CrossRefGoogle Scholar
153Frankel, HL. The spinal injury patient. London, Queen Mary and Westfield College: Tissue ViabiLity Society Autumn Conference, 1991.Google Scholar
154Joseph, B.Insulin in the treatment of non diabetic bedsores. Ann Surg 1930; 92: 318–19.CrossRefGoogle Scholar
155Clarke, AG.Skeletal suspension in the treatment of decubiti. Calif Med 1950; 72: 446–49.Google Scholar
156Altshuler, SS, Sahyun, M, Shneider, H, Satriano, D.Clinical use of amino acids for the maintainance of nitrogen equilibrium. JAMA 1943; 121: 163–67.CrossRefGoogle Scholar
157Constantian, MB, Jackson, HS. Biology and care of the pressure ulcer wound. In: Constantian, MB ed. Pressure ulcers: principles and techniques of management. Boston: Little Brown, 1980: 69100.Google Scholar
158Bastow, MD, Rawlings, J, Allison, S.Benefits of supplementary tube feeding after fractured neck of femur: a randomised controlled trial. Br Med J 1983; 287: 1589–92.CrossRefGoogle ScholarPubMed
159Cullum, N, Clark, M.Intrinsic factors associated with pressure sores in elderly people. J Adv Nurs 1992; 17: 427–31.CrossRefGoogle ScholarPubMed
160Shannan, ML, Skorga, P.Pressure ulcer prevalence in two general hospitals. Decubitus 1989; 2(4): 38.Google Scholar
161Lehman, AS.Nutrition in old age: an update and questions for future research: part 1. Rev Clin Gerontol 1991; 1: 135–45.CrossRefGoogle Scholar
162Fleck, A, Smith, G.Assessment of malnutrition in elderly patients. Lancet 1991; 337: 793.CrossRefGoogle ScholarPubMed
163Stotts, N.Nutrition parameters as predictors of pressure sores in surgical patients. Nurs Res 1985; 34: 383.CrossRefGoogle Scholar
164Irvine, RE.Norethandrolone and prevention of decubitus ulcers. Lancet 1961; ii: 1333–34.CrossRefGoogle Scholar
165Friedman, PJ, Campbell, AJ, Caradoc-Davies, TH.Prospective trial of a new diagnostic criterion for severe wasting malnutrition in the elderly. Age Ageing 1985; 14: 149–54.CrossRefGoogle ScholarPubMed
166Goldstone, LA, Goldstone, J.The Norton score: an early warning of pressure sores? J Adv Nurs 1982; 7: 419–26.CrossRefGoogle ScholarPubMed
167Ferrell, BA, Osterweil, D, Christensen, P.A randomised trial of low-air-loss beds for treatment of pressure ulcers. JAMA 1993; 269: 494–97.CrossRefGoogle ScholarPubMed
168Brown-Sequard, E.Experimental researches applied to physiology and pathology. New York: Baillière, 1853: 1217.CrossRefGoogle ScholarPubMed
169Cope, Z.Prevention and treatment of bedsores. Br Med J 1939; 1: 737–38.CrossRefGoogle ScholarPubMed
170Collins, E, Solowinski, H. Bedsores, prevention and treatment. Am J Nurs 1949; 11: 688–90.Google Scholar
171Fantus, B.The therapy of the Cook County Hospital. JAMA 1935; 104: 4648.Google Scholar
172Newton, M.Pressure areas – how to prevent decubitus ulcers. Am J Nurs 1938; 38: 888–92.Google Scholar
173Bettley, FR.The influence of soap on the permeability of the epidermis. Br J Dermatol 1961; 73: 448–54.CrossRefGoogle ScholarPubMed
174Hughes, JPW, Wigley, GS.Silicone sprays in prevention and treatment of decubitus skin disorders in domiciliary nursing. Br Med J 1962; ii: 153–56.CrossRefGoogle Scholar
175Nasar, MA.Treating pressure sores. Br Med J 1978; i: 1624–25.CrossRefGoogle Scholar
176Flam, E. Skin maintainance in the bed ridden patient. Ostomy/Wound Management 1990; 05/06: 4854.Google Scholar
177Torrance, C.Pressure sores: aetiology, treatment and prevention. London: Croom Helm, 1983: 2134.Google Scholar
178Cruikshank, CND. The microanatomy of the epidermis in relation to trauma. In: Kenedi, RM, Cowden, JM, Scales, JT eds. Bedsore biomechanics. London: Macmillan, 1976: 3946.Google Scholar
179Davies, I. The mechanisms of ageing. In: Monk, BE, Graham-Brown, RAC, Sarkany, I eds. Skin disorders in the elderly. Oxford: Blackwell, 1988: 329.Google Scholar
180Weiss, M, Milman, B, Rosen, B, Eisenstein, Z, Zimlichman, R.Analysis of the diminished skin perfusion in elderly people by laser Doppler flowmetry. Age Ageing 1992; 21: 237–41.CrossRefGoogle ScholarPubMed
181Khan, F, Spence, VA, Belch, JJF.Cutaneous vascular responses and thermoregulation in relation to age. Clin Sci 1992; 82: 521–28.CrossRefGoogle ScholarPubMed
182Horan, MA, Barton, RN, Little, RA. Ageing and the response to injury. In: Grimley, Evans J, Caird, FI eds. Advanced geriatric medicine 7. Guildford: Butterworths, 1988: 101–35.Google Scholar
183Allman, RM.Epidemiology of pressure sores in different populations. Decubitus 1989; 2(2): 3033.Google ScholarPubMed
184Bion, JF.Sedation and analgesia in the intensive care unit. Hosp Update 1988; 14: 1272–86.Google Scholar
185Rudd, TN.The pathogenesis of decubitus ulcers. J Am Geriatr Soc 1962; 10: 4853.CrossRefGoogle ScholarPubMed
186Strunk, H, Ostebrunk, J.Pressure induced skin lesions in cardiac surgery. Care Sci Pract 1988; 6(4): 113–15.Google Scholar
187Wood, M. Drug use in the intensive therapy unit. In: Nimmo, WS, Smith, GM eds. Anaesthesia. Oxford: Blackwell, 1989; 2: 1486–96.Google ScholarPubMed
188Bodenham, A, Couzens, S, Hoskins, R, Park, GR.The haematological effects of inotropic agents. Br J Hosp Med 1989; 42: 147.Google Scholar
189McSorley, PD, Warren, DJ.Effects of propranolol and metoprolol on the peripheral circulation. Br Med J 1978; ii: 15981600.CrossRefGoogle Scholar
190Barrow, TG, Sikes, CR.Decubitus ulcer in rheumatic fever treated with cortisone. JAMA 1951; 147: 4142.CrossRefGoogle ScholarPubMed
191Barton, AA, Barton, M.ACTH and decubitus ulceration; an experimental study. Br J Pharmacol 1969; 36: 219–24.CrossRefGoogle ScholarPubMed
192Barton, AA, Barton, M.Drug based prevention of pressure sores. Lancet 1976; ii: 443–44.CrossRefGoogle Scholar
193Downie, AC, Frost, PG, Fielden, P, Joshi, D, Dancy, CM.Bedside measurement of creatine kinase to guide thrombolysis on the coronary care unit. Lancet 1993; 341: 452–54.CrossRefGoogle ScholarPubMed
194Ranjadayalan, K, Umachandran, V, Timmis, AD. The effects of thrombolytic therapy on temperature responses to acute myocardial infarction. Coronary Artery Dis 1991; 2: 907–12.Google Scholar
195Bliss, MR, Thomas, J.Randomised controlled trials of pressure relieving supports. J Tissue Viability 1992; 2: 8995.CrossRefGoogle Scholar
196Bliss, MR.The use of ripple beds in hospitals. Hosp Health Serv Rev 1979; 74: 190–93.Google Scholar