Relationship between internal risk factors for development of decubitus ulcers and the blood flow response following pressure load

The objective of this study was to investigate the extent to which internal risk factors for the development of decubitus ulcers are related to the bl ood flow response following the relief of a pressure load. There were 122 n ursing home patients (43 men, 69 women, mean age: 81 +/-8 years; range: 60- 97). The following potential, internal risk factors for the development of decubitus ulcers were assessed: chronic disorders (diabetes mellitus, cardi ovascular disease [congestive heart failure, history of myocardial infarct or angina pectoris] and cerebrovascular accident), fever, blood pressure, n utritional status, serum hemoglobin concentration, and serum urea and serum creatinine concentrations. Skin temperature response (latency time and tot al response time) was measured following relief of a 100 kPa test pressure. The presence of cardiovascular disease, cerebrovascular accident, poor nutr itional condition, high serum urea and male gender showed a significant rel ationship with an impaired blood flow response. The delayed latency found s howed a similarity to the so-called "no-reflow phenomenon." The association of cardiovascular disease and a cerebrovascular accident with a delay in t he blood flow response may result from endothelial damage. A poor nutrition al condition may be associated with a deficit of scavengers of oxygen-deriv ed free radicals. The presence of free radicals may damage endothelium duri ng reperfusion, thus influencing the blood flow response. The association o f high serum urea with delayed vasodilatation may theoretically be explaine d by the association of serum urea and impaired kidney functioning, since t he kidney is an important organ in the production of vasoactive substances. Serum urea can also be considered a measure for nutritional condition. Gen der may function as a substitute for other, unmeasured factors that are rel ated to blood flow response.