Abstract
BACKGROUND: Oral mucosal membrane pressure injuries are common yet underrecognized complications in critically ill patients with endotracheal tubes. This study investigated the association between nutrition risk and oral mucosal membrane pressure injuries. METHODS: This multicenter prospective cohort study enrolled 1533 intensive care unit patients with endotracheal tubes between April and December 2023. The primary model examined the association between nutrition risk and oral mucosal membrane pressure injuries. Additional analyses evaluated associations of medical nutrition therapy and inflammatory biomarkers (procalcitonin and C-reactive protein) with the outcome. Cox proportional hazards regression models were used, and five sequential models adjusted for confounders. RESULTS: Overall, 551 patients (36.3%) developed oral mucosal membrane pressure injuries. Nutrition risk was independently associated with an increased risk (hazard ratio [HR] = 1.37; 95% CI, 1.07-1.75). Medical nutrition therapy, including enteral nutrition, parenteral nutrition, and combined therapy, was associated with a reduced risk compared with suspended diet, with longer durations conferring greater benefit (HR = 0.77; 95% CI, 0.74-0.80). Additionally, elevated procalcitonin levels were associated with an increased risk of oral mucosal membrane pressure injuries (HR = 1.35; 95% CI, 1.09-1.68), whereas high C-reactive protein levels, although not statistically significant (HR = 1.09; 95% CI, 0.91-1.30), suggested a potential promoting effect. CONCLUSION: Nutrition risk was an independent risk factor for oral mucosal membrane pressure injuries in critically ill patients with endotracheal tubes. Medical nutrition therapy reduced this risk, particularly with longer durations. Additionally, elevated procalcitonin levels were associated with a higher risk, highlighting the role of inflammation in pressure injury development.