Stage 4 bedsore icu

[Mjhall42077]

Hey wanting to know if anyone is healing from stage 4 bedsore? We're just now starting to heal,my husband that is,but wanting any feed back. The good the bad ugly all of it. My husband is 59 diabetes,Nash of the liver,sarcoidosis,just got home from hospital after almost 4 months almost 2 on ventilator. This will be slowing his mobility cause they want him to stay off of it. We're doing our best especially with high protein diet. I'm not gonna lie, I've been there every day with him didn't leave his side but now that we're home I'm scared. Like tonight I've watched and listen to his breathing. He had covid pneumonia,strep pneumonia,and sepsis.....and power of prayer. I adore my husband,I feel so bad for him. If any of you have healed from one of these bedsores let me know.

[Rhyl1 Partner Moderator ICUsteps]

The risk of infection with a stage 4 pressure sore is high and antibiotics and regular dressings are the way to go. Relieving the pressure around the area and good nutrition are also important as you mention. Grade 4 pressure sore take a long time to heal so try to be patient. There’s some good information online but I would recommend the NHS information at nhs.uk/conditions/pressure-...

[FamilyHistorian]

Fortunately I had nothing like that, they can be difficult to care for.You also said some thing else about lying awake listening to your husband breathing. That’s not unusual but it is also very important that you get proper sleep as well. Some people find the return home more difficult than the stay in hospital.

My wife discovered I was missing breaths at night. So I was tested and found that I was missing on average 47 breaths per hour which meant I had sleep apnoea. It’s treatable and meant my wife started to sleep better. I wasn’t aware of it apart from suddenly gasping for air.

Take care

[Mjhall42077 in reply to FamilyHistorian]

Thank you

[Mjhall42077 in reply to Mjhall42077]

Oh and yes when I took on roll of a crew I panicked. I'm still not sure of myself here but he's been able to survive so far with me. It was hard enough to make the decision I had to make on his behalf in hospital now I'm responsible for taking care of the different areas....Lord have mercy on me is I can say ,or him!!!

[Sepsur]

We run a relative drop-in on zoom every Tuesday night, I’m sure there will be people who can reassure you there. It’s never a huge meeting, so there is plenty of opportunity to ask questions or just listen 😊. cc-sn.org

[CLM68]

I was also told that a really good diet also helped the healing process but this wound will take time to heal

[Grant_za]

This is going to be a rather long answer, but hopefully of benefit to others as well.Good nutrition, and specifically a high protein diet are key to healing.

There are 2 aspects here that need to be addressed:

Healing & prevention.

I'll start with healing.

Stage4 pressure ulcers are usually best treated by a nurse specializing in advanced wound care.

Very often, this will include the use of Negative Pressure Wound Therapy (NPWT) equipment - also known as VAC Therapy.

Smith & Nephew along with KCI appear to be leaders in this field.

In short, a vacuum port is placed directly over the wound, the wound and the port are supported by various dressings. The vacuum applied stimulates blood flow and removes exudate (fluids) from the wound, and also prevents infection.

In addition, the nurse will physically debride (cut away) and dead tissue surrounding the wound.

NPWT generally speeds up healing time by around 30% or so.

Sometimes wound irrigation is also introduced by the NPWT pump, depending on the nature of the wound & surrounding “tunneling”.

Often when the wound has been reduced to around stage2, more conventional dressings and treatment resumes.

Prevention:

Standard protocol requires dictates constant turning of the patient - every 3 hours, and never to a position whereby there is pressure on the wound itself.

This can be challenging in a home environment unless there is 24hr home care support. One can use soft pillows to support the body surrounding the wound in order to prevent pressure being applied to the wound.

A alternating pressure mattress can also be used to assist.

The alternating pressure mattress combined with constant turning will yield good results in prevention.

Negative Pressure Wound Therapy pump, with wound irrigation

[Grant_za]

Pressure ulcers are serious - stage 4 are really serious.Home based wound care, usually with the use of Negative Pressure Wound Therapy (aka vac therapy) will help significantly.

Diet is critical - especially protein.

Perhaps consider a supplement like Protifar.

Protifar is completely tasteless and can be added to sweet or savoury - also good in smoothies.

It does thicken the food / drink item it is added to.

Also consider regular blood tests to check protein and prealbumin levels.

With care, stage4 becomes Stage3 which becomes stage2... full recovery is 100% possible. High protein diets need not be expensive. Things like peanut butter, eggs (get inventive with eggs - they are versatile). Perhaps consider a once off consult with a dietician. They will work out your needs, and take into account what one may or may not enjoy eating.

I'm assuming there is a wound care person assisting. Pressure ulcers need a dressing change every 3 days.

The pressure ulcer needs irrigation with sterile water. The wound would usually need an anti bacterial dressing like inodene, along with a hydrogel the keep the wound moist. On top of that a product like Drawtex to absorb exudite, then a sealable dressing on top. It's all a bit like a layer cake, but easily manageable.

Your local pharmacy will have Smith & Nephew Allevyn wound care products.

If you need a bit of advice or help pls feel free to send me a direct message.