Meta-analysis of factors influencing oral mucosal pressure injuries in ICU patients with endotracheal intubation_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LIU Hailing ¹ , WU Xuanyi ² , WANG Zhiwei ³ ,  ZHANG Li ⁴

1. Second Department of Critical Care Medicine, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830016, P. R. China;
2. Urumqi Stomatological Hospital, Urumqi, Xinjiang 830016, P. R. China;
3. Department of Critical Care Medicine, The Fifth People's Hospital of Qinghai Province, Xining, Qinghai 810000, P. R. China;
4. Nursing Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830016, P. R.China;

Corresponding?author：

Keywords：

Oral mucosal pressure injury; intubation; influencing factors; meta-analysis

DOI：

10.7507/1671-6205.202601094

Video：

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Objective To evaluate factors associated with the occurrence of oral mucosal pressure injuries in intubated intensive care unit (ICU) patients through meta-analysis, providing reference for clinical prevention of oral mucosal pressure injuries. Methods Literature retrieval was conducted in databases including PubMed, Web of Science, Embase, The Cochrane Library, CNKI, CBM, VIP, and Wanfang, supplemented by manual searches. The retrieval time limit was from the establishment of each database to August 2025. Two reviewers independently screened studies, extracted data, and assessed quality. Review Manager 5.3 and Stata 17.0 were used to conduct the meta-analysis of eligible studies. Results A total of 14 studies were included, involving 6536 patients. Meta-analysis revealed that prolonged artificial airway placement duration, higher acute physiology and chronic health evaluation Ⅱ scores, vasoactive drug use, prone position ventilation, serum albumin levels, and Richmond agitation-sedation scale (RASS) scores were risk factors for oral mucosal pressure injuries in ICU intubated patients. Conclusions Oral mucosal pressure injuries remain prevalent among ICU intubated patients. Comprehensive analysis of influencing factors can aid healthcare providers in preventing and optimizing interventions to reduce their occurrence.

Citation： LIU Hailing, WU Xuanyi, WANG Zhiwei, ZHANG Li. Meta-analysis of factors influencing oral mucosal pressure injuries in ICU patients with endotracheal intubation. Chinese Journal of Respiratory and Critical Care Medicine, 2026, 25(7): 509-519. doi: 10.7507/1671-6205.202601094 Copy

1.	Schank JE. The npuap meeting - this was no consensus conference. J Am Coll Clin Wound Spec, 2015, 7(1-3): 19-24.
2.	Edsberg LE, Black JM, Goldberg M, et al. Revised national pressure ulcer advisory panel pressure injury staging system: Revised pressure injury staging system. J Wound Ostomy Continence Nurs, 2016, 43(6): 585-597.
3.	Saleh MYN, Ibrahim EIM. Prevalence, severity, and characteristics of medical device related pressure injuries in adult intensive care patients: A prospective observational study. Int Wound J, 2023, 20(1): 109-119.
4.	Chen G, Li X, Li X, et al. Mucosal membrane pressure injury in intensive care units: a scoping review. Intensive Crit Care Nurs, 2024, 80: 103560.
5.	Li Q, Shi X, Lu X, et al. Incidence of, and factors associated with, oral mucous membrane medical device-related pressure injury in critically ill patients with orotracheal intubation: A prospective cohort study. BMJ Open, 2025, 15(6): e098114.
6.	Higgs A, McGrath BA, Goddard C, et al. Guidelines for the management of tracheal intubation in critically ill adults. Br J Anaesth, 2018, 120(2): 323-352.
7.	Buranarom N, Komin O, Matangkasombut O. Hyposalivation, oral health, and candida colonization in independent dentate elders. PLoS One, 2020, 15(11): e0242832.
8.	Jang CS, Shin YS. Effects of combination oral care on oral health, dry mouth and salivary PH of intubated patients: a randomized controlled trial. Int J Nurs Pract, 2016, 22(5): 503-511.
9.	曾憲濤, 劉慧, 陳曦, 等. Meta分析系列之四: 觀察性研究的質量評價工具. 中國循證心血管醫學雜志, 2012, 4(4): 297-299.
10.	李柄輝, 訾豪, 李路遙, 等. 醫學領域一次研究和二次研究的方法學質量(偏倚風險)評價工具. 醫學新知, 2021, 31(1): 51-58.
11.	劉迪, 李凡, 蔡夢歆, 劉華平. EICU經口氣管插管患者發生相關性口腔黏膜壓力性損傷的危險因素分析. 中文科技期刊數據庫(引文版)醫藥衛生, 2022(3): 010-016.
12.	張樹光, 姜洪彪, 侯杰, 等. ICU經口氣管插管老年病人口腔黏膜壓力性損傷風險預測模型的構建. 護理研究, 2024, 38(20): 3592-3597.
13.	王志偉, 何小燕, 陶珍珍, 等. ICU氣管插管患者口腔黏膜壓力性損傷風險列線圖模型的構建. 中華現代護理雜志, 2024, 30(13): 1764-1770.
14.	喻海濤, 吳運蓮. ICU氣管插管患者口腔黏膜壓力性損傷預測模型的構建及驗證. 中文科技期刊數據庫(全文版)醫藥衛生, 2023(1): 183-186.
15.	王寶芹, 蔣學娟, 史廣玲, 等. ICU氣管插管老年患者口腔黏膜壓力性損傷特征及其影響因素分析. 中華老年口腔醫學雜志, 2024, 22(4): 200-204,229.
16.	李敏, 唐莉, 姚倩, 等. 經口氣管插管患者口腔黏膜壓力性損傷風險預測模型的構建及驗證. 護理與康復, 2024, 23(6): 1-8.
17.	辜甜田, 黃光梅, 張培, 等. 經口氣管插管患者口腔黏膜壓力性損傷風險預測模型的構建與驗證. 護理學雜志, 2024, 39(20): 64-68.
18.	何青云, 黃春美, 姜愛華, 等. 經口氣管插管患者口腔黏膜壓力性損傷的危險因素分析. 浙江醫學教育, 2024, 23(2): 117-122.
19.	張英, 潘瑜, 黃玉鳳, 等. 急診重癥監護室經口氣管插管患者口腔黏膜壓力性損傷的危險因素分析及風險預測模型構建. 實用臨床醫藥雜志, 2025, 29(3): 75-79,83.
20.	Choi BK, Kim M S, Kim SH. Risk prediction models for the development of oral-mucosal pressure injuries in intubated patients in intensive care units: A prospective observational study. J Tissue Viability, 2020, 29(4): 252-257.
21.	Ai X, Deng Y, Wang B, et al. Association between nutrition risk and oral mucosal membrane pressure injury in critically ill adults requiring endotracheal tube placement: a prospective cohort study. JPEN J Parenter Enteral Nutr, 2025, 49(8): 983-992.
22.	Yi C, Yan L, Xiao-Hui Y, et al. Characteristics and risk factors of oral endotracheal tube-related mucous membrane pressure injury in intensive care units. Nurs Crit Care, 2025, 30(4): e70090.
23.	Jia L, Deng Y, Xu Y, et al. Development and validation of a nomogram for oral mucosal membrane pressure injuries in icu patients: a prospective cohort study. J Clin Nurs, 2024, 33(10): 4112-4123.
24.	任曉華, 陳劍. 經口氣管插管病人舌部壓瘡的預防及護理. 全科護理, 2019, 17(15): 1841-1843.
25.	Kim SH, Nah HS, Kim JB, et al. Relationships between oral-mucosal pressure ulcers, mechanical conditions, and individual susceptibility in intubated patients under intensive care: a pcr-based observational study. Biol Res Nurs, 2021, 23(4): 557-567.
26.	Kaese S, Zander MC, Lebiedz P. Successful use of early percutaneous dilatational tracheotomy and the no sedation concept in respiratory failure in critically ill obese subjects. Respir Care, 2016, 61(5): 615-620.
27.	Zhou T, Zheng N, Li X, et al. Prognostic value of neutrophil- lymphocyte count ratio (nlcr) among adult icu patients in comparison to apache ii score and conventional inflammatory markers: a multi center retrospective cohort study. BMC Emerg Med, 2021, 21(1): 24.
28.	Alderden J, Rondinelli J, Pepper G, et al. Risk factors for pressure injuries among critical care patients: a systematic review. Int J Nurs Stud, 2017, 71: 97-114.
29.	管向東, 劉紫錳. 灌注壓的維持: 縮血管藥物如何選擇? 協和醫學雜志, 2019, 10(5): 456-460.
30.	Singh C, Tay J, Shoqirat N. Skin and mucosal damage in patients diagnosed with covid-19: a case report. J Wound Ostomy Continence Nurs, 2020, 47(5): 435-438.
31.	Deng Q, Zhang B, Li W, et al. Changes of blood gas analysis in moderate-to-severe acute respiratory distress syndrome patients during long-term prone position ventilation: a retrospective cohort study. Ann Transl Med, 2023, 11(2): 86.
32.	Liao X, Meng L, Zeng Z. Prone position ventilation for the relief of acute respiratory distress syndrome through improved pulmonary ventilation: Efficacy and safety. Nurs Crit Care, 2024, 29(2): 255-273.
33.	Moore Z, Patton D, Avsar P, et al. Prevention of pressure ulcers among individuals cared for in the prone position: lessons for the covid-19 emergency. J Wound Care, 2020, 29(6): 312-320.
34.	張倩倩, 郭愛敏, 李尊柱, 等. 基于sskin集束化方案的俯臥位通氣患者面部壓力性損傷護理方案的構建. 中華現代護理雜志, 2022, 28(13): 1747-1752.
35.	中華醫學會重癥醫學分會重癥呼吸學組. 急性呼吸窘迫綜合征患者俯臥位通氣治療規范化流程. 中華內科雜志, 2020, 59(10): 781-787.
36.	陳能銳, 秦薇, 張琦, 等. 俯臥位通氣患者器械相關壓力性損傷預防的證據總結. 中國護理管理, 2023, 23(04): 545-550.
37.	彭操, 陳秀文, 任華, 等. 俯臥位通氣患者壓力性損傷預防的最佳證據總結. 中華護理教育, 2021, 18(10): 935-941.
38.	Kim CH, Kim MS, Kang MJ, et al. Oral mucosa pressure ulcers in intensive care unit patients: a preliminary observational study of incidence and risk factors. J Tissue Viability, 2019, 28(1): 27-34.
39.	Lee Y J, Kim JY, Dong CB, et al. Developing risk-adjusted quality indicators for pressure ulcers in long-term care hospitals in the republic of Korea. Int Wound J, 2019, 16 Suppl 1(Suppl 1): 43-50.
40.	Nan R, Su Y, Pei J, et al. Characteristics and risk factors of nasal mucosal pressure injury in intensive care units. J Clin Nurs, 2023, 32(1-2): 346-356.

1. Schank JE. The npuap meeting - this was no consensus conference. J Am Coll Clin Wound Spec, 2015, 7(1-3): 19-24.
2. Edsberg LE, Black JM, Goldberg M, et al. Revised national pressure ulcer advisory panel pressure injury staging system: Revised pressure injury staging system. J Wound Ostomy Continence Nurs, 2016, 43(6): 585-597.
3. Saleh MYN, Ibrahim EIM. Prevalence, severity, and characteristics of medical device related pressure injuries in adult intensive care patients: A prospective observational study. Int Wound J, 2023, 20(1): 109-119.
4. Chen G, Li X, Li X, et al. Mucosal membrane pressure injury in intensive care units: a scoping review. Intensive Crit Care Nurs, 2024, 80: 103560.
5. Li Q, Shi X, Lu X, et al. Incidence of, and factors associated with, oral mucous membrane medical device-related pressure injury in critically ill patients with orotracheal intubation: A prospective cohort study. BMJ Open, 2025, 15(6): e098114.
6. Higgs A, McGrath BA, Goddard C, et al. Guidelines for the management of tracheal intubation in critically ill adults. Br J Anaesth, 2018, 120(2): 323-352.
7. Buranarom N, Komin O, Matangkasombut O. Hyposalivation, oral health, and candida colonization in independent dentate elders. PLoS One, 2020, 15(11): e0242832.
8. Jang CS, Shin YS. Effects of combination oral care on oral health, dry mouth and salivary PH of intubated patients: a randomized controlled trial. Int J Nurs Pract, 2016, 22(5): 503-511.
9. 曾憲濤, 劉慧, 陳曦, 等. Meta分析系列之四: 觀察性研究的質量評價工具. 中國循證心血管醫學雜志, 2012, 4(4): 297-299.
10. 李柄輝, 訾豪, 李路遙, 等. 醫學領域一次研究和二次研究的方法學質量(偏倚風險)評價工具. 醫學新知, 2021, 31(1): 51-58.
11. 劉迪, 李凡, 蔡夢歆, 劉華平. EICU經口氣管插管患者發生相關性口腔黏膜壓力性損傷的危險因素分析. 中文科技期刊數據庫(引文版)醫藥衛生, 2022(3): 010-016.
12. 張樹光, 姜洪彪, 侯杰, 等. ICU經口氣管插管老年病人口腔黏膜壓力性損傷風險預測模型的構建. 護理研究, 2024, 38(20): 3592-3597.
13. 王志偉, 何小燕, 陶珍珍, 等. ICU氣管插管患者口腔黏膜壓力性損傷風險列線圖模型的構建. 中華現代護理雜志, 2024, 30(13): 1764-1770.
14. 喻海濤, 吳運蓮. ICU氣管插管患者口腔黏膜壓力性損傷預測模型的構建及驗證. 中文科技期刊數據庫(全文版)醫藥衛生, 2023(1): 183-186.
15. 王寶芹, 蔣學娟, 史廣玲, 等. ICU氣管插管老年患者口腔黏膜壓力性損傷特征及其影響因素分析. 中華老年口腔醫學雜志, 2024, 22(4): 200-204,229.
16. 李敏, 唐莉, 姚倩, 等. 經口氣管插管患者口腔黏膜壓力性損傷風險預測模型的構建及驗證. 護理與康復, 2024, 23(6): 1-8.
17. 辜甜田, 黃光梅, 張培, 等. 經口氣管插管患者口腔黏膜壓力性損傷風險預測模型的構建與驗證. 護理學雜志, 2024, 39(20): 64-68.
18. 何青云, 黃春美, 姜愛華, 等. 經口氣管插管患者口腔黏膜壓力性損傷的危險因素分析. 浙江醫學教育, 2024, 23(2): 117-122.
19. 張英, 潘瑜, 黃玉鳳, 等. 急診重癥監護室經口氣管插管患者口腔黏膜壓力性損傷的危險因素分析及風險預測模型構建. 實用臨床醫藥雜志, 2025, 29(3): 75-79,83.
20. Choi BK, Kim M S, Kim SH. Risk prediction models for the development of oral-mucosal pressure injuries in intubated patients in intensive care units: A prospective observational study. J Tissue Viability, 2020, 29(4): 252-257.
21. Ai X, Deng Y, Wang B, et al. Association between nutrition risk and oral mucosal membrane pressure injury in critically ill adults requiring endotracheal tube placement: a prospective cohort study. JPEN J Parenter Enteral Nutr, 2025, 49(8): 983-992.
22. Yi C, Yan L, Xiao-Hui Y, et al. Characteristics and risk factors of oral endotracheal tube-related mucous membrane pressure injury in intensive care units. Nurs Crit Care, 2025, 30(4): e70090.
23. Jia L, Deng Y, Xu Y, et al. Development and validation of a nomogram for oral mucosal membrane pressure injuries in icu patients: a prospective cohort study. J Clin Nurs, 2024, 33(10): 4112-4123.
24. 任曉華, 陳劍. 經口氣管插管病人舌部壓瘡的預防及護理. 全科護理, 2019, 17(15): 1841-1843.
25. Kim SH, Nah HS, Kim JB, et al. Relationships between oral-mucosal pressure ulcers, mechanical conditions, and individual susceptibility in intubated patients under intensive care: a pcr-based observational study. Biol Res Nurs, 2021, 23(4): 557-567.
26. Kaese S, Zander MC, Lebiedz P. Successful use of early percutaneous dilatational tracheotomy and the no sedation concept in respiratory failure in critically ill obese subjects. Respir Care, 2016, 61(5): 615-620.
27. Zhou T, Zheng N, Li X, et al. Prognostic value of neutrophil- lymphocyte count ratio (nlcr) among adult icu patients in comparison to apache ii score and conventional inflammatory markers: a multi center retrospective cohort study. BMC Emerg Med, 2021, 21(1): 24.
28. Alderden J, Rondinelli J, Pepper G, et al. Risk factors for pressure injuries among critical care patients: a systematic review. Int J Nurs Stud, 2017, 71: 97-114.
29. 管向東, 劉紫錳. 灌注壓的維持: 縮血管藥物如何選擇? 協和醫學雜志, 2019, 10(5): 456-460.
30. Singh C, Tay J, Shoqirat N. Skin and mucosal damage in patients diagnosed with covid-19: a case report. J Wound Ostomy Continence Nurs, 2020, 47(5): 435-438.
31. Deng Q, Zhang B, Li W, et al. Changes of blood gas analysis in moderate-to-severe acute respiratory distress syndrome patients during long-term prone position ventilation: a retrospective cohort study. Ann Transl Med, 2023, 11(2): 86.
32. Liao X, Meng L, Zeng Z. Prone position ventilation for the relief of acute respiratory distress syndrome through improved pulmonary ventilation: Efficacy and safety. Nurs Crit Care, 2024, 29(2): 255-273.
33. Moore Z, Patton D, Avsar P, et al. Prevention of pressure ulcers among individuals cared for in the prone position: lessons for the covid-19 emergency. J Wound Care, 2020, 29(6): 312-320.
34. 張倩倩, 郭愛敏, 李尊柱, 等. 基于sskin集束化方案的俯臥位通氣患者面部壓力性損傷護理方案的構建. 中華現代護理雜志, 2022, 28(13): 1747-1752.
35. 中華醫學會重癥醫學分會重癥呼吸學組. 急性呼吸窘迫綜合征患者俯臥位通氣治療規范化流程. 中華內科雜志, 2020, 59(10): 781-787.
36. 陳能銳, 秦薇, 張琦, 等. 俯臥位通氣患者器械相關壓力性損傷預防的證據總結. 中國護理管理, 2023, 23(04): 545-550.
37. 彭操, 陳秀文, 任華, 等. 俯臥位通氣患者壓力性損傷預防的最佳證據總結. 中華護理教育, 2021, 18(10): 935-941.
38. Kim CH, Kim MS, Kang MJ, et al. Oral mucosa pressure ulcers in intensive care unit patients: a preliminary observational study of incidence and risk factors. J Tissue Viability, 2019, 28(1): 27-34.
39. Lee Y J, Kim JY, Dong CB, et al. Developing risk-adjusted quality indicators for pressure ulcers in long-term care hospitals in the republic of Korea. Int Wound J, 2019, 16 Suppl 1(Suppl 1): 43-50.
40. Nan R, Su Y, Pei J, et al. Characteristics and risk factors of nasal mucosal pressure injury in intensive care units. J Clin Nurs, 2023, 32(1-2): 346-356.

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Meta-analysis of factors influencing oral mucosal pressure injuries in ICU patients with endotracheal intubation

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