Risk Factors for Pressure Injuries in in Adult Intensive Care Units (ICUs): An Umbrella Review

Introduction: Pressure injuries (PIs) are a significant concern in intensive care units (ICUs) due to their impact on patient morbidity, mortality, and healthcare costs. Several systematic reviews have evaluated risk factors for PI development in critically ill adults, yet no comprehensive overview has synthesized their findings and assessed their methodological quality. This overview aims to address this gap, providing a summary of evidence and quality to inform clinical practice and future research. Objective: The aim of this umbrella review is to identify the risk factors for pressure injuries in adult patients admitted to intensive care units (ICUs). Methods: The methodology will follow a structured approach to identify, evaluate, and summarize systematic reviews and meta-analyses published in Portuguese, English, or Spanish. Eligible studies must include adult populations (≥18 years) in ICU settings and investigate clinical, demographic, or procedural risk factors for pressure injury development. The search strategy will encompass major electronic databases, and the study selection will follow predefined inclusion and exclusion criteria. Systematic reviews focused exclusively on pediatric populations, non-ICU settings, or that do not evaluate pressure injury risk factors will be excluded, as well as narrative and scoping reviews, case reports, opinion pieces, and gray literature. Methodological quality will be assessed using the AMSTAR 2 tool to ensure the reliability of the included evidence. This review will explore the variability of risk factors across different ICU populations and settings, such as age groups, comorbidities, mobility levels, and the use of invasive devices. Additionally, it will aim to identify knowledge gaps in the current literature and inform future research directions. Expected results include the identification of the most frequently reported and clinically relevant risk factors for pressure injuries in critically ill patients. These findings will support evidence-based nursing and medical decision-making by enhancing early risk detection, improving prevention strategies, and guiding resource allocation in ICU settings. Ultimately, this review seeks to contribute to improving patient safety and outcomes through the development of targeted interventions.