Effectiveness of a Combined Aloe Vera-Peppermint Gel on Prevention Pressure Injuries Among Intensive Care Unit Patients: A Randomized Controlled Trial

Inclusion Criteria: 1. ICU patients aged 18 years or older. 2. Admission to the ICU without pressure injury according to the NPUAP scale on the first day of hospitalization. 3. Unconsciousness, being under sedation or assisted ventilation. 4. Patients that are at risk of moderate to severe PIs according to Braden scoring tool and scored less than 13-14. 5. No Diarrhea, serum Albumin level below 3.5 g/dl, no edema. 6. No limit of changes in body position with multiple injuries. 7. Family consent to participate in the study. 8. The patient has no history of autoimmune diseases, renal failure, or diabetes, does not use immunosuppressive medications, and has no evidence of vascular disease. 9. All patients receiving standardized care (repositioning and pressure-relieving mattress). Exclusion Criteria: 1. Family's unwillingness for the patient to continue participation 2. Sensitivity to Aloe Vera-Peppermint Gel after use on a patient's forearm (area of 2 × 2 cm) and this area was evaluated for the presence of redness, swelling and warmth within 45 min. 3. Spinal cord injury cases 4. death or patient transmission in less than 48 hrs. after admission to the ICU.