Pressure sore prevention in the critically ill: what you don't know, what you should know and why it's important

The critically ill are particularly vulnerable to pressure sore development. These expensive and often painful complications have been largely ignored for many years and the entire problem has been managed by nursing staff. Current methods for identifying patients at risk are inadequate and subjective. Scoring systems have been known to over-predict those at risk and this maybe because they frequently originate from elderly care settings. Additionally, their relevance to the critically ill has not yet been established. The use of pressure-relieving devices has become commonplace; however, there is a paucity of data from controlled clinical studies. No uniform approach in measuring the effectiveness of these devices exists. What is certain, though, is that a voluminous amount of work needs to be conducted in order to verify their continued use. It is increasingly apparent that the complex nature of pressure sore development means that it is unrealistic to expect a single discipline to manage the problem effectively. A multidisciplinary team approach is the most appropriate way to improve management in this vital area.