The unavoidable pressure injury/ulcer: a review of skin failure in critically ill patients

Area of Science:

• Critical Care Medicine
• Dermatology
• Gerontology

Background:

• Increasing incidence of pressure injuries (PIs) due to aging populations and longer lifespans.
• PIs increase hospital stays, healthcare costs, and resource burden.
• While most PIs are preventable, some cases of skin failure are unavoidable.

Purpose of the Study:

• To review circumstances decreasing tissue tolerance in critically ill patients.
• To identify factors leading to unavoidable pressure injury development.
• To understand PI formation despite adequate preventive measures.

Main Methods:

• Literature review of factors affecting tissue tolerance in critically ill patients.
• Analysis of conditions contributing to unavoidable skin failure.
• Synthesis of evidence on pressure injury development in intensive care settings.

Main Results:

• Critically ill patients face unique risks including immobility, mechanical ventilation, ARDS, COVID-19, sepsis, organ dysfunction, vasopressors, and ECMO.
• Compounded factors like circulatory collapse, metabolite buildup, impaired lymphatic drainage, comorbidities, and ischemia cause poor perfusion and skin breakdown.
• Similar physiological states during end-of-life organ failure also lead to unavoidable skin deterioration.

Conclusions:

• Certain conditions and therapies in critically ill patients significantly reduce tissue tolerance, leading to unavoidable PIs.
• Understanding these factors is crucial for managing skin integrity in intensive care.
• Further research may refine prevention and management strategies for unavoidable pressure injuries.