Skin Failure: Results of a Think Tank Hosted by the National Pressure Injury Advisory Panel

The term skin failure is used to describe multiple changes in the skin. This article summarizes a concept analysis and deliberations of a multidisciplinary think tank hosted by the National Pressure Injury Advisory Panel August 2024. The panel was tasked with addressing the topic of skin failure in the critically ill person. The term skin failure was introduced many years ago as one component of multi-organ system failure occurring in critically ill patients and those at end of life. However, until recently the phrase has had limited use. The think tank panel examined contemporary uses of the term skin failure and its proposed use in diagnosing and coding skin changes that may also be attributable to pressure. Panelists concluded that skin failure in critically ill adults should be considered non-pressure related. Instead, they defined skin failure as an injury that occurs despite standard preventive interventions and for which no other etiology has been identified. Panelists further acknowledged that a distinct etiology for non-pressure-related skin failure in critically ill patients has not been elucidated; particularly when it occurs on pressure bearing body areas. They recognized that while hypoperfusion is hypothesized to be a principal etiologic factor in non-pressure-related skin failure, the histopathology for non-pressure-related skin failure in the critically ill has not been fully elucidated, and no photographs have been published that depict acute skin failure. Think tank participants concurred that additional research is needed to establish a reproducible description of the etiology, pathophysiology, and natural history of non-pressure-related skin failure. Even though the term skin failure is frequently used in clinical settings, the concept has not been sufficiently well studied to support a specific diagnosis or diagnostic code.