{"title":"The unavoidable pressure injury/ulcer: a review of skin failure in critically ill patients.","authors":"Kelsee K Zajac, Kathryn Schubauer, Richard Simman","doi":"10.12968/jowc.2024.0079","DOIUrl":null,"url":null,"abstract":"<p><p>Due to an ageing population and prolonged lifespan, pressure injury (PI) incidence is increasing. Patients with a PI typically endure longer hospital stays, which create a significant burden on healthcare resources and costs. With appropriate preventive interventions, most PIs can be avoided; however, skin failure may become inevitable in particular instances. These are classified as unavoidable PIs. Patients in a critical condition are exposed to a unique set of therapies, medications and bodily states. Oftentimes, these instances decrease tissue tolerance, which may promote PI formation. Patients who are critically ill, especially those with extended stays in the intensive care unit, are susceptible to skin failure due to: prolonged immobility; mechanical ventilation; acute respiratory distress syndrome; COVID-19; sepsis; multiorgan system dysfunction; vasopressor use; and treatment with extracorporeal membrane oxygenation. Poor perfusion leading to skin breakdown results from the compounding factors of circulatory collapse, build-up of metabolites, compromised lymphatic drainage, patient comorbidities, and ischaemia via capillary blockage in patients who are critically ill. In addition, similar physiology is present during end-of-life multisystem organ failure, which creates unavoidable skin deterioration. The aim of this review is to provide an overview of circumstances which decrease tissue tolerance and ultimately lead to PI development, despite adequate preventive measures in patients who are critically ill.</p>","PeriodicalId":17590,"journal":{"name":"Journal of wound care","volume":null,"pages":null},"PeriodicalIF":1.5000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of wound care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.12968/jowc.2024.0079","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"DERMATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Due to an ageing population and prolonged lifespan, pressure injury (PI) incidence is increasing. Patients with a PI typically endure longer hospital stays, which create a significant burden on healthcare resources and costs. With appropriate preventive interventions, most PIs can be avoided; however, skin failure may become inevitable in particular instances. These are classified as unavoidable PIs. Patients in a critical condition are exposed to a unique set of therapies, medications and bodily states. Oftentimes, these instances decrease tissue tolerance, which may promote PI formation. Patients who are critically ill, especially those with extended stays in the intensive care unit, are susceptible to skin failure due to: prolonged immobility; mechanical ventilation; acute respiratory distress syndrome; COVID-19; sepsis; multiorgan system dysfunction; vasopressor use; and treatment with extracorporeal membrane oxygenation. Poor perfusion leading to skin breakdown results from the compounding factors of circulatory collapse, build-up of metabolites, compromised lymphatic drainage, patient comorbidities, and ischaemia via capillary blockage in patients who are critically ill. In addition, similar physiology is present during end-of-life multisystem organ failure, which creates unavoidable skin deterioration. The aim of this review is to provide an overview of circumstances which decrease tissue tolerance and ultimately lead to PI development, despite adequate preventive measures in patients who are critically ill.
由于人口老龄化和寿命延长,压力损伤(PI)的发病率不断上升。受压伤的患者通常住院时间较长,这给医疗资源和成本造成了沉重负担。通过适当的预防干预措施,大多数压力损伤是可以避免的;但在某些情况下,皮肤损伤可能不可避免。这些情况被归类为不可避免的 PI。病情危重的患者会面临一系列独特的治疗、药物和身体状况。这些情况往往会降低组织的耐受性,从而促进 PI 的形成。危重病人,尤其是在重症监护室长期住院的病人,由于以下原因很容易出现皮肤衰竭:长时间不动;机械通气;急性呼吸窘迫综合征;COVID-19;败血症;多器官系统功能障碍;使用血管加压剂;以及使用体外膜氧合治疗。循环衰竭、代谢物积聚、淋巴引流受阻、患者合并症以及重症患者毛细血管阻塞导致缺血等综合因素造成灌注不良,从而导致皮肤破损。此外,生命末期多系统器官衰竭时也会出现类似的生理现象,从而导致不可避免的皮肤恶化。本综述旨在概述危重病人尽管采取了适当的预防措施,但仍会降低组织耐受性并最终导致 PI 发生的情况。
期刊介绍:
Journal of Wound Care (JWC) is the definitive wound-care journal and the leading source of up-to-date research and clinical information on everything related to tissue viability. The journal was first launched in 1992 and aimed at catering to the needs of the multidisciplinary team. Published monthly, the journal’s international audience includes nurses, doctors and researchers specialising in wound management and tissue viability, as well as generalists wishing to enhance their practice.
In addition to cutting edge and state-of-the-art research and practice articles, JWC also covers topics related to wound-care management, education and novel therapies, as well as JWC cases supplements, a supplement dedicated solely to case reports and case series in wound care. All articles are rigorously peer-reviewed by a panel of international experts, comprised of clinicians, nurses and researchers.
Specifically, JWC publishes:
High quality evidence on all aspects of wound care, including leg ulcers, pressure ulcers, the diabetic foot, burns, surgical wounds, wound infection and more
The latest developments and innovations in wound care through both preclinical and preliminary clinical trials of potential new treatments worldwide
In-depth prospective studies of new treatment applications, as well as high-level research evidence on existing treatments
Clinical case studies providing information on how to deal with complex wounds
Comprehensive literature reviews on current concepts and practice, including cost-effectiveness
Updates on the activities of wound care societies around the world.