Retrospective observational study of ICU acquired pressure injuries indicating acute skin failure

Purpose: To review and identify intrinsic patient factors during acute illness in the pursuit of differentiation of a pressure injury from acute skin failure.Methodology: A 4-year, retrospective observational study on ICU patients who developed a wound to sacrum, coccyx, buttock or heel(s). We analyzed up to three organ/system failures in the study population and the patient’s mortality within 6 mos of new wound identification. All study patients had a pressure injury prevention bundle in place (Sacral foam prevention dressing, heel offloading boots, routine repositioning schedule).

Statistics: The collected data was of 195 ICU patients. The three organ/system failure conditions we observed in the study group were acute pulmonary failure (on ventilator), acute cardiovascular failure (IV vasopressor usage) and renal failure (CVVH/CVVHD). We also analyzed patient mortality. Case mix index (CMI) was compared over the four years to assess patient acuity and was noted to be above 2 during all four years. Demographic data (age and gender) over the four years was also collected.

Results: We found that 88 patients representing 45% of all patients expired within six months of developing the wounds. Among the deceased patients, 73% were with three failing organ systems at the time when wound was first identified. In patients with two failing organ systems, 43% expired. Collected data pointed another interesting fact – over 35% of the wounds were classified as deep tissue pressure injuries (DTPI) in the study population with either acute pulmonary failure, acute cardiovascular failure or renal failure. In the group without any failing systems the DTPI incidence was 21%. We noticed a direct correlation between hospital acquired wounds, increasing CMI and increased mortality.

Conclusion: our findings suggest the newly developed wounds could be skin changes during acute illness related to multiple organ systems failing. This raises a question – could these wounds be classified as “acute skin failure?” Further research is recommended.