Cath Lab Digest

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Index: Ostomy Wound Manage. 2012;58(5):36–43.

Abstract

  Critically ill patients with multi-organ failure are especially susceptible to problems with skin integrity, including skin failure. An 18-month, prospective, descriptive study was conducted to identify and describe characteristics of intensive care unit (ICU) patients with skin failure and examine the relationships among patient demographics, nutritional status, laboratory parameters, the presence of other organ system failures, and use of mechanical assistive devices, support surfaces, and vasopressive and sedative medications. A total of 29 patients with acute skin failure were identified. All (100%) patients with skin failure were diagnosed with failure of at least one other organ system.

Ninety percent (90%) had failure of more than one organ system other than skin, and 90% had an albumin level <3.5 mg/dL. In addition, generalized edema, ventilator use, age >50 years, weight > 150 lb, creatinine >1.5 mg/dL, mean arterial pressure <70 mm Hg, and/or the use of sedatives and/or analgesic medications were observed in >75% of patients with skin failure. Significant positive correlations were seen between several pairs of variables, including sepsis and renal failure, and the concurrent use of several types of vasopressive agents. This is the first known study of its type and results confirm that nonskin organ system failure and skin failure can be expected to be observed at the same time. Research to ascertain whether skin failure occurs at the same time, precedes, or follows the development of nonskin organ system failure is needed, as are studies to understand the relationship among the various risk factors in order to optimize preventive care.

Keywords: critical care, skin physiology, organ failure, nursing clinical research, nursing care

Potential Conflicts of Interest: none disclosed

Introduction

  Regardless of the quality of care received, critically ill patients are at high risk for impaired skin integrity. Pressure ulcer (PU) incidence, one type of skin integrity problem, occurs in 13% to 42% of intensive care patients despite advances in support surface technology and knowledge about PU prevention strategies.¹ Possibly, intrinsic factors are associated with critically ill patients that negate clinician efforts to prevent the development of skin problems.

  The skin and underlying structures are dependent on other organs and body systems to supply nutrition and oxygen, as well as to remove toxins. Critically ill patients with multi-organ failure are especially susceptible to problems with skin integrity, including skin failure. These patients frequently have alterations in tissue perfusion and, because of their failed organs, are unable to maintain homeostasis. This may lead to the death of the skin and underlying structures.

  The purpose of this prospective, descriptive study was to identify and describe the characteristics of intensive care unit (ICU) patients with skin failure and examine the relationships among patient demographics, nutritional status, laboratory parameters, the presence of other organ system failures, and use of mechanical assistive devices, support surfaces, and vasopressive and sedative medications.

Literature Review

  Organ failure in patients admitted to the ICU. Admission to an ICU poses significant risks for the patient. These risks come not only from the disease or trauma that necessitate ICU admission, but also from characteristics of the patients and the treatments designed to help them.