Facilitating Factors in the Proper Identification of Acute Skin Failure: A Systematic Review

Mileski, Michael; McClay, Rebecca; Natividad, Jessica

doi:10.4037/ccn2021145

Cited by 5 publications

(3 citation statements)

References 11 publications

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“…In the setting of critical illness, SF occurs in conjunction with failure of other organ systems, including, cardiac, coagulation, hepatic, pulmonary, neurologic, and renal systems. Acute SF is characterized by hypoperfusion, 1,5 as blood is shunted away from the skin to preserve vital organ perfusion, 5 which ultimately causes tissue/skin ischemia and necrosis. Multiple studies have identified risk factors associated with development of acute SF, including decreased perfusion, multiple organ dysfunction, septic shock, vasopressor therapy, and prolonged mechanical ventilation.…”

mentioning

confidence: 99%

Skin Failure Among Critically Ill Patients Afflicted with Coronavirus Disease 2019 (COVID-19)

Greenway

Leahy

Torrieri

et al. 2021

J Intensive Care Med

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Objective: To characterize skin integrity among coronavirus disease 2019 (COVID-19) patients treated in the intensive care unit (ICU), and identify risk factors for skin failure (SF) in these patients. Design: The characteristic, profound pro-inflammatory, hypercoagulable state of COVID-19 is manifested by the high severity of illness and extensive organ dysfunction observed in these patients. SF in critically ill patients, although described previously, exhibits a uniquely complex pathogenesis in this population. Patients: Retrospective review of all COVID-19 patients (confirmed positive for severe acute respiratory syndrome coronavirus-2 [SARS-CoV-2]) admitted to a single surgical ICU for at least 48 hours between March-June 2020. Interventions: Data were extracted from a COVID-19 institutional data repository that harvested data from electronic health records and other clinical data sources. Demographics; coagulation/inflammation biomarkers; number, location, and stage of SF lesions; resource utilization; and outcomes were captured. Measurements and Main Results: 64 patients met inclusion criteria; 51 (80%) developed SF (SF+ ). Forty-three (85%) developed stage 3 or higher SF (χ2 = 22.66, P < .0001). Thirty-nine of 51 (76%) SF+ patients developed more than one SF lesion (χ2 = 13.26, P = .0003). SF+ patients manifested a profound pro-inflammatory, hypercoagulable phenotype (lower serum albumin and higher ferritin, interleukin [IL]-6 and D-dimer concentrations [all, P < .001]). Durations of mechanical ventilation, vasopressor therapy, and ICU length of stay were significantly longer (all, P < .05) in the SF + patients. Conclusions: The unique characteristics of COVID-19 dermatopathology and the strong correlation between markers of inflammation and development of SF reflect COVID-19-related organ dysfunction and its deleterious effects on the microcirculation. Considering that skin is invaded directly by SARS-CoV-2 and affected by COVID-19-related immune complex deposition and microthrombosis, SF may reflect disease as opposed to pressure injuries related to processes of care. In the context of COVID-19 critical illness, SF should not be considered a “never event.”

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mentioning

confidence: 99%

Skin Failure Among Critically Ill Patients Afflicted with Coronavirus Disease 2019 (COVID-19)

Greenway

Leahy

Torrieri

et al. 2021

J Intensive Care Med

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“…5 The definition of acute skin failure continues to be debated, and there are no distinct diagnostic criteria. [6][7][8][9] But the dermatologic signs and symptoms that have been observed thus far in critically ill patients with COVID-19 are representative of systemic disease, heralding the intravascular, multiorgan dysfunction in the form of skin changes ranging from livedo racemosa to retiform purpura. 10 In addition, patients with severe COVID-19 infection have prothrombotic states that cause microemboli, which block smaller vessels and impair circulation to vulnerable areas of the skin.…”

Section: Introductionmentioning

confidence: 99%

“…The definition of acute skin failure continues to be debated, and there are no distinct diagnostic criteria 6–9 . But the dermatologic signs and symptoms that have been observed thus far in critically ill patients with COVID-19 are representative of systemic disease, heralding the intravascular, multiorgan dysfunction in the form of skin changes ranging from livedo racemosa to retiform purpura 10 .…”

Section: Introductionmentioning

confidence: 99%

Examining Violaceous Skin Discoloration during the COVID-19 Pandemic: Conducting Research in Resource Scarcity

Savage

Lieder

Liu

et al. 2023

Adv Skin Wound Care

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OBJECTIVETo describe the observed patterns and presentations of violaceous discoloration that appeared to be related to the COVID-19 disease process.METHODSThis retrospective observational cohort study included adults who were COVID-19 positive with purpuric/violaceous lesions in pressure-adjacent areas of the gluteus without preexisting pressure injury. Patients were admitted to an ICU at a single quaternary academic medical center between April 1 and May 15, 2020. Data were compiled by review of the electronic health record. The wounds were described by location, tissue type (violaceous, granulation, slough, eschar), wound margin (irregular, diffuse, nonlocalized), and periwound condition (intact).RESULTSA total of 26 patients were included in the study. Purpuric/violaceous wounds were found predominantly on White (92.3%) men (88.0%) aged 60 to 89 years (76.9%) with a body mass index 30 kg/m2 or higher (46.1%). The majority of wounds were located on the sacrococcygeal (42.3%) and fleshy gluteal regions (46.1%).CONCLUSIONSWounds were heterogeneous in appearance (poorly defined violaceous skin discoloration of acute onset), and the patient population had clinical characteristics similar to acute skin failure (eg, concomitant organ failures and hemodynamic instability). Additional larger population-based studies with biopsies may assist in finding patterns related to these dermatologic changes.

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Scientific and Clinical Abstracts From WOCNext® 2022

2022

Journal of Wound, Ostomy &Amp; Continence Nursing

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AIM: To explore the experiences of persons living with an intestinal ostomy using the adjunct of photo-elicitation with interviews. BACKGROUND: Th e creation of an intestinal ostomy results in the revision of an essential bodily function and an alteration of the body image and causes physical, psychological, and social changes in the lifestyle through the adjustment and management of the new condition (Knowles et al., 2014). Th ere are currently no ostomy studies that use photo-elicitation. METHODS: In this qualitative descriptive design, content analysis was used. Ten people living with intestinal ostomy each took part in 2 semistructured interviews that utilized the strategy of photo-elicitation to collect the data. Th e fi rst interview utilized preexisting photos, and the second interview utilized photos that the participants took specifi cally for the study. Meleis' transition theory was utilized as a sensitizing theory. RESULTS: Seven categories emerged from the data analysis. Th e categories were body, feelings, healthcare, coping, fi nances, life impact, and relationships. Th irty percent of the interview content was related directly to the photos shared, with each photo eliciting an average of 150 words. All phases and patterns of Meleis' transition theory were represented in the data (Meleis, 2010). CONCLUSIONS: Th is study highlights the impact of an intestinal ostomy has on people's lives. As participants transitioned to their new reality, it became apparent that they had to adjust to their sense of self, physical being, lifestyle, social and intimate relationships, and the fi nancial implications related to their illness and ostomy supplies. Participants in the study did experience a transition as coding results confi rmed the phases and patterns of Meleis' transition theory. Photo-elicitation is a benefi cial adjunct for data collection with persons living with an intestinal ostomy. REFERENCES

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Facilitating Factors in the Proper Identification of Acute Skin Failure: A Systematic Review

Cited by 5 publications

References 11 publications

Skin Failure Among Critically Ill Patients Afflicted with Coronavirus Disease 2019 (COVID-19)

Skin Failure Among Critically Ill Patients Afflicted with Coronavirus Disease 2019 (COVID-19)

Examining Violaceous Skin Discoloration during the COVID-19 Pandemic: Conducting Research in Resource Scarcity

Scientific and Clinical Abstracts From WOCNext® 2022

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