A prospective, descriptive study of characteristics associated with skin failure in critically ill adults.

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.