ACUTE SKIN FAILURE AND PRESSURE INJURY IN THE PATIENT WITH COVID-19

Authors

  • Aline Oliveira Ramalho Universidade de São Paulo − Escola de Enfermagem − São Paulo (SP), Brasil/ Hospital Sírio Libanês – São Paulo (SP), Brasil. https://orcid.org/0000-0001-6065-5488
  • Talita Santos Rosa Universidade de São Paulo − Escola de Enfermagem − São Paulo (SP), Brasil.
  • Vera Lúcia Conceição de Gouveia Santos Universidade de São Paulo − Escola de Enfermagem − São Paulo (SP), Brasil.
  • Paula Cristina Nogueira Universidade de São Paulo − Escola de Enfermagem − São Paulo (SP), Brasil.

Abstract

Objective: report the case of a critical patient with COVID-19 and show the main findings related to the injury considered acute skin failure (ASF), as well as perform his differential diagnosis with preventable pressure injury (PI). Method: observational, longitudinal, case report type study, developed in a hospital in São Paulo, in the intensive care unit (ICU) exclusively for people diagnosed with COVID-19. Data were collected from a single patient between March and September 2020. Results: A patient with complications from COVID-19 developed a skin lesion, initially defined as PI and later reclassified as ASF. The following findings corroborated the diagnosis: prolonged invasive mechanical ventilation, respiratory, renal and cardiac insufficiency and sepsis of respiratory focus. In addition, other aggravating factors, such as the use of vasoactive drugs, hemodynamic instability with intolerance to minimal repositioning, prolonged fasting and disseminated intravascular coagulopathy associated with coronavirus infection. Conclusion: the report shows that there are difficulties for the differential diagnosis between ASF and PI in clinical practice. This is a new concept, and it is essential that health professionals recognize the main factors associated with the appearance of ASF, many of which are also related to the development of PI, highlighting the need for individualized analysis of these injuries, and ensuring the implementation of interventions for prevention and treatment.

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References

Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med [Internet]. 2020 Apr 30 [cited 2020 Jun 29];382(18):1708–20. Available from: http://www.nejm.org/doi/10.1056/NEJMoa2002032

Cavayas YA, Noël A, Brunette V, Williamson D, Frenette AJ, Arsenault C, et al. Early experience with critically ill patients with COVID-19 in Montreal. Can J Anesth [Internet]. 2020 [cited 2020 Sep 26]; Available from: https://pubmed.ncbi.nlm.nih.gov/32935329/

EPUAP, NPUAP, PPIAP. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. NPUAP, Washington, DC; 2016.

Ayello EA, Sibbald RG. Pressure Injuries: Nursing-Sensitive Indicator or Team- and Systems-Sensitive Indicator? Adv Skin Wound Care [Internet]. 2019 May 1 [cited 2020 Dec 22];32(5):199–200. Available from: http://journals.lww.com/00129334-201905000-00001

Edsberg LE, Langemo D, Baharestani MM, Posthauer ME, Goldberg M. Unavoidable Pressure Injury. J Wound, Ostomy Cont Nurs [Internet]. 2014 [cited 2020 Jun 29];41(4):313–34. Available from: http://journals.lww.com/00152192-201407000-00006

Schmitt S, Andries MK, Ashmore PM, Brunette G, Judge K, Bonham PA. WOCN Society Position Paper: Avoidable Versus Unavoidable Pressure Ulcers/Injuries. J Wound, Ostomy Cont Nurs [Internet]. 2017 [cited 2020 Dec 21];44(5):458–68. Available from: http://journals.lww.com/00152192-201709000-00012

Sibbald RG, Ayello EA. Terminal Ulcers, SCALE, Skin Failure, and Unavoidable Pressure Injuries. Adv Skin Wound Care [Internet]. 2020 Mar 1 [cited 2020 Sep 20];33(3):137–45. Available from: http://journals.lww.com/10.1097/01.ASW.0000653148.28858.50

Ayello EA, Levine JM, Langemo D, Kennedy-Evans K Lou, Brennan MR, Sibbald RG. Reexamining the Literature on Terminal Ulcers, SCALE, Skin Failure, and Unavoidable Pressure Injuries. Adv Ski Wound Care. 2019 Mar 1;32(3):109–21.

Langemo DK, Brown G. Skin Fails Too: Acute, Chronic, and End-Stage Skin Failure [Internet]. 2006. Available from: https://journals.lww.com/aswcjournal

Levine JM. Unavoidable Pressure Injuries, Terminal Ulceration, and Skin Failure. Adv Skin Wound Care [Internet]. 2017 May [cited 2020 Nov 14];30(5):200–2. Available from: http://journals.lww.com/00129334-201705000-00002

Delmore B, Cox J, Rolnitzky L, Chu A, Stolfi A. Differentiating a pressure ulcer from acute skin failure in the adult critical care patient. Adv Ski Wound Care. 2015 Nov 1;28(11):514–24.

Nowicki JL, Mullany D, Spooner A, Nowicki TA, Mckay PM, Corley A, et al. Are pressure injuries related to skin failure in critically ill patients? Aust Crit Care [Internet]. 2018 Sep 1 [cited 2020 Jun 29];31(5):257–63. Available from: https://pubmed.ncbi.nlm.nih.gov/28838626/

Delmore B, Cox J, Smith D, Chu AS, Rolnitzky L. Acute Skin Failure in the Critical Care Patient. Adv Ski Wound Care. 2020 Apr 1;33(4):192–201.

Dalgleish L, Campbell J, Finlayson K, Coyer F. Acute Skin Failure in the Critically Ill Adult Population. Adv Skin Wound Care [Internet]. 2020 Feb 1 [cited 2020 Sep 16];33(2):76–83. Available from: http://journals.lww.com/10.1097/01.ASW.0000617844.69248.92

Gary Sibbald R, Med F, Lutz J, Sylvia C, Alvarez O, Ayello EA, et al. Co-Chairpersons Medical Writer Panel Facilitator Additional Panel Members SCALE Expert Panel Members. 2009.

Cuddigan J., Joice B, Capasso V, Jill C, Barbara D, Munoz Nacy, et al. Unavoidable Pressure Injury during COVID-19 Pandemic: A Position Paper from the National Pressure Injury Advisory Panel. 2020.

Aline de Oliveira Ramalho, Paula de Souza Silva Freitas, Juliano Teixeira Moraes, Paula Cristina Nogueira. Reflections on recommendations for the prevention of pressure injuries during the COVID-19 pandemic [Internet]. [cited 2020 Nov 13]. Available from: https://www.revistaestima.com.br/estima/article/view/940/345

Kim JH, Shin HK, Jung GY, Lee DL. A case of acute skin failure misdiagnosed as a pressure ulcer, leading to a legal dispute. Arch Plast Surg [Internet]. 2019 [cited 2020 Sep 25];46:75–8. Available from: https://doi.org/10.5999/aps.2018.00087

Gray M. Context for Practice: WOC Specialty Practice at the Front Lines during a Global Pandemic. Vol. 47, Journal of Wound, Ostomy and Continence Nursing. Lippincott Williams and Wilkins; 2020. p. 309–10.

Pontieri-Lewis V. Adapting WOC Nursing Practice to the COVID-19 Pandemic: A View from Here [Internet]. Vol. 47, Journal of Wound, Ostomy and Continence Nursing. Lippincott Williams and Wilkins; 2020 [cited 2020 Dec 21]. p. 321–3. Available from: https://pubmed.ncbi.nlm.nih.gov/32511150/

EPUAP, NPIAP P. Europen Pressure Ulcer Advisory Panel, National Pressure Injuri Advisory Panel and Pan Pacific Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Quick Reference Guide. Emily Haesler (Ed.). EPUAP/NPIAP/PPPIA:2019. 2019.

Black JM. Root Cause Analysis for Hospital-Acquired Pressure Injury. 2019 [cited 2020 Dec 21]; Available from: www.jwocnonline.com

Almeida LV de, Bizutti NS, Draganov PB. Impactos da acreditação Magnet Recognition nos serviços de enfermagem: uma revisão narrativa. Rev Adm em Saúde [Internet]. 2019 Dec 8 [cited 2020 Dec 21];19(77). Available from: http://dx.doi.org/10.23973/ras.77.198

Published

2021-03-10

How to Cite

1.
Ramalho AO, Santos Rosa T, Lúcia Conceição de Gouveia Santos V, Cristina Nogueira P. ACUTE SKIN FAILURE AND PRESSURE INJURY IN THE PATIENT WITH COVID-19. ESTIMA [Internet]. 2021 Mar. 10 [cited 2021 Oct. 22];19. Available from: https://www.revistaestima.com.br/estima/article/view/1007

Issue

Section

Case report

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