Characterizing acute skin failure in the critically ill

Summary: Prevention of hospital acquired wounds is of great concern to clinicians and institutions. Unpreventable wounds as a result of acute skin failure (ASF), akin to other types of organ failure, has not been well studied and remains poorly understood. The purpose of this study is to describe the natural history and risk factors associated with the development of ASF and propose a risk prediction model. It is crucial to establish ASF as a distinct clinical syndrome and investigate its underlying mechanisms due to its significant impact on patient care and healthcare policy. 16 patients with multiorgan dysfunction who developed increasing number of wounds despite aggressive preventative strategies and standard of care treatment at the University of Miami Hospital over a four-year period were identified. All patients experienced unfavorable evolution of wounds and an increase in the number of wounds, with an average number of lesions prior to diagnosis being 2.68 and increasing to 7.21 after diagnosis. In addition to this 2.7x increase in number of wounds, some of these wounds developed in non-pressure dependent areas and did not show thermographic infrared findings associated with pressure ulcers. 62.5% (n=10) of patients in this cohort are deceased, with an average number of days between diagnosis and death being 104.8. However, 25% (n=4) were transferred to long term acute care facilities so this reported mortality is likely an underestimation. Upon analysis of risk factors, 100% (n=16) of patients had an albumin <3.5, 93.75% (n=15) had hemodynamic instability requiring vasopressors, 93.75% (n=15) had acute respiratory failure requiring mechanical ventilation, 87.5% (n=14) had a diagnosis of sepsis, and 87.5% (n=14) had acute kidney injury requiring hemodialysis. In conclusion, organ dysfunction, nutritional deficiency, and hemodynamic instability are highly sensitive findings for diagnosis of ASF. A call to action for hospital administration and critical care and wound care providers to distinguish ASF from hospital-acquired pressure injuries is paramount. Peyton Warp¹, Scott Elman¹ 1. University of Miami Miller School of Medicine, Miami, FL, United States. Clinical Research: Epidemiology and Observational Research