Downloading skin failure

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I propose clarification of nomenclature through recognition of skin failure as a clinical syndrome that shares similar mechanisms with other organs. This will encourage a broader conceptual framework that some pressure ulcers, whether or not associated with mortality, are unavoidable consequences of skin failure.

Skin Failure: A Working Definition. When defining skin failure, a logical place to start is the normal function of skin. If skin no longer performs its role maintaining vasomotor tone, body temperature and water balance, and ceases protecting the body from infection and mechanical trauma, it is failing.

Skin failure can account for the high rate of breakdown in the setting of multi-organ system failure, and unavoidable pressure injury when preventive interventions have been implemented. By folding these observations into the spectrum of skin failure, quality deficit implications are removed and the terminology becomes more accurate and uniform. Skin failure fits neatly into the phenomenon of unavoidable pressure ulceration.

Evidence shows that unavoidable wounds occurs frequently in the setting of hypoxia and multi-organ system disease. It is natural to conclude that once skin can no longer survive intact in the setting of severe physiologic and mechanical stress i. If a pressure ulcer is an unavoidable result of multi-organ system dysfunction, sepsis, SIRS, or end-of-life conditions, it is incorrect to attribute this outcome to inadequate care when providers have implemented appropriate preventive interventions.

Doing so mars the reputations of facilities and practitioners and gives rise to patient and family dissatisfaction. Recognition of skin failure will lay the foundation for common nomenclature and open new directions for research.