Greenway, Andrew;
Leahy, Nicole;
Torrieri, Lisa;
An, Anjile;
Fink, Sarah A.;
Witenko, Corey;
Shikar, Morgan;
Winchell, Robert J.;
Barie, Philip S.;
Liu, Susan I.
Skin Failure Among Critically Ill Patients Afflicted with Coronavirus Disease 2019 (COVID-19)
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Medientyp:
E-Artikel
Titel:
Skin Failure Among Critically Ill Patients Afflicted with Coronavirus Disease 2019 (COVID-19)
Beteiligte:
Greenway, Andrew;
Leahy, Nicole;
Torrieri, Lisa;
An, Anjile;
Fink, Sarah A.;
Witenko, Corey;
Shikar, Morgan;
Winchell, Robert J.;
Barie, Philip S.;
Liu, Susan I.
Erschienen:
SAGE Publications, 2021
Erschienen in:
Journal of Intensive Care Medicine, 36 (2021) 11, Seite 1331-1339
Sprache:
Englisch
DOI:
10.1177/08850666211046532
ISSN:
0885-0666;
1525-1489
Entstehung:
Anmerkungen:
Beschreibung:
<jats:p> 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 (χ<jats:sup>2</jats:sup> = 22.66, P < .0001). Thirty-nine of 51 (76%) SF+ patients developed more than one SF lesion (χ<jats:sup>2</jats:sup> = 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.” </jats:p>