Mitigating Skin Failure in Critically Ill Patients at the End of Life: A Case Report

INTRODUCTION: Limited research on preventing and managing skin failure events such as deep tissue injuries and Kennedy terminal ulcers is available. These skin failure events often appear among patients experiencing multiple organ failure with hypoperfusion to the skin despite evidence-based nursing interventions to enhance skin integrity. CLINICAL FINDINGS: A 68-year-old White man presented at a trauma hospital after several recent falls at home. He immediately required hospitalization. Several medical complications, including a deep tissue pressure injury, evolved. The pressure injury remained clinically stable throughout his hospitalization. DIAGNOSIS: The patient received a diagnosis of deep tissue pressure injury. INTERVENTIONS: Aggressive medical management, implementation of a turning schedule on a low-air-loss surface, foam dressings, and offloading boots were used to prevent skin damage and preserve skin integrity. OUTCOMES: The patient's condition declined and he developed a deep tissue pressure injury on the sacrum that did not advance or become infected. The family agreed to comfort measures and he soon died. CONCLUSION: Skin failure events such as deep tissue pressure injuries and Kennedy terminal ulcers often occur among critically ill patients, older patients, those approaching end of life, and other patients with prolonged pressure upon body surfaces. The Centers for Medicare & Medicaid Services holds hospitals financially accountable for sequelae of events associated with hospital-acquired full-thickness pressure injuries. Additional research to categorize skin failure events as secondary to hypoperfusion and not medical mismanagement can optimize patient safety and positively impact the finances and credibility of medical organizations.