Relationship between morphological characteristics and etiology of pressure ulcers in intensive care unit patients

PURPOSE:: Pressure ulcer (PU) prevention is crucial for critically ill patients in the intensive care unit, but etiologic factors leading to their development have not yet been completely elucidated. This study explores the relationships among etiologic factors, interventional nursing care, and morphological characteristics of PUs in intensive care unit patients. DESIGN:: We used a qualitative exploratory method to link morphological characteristics of specific PUs to etiologic factors. METHODS:: Details of individual PUs were described by sketching the PU photograph and categorized to characterize the morphology of PUs. After identification of characteristics, the development process was evaluated by in-depth review of medical records. RESULTS:: The morphological characteristics of 30 PUs were organized into 4 categories. This process revealed a type of PU not previously described, which we labeled "leaf-type." These PUs were located on the lower sacrum, rhombic-oval in shape, and characterized by purpura and PU wrinkles. Possible etiologic factors for the specific PUs were divided into 4 categories: (1) the occurrence of PU risk episodes, (2) failure of the peripheral circulation, (3) periods of critical immobility, and (4) position change techniques inducing skin deformation. CONCLUSION:: PU can be categorized into 4 morphological types, including a new category of leaf-shaped PU. We found that frequently repeated position changes such as lateral tilt and repeated head elevation caused deformation of the sacral skin that may play a role in PU development.