Pressure Injuries in Critical Care Patients: A Conceptual Schema

BACKGROUND: The first step in successful pressure injury (PI) prevention is to determine appropriate risk factors. In patients who are critically ill, PI risk is multietiologic, including the pathophysiologic impacts associated with a critical illness, concomitant preexisting comorbid conditions, and treatment-related factors that are essential in the ongoing management of a critical illness. OBJECTIVE: To outline a conceptual schema describing the relationships among the empirically supported risk factors, the etiologic factors, and themitigating measures that influence PI development in the critical care population. METHODS: Risk factors for PI included in the conceptual schema were identified after a comprehensive review of the literature. Risk factors were categorized as static intrinsic factors, dynamic intrinsic factors, or dynamic extrinsic factors. RESULTS: The schema illustrates the complex relationships between risk factor duration and intensity and the underlying etiology of PI development. The relationships among cumulative risk factors, etiologic factors, and mitigating measures for PI prevention are also outlined in the schema within the context of potentially unavoidable PI development. CONCLUSION: Examining PI development in patients who are critically ill through the lens of a conceptual schema may guide future research endeavors focusing on the etiologic bases for PI development. It may also provide a framework to explore alternatives to current formal PI risk assessment in this unique subset of hospitalized patients.