key: cord-0962596-tpnee3gq
authors: Yu, Nanze; Li, Zhijin; Long, Xiao; Huang, Jiuzuo; Cao, Wei; Zhang, Yan; Yang, Yang; Liu, Zhengyin; Liu, Zhifei; Zhang, Shuyang; Wang, Xiaojun
title: Pressure Injury: A Non-negligible Comorbidity for Critical Covid-19 Patients
date: 2020-08-13
journal: J Plast Reconstr Aesthet Surg
DOI: 10.1016/j.bjps.2020.08.006
sha: 0ece8b1f4cb61a1e1e795f476ec456fa29347beb
doc_id: 962596
cord_uid: tpnee3gq

nan

A multidisciplinary team from Peking Union Medical College Hospital (PUMCH) managed an ICU from Feb 4 th to April 12 th , in the Sino-French New City Branch of Tongji Hospital, Wuhan, a designated hospital for Covid-19. 1 Among the 109 critically ill patients admitted to the unit, 46 (42.2%) patients (27 male, 19 female) with a median age of 66 years eventually developed various stages of pressure injury (Table 1 , Fig. S1 -4 in the Supplementary Appendix), despite of all the proper management.

All these 46 patients were in critical condition and received mechanical ventilation. The median interval from symptom onset to invasive ventilation was only 18 days. Forty-one (89.1%) of them had at least one of the coexisting disorders when admitted, including hypertension (56.5%), diabetes (17.4%), cerebrovascular disease (15.2%), and coronary heart disease (15.2%). Compared with the general population of Covid-19 patients in China, 2 our patients had a higher incidence of shortness of breath (82.6%) early. Other common symptoms included fever (87.0%), cough (78.3%) and fatigue (43.5%). Gastrointestinal symptoms, such as diarrhea (21.7%) and nausea or vomiting (15.2%) were also not uncommon.

Except mechanical ventilation and coexisting disorders, other risk factors for pressure injury including malnutrition, anemia, vasopressor support, intermittent haemodialysis, and sedation were also commonly seen in our patients (Table 1) . It is worth mentioning that 16 (34.8%) patients presented acro-ischemia ( Fig. S6-9 in the Supplementary Appendix), which is a demonstration of impaired microcirculation of the skin. As one of the indicators of poor prognosis in severe Covid-19 patients, 1,3 abnormal coagulation may also indicate the vulnerability of soft tissues.

The median interval from intubation to the presence of pressure injury was 8 days. Sacrum (89.1%) was the most common location to emerge pressure injury, as might be expected, followed by the face (23.9%) due to the prone position ventilation adopted to optimize oxygenation, heels (21.7%) and hips (8.7%). Swab samples were taken from the pressure wounds of 23 (50.0%) laboratorially confirmed cases (Fig. S5 in the Supplementary Appendix). No SARS-CoV-2 virus was found on reverse transcriptase polymerase chain reaction assay.

Sixteen (34.8%) patients successfully detached from ventilators were transferred from ICU to general wards. Although the development of pressure injury is not a direct cause of mortality, it significantly increases morbidity, nursing burden and healthcare costs, and should not be neglected in the treatment of critical Covid-19 patients. * Stage I pressure injury describes intact skin with non-blanchable erythema. No swab sample was obtained in this stage. † Any type of cancer was included in this category. ‡ All the laboratory values were obtained from laboratory reports before medical intervention. § The reference value for the fibrin degradation products level was 150 mg/liter or less. ¶ The reference value for the D-dimer level was 21 mg/liter or less.

Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19

Clinical characteristics of coronavirus disease 2019 in China

Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia