{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T14:46:47Z","timestamp":1776091607424,"version":"3.50.1"},"reference-count":12,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:p>Patients admitted to the intensive care unit (ICU) are at a high risk for developing pressure injuries. A patient requiring multiorgan support is at a higher risk for pressure injuries related to immobility, sedation, vasopressors, and hypoxia. To mitigate pressure injuries, our hospital utilizes a bundle approach to prevent skin injury. However, despite efforts to prevent pressure injuries, we found our patients in the ICU with the diagnosis of COVID-19 went on to develop significant pressure and mucosal injuries. This is a case report of 4 patients diagnosed with COVID-19 who developed significant skin and mucosal injuries during their ICU admissions in the month of March 2020. We found that patients developed skin conditions that were initially thought to be deep-tissue injuries (DTIs) early in the admission. The DTIs progressed over the course of the admission in the ICU and evolved to thick adherent eschar that appeared to be unstageable pressure injuries, which extended beyond the soft tissue directly over the bony prominence. We also found that skin damage to the mucosa of the nares, tongue, lips, and urethra presented first as inflammation and then progressed to thick eschar. Despite maximum pressure relief with the use of a pressure-relieving turn and position system, bordered foam dressings, fluidized positioners, specialty beds, and leadership support for twice-a-week skin checks, our patients diagnosed with COVID-19 developed extensive skin damage across the fleshy portion of the buttocks and on the mucosa of the nares, tongue, lips, and urethra during minimal exposure to pressure. Although the initial presentation of the skin damage appeared to be related to pressure, the extent of the skin damage suggests a vascular inflammatory process beyond skin damage related to pressure.<\/jats:p>","DOI":"10.1097\/won.0000000000000690","type":"journal-article","created":{"date-parts":[[2020,8,28]],"date-time":"2020-08-28T18:29:53Z","timestamp":1598639393000},"page":"435-438","source":"Crossref","is-referenced-by-count":27,"title":["Skin and Mucosal Damage in Patients Diagnosed With COVID-19"],"prefix":"10.1097","volume":"47","author":[{"given":"Charleen","family":"Singh","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jafar","family":"Tay","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noordeen","family":"Shoqirat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2020,8,20]]},"reference":[{"issue":"7","key":"R1-20230826","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1097\/01.ASW.0000534699.50162.4e","article-title":"Pressure injury risk factors in critical care patients: a descriptive analysis","volume":"31","author":"Cox","year":"2018","journal-title":"Adv Skin Wound Care"},{"issue":"2","key":"R2-20230826","first-page":"13","article-title":"Comorbidity analysis on ICU big data","volume":"7","author":"Hyun","year":"2019","journal-title":"Int J Adv Culture Technol"},{"issue":"6","key":"R3-20230826","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1097\/WON.0000000000000281","article-title":"Revised National Pressure Ulcer Advisory Panel pressure injury staging system: revised pressure injury staging system","volume":"43","author":"Edsberg","year":"2016","journal-title":"J Wound Ostomy Continence Nurs"},{"issue":"2","key":"R4-20230826","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1136\/bmjqs-2017-007505","article-title":"Value of hospital resources for effective pressure injury prevention: a cost-effectiveness analysis","volume":"28","author":"Padula","year":"2019","journal-title":"BMJ Qual Saf"},{"key":"R5-20230826","doi-asserted-by":"crossref","first-page":"103400","DOI":"10.1016\/j.ijnurstu.2019.103400","article-title":"Effectiveness of prophylactic sacral protective dressings to prevent pressure injury: a systematic review and meta-analysis","volume":"100","author":"Fulbrook","year":"2019","journal-title":"Int J Nurs Stud"},{"issue":"7","key":"R6-20230826","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1111\/jonm.12396","article-title":"Towards international consensus on patient harm: perspectives on pressure injury policy","volume":"24","author":"Jackson","year":"2016","journal-title":"J Nurs Manage"},{"key":"R7-20230826","doi-asserted-by":"crossref","first-page":"39","DOI":"10.20517\/2347-9264.2018.41","article-title":"Tissue conditioning strategies to improve perfusion and reduce ischemia-reperfusion injury","volume":"5","author":"Krauss","year":"2018","journal-title":"Plast Aesthet Res"},{"issue":"5","key":"R8-20230826","doi-asserted-by":"crossref","first-page":"1128e","DOI":"10.1097\/PRS.0000000000003271","article-title":"Adipose tissue drives response to ischemia-reperfusion injury in a murine pressure sore model","volume":"139","author":"Gust","year":"2017","journal-title":"Plast Reconstr Surg"},{"issue":"3","key":"R9-20230826","doi-asserted-by":"crossref","first-page":"284","DOI":"10.3390\/ijms17030284","article-title":"Pressure combined with ischemia\/reperfusion injury induces deep tissue injury via endoplasmic reticulum stress in a rat pressure ulcer model","volume":"17","author":"Cui","year":"2016","journal-title":"Int J Mol Sci"},{"issue":"6","key":"R10-20230826","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1002\/eji.201747347","article-title":"The impact of ischemia-reperfusion injuries on skin resident murine dendritic cells","volume":"48","author":"Goh","year":"2018","journal-title":"Eur J Immunol"},{"issue":"2","key":"R11-20230826","doi-asserted-by":"crossref","first-page":"110","DOI":"10.28920\/dhm47.2.110-117","article-title":"Ischaemia-reperfusion injury and hyperbaric oxygen pathways: a review of cellular mechanisms","volume":"47","author":"Francis","year":"2017","journal-title":"Diving Hyperb Med"},{"issue":"3","key":"R12-20230826","doi-asserted-by":"crossref","first-page":"131","DOI":"10.12788\/jcom.0005","article-title":"Atypical features of COVID-19: a literature review","volume":"27","author":"Small","year":"2020","journal-title":"J Clin Outcome Manag"}],"container-title":["Journal of Wound, Ostomy &amp; Continence Nursing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/WON.0000000000000690","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,26]],"date-time":"2023-08-26T07:27:14Z","timestamp":1693034834000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/WON.0000000000000690"}},"subtitle":["A Case Report"],"short-title":[],"issued":{"date-parts":[[2020,8,20]]},"references-count":12,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.1097\/won.0000000000000690","relation":{},"ISSN":["1071-5754"],"issn-type":[{"value":"1071-5754","type":"print"}],"subject":[],"published":{"date-parts":[[2020,8,20]]}}}