title: Relationship between morphological characteristics and etiology of pressure ulcers in intensive care unit patients.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Gerontological Nursing/Wound Care Management, The University of Tokyo, Tokyo, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Nanjo
authors.forename: Gojiro
authors.initials: G
authors.lastname: Nakagami
authors.forename: Toshiko
authors.initials: T
authors.lastname: Kaitani
authors.forename: Ayumi
authors.initials: A
authors.lastname: Naito
authors.forename: Kimie
authors.initials: K
authors.lastname: Takehara
authors.forename: Jiao
authors.initials: J
authors.lastname: Lijuan
authors.forename: Naoki
authors.initials: N
authors.lastname: Yahagi
authors.forename: Hiromi
authors.initials: H
authors.lastname: Sanada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D016638:Critical Illness; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007103:Immobilization / Q000009:adverse effects; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment; D003668:Pressure Ulcer / Q000209:etiology* / Q000451:nursing* / Q000517:prevention & control; D018570:Risk Assessment; D012867:Skin / Q000473:pathology*; D017592:Skin Care / Q000379:methods; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult