Pressure injury heralding death – literature review and own experiences

Pressure ulcers in critically ill patients are a global problem. The authors of many publications have increasingly emphasized the multifactorial pathogenesis of skin damage at the end of life. Over the past decade, the problem of terminal pressure ulcers has been increasingly addressed in the global literature. The Consensus on Skin Changes at Life’s End (SCALE) classifies and identifies ”unavoidable” wounds, and provides direction to the patient and family. The aim of this article is to present targeted interventions and terminology for pressure ulcers occurring at the end of life based on the literature analysis and the current PTLR 2020 and EPUAP/NPIAP 2019 pressure ulcer prevention and treatment guidelines, SCALE 2009, 2019. The occurrence of unavoidable pressure ulcers (prodromes of death) should be considered in the case of prolonged terminal illness in any patient at risk for malnutrition and chronic illness. Reliable assessment of the patient’s condition and recognition of the beginning of the dying process is an essential component of professional medical care. The development of a strategy of actions regarding wound management is a necessary element aimed at reducing the unpleasant experience for the patient, and thus providing the possibility to create dignified conditions for dying.