LAUSR

Dear Editors, Coronavirus disease 2019 (COVID-19) has spread exponentially throughout the world. Current reports from United States and Italy suggest that the proportion of ICU admissions should be between 5% and 12% of the total cases, with high rate of the aged and mechanically ventilated. As we know, the development of a pressure ulcer is a complex process that requires the application of external force to the skin (such as sacrum and ischium) and host-specific factors, especially in the patients over age 65 years old and with critical ill condition. The most important risk factors include immobility and reduced perfusion which are also the features of critical ill COVID-19 patients. Unlike usual condition, COVID-19 is highly contagious, especially among medical staff. For patients with stage II or above pressure ulcers, the costs of medical resource increases significantly in our hospital. Meanwhile, patients on mechanical ventilation are difficult to turn, and the risk of medical care exposure infection increases. In addition, diarrhoea is one of the common (2%-49.5%) symptoms of COVID19, and could also contribute to the occurrence of sacral pressure ulcer in ICU patients. The sacral pressure ulcer is also very susceptible to contamination by faeces. Unfortunately, faecal excretion persisted after sputum excretion in 23% to 82% patients for 1–11 days, suggesting that the faeces of COVID-19 patients are potentially infectious. Therefore, how we can primarily prevent and appropriately manage the COVID-19 patients in ICU with pressure ulcer is an important issue. We address several points according to our experience during the pandemic.