ICU patients with hypotension, especially those with systolic BPs of 60 mm Hg or less, even for a short time, can experience tissue breakdown because of decreased perfusion pressures. Patients with a history of previous pressure ulcers are especially at risk. Areas of scar tissue are more likely to break down than intact skin. Patients with low ejection fractions have significantly reduced peripheral perfusion and very low capillary closing pressures. Less pressure over a shorter time will produce an injury.
Malnutrition is a significant factor in the development of pressure ulcers.
The more severe the deficiency, the greater the risk. Incontinence increases risk by causing chemical irritation and by creating an excessively moist environment. Excoriation and maceration can occur even after a brief episode of incontinence. Patients with fecal incontinence have more than 20 times the risk of pressure ulcers than continent patients.