Pressure injury management in critically ill patients with COVID-19 in a makeshift hospital in Indonesia: A report of two cases

Abstract

Patients who are critically ill with COVID-19 need ventilation support in the ICU. However, ICU patients are at higher risk of developing a pressure injury (PI). Unfortunately, PI prevention is not optimally implemented in Indonesia, especially in the makeshift hospitals created during the COVID-19 pandemic. Here, the authors report two cases of critically ill COVID-19 patients who developed large sacral PIs during hospitalisation in a makeshift hospital in Indonesia. The first patient developed a grade III, 7 cm × 7 cm sacral PI on the 14th day of hospitalisation. The second patient developed a grade IV, 12 cm × 8 cm sacral PI on the 16th day of hospitalisation. Both patients had elevated D-dimer levels and used a noninvasive ventilator for one week. The wounds were treated with surgical debridement, silver hydrogel dressing, and hydrocolloid dressing, and complemented with static air mattress overlay. The authors recommend that in situations where there is a shortage of healthcare workers, the government should provide pressure-redistribution devices and silicone foam dressings for all critically ill patients to prevent PI development and lighten the workload of healthcare workers.