Does pressure cause pressure ulcers? An inquiry into the etiology of pressure ulcers

Pressure ulcers remain problematic across health care settings, with prevalence and incidence changing little over the past 2 decades. Because external pressure is viewed as the chief factor in the development of pressure ulcers, considerable research has focused on pressure relief. Because relief of external pressure is possible, and would hypothetically eliminate all pressure ulcers, the development of a pressure ulcer is often regarded as a failure of the care system. This logic conveys the notion that sustained pressure is the only factor in the development of pressure ulcers and disregards additional factors in the pathogenesis of pressure ulcers intrinsic to the patient. Patient-specific factors leading to derangement in tissue perfusion may account for an observed development of a pressure ulcer, despite the provision of common prevention measures that include pressure reduction. A more comprehensive understanding of unique individual intrinsic factors may lead to more effective interventions.