All chronically critically ill patients are at high risk for development and progression of pressure ulcers. Constant surveillance including daily examination of the skin must be part of the care protocol. All pressure ulcers are chronic wounds that have an inherent, physiologic impairment to healing. As soon as a pressure ulcer develops, intervention should begin immediately, and a treatment plan should be determined. We believe that early intervention and appropriate treatment, guided by the paradigm we have described, can retard progression and promote healing [49]. Treatment decisions should be made within the context of the patient's overall care goals.