Barrier Functions oF Skin in ICU: SKIN-BAR (SKIN-BAR)

April 28, 2026 updated by: Koç University

Investigation of Skin Barrier Function Using Biosensor Methods in Risky Skin Regions and Developed Pressure Injuries in Intensive Care Patients, and Identification of Influencing Factors: The SKIN-BAR Project

This study aims to investigate skin barrier function in intensive care unit (ICU) patients using biosensor-based measurements. Biophysical parameters including transepidermal water loss (TEWL), skin pH, stratum corneum hydration, local skin temperature, and sebum will be assessed in anatomical regions at risk for pressure injuries. The study will examine temporal changes in these parameters, their interrelationships, and their association with pressure injury development.

Study Overview

Status

Not yet recruiting

Conditions

Detailed Description

Pressure injuries (PIs) remain a major complication in intensive care units (ICUs), associated with increased morbidity, mortality, and healthcare costs. Early detection and prevention are critical; however, current assessment methods rely largely on subjective clinical evaluation and risk scales, which may lack sensitivity in detecting subclinical skin barrier impairment.

Recent advances in biosensor technology enable objective, non-invasive assessment of skin barrier function through biophysical parameters such as transepidermal water loss (TEWL), skin pH, stratum corneum hydration, local temperature, and sebum levels. These parameters reflect epidermal integrity and may provide early indicators of pressure-induced tissue damage before visible clinical signs emerge.

The SKIN-BAR study is designed as a prospective, longitudinal cohort study conducted in ICU patients. The primary objective is to evaluate skin barrier function in pressure injury-prone anatomical regions and to identify factors influencing these parameters. Specifically, the study aims to:

  1. assess temporal changes in biophysical skin parameters,
  2. examine relationships between these parameters,
  3. compare measurements between pressure injury-developing and non-developing patients, and
  4. identify clinical and demographic factors associated with impaired skin barrier function.

Data will be collected using validated, non-invasive biosensor devices. Measurements will be performed at multiple time points (including early ICU admission and follow-up intervals) and across multiple anatomical sites, including the sacrum, trochanters, scapulae, lateral legs, and posterior neck. Control measurements from adjacent intact skin will also be obtained.

A comprehensive dataset including clinical, demographic, and physiological variables will be analyzed to determine predictors of pressure injury development and to better understand the pathophysiological mechanisms underlying skin barrier disruption in critically ill patients.

This study is expected to contribute to the development of objective, evidence-based approaches for early detection and prevention of pressure injuries in ICU settings and to support the integration of biosensor technologies into clinical care protocols.

Study Type

Observational

Enrollment (Estimated)

156

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

  • Name: TUĞBA ERDEM, PhD
  • Phone Number: +90 532 739 15 01
  • Email: tyeni@ku.edu.tr

Study Locations

  • Turkey (Türkiye)
      • Istanbul, Turkey (Türkiye), 34000
        • Koc University
        • Contact:
        • Contact:
          • Meryem YILDIZ AYVAZ, PhD
          • Phone Number: +90 554 379 8373
          • Email: mayvaz@ku.edu.tr
        • Sub-Investigator:
          • EVREN ŞENTÜRK, PROFESSOR
        • Sub-Investigator:
          • EREN AÇIK, Medical Doctor
        • Sub-Investigator:
          • ŞÜKRAN GURA, MSc Nurse
        • Sub-Investigator:
          • MERYEM YILDIZ AYVAZ, PhD
        • Principal Investigator:
          • TUĞBA ERDEM, PhD

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Sampling Method

Probability Sample

Study Population

Adult critically ill patients admitted to the intensive care unit (ICU) and at risk for pressure injury development will be enrolled. Participants will undergo longitudinal, non-invasive biosensor-based assessments of skin barrier function in pressure injury-prone anatomical regions throughout their ICU stay. The population will include both patients who develop pressure injuries and those who do not.

Description

Inclusion Criteria:

  • Adults aged >18 years
  • Admission to the intensive care unit
  • Initial skin assessment completed within the first 4 hours after ICU admission
  • Hemodynamically stable enough to undergo follow-up and repeated skin measurements
  • Intact skin integrity at ICU admission
  • Willingness to participate in the study, with informed consent provided by the participant or legally authorized representative

Exclusion Criteria:

  • Inability to tolerate position changes
  • Post-cardiopulmonary resuscitation care period at enrollment
  • Cardiac arrest or cardiopulmonary resuscitation during follow-up
  • Severe edema or subcutaneous fluid accumulation
  • Presence of skin lesions before ICU admission
  • Systemic dermatologic disease directly affecting skin barrier function

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Cohort 1: Patients Without Pressure Injury
ICU patients who do not develop pressure injuries during the follow-up period. Skin barrier function parameters (TEWL, pH, stratum corneum hydration, local skin temperature) will be measured longitudinally in pressure injury-prone anatomical regions.
Cohort 2: Patients With Pressure Injury
ICU patients who develop pressure injuries during the follow-up period. Skin barrier function parameters will be assessed in both pressure injury-prone regions and adjacent intact skin areas to evaluate changes associated with pressure injury development.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in transepidermal water loss (TEWL) in pressure injury-prone anatomical regions
Time Frame: From ICU admission (within the first 4 hours), 24 hours, 48 hours, 96 hours, day 13.
Transepidermal water loss (TEWL) values measured using a non-invasive biosensor device in pressure injury-prone anatomical regions, including the sacrum, right and left trochanters, right and left lateral legs, right and left scapulae, and posterior neck. TEWL will be evaluated longitudinally to determine temporal changes in skin barrier function and its association with pressure injury development.
From ICU admission (within the first 4 hours), 24 hours, 48 hours, 96 hours, day 13.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in skin surface pH in pressure injury-prone anatomical regions
Time Frame: From ICU admission (within the first 4 hours), 24 hours, 48 hours, 96 hours, day 13.
Skin surface pH values measured longitudinally in pressure injury-prone anatomical regions using a non-invasive pH meter to assess changes in skin barrier acidity over time.
From ICU admission (within the first 4 hours), 24 hours, 48 hours, 96 hours, day 13.
Change in local skin temperature in pressure injury-prone anatomical regions
Time Frame: From ICU admission (within the first 4 hours), 24 hours, 48 hours, 96 hours, day 13.
Local skin temperature measured in pressure injury-prone anatomical regions as a biophysical indicator of tissue stress and early skin barrier alteration.
From ICU admission (within the first 4 hours), 24 hours, 48 hours, 96 hours, day 13.
Incidence of pressure injury during ICU stay
Time Frame: Daily from baseline through Day 13 (or until ICU discharge, whichever occurs first)
Occurrence of new pressure injuries during ICU stay, assessed according to international pressure injury classification criteria.
Daily from baseline through Day 13 (or until ICU discharge, whichever occurs first)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Koç University

Collaborators

Koç University Hospital

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

July 1, 2026

Primary Completion (Estimated)

July 1, 2028

Study Completion (Estimated)

October 1, 2028

Study Registration Dates

First Submitted

April 21, 2026

First Submitted That Met QC Criteria

April 28, 2026

First Posted (Actual)

May 1, 2026

Study Record Updates

Last Update Posted (Actual)

May 1, 2026

Last Update Submitted That Met QC Criteria

April 28, 2026

Last Verified

April 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 425S012

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

IPD Plan Description

Individual participant data (IPD) sharing is currently undecided. Due to the sensitive nature of clinical data collected in an intensive care unit setting and institutional data protection policies, data sharing will be considered after study completion. Any potential data sharing will involve fully de-identified datasets and will require appropriate ethical approvals and data use agreements.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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