Alternating pressure air mattresses as prevention for pressure ulcers: a literature review

OBJECTIVES: The purpose of this paper is to examine and synthesise the literature on alternating pressure air mattresses (APAMs) as a preventive measure for pressure ulcers. DESIGN: Literature review. DATA SOURCES: PubMed, Cinahl, Central, Embase, and Medline databases were searched to identify original and relevant articles. Additional publications were retrieved from the references cited in the publications identified during the electronic database search. RESULTS: Thirty-five studies were included. Effectiveness and comfort of APAMs were the main focuses of the studies evaluating APAMs. Pressure ulcer incidence, contact interface pressure, and blood perfusion were the most frequently used outcome measures to evaluate the effectiveness of APAMs. Fifteen randomised controlled trials (RCTs) analysed the pressure ulcer incidence. One RCT compared a standard hospital mattress with an APAM and found that the APAM was a more effective preventive measure. RCTs comparing APAMs with constant-low-air mattresses resulted in conflicting evidence. There was also no clear evidence as to which type of APAM performed better. All RCTs had methodological flaws. The use of contact interface pressure and blood perfusion measurements to evaluate the effectiveness of APAMs is questionable. Comfort of APAMs was the primary outcome measure in only four studies. Different methods for assessment were used and different types of APAMs were evaluated. Better measures for comfort are needed. A few studies discussed technical problems associated with APAMs. Educating nurses in the correct use of APAMs is advisable. CONCLUSION: Taking into account the methodological issues, we can conclude that APAMs are likely to be more effective than standard hospital mattresses. Contact interface pressure and blood perfusion give only a hypothetical conclusion about APAMs' effectiveness. Additional large, high-quality RCTs are needed. No conclusions can be drawn regarding the comfort of APAMs. A number of technical problems associated with APAMs are related to nurses' improper use of the devices.     

Preventing pressure ulcers: choosing a mattress

The standard hospital mattress is not suitable for patients at risk of developing pressure ulcers. The type of mattress or overlay system they require will depend on their pressure ulcer risk, medical history and local practice. This article provides a guide to pressure-relieving mattresses.     

A static-led approach to pressure ulcers: an evaluation after 3 years

Pressure damage has high cost implications to the patient and care providers. The choice of appropriate equipment to help in the prevention of tissue damage is hampered by extensive choice and little guidance on the most effective product to use. The static-led approach was introduced into Carmarthenshire NHS Trust 3 years ago. This approach simplified the choice of equipment, improving the appropriate usage and reducing expenditure. This article aims to evaluate the approach 3 years after its introduction to determine if the benefits to the patient and the organization still apply.     

Preventing device-related pressure ulcers: using data to guide statewide change

Data collected through Minnesota's mandatory statewide reporting system indicate that prevention of hospital-acquired pressure ulcers continues to be a challenge, particularly for patients who require the use of stabilization collars or other immobilizers, respiratory equipment, orthotics, and tubing. This article describes the process of identifying a pattern of device-related pressure ulcers through statewide pressure ulcer reports and developing a set of recommendations for prevention.     

The prevalence of pressure ulcers in four paediatric institutions

Aim and objective. Pressure ulcers are a common nursing care issue in hospitals. They are associated with psychological and physical suffering, an increased morbidity and mortality rate and higher overall health care costs. The aim of the current study is to describe the frequency of pressure ulcers in a paediatric care setting and to identify the population at risk, as well as to assess the factors predisposing to the development of pressure ulcers. Design. A point prevalence study. Methods. The study was conducted in four paediatric hospitals in the German‐speaking part of Switzerland and included children from the age of 0–18 years. The method of data collection was a direct systematic inspection and assessment of the skin, taking into account the clinical condition of the patient for risk assessment. A valid risk assessment and data collection instrument was used and, each patient was assessed by a previously instructed rater pair. Results. Of all possible patients, 81% (n = 155) were included. An overall pressure ulcer prevalence of 27·7% (including grade 1) was registered. Thirty‐six patients (84%) had grade 1 ulcers, including many caused by external medical devices. Sixty‐five per cent (n = 100) of all patients were considered at risk (Braden score ≤ 20) of developing a pressure ulcer. Thirty‐five per cent of patients in the risk group were afflicted with one or more pressure ulcers. Conclusions. The prevalence of pressure ulcers in paediatric patients is greater then previously appreciated and the problem requires further exploration. The high percentage of grade 1 pressure ulcers caused by medical devices requires nursing interventions to prevent lesions for these patients. Relevance to clinical practice. The high prevalence rate in paediatric patients is disconcerting and requires further exploration in terms of interventions needed to improve outcomes for this patient group.     

Evaluation of patient outcomes: pressure ulcer prevention mattresses

This article reports the findings of a small evaluation audit which compares the Dyna-Form Mercury Advance Mattress to that of the Softform Premier Active Mattress (a foam mattress with dynamic underlay). A small group of patients with similar co-morbidities who were an emergency admission were recruited to an evaluation audit. Their median age and Waterlow score indicated that these patients were at high risk of pressure ulcer development. All patients were given the same nursing care on the two mattresses and all were moved, handled and repositioned 2-4 hourly. Of the patients nursed on the Dyna-Form Mercury Advance mattress, three did not develop pressure ulcers. The two who already had pressure ulcers when they were recruited appeared to have healed within four days. Of the patients nursed on the Softform Premier Active mattress, three patients did not develop ulcers and two did. Although the sample size was small, the comprehensive assessment gave interesting results, particularly on the Dyna-Form Mercury Advance. A larger study may be of benefit to demonstrate efficacy of these products further.     

Comparison of two repositioning schedules for the prevention of pressure ulcers in patients on mechanical ventilation with alternating pressure air mattresses

Purpose

The objective was to compare the effectiveness of repositioning every 2 or 4 h for preventing pressure ulcer development in patients in intensive care unit under mechanical ventilation (MV).

Methods

This was a pragmatic, open-label randomized clinical trial in consecutive patients on an alternating pressure air mattress (APAM) requiring invasive MV for at least 24 h in a university hospital in Spain. Eligible participants were randomly assigned to groups for repositioning every 2 (n = 165) or 4 (n = 164) h. The primary outcome was the incidence of a pressure ulcer of at least grade II during ICU stay.

Results

A pressure ulcer of at least grade II developed in 10.3 % (17/165) of patients turned every 2 h versus 13.4 % (22/164) of those turned every 4 h (hazard ratio [HR] 0.89, 95 % confidence interval [CI] 0.46–1.71, P = 0.73). The composite end point of device-related adverse events was recorded in 47.9 versus 36.6 % (HR 1.50, CI 95 % 1.06–2.11, P = 0.02), unplanned extubation in 11.5 versus 6.7 % (HR 1.77, 95 % CI 0.84–3.75, P = 0. 13), and endotracheal tube obstruction in 36.4 versus 30.5 %, respectively (HR 1.44, 95 % CI 0.98–2.12, P = 0.065). The median (interquartile range) daily nursing workload for manual repositioning was 21 (14–27) versus 11 min/patient (8–15) (P < 0.001).

Conclusions

A strategy aimed at increasing repositioning frequency (2 versus 4 h) in patients under MV and on an APAM did not reduce the incidence of pressure ulcers. However, it did increase device-related adverse events and daily nursing workload.     

Special mattresses: effectiveness in preventing decubitus ulcers in chronic neurologic patients

Thirty-two chronic neurologic patients between 19 and 60 years of age were randomly assigned, for a period of three months, to either an alternating air mattress or a silicore mattress to test the preventive qualities of special mattresses in the occurrence of decubitus ulcers. The two groups were comparable on the variables of age, weight, diagnoses, history of disease process, history of being wheelchair bound, history of previous pressures, and mean scores on Norton's scale of risk, which is based on the subject's physical condition, mental alertness, ambulation, mobility and incontinence. No significant differences were observed in the preventive qualities of the two types of special mattresses in terms of the incidence, location, severity, or healing duration of the subjects' decubitus ulcers. Improved studies of common special mattresses are suggested.