Effects of backrest elevation and position on pulmonary artery pressures

This repeated measures study identified each subject's baseline range of fluctuation in pulmonary artery pressures and used this information to evaluate the effects of changes in backrest elevation (0 degrees and 30 degrees) and position (supine and lateral) on pulmonary artery pressures. Sixteen hemodynamically stable patients were studied. Six measures of pulmonary artery pressure were obtained with subjects in the supine (flat) position. Pulmonary artery systolic pressures fluctuated from 2-16 mm Hg, pulmonary artery diastolic pressures from 0-11 mm Hg, and pulmonary artery mean pressures from 0-13 mm Hg. Only pulmonary artery diastolic pressures were not altered in a statistically significant way with backrest elevation. Even though backrest elevation produced clinically significant changes (those exceeding the subject's baseline range of fluctuation) in some subjects, no other changes in parameters of hemodynamic status were observed. These results suggest that pulmonary artery pressures may be obtained with backrests elevated. Since position changes produced both statistically and clinically significant changes in all pulmonary artery pressures, the use of lateral positions during pulmonary artery pressure measurement is not recommended.     

Effectiveness of mattress overlays in reducing interface pressures during recumbency

This study evaluates the pressure-reduction characteristics of seven mattress overlays. Thirty subjects were evaluated on each support surface to determine the interface pressures that are generated under the most common pressure sore sites. The results of this study indicate that there is great variability in the effectiveness of traditional mattress overlays. The most effective overlays are the Roho and Akros DFD mattresses; whereas 2-inch thick convoluted foam provides no significant protection for the trochanter when the subjects were lying on their sides (lateral position).     

气垫床对卧床病人局部受压程度的影响

目的探讨气垫床预防卧床病人压疮的作用。方法采用便利抽样及自身对照的方法,收集病例40例,应用Xsen-sor压力地图系统分别测量出病人平卧普通病床2h后(对照组)及气垫床2h后(试验组)身体局部受压的压强大小以及严重受压的面积,比较试验组与对照组的主要严重受压部位、严重受压部位的平均压强峰值、全身平均压强、严重受压部位面积大小。结果两组严重受压部位比较,差异无统计学意义;两组严重受压部位的平均压强峰值、全身平均压强、严重受压部位面积大小等比较,差异均有统计学意义。结论气垫床能有效减小卧床病人严重受压局部的垂直压力及受压面积,对预防压疮有积极作用,但预防压疮仍须采取综合性的措施。     

Effect of backrest position on intracranial and cerebral perfusion pressures in traumatically brain-injured adults.

BACKGROUND: Backrest positioning for brain-injured adults is variable. Some data support using a flat backrest to optimize cerebral perfusion pressure; other data support elevating the head of the bed at least 30 degrees to reduce intracranial pressure. OBJECTIVE: To determine whether a flat backrest position or a backrest elevation of 30 degrees provides both optimal cerebral perfusion pressure and optimal intracranial pressure in adults with brain injuries. METHODS: A randomized crossover experimental design was used to collect data on 8 adults 18 to 45 years old who had nonvascular, closed-head, traumatic brain injury. Repeated-measures multivariate analysis of variance was used to analyze the data. RESULTS: Overall, compared with use of a flat/horizontal position, use of a backrest elevation of 30 degrees resulted in significant and clinically important improvements in both intracranial and cerebral perfusion pressures. None of the subjects experienced adverse clinical changes in either intracranial pressure or cerebral perfusion pressure with either backrest position. CONCLUSION: The results strengthen the research foundation for raising the backrest position for adults, 18 to 45 years old, who have nonvascular, nonpenetrating, severe brain injuries.     

Skin blood flow in relation to external pressure and temperature in the supine position on a standard hospital mattress

The purpose of this investigation was to study the relationship between skin blood flow, external pressure and temperature in the skin over bony prominences and muscle padded areas, when healthy individuals and patients with hemiplegia were lying in the supine position on a standard hospital mattress. The pressure values under the gluteus maximus muscle and the sacrum increased significantly in the supine position with bent knees. The heels resting on the mattress gave very high pressure values. Some patients had no observable skin blood flow in the skin over the sacrum and the gluteus maximus muscle. In many individuals there was no observable blood flow in the skin over the heel among both healthy individuals and patients, which was confirmed by very high post-ischemic reactive hyperaemia. There is also a heat accumulation when lying on the mattress which increases the requirement for skin blood flow.     

Effect of backrest position on intracranial and cerebral perfusion pressures

Prevention of secondary injury resulting from increased intracranial pressure (ICP) and the promotion of adequate cerebral blood flow are major concerns of health care professionals caring for the neurologic patient. For the past two decades studies have indicated raising the head of the bed lowers ICP. However, when perfusion pressure has been measured along with ICP, results have been conflicting. Some investigators found cerebral perfusion pressure (CPP) decreased with head elevation; others found no change. This study examined the effect of four backrest positions (flat, head elevated 30 degrees, head elevated 30 degrees with knee gatch elevated and reverse Trendelenberg) on ICP, CPP and transcranial doppler flow velocities in four subjects. Each was placed in the flat position for 15 minutes followed by 15 minutes in one of the three randomly assigned elevated backrest positions. Findings suggest backrest position should be individually assigned after analysis of the response of the ICP, CPP and blood flow velocities to that position.     

Effects of different heel angles in sleep mode on heel interface pressure in the elderly

BackgroundThe heels are one of the most common sites of pressure ulcers, and the incidence rate in the elderly aged 70 years or older is high. Although there is literature on heel interface pressure, the heel interface pressure of the elderly in different postures has not yet been explored, which will be investigated in this study, as well as the effects of different foot positions. Their skin conditions will also be examined.MethodsTwenty-five females and twenty-six males, 70 years old or older, are evaluated while lying down, with only their naked foot in its natural position on a mattress, as well as placed on a standard or pressure-relieving mattress in different positions. The moisture, sebum content, and elasticity of the skin of the heel are tested.FindingsThe heel of most of the participants is positioned at a 60°–69° or 90°–99° angle to the support surface. The heel interface pressure is the greatest when the foot is upright. The age, weight, and body mass index have no significant impacts. The moisture and sebum content are extremely low while elasticity is normal.InterpretationThe relaxed position of the foot is in neutral external rotation and upright positions. A greater amount of pressure is experienced when the foot is upright. The pressure-relieving mattress is more effective for reducing heel pressure but may not apply to all cases. Finally, the skin of the heel is dry and lacks sebum, which implies greater risk of developing heel sores.     

The occipital and sacral pressures experienced by healthy volunteers under spinal immobilization: a trial of three surfaces.

BACKGROUND: The development of a pressure ulcer is of great significance to the life-long rehabilitative management of the person with a spinal cord injury, and may indeed delay and repeatedly interfere with that process. That the period preceding admission to the specialized spinal injury unit is crucial with regard to pressure ulcer development is evident in the professional literature. Both anecdotal and empirical evidence indicates that a significant number of pressure ulcers occur as a result of management provided prior to admission, and that such ulcers are more likely to occur in those patients who have undergone a transfer process from a hospital distal to the specialist unit on a hard spinal board. AIM: In consideration of this and of the fact that, in Ireland, the interhospital transfer of spinal injured patients has usually involved the employment of such spinal boards to achieve immobilization, this study sought to identify whether or not the pressure experienced by individuals at two anatomical locations was dependent on the support surface employed. METHODOLOGY: Pressure under the occiput and sacrum of three healthy volunteers immobilized on three support surfaces was measured using air-filled pressure-measuring sacks. The surfaces employed were an uncovered spinal board; a spinal board with inflatable raft devise; and a full-body vacuum splint. DISCUSSION: Marked reductions in pressure were measured when using the inflatable raft and the vacuum mattress. The results of this study will provide a basis for a larger study and, through that, the formulation of recommendations for standardized practice along a national care pathway.     

Development of a clinical instrument to measure heel pad indentation

OBJECTIVE: To provide an accurate, reliable, non-invasive, portable instrument to measure heel pad indentation in a clinical setting. DESIGN: A novel instrument was applied to assess heel pad indentation. BACKGROUND: For the lack of quantitative biomechanical tools for in vivo assessment, palpation is used to evaluate heel pad stiffness subjectively in everyday clinical practice. Furthermore, previous studies have evaluated heel pad stiffness using non-portable instrumentation. METHODS: Cylindrical probe was attached to an electronic force gauge unit that passed through a Perspex plate for placement on heel pad. Displacement of the plate was connected to a linear variable differential transformer. A laptop PC allowed for portability and storage of data. An exponential curve described the force-displacement data. Ten healthy subjects (mean 21. 7; SD, 1.7 years) were assessed on ten separate occasions. The procedure was standardised for subject position and placement. RESULTS: Accuracy and reliability of each device component was established. An intraclass correlation (2,1) of 0.90 and 0.88 demonstrated curve coefficients b1 and b0 respectively. A paired t-test demonstrated no significant difference between the left and right foot coefficients. CONCLUSION: The results demonstrated that each system component could be measured accurately and reliable. Reproducible results were obtained over separate occasions. The study has described a method to analyse the force-displacement curve. RelevanceThe development of a hand-held device may help the clinician to assess heel pad stiffness in the clinical setting. Heel pad stiffness may be associated in the development of plantar heel pain in athletes.     

医用三节可调节床垫的研制及临床应用

[目的]制作一款安全、方便的可调节床垫,应用于冠心病合并心功能不全并伴有腰椎间盘突出的病人,以减轻病人腰背部疼痛等不适。[方法]依据轴承原理,自行设计制作了医用三节可调节床垫。选取心内科住院的冠心病合并心功能不全并伴有腰椎间盘突出症病人80例作为观察对象,采用自身对照法,观察病人使用医用软床垫和三节可调节床垫后变换体位自如程度、腰背部疼痛程度、氧饱和度和睡眠时间。[结果]使用三节可调节床垫后,病人氧饱和度不受影响、变换体位自如、腰背部疼痛明显减轻、睡眠时间延长,提高了病人的舒适度。[结论]三节可调节床垫设计合理,安全实用,能切实解决和满足特殊病人的特殊需求。     

多功能床垫的制作与使用

为了适应护理示范医院的需要,夯实基础护理,提供满意服务,我科自行设计了一种多功能床垫,便于长期卧床的老年病人进行床上各种生活护理与基础护理,具体介绍如下.     

多功能床垫的制作与使用

为了适应护理示范医院的需要,夯实基础护理,提供满意服务,我科自行设计了一种多功能床垫,便于长期卧床的老年病人进行床上各种生活护理与基础护理,具体介绍如下。     

俯卧位床垫预防玻璃体切割术后高眼压的效果研究

[目的]探讨俯卧位床垫预防玻璃体切割术后高眼压的效果,总结术后高眼压的护理,提高玻璃体切割术的临床效果。[方法]将200例既往无眼科手术病史、单眼进行玻璃体切割术的病人随机分成观察组96例与常规组104例,常规组按常规进行护理,观察组使用俯卧位床垫,分别于手术后第1天开始,测量眼压(测3次取平均值),眼压大于21mmHg为术后高眼压。统计术后24h、48h、72h两组病人高眼压的发生率及眼压变化。[结果]术后不同时间段观察组高眼压发生率都低于常规组(P0.05)。[结论]俯卧位床垫能有效预防玻璃体切割术后高眼压的发生。