Alternating pressure (active) air surfaces for preventing pressure ulcers

Abstract

Background Pressure ulcers (also known as pressure injuries, pressure sores, decubitus ulcers and bed sores) are localised injuries to the skin or underlying soft tissue, or both, caused by unrelieved pressure, shear or friction. Alternating pressure (active) air surfaces are widely used with the aim of preventing pressure ulcers. Objectives To assess the effects of alternating pressure (active) air surfaces (beds, mattresses or overlays) compared with any support surface on the incidence of pressure ulcers in any population in any setting. Search methods In November 2019, we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In‐Process & Other Non‐Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta‐analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. Selection criteria We included randomised controlled trials that allocated participants of any age to alternating pressure (active) air beds, overlays or mattresses. Comparators were any beds, overlays or mattresses. Data collection and analysis At least two review authors independently assessed studies using predetermined inclusion criteria. We carried out data extraction, 'Risk of bias' assessment using the Cochrane 'Risk of bias' tool, and the certainty of the evidence assessment according to Grading of Recommendations, Assessment, Development and Evaluations methodology. Main results We included 32 studies (9058 participants) in the review. Most studies were small (median study sample size: 83 participants). The average age of participants ranged from 37.2 to 87.0 years (median: 69.1 years). Participants were largely from acute care settings (including accident and emergency departments). We synthesised data for six comparisons in the review: alternating pressure (active) air surfaces versus: foam surfaces, reactive air surfaces, reactive water surfaces, reactive fibre surfaces, reactive gel surfaces used in the operating room followed by foam surfaces used on the ward bed, and another type of alternating pressure air surface. Of the 32 included studies, 25 (78.1%) presented findings which were considered at high overall risk of bias. Primary outcome: pressure ulcer incidence Alternating pressure (active) air surfaces may reduce the proportion of participants developing a new pressure ulcer compared with foam surfaces (risk ratio (RR) 0.63, 95% confidence interval (CI) 0.34 to 1.17; I 2 = 63%; 4 studies, 2247 participants; low‐certainty evidence). Alternating pressure (activ...

Consistent practices in pressure ulcer prevention based on international care guidelines: A cross‐sectional study

“…The use of pressure relief devices, such as specialist mattresses, is one of the key PU prevention practices in PU prevention guidelines 3 even though the evidence is somewhat uncertain about the differences in the effects of these devices. 34 In addition, not all the devices, such as water‐filled gloves or sheepskins, are recommended as they might cause more harm than good. 1 Documentation as a PU prevention practice was used quite regularly among the participating nurses.…”

Extrinsic factors of pressure injuries in patients during surgery: A frequency matched retrospective study

“…Furthermore, the fibres on the surfaces of electric blankets are longer, which also increases friction and thereby generates heat, increasing the risk of PIs as well. 38,39 In this study, in the use of thermoregulation devices, the regression coefficient of the use of electric blankets was significantly positive. The results of this study also confirmed that using electric blankets during surgery increases the risk of PIs and that said risk is 8.14 times higher than the risk of PIs in patients not using electric blankets.…”

Incidence and Characteristics of Suspected Deep Tissue Pressure Injuries on the Foot and Ankle

“…Pressure redistributing or off-loading measures in health care are supported by limited evidence; nevertheless, their use is recommended in clinical practice guidelines for pressure injury prevention 8,21. Strategies include regular turning and repositioning, use of pressure redistributing devices, and off-loading pressures on the heel 8,21–23. Many patients within our study had some form of pressure injury redistribution such as regular turning and repositioning and use of pressure redistributing support surface (mattress).…”