Beds, overlays and mattresses for preventing and treating pressure ulcers: an overview of Cochrane Reviews and network meta-analysis

Abstract

Background Pressure ulcers (also known as pressure injuries, pressure sores and bed sores) are localised injuries to the skin or underlying soft tissue, or both, caused by unrelieved pressure, shear or friction. Specific kinds of beds, overlays and mattresses are widely used with the aim of preventing and treating pressure ulcers. Objectives To summarise evidence from Cochrane Reviews that assess the effects of beds, overlays and mattresses on reducing the incidence of pressure ulcers and on increasing pressure ulcer healing in any setting and population. To assess the relative effects of different types of beds, overlays and mattresses for reducing the incidence of pressure ulcers and increasing pressure ulcer healing in any setting and population. To cumulatively rank the different treatment options of beds, overlays and mattresses in order of their effectiveness in pressure ulcer prevention and treatment. Methods In July 2020, we searched the Cochrane Library. Cochrane Reviews reporting the effectiveness of beds, mattresses or overlays for preventing or treating pressure ulcers were eligible for inclusion in this overview. Two review authors independently screened search results and undertook data extraction and risk of bias assessment using the ROBIS tool. We summarised the reported evidence in an overview of reviews. Where possible, we included the randomised controlled trials from each included review in network meta‐analyses. We assessed the relative effectiveness of beds, overlays and mattresses for preventing or treating pressure ulcers and their probabilities of being, comparably, the most effective treatment. We assessed the certainty of the evidence using the GRADE approach. Main results We include six Cochrane Reviews in this overview of reviews, all at low or unclear risk of bias. Pressure ulcer prevention: four reviews (of 68 studies with 18,174 participants) report direct evidence for 27 pairwise comparisons between 12 types of support surface on the following outcomes: pressure ulcer incidence, time to pressure ulcer incidence, patient comfort response, adverse event rates, health‐related quality of life, and cost‐effectiveness. Here we focus on outcomes with some evidence at a minimum of low certainty. (1) Pressure ulcer incidence: our overview includes direct evidence for 27 comparisons that mostly (19/27) have very low‐certainty evidence concerning reduction of pressure ulcer risk. We included 40 studies (12,517 participants; 1298 participants with new ulcers) in a network meta‐analysis involving 13 types of intervention. Data informing the network are sparse and this, together with the high risk of bias in most studies informing the network, means most network contrasts (64/78) yield evidence of very low certainty. There is low‐certainty evidence that, compared with foam surfaces (reference treatment), r...

Health Value of China’s Long-term Care Insurance in Older Disabled People: Role of Institutional Care

“…Pressure ulcers are frequent complications of disabled patients and are generally connected with poor prognosis [29,30]. Therefore, their early risk assessment and management such as identi cation of malnutrition and nutritional supplementation, effective skincare (creams, dressings, and management of incontinence), various support surfaces, and regular turning strategies, are important for disabled people [29,30,31]. With the substitution effect of the LTCI policy, patients with institutional care could have obtained better disease management and individualized disability care plans, leading to an improved quality of life (QoL).…”

Guideline for Prevention of Perioperative Pressure Injury

“…To help reduce the risk of PI, all perioperative patients should be positioned on surfaces that redistribute pressure 1,7 . The interdisciplinary PI prevention team members should determine the type of support surfaces that should be used for perioperative patients in the organization.…”

“…Foam support surfaces have been demonstrated to be inferior to all other support surfaces for preventing PI. According to a recent systematic review and meta‐analysis of support surfaces, reactive air surfaces may be better than foam surfaces for preventing and healing PIs, alternating pressure air surfaces may be better (and less expensive overall) than foam surfaces for preventing PIs, and reactive gel surfaces may be better than foam surfaces for preventing PIs and were especially effective for patients undergoing surgery for several hours 7 . A new recommendation was added in this section that patients at high risk of PI should be placed on high‐ specification reactive or alternating pressure support surfaces before and after surgery 1,6,7 …”

“…1 To help reduce the risk of PI, all perioperative patients should be positioned on surfaces that redistribute pressure. 1,7 The interdisciplinary PI prevention team members should determine the type of support surfaces that should be used for perioperative patients in the organization. The most effective support surfaces provide pressure redistribution by having the lowest interface pressures (ie, load between the skin and the support surface), lowest peak interface pressure, and highest skin contact area.…”

“…7 A new recommendation was added in this section that patients at high risk of PI should be placed on highspecification reactive or alternating pressure support surfaces before and after surgery. 1,6,7…”