Effects of alternating pressure air mattresses on pressure injury prevention: A systematic review of randomized controlled trials

Abstract

Background Pressure injury (PI) is a significant health problem among inpatients that affects their health, quality of life, and expenses. Aim This systematic review aimed to compare effects of alternating pressure air mattresses (APMs) with other types of supporting surfaces as a tool for PI prevention. Methods The literature published between 2009 and 2020 was searched using the databases PubMed, EMBASE, CINAHL, and Cochrane. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses process was followed, including independent study selection and data extraction. Quality appraisal was conducted using the Cochrane Risk of Bias Tool (RoB 2.0). Results A total of six randomized controlled trials (RCTs) were analyzed. The incidence of hospital‐acquired PIs at stage 1 or higher was reported in the APM group from 0.3% to 25%. In one study, APMs were found to be less effective than static air mattresses (SAMs); in contrast, two studies found no difference. In one study, the APM was reported to be more effective than the viscoelastic foam mattress (VFM). On the contrary, in a more recent study, the APM was reported to be less effective than the VFM, and there was no difference compared with high‐specification foam mattresses in another study. Using the RoB 2.0 tool, one study was evaluated at “low risk of bias,” another as “some concern,” and four as “high risk.” Linking Evidence to Action There is insufficient evidence to suggest that APM is more effective in preventing PIs than other supporting surfaces. Evidence to date suggests that APM can be used in patients at risk for PIs. It is important to change position regardless of the type of support surface used. Highly controlled RCTs with low risk of bias are needed to provide strong evidence for identifying the most effective PI prevention support surfaces.

Effects of predictive nursing interventions on pressure ulcer in elderly bedridden patients

“…Currently, clinical treatments for PUs primarily include air mattresses, localized support surfaces, nutritional support, regular position changes and antimicrobial dressings. However, these methods have shown limited effectiveness, and healing remains difficult for the majority of such patients 22–25 . Therefore, preventing and reducing the incidence of PUs in elderly bedridden patients is a crucial goal in clinical nursing.…”

“…However, these methods have shown limited effectiveness, and healing remains difficult for the majority of such patients. 22 , 23 , 24 , 25 Therefore, preventing and reducing the incidence of PUs in elderly bedridden patients is a crucial goal in clinical nursing.…”

Organizational development and management factors involved in the prevention and effective therapy of pressure ulcers: The results of the national survey conducted among Hungarian public hospitals

“…24 Recent studies have compared support surfaces (foam surfaces and other surfaces, for example, reactive fibre surfaces, reactive gel surfaces, reactive foam and gel surfaces, or reactive water surfaces, alternating pressure [active] air surfaces and reactive air surfaces) specialized in PU prevention in terms of PU incidence, patient comfort, adverse events, and health-related quality. [25][26][27] In their study, Shi et al found that foam surfaces may increase PU incidence compared to alternating pressure (active) and reactive air surfaces. 14 Alternating pressure (active) air surfaces are probably more cost-effective than foam surfaces in preventing new PUs.…”

“…Foam alternatives to standard hospital mattresses reduce the incidence of PUs in people at risk especially people at high risk of developing PUs should use higher‐specification foam mattresses rather than standard hospital mattresses 24 . Recent studies have compared support surfaces (foam surfaces and other surfaces, for example, reactive fibre surfaces, reactive gel surfaces, reactive foam and gel surfaces, or reactive water surfaces, alternating pressure [active] air surfaces and reactive air surfaces) specialized in PU prevention in terms of PU incidence, patient comfort, adverse events, and health‐related quality 25–27 …”

Can a prolonged healing pressure injury be benefited by using an AI mattress? A case study

“…The purpose of using support surfaces is to maximize the body surface area where the body contacts a bed, distribute the body weight, lower the pressure, reduce shearing forces, and control the local microclimate [ 7 , 9 ]. However, the selection of appropriate mattresses in clinical practice remains difficult since most support surfaces recommended are either by expert opinion or via low levels of evidence [ 7 , 10 , 11 ]. Normal capillary closure pressure ranges from 20 mmHg to 40mmHg, with 32 mmHg considered the average [ 4 , 5 ].…”