Effects of turning on skin‐bed interface pressures in healthy adults

Peterson, Matthew J.; Schwab, Wilhelm K.; Oostrom, Johannes H. van; Gravenstein, Nikolaus; Caruso, Lawrence J.

doi:10.1111/j.1365-2648.2010.05292.x

Cited by 32 publications

(24 citation statements)

References 24 publications

(36 reference statements)

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“…An interface pressure greater than 32 mm Hg is the point at which tissue hypoperfusion is believed to occur. 20 Therefore, regular repositioning is necessary. 31,32 Pressure-relieving mattresses can prevent pressure ulcers in ICU patients.…”

Section: Discussionmentioning

confidence: 99%

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Head-of-Bed Elevation and Early Outcomes of Gastric Reflux, Aspiration and Pressure Ulcers: A Feasibility Study

Schallom¹,

Dykeman²,

Metheny³

et al. 2014

American Journal of Critical Care

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A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. Describe the risks and benefits of head-of-bed elevation. 2. Identify the findings at 30° and 45° head-ofbed elevation. 3. Discuss the early outcomes regarding head-ofbed elevation. Background Guidelines recommending head of bed (HOB) elevation greater than 30º to prevent ventilator-associated pneumonia conflict with guidelines to prevent pressure ulcers, which recommend HOB elevation less than 30º. Objectives To examine the feasibility of 45º HOB elevation and describe and compare the occurrence of reflux, aspiration, and pressure ulcer development at 30º and 45º HOB elevation. Methods A randomized 2-day crossover trial was conducted. HOB angle was measured every 30 seconds. Oral and tracheal secretions were analyzed for pepsin presence. Skin was assessed for pressure ulcers. Wilcoxon signed rank tests and

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Section: Discussionmentioning

confidence: 99%

“…19,20 Guidelines for preventing pressure ulcers recommend HOB elevation of 30º or less. 21,22 Based on these conflicting guidelines and difficulty maintaining higher HOB elevations, a study was needed to compare the outcomes of reflux, aspiration, and pressure ulcers simultaneously.…”

mentioning

confidence: 99%

Head-of-Bed Elevation and Early Outcomes of Gastric Reflux, Aspiration and Pressure Ulcers: A Feasibility Study

Schallom¹,

Dykeman²,

Metheny³

et al. 2014

American Journal of Critical Care

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“…Our prior work found that standard, lateral turning by experienced nurses does not reliably relieve all areas of high skin-bed interface pressures in the perisacral region of nondisabled adult subjects [42], i.e., the collective tissue area around the sacrum, coccyx, and ischial tuberosities. Even though subjects are repositioned and the perisacral area is no longer touching the mattress, this perisacral skin area remains exposed to significant levels of interface pressure between the pillow or wedge that is supporting the laterally turned position.…”

Section: Patient Repositioningmentioning

confidence: 96%

“…Furthermore, specific skin areas remain at risk even after being placed in all three positions: supine, turned left, and turned right. These specific skin regions are termed "triple-jeopardy areas" because the same tissue remains at risk while in any of the three different positions [42]. This may help explain why pressure ulcers still develop despite implementation of standard preventive measures, including scheduled patient repositioning.…”

Section: Patient Repositioningmentioning

confidence: 99%

Patient repositioning and pressure ulcer risk�Monitoring interface pressures of at-risk patients

Peterson¹,

Gravenstein²,

Schwab³

et al. 2013

JRRD

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Abstract-Repositioning patients regularly to prevent pressure ulcers and reduce interface pressures is the standard of care, yet prior work has found that standard repositioning does not relieve all areas of at-risk tissue in nondisabled subjects. To determine whether this holds true for high-risk patients, we assessed the effectiveness of routine repositioning in relieving at-risk tissue of the perisacral area using interface pressure mapping. Bedridden patients at risk for pressure ulcer formation (n = 23, Braden score <18) had their perisacral skin-bed interface pressures recorded every 30 s while they received routine repositioning care for 4-6 h. All participants had specific skin areas (206 +/-182 cm 2 ) that exceeded elevated pressure thresholds for >95% of the observation period. Thirteen participants were observed in three distinct positions (supine, turned left, turned right), and all had specific skin areas (166 +/-184 cm 2 ) that exceeded pressure thresholds for >95% of the observation period. At-risk patients have skin areas that are likely always at risk throughout their hospital stay despite repositioning. Healthcare providers are unaware of the actual tissue-relieving effectiveness (or lack thereof) of their repositioning interventions, which may partially explain why pressure ulcer mitigation strategies are not always successful. Relieving at-risk tissue is a necessary part of pressure ulcer prevention, but the repositioning practice itself needs improvement.

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“…Three of the studies [38][39][40] described in Table 3 were conducted with healthy persons and show that interface pressure between the skin and bed surface is increased as the HOB angle is increased.…”

Section: Evidence To Support a Low Hob Elevation To Prevent Pressure mentioning

confidence: 99%

Head-of-Bed Elevation in Critically Ill Patients: A Review

Metheny

Frantz

2013

Critical Care Nurse

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Clinicians are confused by conflicting guidelines about the use of head-of-bed elevation to prevent aspiration and pressure ulcers in critically ill patients. Research-based information in support of guidelines for head-of-bed elevation to prevent either condition is limited. However, positioning of the head of the bed has been studied more extensively for the prevention of aspiration than for the prevention of pressure ulcers, especially in critically ill patients. More research on pressure ulcers has been conducted in healthy persons or residents of nursing homes than in critically ill patients. Thus, the optimal elevation for the head of the bed to balance the risks for aspiration and pressure ulcers in critically ill patients who are receiving mechanical ventilation and tube feedings is unknown. Currently available information provides some indications of how to position patients; however, randomized controlled trials where both outcomes are evaluated simultaneously at various head-of-bed positions are needed.

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Effects of turning on skin‐bed interface pressures in healthy adults

Cited by 32 publications

References 24 publications

Head-of-Bed Elevation and Early Outcomes of Gastric Reflux, Aspiration and Pressure Ulcers: A Feasibility Study

Head-of-Bed Elevation and Early Outcomes of Gastric Reflux, Aspiration and Pressure Ulcers: A Feasibility Study

Patient repositioning and pressure ulcer risk�Monitoring interface pressures of at-risk patients

Head-of-Bed Elevation in Critically Ill Patients: A Review

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