Evidence supporting the use of two-hourly turning for pressure ulcer prevention

Hagisawa, Satsue; Ferguson-Pell, Martin

doi:10.1016/j.jtv.2007.10.001

Cited by 30 publications

(27 citation statements)

References 11 publications

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“…Turning patients regularly to prevent pressure ulcers has long been recommended. 30 However, in the side-lying position at 30º, interface pressures of 32 mm Hg or greater may occur. An interface pressure greater than 32 mm Hg is the point at which tissue hypoperfusion is believed to occur.…”

Section: Discussionmentioning

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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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%

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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“…However, there is no evidence for the optimum frequency for repositioning the critically ill ICU patients. Two-hourly repositioning of patients is accepted as standard practice on the basis of anecdotal data [39] . Goldhill and colleagues undertook a prospective observational study to examine ICU patient position and frequency of turning.…”

Section: Prolonged Immobilitymentioning

confidence: 99%

Pressure ulcers in the adult intensive care unit: a literature review of patient risk factors and risk assessment scales

Tayyib¹,

Coyer²,

Lewis³

2013

JNEP

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Background: Critically ill patients are at high risk for pressure ulcer (PrU) development due to their high acuity and the invasive nature of the multiple interventions and therapies they receive. With reported incidence rates of PrU development in the adult critical care population as high as 56%, the identification of patients at high risk of PrU development is essential. This paper will explore the association between PrU development and risk factors. It will also explore PrU development and the use of risk assessment scales for critically ill patients in adult intensive care units. Method:A literature search from 2000 to 2012 using the CINHAL, Cochrane Library, EBSCOHost, Medline (via EBSCOHost), PubMed, ProQuest and Google Scholar databases was conducted. Key words used were: pressure ulcer/s; pressure sore/s; decubitus ulcer/s; bed sore/s; critical care; intensive care; critical illness; prevalence; incidence; prevention; management; risk factor; risk assessment scale.Results: Nineteen articles were included in this review; eight studies addressing PrU risk factors, eight studies addressing risk assessment scales and three studies overlapping both. Results from the studies reviewed identified 28 intrinsic and extrinsic risk factors which may lead to PrU development. Development of a risk factor prediction model in this patient population, although beneficial, appears problematic due to many issues such as diverse diagnoses and subsequent patient needs. Additionally, several risk assessment instruments have been developed for early screening of patients at higher risk of developing PrU in the ICU. No existing risk assessment scales are valid for identification high risk critically ill patient, with the majority of scales potentially over-predicting patients at risk for PrU development. Conclusion:Research studies to inform the risk factors for potential pressure ulcer development are inconsistent. Additionally, there is no consistent or clear evidence which demonstrates any scale to better or more effective than another when used to identify the patients at risk for PrU development. Furthermore robust research is needed to identify the risk factors and develop valid scales for measuring the risk of PrU development in ICU.

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“…The idea of necessary repositioning has appeared throughout literature and textbooks since the 1800s [30]. Evidence that some repositioning is necessary can be found across decades of literature.…”

Section: Turning Frequencymentioning

confidence: 99%

“…Despite efforts by a number of researchers to identify the origins of this practice, or at the very least identify evidence supporting the 2-hour turning practice, no strong scientific support exists [30,[32][33]. In fact, earlier texts often included suggestions that the turning schedule depend on the magnitude of loading and condition of the patient.…”

Section: Turning Frequencymentioning

confidence: 99%

Assessing evidence supporting redistribution of pressure for pressure ulcer prevention: A review

Sprigle¹,

Sonenblum²

2011

JRRD

102

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Abstract-The formation and underlying causes of p ressure ulcers (PUs) are quite complex, with multiple influencing factors. However, by definition pressure ulcers cannot form without loading, or pressure, on tissue. Clinical interventions typically target the magnitude and/or duration of loading. Pressure magnitude is managed by the selection of support surfaces and postural supports as well as body posture on supporting surfaces. Duration is addressed via turning and weight shifting frequency as well as with th e use of dynamic s urfaces that actively redistribute pressure on the body surfaces. This article shows that preventative interventions must be targeted to both magnitude and duration and addresses the rationale behind several common clinical interventions-some with more scientific evidence than others.

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Evidence supporting the use of two-hourly turning for pressure ulcer prevention

Cited by 30 publications

References 11 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

Pressure ulcers in the adult intensive care unit: a literature review of patient risk factors and risk assessment scales

Assessing evidence supporting redistribution of pressure for pressure ulcer prevention: A review

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