Pressure Mattresses in pressure ulcer prevention.

Pressure Mattresses in
pressure ulcer prevention
Presenter

Introduction
 Pressure ulcers develop due to localization of body
parts due to sleeping or sitting in one position for long.
 Pressure ulcer development varies from patient to
patient and are determined by factors like age, body
weight and skin health.
 Pressure mattresses are designed to prevent ulcers and
keep the patient healthy.
 The mattress seeks to increase comfort through high
level body support in different body parts.

Level of evidence
 RCTs are the second highest level of evidence
 They are the gold standard of research since they are
effective in testing the efficacy of an intervention
(Burns, Rohrich, & Chung, 2011).
 This is based on well designed randomized control trail
where the participants are randomized into groups.
 This is also based on the strong number of participants
used in the study(Burns, Rohrich, & Chung, 2011).

Beeckman, et
al. (2019)
Camargo, et al.
(2018)
Nixon, et al.
(2019)
McGinnis et al.
(2017)
Evidence
hierarchy
RCT are second
level evidence
(Burns, Rohrich,
& Chung, 2011).
RCT are second
level evidence
(Burns, Rohrich,
& Chung, 2011).
RCT are second
level evidence
(Burns, Rohrich,
& Chung, 2011).
RCT are second
level evidence
(Burns, Rohrich,
& Chung, 2011).
Appropriatenes
s of study
design
Multi-center
randomized
controlled trail
allowed the
researchers to
measure the
clinical
outcomes in
different patient
situations to
increase clinical
outcomes.
The RCT with
intention to treat
was used to
increase clinical
outcomes with
six subscales
used in grouping
the patients and
assessing the
level of ulcers.
Multi-center,
Phase III, open,
prospective,
parallel group,
randomized
controlled trial
was used due to
the high number
of locations
being used in the
study.
Patients were
randomized in
two groups, the
control group
and the
intervention
group allowing
the researcher to
measure the
outcomes of the
study

Strength of RCTs
 RCTs allow the testing of clinical interventions by comparing the
results between two groups.
 Randomization of participants in the studies increases validity,
reduces bias, increases reliability and easy generalization of the
findings.
 RCTs also allow the study of the participants within their local
settings thus covering the required clinical outcomes.
 Most RCTs involve a larger sample group with participants being
studied for sometime to fully measure clinical outcomes.
 Inclusion of patients is also based on cohorts which increases the
generalizability of the results within the study group.

Camargo, et al. (2018) appraisal
Critically ill patients were studied and the pressure mattress was used as a comparator to
determine the outcomes between the two groups.
RCTs use control groups in studies to measure the clinical outcome in the control group.
Patients were randomized using a computer program to increase the validity of the results
and were blinded to increase the reliability and reduce bias.
Randomization and blinding form the strength of RCTs since there is little bias from the
researcher and the participants.
All participants were accounted for through follow up, which increased the
generalizability of the results since these findings indicate that the data represents the
sample group.
To increase data reliability in this study, the participants were analyzed in their respective
groups.

Appraisal cnt.
 Blinding of participants was used for patients to reduce the risk of
bias in data collection.
 To measure the changes well, all participants were similar since
the study was based on institutional pressure injury prevention
strategies.
 When all participants are similar in inclusion, the measures in the
control group are effective in achieving the intended outcomes.
 The groups were treated equally since patients were supposed to
receive the required prevention measures to be used in assessing
the effectiveness of the pressure mattress.

Appraisal cont.
 The main study outcome was the occurrence of stage 2 pressure
injury which was compared between the two groups.
 In RCTs, the study outcomes measure the difference between the
general group and the control group which forms the strength of the
study evidence.
 The study reported that the development of pressure ulcer was based
length of stay and the support surface used.
 Pressure mattresses or support surfaces reduced pressure ulcer
incidence in critical patients.
 The confidence level of the study was not calculated which makes it
difficult to determine the trueness of the findings in the study.

Appraisal cnt.
 The participants in the study present similar settings which
increases the applicability of the results.
 Generalizability of the findings is based on the strength of
RCTs where patients were randomized and controls used to
increased reliability.
 This study reported no harm to participants but rather the
control group patients reported better outcomes.
 This study can be generalized to other clinical situations due
to the intervention benefits reported in the control group.

Results
 RCTs are reported using quantitative data presentation tools.
 Beeckman, et al. (2019) reported reduced incidences of category
II-IV pressure ulcers in the intervention group.
 Camargo, et al. (2018) reported 80% difference in the
development of pressure ulcer between the control and the
intervention group.
 Nixona, et al. (2019) reported high benefits of using alternating
pressure mattresses as compared to with a long term economic
benefits to the government in reduced expenditure on treatment
and management of pressure ulcers.

Study Findings on Role of pressure
mattress in pressure ulcer prevention
 The mattress can be static or reactive air mattresses.
 Static mattresses contain multiple pressure-relieving foams for
distributing the weight over the surface lowering the risk of body
pressure.
 Airflow mattresses have lateral air cells for redistributing pressure
when the patient is on a dynamic surface.
 The mattresses are designed to offer high level pressure support in
different body areas.
 Static air mattresses are designed with air pockets

Findings: Role of pressure mattress cont.
 The mattress increases the quality of life of the patient
through increased comfort and spreading of body pressure.
 The design of pressure mattress allows healing of ulcers
through reducing the pressure exerted on the damaged area.
 Some mattresses have air cells which deflate and inflate to
allow healing.
 The pressure mattress is supposed to be selected based on
factors like skin assessment and the site at risk.

Limitations of pressure mattresses
 Pressure mattresses are expensive making their
affordability limited to a few hospitals on home care
centers.
 Static air mattresses are cheaper and more effective
since they can be easily afforded by most people and
healthcare provision centers.
 Studies did not consider the role other factors like
lifestyle and diet which can exacerbate or even
increase the healing of pressure ulcers.

Conclusion
 Healthcare centers with critically ill patients need to consider the
use of pressure mattresses.
 Where the facilities cannot afford the alternating mattress then
the static mattress can be used.
 Other viscoelastic support surfaces are also important in reducing
the risk of pressure ulcers.
 The assessment of the support surface for use within clinical
settings need to also include the needs of the patient.
 The support surfaces offer clinical and economic outcomes in
managing the problem and associated costs.

References
 Beeckman, D., Serraes, B., Anrys, C., Tiggelen, H. V., Van-Hecke, A., &
Verhaeghe, S. (2019). A multicentre prospective randomised controlled clinical trial
comparing the effectiveness and cost of a static air mattress and alternating air
pressure mattress to prevent pressure ulcers in nursing home residents.
International Journal of Nursing Studies, 97, 105-113. doi:
https://doi.org/10.1016/j.ijnurstu.2019.05.015
 Burns, P. B., Rohrich, R. J., & Chung, K. C. (2011). The Levels of Evidence and
their role in Evidence-Based Medicine. Plastic and reconstructive surgery,, 128(1),
305–310.
 Camargo, W. H., Pereira, R. d., Tanita, M. T., Heko, L., Grion, I. C., Festti, J., . . .
Grion, C. M. (2018,). The Effect of Support Surfaces on the Incidence of Pressure
Injuries in Critically Ill Patients: A Randomized Clinical Trial. Critical Care
Research and Practice, 10(5). doi: https://doi.org/10.1155/2018/3712067

 McGinnis, E., Brown, S., Collier, H., Faulks, P., Gilberts, R., Greenwood, C., .
. . Coleman, S. (2017). Pressure Relieving Support Surfaces: a Randomized
Evaluation 2 (PRESSURE 2) photographic validation sub-study: study
protocol for a randomized controlled trial. Bio Med Central, 18(132), 1-10.
doi:10.1186/s13063-017-1851-5
 Nixona, J., Smitha, I. L., Brown, S., McGinnisa, E., Vargas-alaciosi, A.,
Nelson, E. A., . . . Cla. (2019). Pressure Relieving Support Surfaces for
Pressure Ulcer Prevention (PRESSURE2): Clinical and Health Economic
Results of a Randomized Controlled Trial. Eclinical Medicine, 14.