BN705: Pressure Mattresses and Their Use in Treating Pressure Ulcers

This report delves into the clinical issue of pressure ulcers, emphasizing their significance in nursing practice. Task one provides a comprehensive overview, defining pressure ulcers, exploring their causes (friction, shearing forces, pressure, and body surface force), and classifying them into four categories. It highlights the impact of prolonged pressure and impaired blood circulation, leading to tissue damage. The PICO framework is introduced, focusing on the use of pressure-relieving mattresses as an intervention. The report explores the mechanics of pressure ulcer development, linking external pressure to increased intestinal and venous pressure, ultimately affecting capillary arterial pressure and causing edema and tissue necrosis. Different types of pressure mattresses, including static/reactive, alternating/active, and hybrid mattresses, are described, and their effectiveness is discussed. Task two reviews two research articles, Malbrain et al. (2010) and Meaume & Marty (2018), which investigate the efficacy of pressure mattresses in preventing and treating pressure ulcers. The Malbrain study, a randomized controlled trial, compares reactive air and alternating pressure mattresses in ICU patients, while Meaume & Marty (2018) study assesses the incidence of pressure ulcers in patients using alternating mattress overlays. The report evaluates the methodology, generalizability, accuracy, reliability, and validity of the studies, concluding that pressure redistribution support surfaces are vital in managing pressure ulcers. The report also addresses the applicability and limitations of the studies, reinforcing the evidence-based practice of using pressure mattresses in healthcare.

Running head: USE OF PRESSURE MATTRESSES TO TREAT PRESSURE ULCERS
1
Use of Pressure Mattresses to Treat Pressure Ulcers
Student’s Name
University

USE OF PRESSURE MATTRESSES TO TREAT PRESSURE ULCERS 2
Use of Pressure Mattresses to Treat Pressure Ulcers
Introduction
Pressure ulcers are sores that develop on the skin and its underlying tissue due to
prolonged pressure on the skin. This means that people who are confined in bed or wheelchairs
for long periods of time. This means that any part of the body that is under pressure can be
affected. This calls for the need to use different devices to reduce the pressure and treat the
affected areas.
Problem=pressure ulcer patients
Intervention= use pressure relieving mattress
Comparison= effectiveness of pressure mattress in relieving pressure ulcer
Outcome= the use of pressure mattress to prevent and treat pressure ulcers
Task one: overview of pressure ulcer and pressure mattresses
Pressure sores or ulcers are areas that have been subjected to pressure thus leading to the
damage of the skin tissue. In most cases, these are vulnerable parts of the body that are affected
by blood circulation thus making the area to decay. This means that each patient presents
different pressure ulcers which are largely grouped into four categories: erythema of intact skin
that does not blanch when pressured; partial thickness skin loss; decubitus ulcers seen in full
thickness skin loss and full thickness skin loss with extensive destruction, or tissue necrosis
(Serrae, Leen, Schols, Hecke, & Verhaeghe, 2017). There are many factors that cause pressure
ulcers but four common ones are friction, shearing forces, pressure and the force exerted on a
uniform surface by the body. According to Reuler, Cooney, & Portland (2016), experimental
research that has been on the pressure gradient that causes the ulcers how that in the skin
capillary anterior, the limb pressure is 32mm HG, venous limb pressure is 12mm HG and

USE OF PRESSURE MATTRESSES TO TREAT PRESSURE ULCERS 3
medicapillary pressure is 20mm HG and thus the fact that the pressure is not equally distributed
when one is sleeping and only concentrate in focal areas means that somebody parts do not get
enough blood circulation which increases the pressure exerted on the surface, beyond the
biological one. this is how the pressure ulcer develops since the skin either suffers from friction,
shearing forces, pressure and the force exerted on a uniform surface by the body which leads to
the pressure ulcer.
Studies in pressure ulcer have revealed that negative intestinal fluid pressure in the body
is balanced with a positive solid tissue pressure to ensure that the total tissue pressure is zero.
This means that under normal conditions, it rear for people to remain in one position for over 25
hours thus this means that the body movements that one has led to the maintenance of the total
pressure at zero. However, when one is sick, they remain on one position for a long time thus
applying external pressure on the body, increasing intestinal pressure which in turn increases the
pressure in the venous limb which in turn increases the total tissue pressure which makes the
capillary arterial pressure to increase, leading to filtration arterial pressure, fluid filtration, edema
and autolysis (Van Leen, Hovius, Neyens, Halfens, & Schols, 2011). This how hoe the pressure
ulcer develops since the pressure gradient of the occlusion of lymphatic vessels impairs the
active contractility of the lymphatic thus leading to aerobic metabolic wastes accumulating in the
affected part thus causing tissue necrosis.
Thus to reduce this problem, Serraes & Beeckman (2016) argue that pressure mattresses
have been highly prescribed as the best option for preventing bed sores and keeping the patient
healthy. This is designed to increase comfort for the individual by providing high-level support
for different parts of the body thus ensuring that the pressure that they mount is reduced. Such
mattresses are carefully designed with air pockets that place pressure on the main pressure points

USE OF PRESSURE MATTRESSES TO TREAT PRESSURE ULCERS 4
in the body that create the sores. This means that there are different types of mattresses: static/
reactive mattresses, alternating or active mattresses, and hybrid or combination mattresses.
Static or reactive mattresses have multiple pressure relieving foams whose surface is
static thus allowing the even distribution of weight over the surface to lower pressure (Serraes &
Beeckman, 2016). Such mattresses, respond to the body shape, heat and movement of the body
making it easy for the patient to feel comfortable. Thus this mattress is more suited for ulcer
prevention rather than treatment. Thus to achieve the efficiency of the mattress, the caregiver
needs to regularly reposition and moved regularly to reduce the development of sores.
The air-flow mattress or alternating pressure mattress redistributes the pressure through a
dynamic lying surface. This type of mattress has lateral air cells that are constantly alternated to
control air-flow through a pump unit that is connected to the mattress. This pump inflates and
deflates the cells of the body. This means that when inflated, the cells provide support while
when deflated they provide relief (Misaki, et al., 2014). Since the pump alternately inflates and
deflates different areas of the mattress, it achieves the distribution of pressure on different body
parts to prevent or treat the pressure ulcer. The effectiveness of the mattress is to reduce the need
for manual repositioning which can be tiresome.
Lastly, the hybrid mattress combines the elements of static and alternating mattress
system to provide optimum pressure for the user (Jiang, Li, & Zhang, 2014). This means that the
mattress maintains a high level of comfort while at the same time increasing the efficiency that
the patient derives from the mattress.
Task two: article review
Malbrain, M., Hendriks, B., Wijnands, P., Denie, D., Jans, A., Vanpellicom, J., &
Keulenaer, B. D. (2010). A pilot randomised controlled trial comparing reactive air and

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active alternating pressure mattresses in the prevention and treatment of pressure ulcers
among medical ICU patients. Journal of Tissue Viability, 19, 7-15
Malbrain, Hendriks, Wijnands, Denie, Jans, Vanpellicom & Keulenaer (2010) study was
a randomized controlled trial that sought to compare the use of reactive air and alternative
pressure mattress in preventing and treating pressure ulcers in ICU patients. The study included
Ziekenhuis Netwerk Antwerpen, Campus Stuiven-berg, Antwerp, Belgium. The criteria for
inclusion were patients requiring mechanical ventilation with an estimated duration of at least
five days with intact skin or pressure ulcer sin during admission. The patients in the study were
blinded so that they did not know which group they belonged to. This means that the consent of
the patient was sought first since the patients were studied while in the ICU and unconscious.
The random study was based on two different devices ROHO®DRY FLOATATION® mattress
overlay (ROHO Inc, Belleville, IL, USA) or the NIMBUS 3 (ArjoHuntleigh, Luton,
Bedfordshire, UK) active alternating pressure mattress. The ROHO system is a manual reactive
low-pressure mattress while the NIMBUS 3 mattress is an automatic alternating pressure
mattress with 20 individual cells ((three head, eight torso, four, and five heels) that deflate
alternately within 10 minutes. To ensure that the results are reliable and not biased, all patients
were treated according to the protocol for the prevention of pressure ulcers.
During data collection, the basic demographics, the severity of the disease and
hematological data were collected at first. This was followed by daily inspection of bony
prominences by the ICU nurse where the outcomes were documented and then this was repeated
after one week. Any PU’s that developed were assessed independently by the doctor. To ensure
that all the information is captured, the nurse was supposed to document all the various positions
and their duration.

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The results showed that in the NIMBUS group, one patient developed sacral persistent
erythema and one that had sacral ulcer developed persistent erythema on the heel. In the ROHO
group, only two patients developed deep sacral PU and also one subject that sacral ulcer during
admission also developed persistent erythema on the heel. Further healing was high since three
five patients in the NIMBUS 3 group had pressure damage but none of them deteriorated since
all the ulcers improved with 18% of them remaining unchanged. On the other hand, the ROHO
group that was presented with a single overlay group presented no change in the nature of the PU
WITH 33% of the ulcers remained unchanged while 67% deteriorated.
Thus the study concluded that pressure redistribution support surfaces are important in
preventing and managing pressure ulcers in ICU patients. Thus the devices can be grouped into
constant low pressure and alternating pressure systems. Thus through the distribution of the body
on the surface of the mattress or period loading and off-loading the tissues allows the pressure to
be reduced thus leading to reduced pressure.
Applicability of the study
This study is relevant since it strongly recommends the use of the NIMBUS 3 mattress as
the best option for preventing and treating pressure ulcer since it has the same conclusions with
Moysidis, Niebel, & Bartsch (2011). This means that low-pressure therapy protocols are
unsupported and need to be studied further to establish their relevance before clinical adoption
(Pernik, et al., 2016). However, the study can be generalized by saying the pressure mattresses
are effective in preventing and treating pressure ulcers.
Limitation of the study
The main limitation of the study is that no one declared conflict of interest in the research
which may have compromised the results of the study.

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Validity and reliability
When compared with other studies that had been done in the US, existing evidence shows
the support for active mattresses as the best way for treating and preventing pressure ulcer. This
method has been highly appropriate for patients who are not able to support themselves. This
study is similar to other studies that have been carried out.
Meaume, S., & Marty, M. (2018). Pressure ulcer prevention using an alternating-pressure
mattress overlay: the MATCARP project. Journal of Wound Care, 27(8), 488-494
Meaume & Marty (2018) study focused on assessing the incidence of pressure ulcer in
patients that were lying in for 15-20 hours per day by using an alternating mattress overlay as a
way of reducing the pressure on the patient. This study was done on patients who had full
knowledge of what was going rather than a blinded study. This means that the study was based
on patients that were not clinically randomized but rather the circumstances that reflected the
needs of the research topic. Through a prospective observational study that was conducted in
three rehabilitation centers and then the participants followed up after 35 days. The inclusion-
exclusion criteria were patients who were eighteen years and above and were sitting in a chair for
at least two hours while lying between 15-20 hours per day on alternating-pressure mattress
overlay (AMPO). Weight is also an important element of pressure thus the patients were
supposed to weigh between 40-169 kgs based on the manufacturer’s specification of AMPO. The
data was then collected through monitoring of the patient by the care team. Visit information was
collected at the baseline and the patients were monitored for 35 days. Secondary objectives for
the study were collected through a five-point rating scale.
Reliability and validity of the study

USE OF PRESSURE MATTRESSES TO TREAT PRESSURE ULCERS 8
The reliability of any study is based on the relationship that the study has to other studies
that have been done before. The study reported that the factors for the prevalence and incidence
of the pressure ulcer are dependent on the degree of the patient’s condition. Thus in the study, it
was reported that in high-risk patients that were using the alternating pressure air mattress, it was
found to be effective since only 30% of the patients developed category two pressure ulcer.
When related to other studies it was reported that the incidence at 60 days was 10% which means
that the alternating pressure mattress is effective in reducing pressure ulcer (Rich, Shardell, &
Hawkes, 2011).
Applicability of the study
When compared to other studies that had been done before, it reported that the incidence
and prevalence of pressure ulcers were not just dependent on the pressure mattress but rather
other factors that can also contribute to the prevalence of the condition. These factors include the
type of prevention strategy adopted by the hospital. The risk of occurrence, the type of mattress
used and the preventive measures adopted (Moore & Cowman, 2015). This means that the level
will vary from patient to patient with high spinal cord lesions being the most common pressure
ulcers that are experienced.
Limitation
This study was also limited by the fact that it lacked a control group which could have
been used to assess the effectiveness of the chosen method. further, the follow-up period of 35
days seemed to be long since in some cases high-risk patients can develop the pressure ulcers
within a few. Soban, Hempel, Munjas, Miles, & Rubenstein (2011) suggests that pressure ulcers
can develop within a very short time thus they need to be studied based on the natur of the
patient rather than a general timeline for all patients. This means that the exclusion-inclusion

USE OF PRESSURE MATTRESSES TO TREAT PRESSURE ULCERS 9
criteria may have left out patients like the ones that had malnutrition. Thus the author calls for a
further review to understand the impact of using pressure mattress to reduce pressure ulcer.
Task three: recommendations
One way to treat pressure ulcers is repositioning of the patient to reduce the amount of
pressure that is applied to the ulcer. This means that to reduce pressure ulcer, there is a need to
ensure that the pressure exerted on the affected parts of the body is alternated every time now
and then. According to Sullivan & Schoelles (2013), proper positioning of the patient and
ensuring that the position and repositioning are achieved within the required interval is
paramount in reducing and treating pressure ulcer. This means that this is a multicomponent
approach that ensures there are proper mechanisms for positioning the patient to achieve the
intended clinical outcomes. Most organizations focus on the use of standardized risk assessment
methods through a three to five evidence-based practices to improve patient outcomes. This
implies that clinical regulations are important in designing the repositioning cycle to reduce the
pressure ulcer effects. Whether the patient is using alternating or manual pressure mattresses, the
repositioning interval needs to be uniform across the patient group to achieve the required
clinical outcomes (Jankowski & Nadzam, 2011). The facility needs to comply with the set
protocols and requirements in the use of devices like the pressure mattress to ensure that there
are proper mechanisms for increasing the effectiveness of the method.
Another recommendation is the use of implementation tools for audit and audit of the
patient. This means that for proper repositioning intervals to be monitored well by the
practitioner and the patient, it is important for proper training to both the health professional and
the patient to enable then understand the deficit areas that need to be addressed. Patient-centered
approaches focus on ensuring that the patient is empowered with the required clinical skills that

USE OF PRESSURE MATTRESSES TO TREAT PRESSURE ULCERS
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can enable him/her to respond to clinical indicators. This implies that reposition is not only a
practitioner role but rather a collaborative practice that the patient and the practitioner work
together to prevent and treat the pressure ulcer (Vermette, Reeves, & Lemaire, 2012). For
example, in some cases, the practitioners and the patient required training and education to
develop the clinical skills for meeting the needs of the patient. This means that the nurses need to
be trained with proper skills on how to implement the positioning strategy that the patients
require. This should be a collaborative process where the health professionals and the patients
work together to achieve the intended clinical outcomes. This means that the patient needs to be
assisted to learn the role of the positioning, the timing and the way the positions need to change
from one to another. This leads to better clinical outcomes.
Another recommendation is the need for hospitals to use active systems or alternating
pressure system mattresses for the prevention and treatment of pressure ulcers. There are
different machine tools and technologies that exist for the treatment and prevention of pressure
ulcers. However, Vanderwee, Grypdonck, & Defloor (2015) add that the most viable method is
the use of the active system yields more results since it periodically loads and offloads the tissue
leading to active pressure relief and re-establishing of perfusion which heals or prevents the
pressure ulcer. This means that an alternative system is the best since like the case of the
NIMBUS three, it loads and relieves pressure on different parts of the body leading to better
clinical outcomes. This supports the use of the alternating pressure mattress rather than the
inactive pressure mattress that requires the patient pressure to be controlled through the
repositioning of the patient within regular intervals. Thus this type of mattress takes care of all

USE OF PRESSURE MATTRESSES TO TREAT PRESSURE ULCERS
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the precautionary measures needed to assist the patient to prevent the development of pressure
ulcers and at the same time heal the ones that had started developing.
However, there is the need for proper research on the usefulness or application of the two
types of mattresses since patients present different clinical conditions that require varying needs
that call for proper documentation on the type of patients that they need to be applied to. For
example, patients with complete co-morbidities like those with hemodynamic instability require
more aggressive off-loading which means that their pressure needs to be held as low as possible
for a long time which will still lead to the development of pressure ulcers. This has been
highlighted by Malbrain, et al. (2010) which calls for the need of research to establish ways of
ensuring that the effectiveness of the mattress can be improved by considering the situations of
different patients within healthcare settings. This will be important in establishing ways of
correcting how pressure ulcer can be reduced by all means.
Lastly, Brindle, et al. (2013) suggest that there is need to balance between repositioning
of the patient and redistribution of pressure to achieve other secondary benefits like relieving
pain associated with maintaining constant positions and even muscle contracture. This calls for
the need for practitioners to improve their skills on how to balance between the two. Further, in
their study, Lahmann & Kottner (2011) different patients present different conditions. For
example, the elderly may require different levels of repositioning as compared to young people.
This calls for the need for proper research to establish the required clinical standards that
practitioners can use to meet their needs.
Conclusion

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Therefore, the pressure mattress is one of the best ways of treating and preventing the
development of pressure ulcers by the patient. Thus this device works by relieving the
distribution of body weight pressure, allowing blood circulation that is important in preventing
the ulcers. Whether it is the reactive or active mattress, the mechanism of working is the same
since they work on the distribution of pressure in the body reducing the challenge that the body
faces. This leads to both comfort and prevention of the body sores from developing on the
vulnerable parts. Thus the pressure mattress offers both clinical and physical benefits to the
patient who uses it to treat and prevent bedsores.

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References
Brindle, C. T., Malhotra, R., O'Rourke, S., Currie, L., Chadwik, D., Falls, P., . . . Creehan, S.
(2013). Turning and Repositioning the Critically Ill Patient With Hemodynamic
Instability: A Literature Review and Consensus Recommendations. Journal of Wound,
Ostomy and Continence Nursing, 40(3), 254–267.
Jankowski, J., & Nadzam, D. (2011). Identifying gaps, barriers, and solutions in implementing
pressure ulcer prevention programs. Journal of Quality Patient Safety, 37, 253-264.
Jiang, Q., Li, X., & Zhang, A. (2014). Multicenter comparison of the efficacy on prevention of
pressure ulcer in postoperative patients between two types of pressure-relieving
mattresses in China. Internationa Journal of Clinical Experience in Medication, 7(9),
2820-2827.
Lahmann, N. A., & Kottner, J. (2011). Relation between pressure, friction and pressure ulcer
categories: a secondary data analysis of hospital patients using CHAID methods.
International Journal of Nursing Studies, 48, 1487-1494.
Malbrain, M., Hendriks, B., Wijnands, P., Denie, D., Jans, A., Vanpellicom, J., & Keulenaer, B.
D. (2010). A pilot randomised controlled trial comparing reactive air and active
alternating pressure mattresses in the prevention and treatment of pressure ulcers among
medical ICU patients. Journal of Tissue Viability, 19, 7-15. Retrieved from
https://pdf.sciencedirectassets.com/276836/1-s2.0-S0965206X10X0002X/1-s2.0-
S0965206X09000643/main.pdf?x-amz-security-token=AgoJb3JpZ2luX2VjEPP%2F%2F
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Meaume, S., & Marty, M. (2018). Pressure ulcer prevention using an alternating-pressure
mattress overlay: the MATCARP project. Journal of Wound Care, 27(8), 488-494.
Retrieved from https://www.theotshow.com/__media/libraries/exhibitor-press-releases/
1111A9D7-5056-B759-2A1105C14422D938-image.pdf
Misaki, A., ImanishI, K., Takasugi, S.-i., Wada, M., Fukagawa, S., & Furue, M. (2014). Body
Pressure Sensing Mattress for Bedsore Prevention. Sei Technical Review, 96-99.
Moore, Z., & Cowman, S. (2015). Repositioning for treating pressure ulcers. The Cochrane
Database of Systematic Reviews, 1.
Moysidis, T., Niebel, W., & Bartsch, K. (2011). Prevention of pressure ulcers: interaction of
body characteristics and different mattresses. International Wound Journal, 8, 578-584.
Pernik, M. N., Seidel, H., Blalock, R., Burgess, A., Horodyski, M., Rechtine, G., & Prasarn, M.
(2016). Comparison of tissue-interface pressure in healthy subjects lying on two trauma
splinting devices: The vacuum mattress splint and long spine board. Injury, 47(8), 1801–
1805.
Reuler, J. B., Cooney, T. G., & Portland, O. (2016). The Pressure Sore: Pathophysiology and
Principles of Management. Annals of Internal Medicine, 94, 662-666.
Rich, S., Shardell, M., & Hawkes, W. (2011). Pressure-redistributing support surface use and
pressure ulcer incidence in elderly hip fracture patients. Journal of American Geriatric
Society, 6, 1052-1059.

USE OF PRESSURE MATTRESSES TO TREAT PRESSURE ULCERS
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Serrae, B., Leen, M. v., Schols, J., Hecke, A. V., & Verhaeghe, S. (2017). Prevention of pressure
ulcers with a static air support surface: A systematic review. International Wound
Journal, 5(1).
Serraes, B., & Beeckman, D. (2016). Static air support surfaces to prevent pressure injuries: a
multicenter Cohart study in Belgian nursing homes. Journal of Wound Ostomy Continued
Nursing, 43(4), 375-378.
Serraes, B., & Beeckman, D. (2016). Static air support surfaces to prevent pressure injuries: a
multicenter Cohart study in Belgian nursing homes. Journal of Wound Ostomy Continued
Nursing, 43(4), 375-378.
Soban, L., Hempel, S., Munjas, B., Miles, J., & Rubenstein, L. (2011). Preventing pressure
ulcers in hospitals: a systematic review of nurse-focused quality improvement
interventions. Community Journasl of Quality Patient Safety, 1(37), 245-252.
Sullivan, N., & Schoelles, K. M. (2013). Preventing In-Facility Pressure Ulcers as a Patient
Safety Strategy: A Systematic Review Free. Annals of Internal Medicine, 158(5), 410-
416.
Van Leen, M., Hovius, S., Neyens, J., Halfens, R., & Schols, J. (2011). Pressure relief, cold foam
or static air? A single center, prospective, controlled randomized clinical trial in a Dutch
nursing home. Journal of Tissue Viability, 20(1), 30-34.
Vanderwee, K., Grypdonck, M. H., & Defloor, T. (2015). Effectiveness of an alternating
pressure air mattress for the prevention of pressure ulcers. Age and Ageing, 34(3), 261–
267.

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Vermette, S., Reeves, I., & Lemaire, J. (2012). Cost effectiveness of an air-inflated static overlay
for pressure ulcer prevention: a randomized, controlled trial. Wounds, 24(8), 207-214.