A Multicenter, Comparative Study of Two Pressure-Redistribution Mattresses with Repositioning Intervals for Critical Care Patients

Jiang, Qixia; Liu, Yuxiu; Yu, Hui; Song, Siping; Li, Guohong; Liu, Haiying; Zhou, Yi; Zhu, Yajun Emily; Jia, Jing; Huang, Yunjuan; Wang, Jiandong

doi:10.1097/01.asw.0000653160.13611.5d

Cited by 14 publications

(59 citation statements)

References 23 publications

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“…Evidence regarding median time to pressure injury development varies; for example, recent acute care evidence shows a 2-5 day median time to pressure injury development when using high density foam mattresses and 4-hour repositioning. 22 TEAM-UP's 28-day follow-up period was longer than prior nursing home randomized control trials' intervention periods. 13,14 Prior research supports the adequacy of the 4-week Intervention time period to permit development of pressure injuries in the sample studied.…”

Section: Limitationsmentioning

confidence: 98%

Effect of Varying Repositioning Frequency on Prevention of Pressure Injuries in Nursing Home Residents: TEAM‐UP Cluster‐Randomized Clinical Trial Results

Yap

Horn

Sharkey

et al. 2021

Preprint

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Background: Pressure injuries (PrIs) cause pain and infection, lengthen institutional care, raise healthcare costs, and hasten death in nursing home (NH) residents. Repositioning residents to offload pressure on tissues is the most common prevention strategy, yetthe optimal interval remains uncertain.Objective: Investigate clinical effectiveness of three nursing-home-wide repositioning intervals (2-,3-, or 4-hours) without compromising PrI incidence in four weeks in adult nursing home residents.Design, Setting, and Participants: Anembedded pragmatic cluster randomized controlled trial was conducted in 9 NHs from a large proprietary system located in 34 states. Each NH was randomly assigned to one of three NH-wide repositioning interval Arms (every 2, 3, or 4 hours). Data were provided for 12-month Baseline and 4-week Intervention during the Turn Everyone And Move for Ulcer Prevention (TEAM-UP) study. Intervention residents were without current PrIs, had PrIrisk (Braden Score) ≥10 (low, mild, moderate, or high risk; not severe risk), and used viable 7” high-density foam mattresses.Methods: Each Arm included three NHs with assigned single repositioning interval as standard care during the 4-week Intervention. Mandatory staff education sessions were provided.A wireless patient monitoring system, using wearable single-use patient sensors, cued staff by displaying resident repositioning need on conveniently placed monitors.Primary outcome was PrI incidence; secondary outcome was staff repositioning compliance fidelity.Results: Eleven hundred residents from 9 NHs were fitted with sensors; 108 of these were ineligible for some analyses due to missing Baseline data. Effective sample size included 992 residents (mean age 78 years [SD13]; 63% female). Pressure injury incidence during the Intervention was 0.0% compared to 5.24% in Baseline, even though Intervention resident clinical risk scores were significantlyhigher (p<0.001). Repositioning compliance for 4-hour repositioning interval (95%) was significantly better than 2- (80%) or 3- (90%) hours (p<.001).Conclusions: This study contributes to understanding alternativerepositioning intervalssuggestingcurrent 2-hour protocolscan be relaxed for many without compromising PrI development. Causal link was not established between three repositioning interval treatments and primary outcome—PrIs; however, no new PrIs developed. Cueing staff may benefit repositioningimplementation; compliance improved as repositioning interval lengthened.Trial Registration: (ClinicalTrials.gov Identifier: NCT02996331).Date: 16/05/2017

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Section: Limitationsmentioning

confidence: 98%

Effect of Varying Repositioning Frequency on Prevention of Pressure Injuries in Nursing Home Residents: TEAM‐UP Cluster‐Randomized Clinical Trial Results

Yap

Horn

Sharkey

et al. 2021

Preprint

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“…There was no significant difference in the incidence of PI between APMs and HSFMs (Nixon et al, 2019) and contradicting results were reported in studies comparing APMs and VFMs (Jiang et al, 2020;Sauvage et al, 2017). One study (Sauvage et al, 2017) used an ITT analysis, but the dropout rates for APMs and VFMs were 28% and 17%, respectively.…”

Section: Discussionmentioning

confidence: 91%

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

Kim

et al. 2022

Worldviews Ev Based Nurs

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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.

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“…The use of a viscoelastic foam mattress with patient repositioning every 4 h had similar injury incidence compared with an air mattress with repositioning every 2 h [ 55 ].…”

Section: Resultsmentioning

confidence: 99%

The prevention of pressure injuries in the positioning and mobilization of patients in the ICU: a good clinical practice document by the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI)

Ippolito

Cortegiani

Biancofiore

et al. 2022

J Anesth Analg Crit Care

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Background The aim of this document is to support clinical decision-making concerning positioning and mobilization of the critically ill patient in the early identification and resolution of risk factors (primary prevention) and in the early recognition of those most at risk (secondary prevention). The addresses of this document are physicians, nurses, physiotherapists, and other professionals involved in patient positioning in the intensive care unit (ICU). Methods A consensus pathway was followed using the Nominal Focus Group and the Delphi Technique, integrating a phase of focused group discussion online and with a pre-coded guide to an individual phase. A multidisciplinary advisory board composed by nine experts on the topic contributed to both the phases of the process, to reach a consensus on four clinical questions positioning and mobilization of the critically ill patient. Results The topics addressed by the clinical questions were the risks associated with obligatory positioning and therapeutic positions, the effective interventions in preventing pressure injuries, the appropriate instruments for screening for pressure injuries in the ICU, and the cost-effectiveness of preventive interventions relating to ICU positioning. A total of 27 statements addressing these clinical questions were produced by the panel. Among the statements, nine provided guidance on how to manage safely some specific patients’ positions, including the prone position; five suggested specific screening tools and patients’ factors to consider when assessing the individual risk of developing pressure injuries; five gave indications on mobilization and repositioning; and eight focused on the use of devices, such as positioners and preventive dressings. Conclusions The statements may represent a practical guidance for a broad public of healthcare professionals involved in the management of critically ill patients.

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A Multicenter, Comparative Study of Two Pressure-Redistribution Mattresses with Repositioning Intervals for Critical Care Patients

Cited by 14 publications

References 23 publications

Effect of Varying Repositioning Frequency on Prevention of Pressure Injuries in Nursing Home Residents: TEAM‐UP Cluster‐Randomized Clinical Trial Results

Effect of Varying Repositioning Frequency on Prevention of Pressure Injuries in Nursing Home Residents: TEAM‐UP Cluster‐Randomized Clinical Trial Results

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

The prevention of pressure injuries in the positioning and mobilization of patients in the ICU: a good clinical practice document by the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI)

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