Prevention of pressure ulcers with a static air support surface: A systematic review

Abstract

The aims of this study were to identify, assess, and summarise available evidence about the effectiveness of static air mattress overlays to prevent pressure ulcers. The primary outcome was the incidence of pressure ulcers. Secondary outcomes included costs and patient comfort. This study was a systematic review. Six electronic databases were consulted: Cochrane Library, EMBASE, PubMed (Medline), CINAHL (EBSCOhost interface), Science direct, and Web of Science. In addition, a hand search through reviews, conference proceedings, and the reference lists of the included studies was performed to identify additional studies. Potential studies were reviewed and assessed by 2 independent authors based on the title and abstract. Decisions regarding inclusion or exclusion of the studies were based on a consensus between the authors. Studies were included if the following criteria were met: reporting an original study; the outcome was the incidence of pressure ulcer categories I to IV when using a static air mattress overlay and/or in comparison with other pressure-redistribution device(s); and studies published in English, French, and Dutch. No limitation was set on study setting, design, and date of publication. The methodological quality assessment was evaluated using the Critical Appraisal Skills Program Tool. Results were reported in a descriptive way to reflect the exploratory nature of the review. The searches included 13 studies: randomised controlled trials (n = 11) and cohort studies (n = 2). The mean pressure ulcer incidence figures found in the different settings were, respectively, 7.8% pressure ulcers of categories II to IV in nursing homes, 9.06% pressure ulcers of categories I to IV in intensive care settings, and 12% pressure ulcers of categories I to IV in orthopaedic wards. Seven comparative studies reported a lower incidence in the groups of patients on a static air mattress overlay. Three studies reported a statistical (P < .1) lower incidence compared with a standard hospital mattress (10 cm thick, density 35 kg/m ), a foam mattress (15 cm thick), and a viscoelastic foam mattress (15 cm thick). No significant difference in incidence, purchase costs, and patient comfort was found compared with dynamic air mattresses. This review focused on the effectiveness of static air mattress overlays to prevent pressure ulcers. There are indications that these mattress overlays are more effective in preventing pressure ulcers compared with the use of a standard mattress or a pressure-reducing foam mattress in nursing homes and intensive care settings. However, interpretation of the evidence should be performed with caution due to the wide variety of methodological and/or reporting quality levels of the included studies.

The Standardized Pressure Injury Prevention Protocol for improving nursing compliance with best practice guidelines

“…Per the guideline, the critically ill patient requires a surface that immerses the patient to reduce pressure, and when the critically ill patient cannot be turned, the surface should be upgraded to an alternating pressure mattress. A recent systemic review reported that static air overlays can also reduce pressure injury risk in the intensive care unit (ICU) (Serraes et al., ). Delay in using an upgraded support surface for patients has also been associated with greater numbers of pressure injuries in the critically ill (Bly, Schallom, Sona, & Klinkenberg, ).…”

Prevention of pressure ulcers with a motorized air support in at-risk patients hospitalized in rehabilitation departments APAM + an observational prevalence study with historical control and incidence study

“…if this type of non-exhaustive assessment had been conducted in this study, the incidence of stage ii to iV pressure ulcers would have been 3.5%. These elements must be compared with the results of the incidence of stage ii to iV pressure ulcers resulting from a systematic review of the literature concerning 13 studies evaluating the effect of prevention with static air mattresses 13 and which shows an average incidence of 7.8% when using such supports. Under these conditions, the ratio of stage ii to iV incidences with axtair automorpho ® Plus and with static support is 0.44 (3.5%/7.8%) and corresponds to the ratio of 0.42 of the incidence of pressure sores with motorized air structures and with classical supports calculated by c. Shi 14 in a meta-analysis of 65 studies.…”

Independent risk factors for pressure ulcer development in a high‐risk nursing home population receiving evidence‐based pressure ulcer prevention: Results from a study in 26 nursing homes in Belgium

“…This result indicates that a static air support surface provides possibly protection against PU development. Indeed, static air support surfaces were suggested to be more effective in PU prevention than standard hospital mattresses and pressure‐redistributing foam mattresses . Several studies comparing the effectiveness of static air support surfaces with high technology support surfaces (eg, alternating pressure air mattresses) did not, however, find significant differences in effectiveness between these two types of support surfaces .…”

“…Indeed, static air support surfaces were suggested to be more effective in PU prevention than standard hospital mattresses and pressure‐redistributing foam mattresses . Several studies comparing the effectiveness of static air support surfaces with high technology support surfaces (eg, alternating pressure air mattresses) did not, however, find significant differences in effectiveness between these two types of support surfaces . As there is insufficient evidence about which pressure‐redistributing support surface is superior over another, decisions about which support surface to use should be based on an assessment including the risk of PU development, comfort, and general health state of the individual…”