Reducing the Incidence and Prevalence of Pressure Injury in Adult ICU Patients with Support Surface Use: A Systematic Review

Abstract

GENERAL PURPOSE To provide information on the effectiveness of active and reactive support surfaces in reducing the incidence and prevalence of pressure injuries (PIs) in adult ICU patients. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will: 1. Distinguish features of active and reactive support surfaces used in the ICU.2. Compare the PI incidence in patients using a variety of support surfaces.3. Synthesize recommendations for the use of support surfaces to reduce the risk of PI in adult ICU patients. OBJECTIVE To identify and analyze scientific evidence on the effectiveness of active and reactive support surfaces in reducing the incidence and prevalence of pressure injury (PI) in adult ICU patients. DATA SOURCES PubMed, ProQuest, ScienceDirect, Wiley Online Library, ClinicalKey for Nursing, Cochrane Library, and secondary searches. STUDY SELECTION Studies were included if they related to support surfaces, involved adult ICU patients aged ≥18 years, and the primary outcome measured was incidence or prevalence of PI. The initial search resulted in 8,357 articles; after exclusions, 31 complete texts were assessed for feasibility. A total of eight articles were included in this review. A bias risk assessment was performed using the Cochrane Risk of Bias Assessment Tool. DATA EXTRACTION Data were extracted by one reviewer and summarized in a table of study results that was examined and verified by two other reviewers. DATA SYNTHESIS Reactive (constant low pressure) support surfaces included viscoelastic foam mattresses, static air mattresses, and low-air-loss mattresses, whereas the active support surface consisted of alternating-pressure air mattresses. Alternating pressure mattress and viscoelastic foam mattress use both resulted in significantly lower PI incidence. CONCLUSION Support surface use is limited, and no particular type is proven to be superior to others. Clinicians should select support surfaces based on their therapeutic features and how well they meet the patient’s particular needs.

Therapeutic Support for Pressure Injuries

“…This report includes 1 overview of reviews with an NMA, 1 5 SRs [14][15][16][17][18] (2 with meta-analyses 16,18 ), 2 RCTs, 19,20 and 6 non-randomized studies. [21][22][23][24][25][26] There was some overlap of studies included in the overview of reviews and SRs, and the degree of overlap is summarized in Appendix 5.…”

“…One SR 17 searched until June 2021, and 2 SRs 16,18 reported their search was updated to the end of 2019. The remaining 2 SRs 14,15 did not report the date ranges covered by their searches or when they conducted their searches. Three SRs [16][17][18] were restricted to RCTs only, while 2 SRs 14,15 included RCTs and non-randomized studies.…”

“…The remaining 2 SRs 14,15 did not report the date ranges covered by their searches or when they conducted their searches. Three SRs [16][17][18] were restricted to RCTs only, while 2 SRs 14,15 included RCTs and non-randomized studies. Two SRs 16,18 had broader inclusion criteria than this report: 1 SR had 8 relevant RCTs, 16 and the other SR had 29 relevant RCTs.…”

“…The first author of the overview of reviews was from the UK, 1 and the first authors of the SRs were from Australia, 16,18 Indonesia, 14 the UK, 17 and the US. 15 The primary studies included in these reviews came from Australia, Belgium, Brazil, Canada, China, Denmark, Finland, France, Germany, Iran, Italy, Japan, Netherlands, South Korea, Sweden, Turkey, the UK, and the US.…”

“…This SR 17 also focused on patients who remained seated for extended periods of time. Two SRs, 14,16 1 RCT, 19 and 2 non-randomized studies 23,24 focused on patients in the ICU. One SR 18 and 2 non-randomized studies 21,25 focused on patients in acute hospital settings.…”