title: Pressure ulcer incidence and progression in critically ill subjects: influence of low air loss mattress versus a powered air pressure redistribution mattress.
abstract: OBJECTIVE
  The primary objective of this study was to compare facility-acquired pressure ulcer incidence and progression of pressure ulcers present on admission in critically ill patients, using 2 different support surfaces.
  
  
  METHODS
  We completed a comparison cohort study in a surgical intensive care unit (ICU).
  
  
  METHODS
  The study setting was a 12-bed cardiovascular ICU in a university-based hospital in the Midwestern United States. The sample comprised 52 critically ill patients; 31 were placed on low air loss weight-based pressure redistribution-microclimate management system beds and 21 were placed on integrated powered air pressure redistribution beds.
  
  
  METHODS
  Prior to the start of the study, 5 low airloss beds were placed in open rooms in the cardiovascular surgical ICU. Inclusion criteria were anticipated ICU stay of 3 days, and patients did not receive a speciality bed for pulmonary or wound issues. Initial assessment of the patients included risk assessment and prior events that would increase risk for pressure ulcer development such as extended time in operating room, along with skin assessment for existing pressure ulcers. Subjects in both groups had ongoing skin assessment every 3 to 4 days and a subjective evaluation of heel elevation and turning or repositioning by the researcher. Data were collected until the subjects were dismissed from the ICU. Patients admitted to the unit were assigned to open rooms following the usual protocols.
  
  
  RESULTS
  The mean length of stay was 7.0 days, with an 8.1-day length of stay for subjects on "low air loss with microclimate management" beds (LAL-MCM) and 6.6 days on the integrated power pressure air redistribution (IP-AR) beds (P = NS). The incidence of pressure ulcers on the buttocks, sacrum, or coccyx was 0% (0/31) on the low air loss bed and 18% (4/21) on the IP-AR bed (P = .046). Five subjects had 6 pressure ulcers on admission. Two pressure ulcers on 2 patients worsened on the integrated power air redistribution beds, which required specialty bed rental costing the facility $4116. No subjects on the low air loss beds experienced worsening of existing pressure ulcer. One patient with a deep tissue injury present on admission improved on the LAL-MCM bed. The IP-AR beds were approximately 7 years old, and the LAL-MCM beds were new.
  
  
  CONCLUSIONS
  Critically ill subjects placed on low air loss beds with microclimate management in surgical ICUs had a lower pressure ulcer incidence than those placed on integrated powered air pressure redistribution beds. The clinical performance of the IP-AR surfaces may have been influenced by their age.
authors.affiliation: College of Nursing, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE 68198, USA. cberke@nebraskamed.com
authors.forename: Joyce
authors.initials: J
authors.lastname: Black
authors.forename: Christine
authors.initials: C
authors.lastname: Berke
authors.forename: Gail
authors.initials: G
authors.lastname: Urzendowski
mesh_terms: D000328:Adult; D001513:Beds / Q000592:standards*; D015331:Cohort Studies; D016638:Critical Illness / Q000628:therapy; D018450:Disease Progression; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011312:Pressure; D003668:Pressure Ulcer / Q000453:epidemiology* / Q000517:prevention & control; D011322:Primary Prevention / Q000379:methods; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017592:Skin Care / Q000379:methods; D014945:Wound Healing / Q000502:physiology; D014947:Wounds and Injuries / Q000628:therapy