What is the best support surface in prevention and treatment, as of 2012, for a patient at risk and/or suffering from pressure ulcer sore? Developing French guidelines for clinical practice.
BACKGROUND
The use of support surfaces in the prevention and treatment of pressure ulcers prevention is an important part of care for a patient at risk and/or suffering from sore(s).


OBJECTIVE
Define which support surfaces to use in prevention and treatment of at-risk and/or pressure sore patients.


METHODS
A systematic review of the literature querying the several Pascal Biomed, PubMed and Cochrane Library databases from 2000 through 2010. RESULTS (GRADE A): In prevention, a structured foam mattress is more efficient than a standard hospital mattress. An alternating pressure mattress is more effective than a visco-elastic mattress limiting the occurrence heel pressure ulcers, but those that do occur are more serious. A low-air-loss bed is more efficient than a mixed pulsating air mattress in prevention of heel pressure ulcers. Some types of sheepskin can reduce sacral pressure ulcer incidence in orthopedic patients. Use of an overlay on an operating table limits the occurrence of peroperative and postoperative pressure ulcers. An air-fluidized bed improves pressure ulcer healing.


CONCLUSIONS
The data in the literature are not always relevant and do not suffice to dictate a clinician's choices. We are compelled to recognize the methodological limitations of many studies, the lack of corporate interest in conducting such studies and the relatively small number of available trials. However, the effectiveness of some support surfaces reaches a sufficient level of evidence, especially when they are associated with postural, hydration and nutritional measures.


CONCLUSIONS
Support surfaces are recommended in prevention and treatment of patients at risk and/or already suffering from pressure ulcer, and their use should constitute part of an overall preventive or curative strategy.
Pôle régional du handicap, centre de l'Arche, Saint-Saturnin, France. dcolin@ch-arche.fr
D
D
Colin
J-M
JM
Rochet
P
P
Ribinik
B
B
Barrois
Y
Y
Passadori
J-M
JM
Michel
D001513:Beds; D004867:Equipment Design; D061826:Foot Orthoses; D006801:Humans; D058638:Operating Tables; D017410:Practice Guidelines as Topic; D003668:Pressure Ulcer / Q000628:therapy*