title: Comparison of two repositioning schedules for the prevention of pressure ulcers in patients on mechanical ventilation with alternating pressure air mattresses.
abstract: OBJECTIVE
  The objective was to compare the effectiveness of repositioning every 2 or 4 h for preventing pressure ulcer development in patients in intensive care unit under mechanical ventilation (MV).
  
  
  METHODS
  This was a pragmatic, open-label randomized clinical trial in consecutive patients on an alternating pressure air mattress (APAM) requiring invasive MV for at least 24 h in a university hospital in Spain. Eligible participants were randomly assigned to groups for repositioning every 2 (n = 165) or 4 (n = 164) h. The primary outcome was the incidence of a pressure ulcer of at least grade II during ICU stay.
  
  
  RESULTS
  A pressure ulcer of at least grade II developed in 10.3% (17/165) of patients turned every 2 h versus 13.4% (22/164) of those turned every 4 h (hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.46-1.71, P = 0.73). The composite end point of device-related adverse events was recorded in 47.9 versus 36.6% (HR 1.50, CI 95% 1.06-2.11, P = 0.02), unplanned extubation in 11.5 versus 6.7% (HR 1.77, 95% CI 0.84-3.75, P = 0. 13), and endotracheal tube obstruction in 36.4 versus 30.5%, respectively (HR 1.44, 95% CI 0.98-2.12, P = 0.065). The median (interquartile range) daily nursing workload for manual repositioning was 21 (14-27) versus 11 min/patient (8-15) (P < 0.001).
  
  
  CONCLUSIONS
  A strategy aimed at increasing repositioning frequency (2 versus 4 h) in patients under MV and on an APAM did not reduce the incidence of pressure ulcers. However, it did increase device-related adverse events and daily nursing workload.
authors.affiliation: Intensive Care Unit, Hospital Universitario Virgen de las Nieves, C/Avenida de las Fuerzas Armadas, 2, 18014, Granada, Spain, franciscol.manzano.sspa@juntadeandalucia.es.
authors.forename: Francisco
authors.initials: F
authors.lastname: Manzano
authors.forename: Manuel
authors.initials: M
authors.lastname: Colmenero
authors.forename: Ana María
authors.initials: AM
authors.lastname: Pérez-Pérez
authors.forename: Delphine
authors.initials: D
authors.lastname: Roldán
authors.forename: María del Mar
authors.initials: Mdel M
authors.lastname: Jiménez-Quintana
authors.forename: María Reyes
authors.initials: MR
authors.lastname: Mañas
authors.forename: María Angustias
authors.initials: MA
authors.lastname: Sánchez-Moya
authors.forename: Carmen
authors.initials: C
authors.lastname: Guerrero
authors.forename: María Ángeles
authors.initials: MÁ
authors.lastname: Moral-Marfil
authors.forename: Emilio
authors.initials: E
authors.lastname: Sánchez-Cantalejo
authors.forename: Enrique
authors.initials: E
authors.lastname: Fernández-Mondéjar
mesh_terms: D001513:Beds; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D003668:Pressure Ulcer / Q000517:prevention & control*; D012121:Respiration, Artificial; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome