title: Microcirculatory responses of sacral tissue in healthy individuals and inpatients on different pressure-redistribution mattresses.
abstract: OBJECTIVE
  The aim of this study was to explore the interaction between interface pressure, pressure-induced vasodilation, and reactive hyperaemia with different pressure-redistribution mattresses.
  
  
  METHODS
  A cross-sectional study was performed with a convenience sample of healthy young individuals, and healthy older individuals and inpatients, at a university hospital in Sweden. Blood flow was measured at depths of 1mm, 2mm, and 10mm using laser Doppler flowmetry and photoplethysmography. The blood flow, interface pressure and skin temperature were measured in the sacral tissue before, during, and after load while lying on one standard hospital mattress and three different pressure-redistribution mattresses.
  
  
  RESULTS
  There were significant differences between the average sacral pressure, peak sacral pressure, and local probe pressure on the three pressure-redistribution mattresses, the lowest values found were with the visco-elastic foam/air mattress (23.5 ± 2.5mmHg, 49.3 ± 11.1mmHg, 29.2 ± 14.0mmHg, respectively). Blood flow, measured as pressure-induced vasodilation, was most affected in the visco-elastic foam/air group compared to the alternating pressure mattress group at tissue depths of 2mm (39.0% and 20.0%, respectively), and 10mm (56.9 % and 35.1%, respectively). Subjects in all three groups, including healthy 18-65 year olds, were identified with no pressure-induced vasodilation or reactive hyperaemia on any mattress (n=11), which is considered a high-risk blood flow response.
  
  
  CONCLUSIONS
  Interface pressure magnitudes considered not harmful during pressure-exposure on different pressure-redistribution mattresses can affect the microcirculation in different tissue structures. Despite having the lowest pressure values compared with the other mattresses, the visco-elastic foam/air mattress had the highest proportion of subjects with decreased blood flow. Healthy young individuals were identified with the high-risk blood flow response, suggesting an innate vulnerability to pressure exposure. Furthermore, the evaluation of pressure-redistribution support surfaces in terms of mean blood flow during and after tissue exposure is not feasible, but assessment of pressure-induced vasodilation and reactive hyperaemia could be a new way to assess individualised physiological measurements of mechanisms known to be related to pressure ulcer development.
authors.affiliation: Department of Hand Surgery, Plastic Surgery and Burns and the Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Bergstrand
authors.affiliation: Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.|Department of Dermatology, Södra Älvsborgs Sjukhus, Borås, Sweden.
authors.forename: U
authors.initials: U
authors.lastname: Källman
authors.affiliation: Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: A-C
authors.initials: AC
authors.lastname: Ek
authors.affiliation: Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Engström
authors.affiliation: Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Lindgren
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001513:Beds; D001783:Blood Flow Velocity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006940:Hyperemia / Q000209:etiology / Q000503:physiopathology*; D007297:Inpatients; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D011312:Pressure / Q000009:adverse effects*; D003668:Pressure Ulcer / Q000209:etiology / Q000517:prevention & control*; D012447:Sacrum / Q000098:blood supply* / Q000503:physiopathology; D012881:Skin Temperature; D013548:Sweden; D014664:Vasodilation / Q000502:physiology*; D055815:Young Adult
keywords: interface pressure; pressure ulcer; pressure-induced vasodilation; reactive hyperaemia; tissue blood flow