The effect of using a low-air-loss surface on the skin integrity of obese patients: results of a pilot study.

Obese patients often are immobile, acutely ill, and at high risk for developing pressure ulcers when admitted to acute care facilities. Pressure-relieving mattresses are an integral part of a pressure ulcer prevention plan of care. Patients with a body mass index (BMI) >35, weight between 250 and 500 lb, and a minimum 3-day length of stay were recruited to participate in a pilot study to evaluate the safety and use of a new low-air-loss, continuous lateral rotation bariatric bed. Skin inspection was performed at the beginning and end of the study (maximum 7 days). Participants included 21 consecutively admitted patients (10 men, 11 women, average age 51.7 years [range 32 to 76], average BMI = 51.4 [range 37 to 71]) with an average Braden pressure ulcer risk score of 14.7 (range 9 to 21). Most (n = 11) were receiving treatment in the intensive care unit. Six patients had 10 pressure ulcers (six Stage I, four Stage II). Average length of stay on the surface was 4.8 days (range: 2 to 8 days); ulcers decreased from an average size of 5.2 cm2 to 2.6 cm2. No new pressure ulcers developed. Controlled clinical studies to assess the efficacy of pressure redistribution mattresses in this high-risk population are needed.

Prevention of pressure ulcers in patients being managed on CLRT: is supplemental repositioning needed?

OBJECTIVE: To determine if there is a difference in interface pressures for patients using continuous lateral rotation therapy (CLRT) without pillow repositioning compared with interface pressures for the same patients on CLRT with pillow repositioning. DESIGN: Quasi-experimental. SETTING AND SUBJECTS: Six critically ill but stable patients (4 female and 2 male, aged 20 to 86 years) in medical, surgical, and trauma intensive care units in a large urban, tertiary care hospital in the southwestern United States were investigated. INSTRUMENTS: Tissue interface mapping was completed using Xsensor cushions or full-body mats. METHODS: Tissue interface pressures were measured with and without pillow propping while on CLRT. RESULTS: No clinically relevant differences in interface pressure mapping were observed when CLRT with pillow repositioning was compared with CLRT alone. CONCLUSIONS: The results of this small pilot study suggest that positioning patients on pillows while on CLRT may not be necessary. Results also suggest that positioning with pillows may diminish pulmonary benefits of CLRT. Additional research is needed to confirm these hypotheses.