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Clinical Governance and Practice Development 

Table of Contents

An evidence summary.

Why change is needed.

Review question(s)

Methods.

Inclusion criteria for studies.

Search strategy.

Results.

The evidence.

Research gaps.

References.

An Evidence Summary

The document condenses current evidence on the comparison of using air mattress to normal mattress to reduce pressure injury in patients with reduced mobility.

Why Change Is Needed?

A mattress is essential for comfort while sleeping in case of healthy as well as sick people. For bedridden people or with a reduced ability to move, the choice of bed mattress is predominant. With the advancement of science, manually controlled mattresses are replaced with electronic ones. Selection of the perfect mattress depends on mainly three factors, firstly on the health condition of the patient, secondly on the size of the mattress, and third on the budget. Another important factor that should be kept in mind while choosing beds for bedridden patients is the prevention of bedsores (Shih et al., 2020). One needs to judge the habits of the patient while sleeping, whether he/she sleeps on the back or side while buying a mattress.

Regular or normal air mattress like innerspring is the most common, affordable form of mattress that is well adapted by anyone. But the use of this kind of mattress increases the chances of infections like ulcers and bedsores in case of reduced mobility patients because they spend most of their time in bed. In the case of elderly people, generally due to the absence of a minimal amount of fat the accumulation of pressure on common areas of strain while lying can result in reduced airflow and thus causing infection. Hence, the need for an air mattress for proper air circulation is indispensable (Richard‐Denis, Thompson& Mac‐Thiong, 2017).

Medical air mattresses are nowadays the most convenient for bedridden patients. They provide relief from pressure injuries by redistributing the patient’s weight more evenly across the surface of the mattress and increasing the airflow through the mattress so that the underside of the patient by supplying enough oxygen to let it remain dry and cool. Additional systems like smooth airflow systems through the mattress are also provided to ensure a dry, comforting feeling for the patient (Chai et al., 2017). Another type includes Micro-stimulation Technology that provides gentle stimulation to the nerve tracts of the body while the patient is sleeping to relieve the patient from soreness throughout the night. Air pumps used to fill up air for these air mattresses operate almost silently with negotiable vibrations so that the patient is not disturbed.

Customer feedback is satisfactory noting that they can barely feel the pump running but feels a significant decrease in moisture accumulation while in bed due to the reduced airflow. The user can also shift between two modes of air supply in certain mattresses. They are - alternating and static modes. In the alternating mode, airflow rate inside the mattress’s air cell regions takes place over time, whereas in the case of static mode the same consistent rate of airflow happens throughout the use. The only risk is the leakage of the airflow system due to excessive wear and tear which can be considered an exceptional case (Clark, Smith & Jones, 2018). Material quality used for building the mattress should also be taken into matter. Nylon cover can protect the skin by reducing friction. Anti-inflammable and anti-bacterial cover is also available.

The use of specialized gel memory foam-based cover can reduce night sweats, provide a cool sleeping experience by draining away the body heat, and prevent cramping. Water-resistant covers are also essential to drain away any kind of moisture. Another innovative model of airflow system is the use of air bubbles that not only promotes proper airflow but also helps in even weight distribution by altering the pressure distribution (Uttarachon, Sawattiganont & Kovindha, 2019). This innovative system of alternating pressure change occurs when each bubble cell deflates and inflates every six minutes oscillating the pressure between them. Therapeutically this method can release tension and discomfort from key pressure points like knees and shoulders also aiding skin maceration. The low air loss model of the airflow system works with multiple inflatable air tubes that can expand and flatten off, thus mimicking the movement of the patient who is changing the positions in bed. This air circulation not only heals ulcers but also prevents new ones from appearing.

Review Question (s)

In the patient with reduced mobility, does an air mattress compared to a normal mattress help to prevent or reduce pressure injury?

Methods of Dominance of Air Mattress to Normal Mattress

The pieces of evidence are collected from the best available evidence of intervention effectiveness identified from PubMed only.

Inclusion Criteria for Studies

Population

Human population aged between 40-80, especially people with reduced mobility

Intervention

Air mattress

 Comparisons

Normal mattress

 Outcomes

Air mattress provides more comfort and is therapeutically more beneficial with varied resources than a normal mattress.

Study types

Systemic reviews, meta-analyses, RCTs and economic evaluations.

Table 1: PICO (S)

(Source: Created by researcher)

Search Strategy

PubMed was used to search all the data for this project and the last five years’ articles were used to acquire better results thus giving a clear idea of how air mattresses are much superior in providing care and comfort in comparison to regular or normal mattresses.

  1. Patients who are generally more prone to bedsores and is aged (60-80) were taken into consideration.
  2. Air mattresses and their endless therapeutic benefits were brought under the light.
  3. Normal mattresses and their fewer advantages were less considered.
  4. After-effects of surgical site infection or postoperative infection were also taken into account (Meaume & Marty, 2018).

Results of Dominance of Air Mattress to Normal Mattress

Five randomized controlled (RCT) trials are selected for this study to gather proper information about the importance of air mattresses over normal mattresses for the patients suffering from pressure injury and with reduced mobility. No economic evaluations were found and no living entities were reported to harm because of the study.

Citation

(first author, date of publication, title)

Study design

Sampling and setting

(number of participants and where the study was conducted)

Level of evidence

Study findings (a major finding that is relevant to your review question)

Dekkers et al. (2018)

Effects of the SGLT-2 inhibitor dapagliflozin on glomerular and tubular injury markers.

RCT

n=33 with type 2 diabetes

Medium

Diabetes type 2 ensures pressure injury and air mattresses can help in post-operative situation

Carlson et al. (2019)

Lifestyle intervention for adults with spinal cord injury: Results of the USC-RLANRC Pressure Ulcer Prevention Study

RCT

n=166 for randomized trial

Medium

SCI populations have highly affected by pressure injury and proper care is needed for them

Kalowes, Messina & Li (2016)

Five-Layered Soft Silicone Foam Dressing to Prevent Pressure Ulcers in the Intensive Care Unit.

RCT

n=366 and this randomised controlled trial was conducted in intensive care unit of trauma hospital

Good

The incidence rate of HAPUs was significantly less in patients treated with the foam dressing than in the control group

Andrews et al. (2015) Hypothermia for Intracranial Hypertension after Traumatic Brain Injury.

RCT

n= 387 adults with intracranial pressure from 18 countries

Good

Air mattresses can be used for safety concerns of patients

Latimer et al. (2019)

Pressure injury prevalence and predictors among older adults in the first 36 hours of hospitalisation.

RCT

n= random participants collected from Facebook

High Quality

Isometric exercise is necessary for pressure injury patients to reduce its viability

Table 2: Summary of articles

(Source: Created by researcher)

The Evidence

This article is based on the studies from five journals collected from the PubMed search engine. The studies lighted up the period from 2015-2019 that is of the last five years.

Participants: Patients of reduced movement mainly old aged were considered. Although pressure injury occurs irrespective of age but mainly those people having low-fat content in their underside face major problems. Aged people have wrinkled skin that can cause friction and result in skin maceration.

Interventionand comparison: Patients with restricted mobility are estimated to be affected by serious health issues. So, they need proper rest and sleep. This condition requires lying in bed throughout the day. The underside of the lying surface is not at all exposed to air and thus can cause ulcers. In such cases, the regular mattress cannot provide the requisite airflow. Medical air mattresses provide fitful rest and comfort. Air mattresses have come up with modern technologies that don’t require manual control and come with exactly the need of the user.

The evidence collected from this summary has been grouped under the headings in accordance with the focus of the outcomes:

  1. Improved blood circulation - air mattresses can improve blood circulation and provide pressure relief to the patient. Since the pressure points can be changed, air mattresses provide a fresh feel to the patient (Al-Otaibi, Al-Nowaiser & Rahman, 2019).
  2. Changeable pressure points – since pressure points and the airflow can be easily changed it is unlikely that the patient will get bedsore.
  3. Latest technology and fireproofing- air mattresses mentioned in the articles are based on the latest technologies and should secure patients from any kind of fire hazard.

Research Gaps

This research has been conducted only with the older adults and no other populations and their effect for pressure injury has been detected. Therefore, this study is not complete in nature and evaluation of disadvantages for normal mattresses is also low in nature. On the other hand, only randomised controlled trial is selected for this study and no such systematic review or in-field survey has been conducted. Along with this, quantitative data analysis process has not been acquired by the researchers and this is quite problematic to deliver proper validity and reliability. Therefore, future improvements are needed for this study to ensure better validation and acceptability of data among participants can also be developed.

References for Dominance of Air Mattress to Normal Mattress

Al-Otaibi, Y. K., Al-Nowaiser, N., & Rahman, A. (2019). Reducing hospital-acquired pressure injuries. BMJ Open Quality, 8(1). Retrieved from: https://scholar.google.com/scholar?output=instlink&q=info:3ffsR88OltQJ:scholar.google.com/&hl=en&as_sdt=0,5&as_ylo=2016&scillfp=3328809591888694396&oi=lle

Andrews, P. J., Sinclair, H. L., Rodriguez, A., Harris, B. A., Battison, C. G., Rhodes, J. K., Murray, G. D., & Eurotherm3235 Trial Collaborators (2015). Hypothermia for Intracranial Hypertension after Traumatic Brain Injury. The New England Journal Of Medicine373(25), 2403–2412. Retrieved from: https://doi.org/10.1056/NEJMoa1507581

Carlson, M., Vigen, C., Rubayi, S., Blanche, E. I., Blanchard, J., Atkins, M., Bates-Jensen, B., Garber, S. L., Pyatak, E. A., Diaz, J., Florindez, L. I., Hay, J. W., Mallinson, T., Unger, J. B., Azen, S. P., Scott, M., Cogan, A., & Clark, F. (2019). Lifestyle intervention for adults with spinal cord injury: Results of the USC-RLANRC Pressure Ulcer Prevention Study. The Journal Of Spinal Cord Medicine42(1), 2–19. Retrieved from: https://doi.org/10.1080/10790268.2017.1313931

Chai, C. Y., Sadou, O., Worsley, P., & Bader, D. L. (2017). Pressure signatures can influence tissue response for individuals supported on an alternating pressure mattress. Journal Of Tissue Viability, 26(3), 180-188. Retrieved from: https://eprints.soton.ac.uk/410231/1/Pressure_signatures_can_influence_tissue_response_for_individuals.pdf

Clark, M, Smith, T, & Jones, N. (2018). Evaluation of static and powered hybrid mattresses. Wounds UK, 14(3). Retrieved from: https://www.woundsinternational.com/uploads/resources/9f3790937ba3b750497fc7d760d21813.pdf

Dekkers, C., Petrykiv, S., Laverman, G. D., Cherney, D. Z., Gansevoort, R. T., & Heerspink, H. (2018). Effects of the SGLT-2 inhibitor dapagliflozin on glomerular and tubular injury markers. Diabetes, Obesity & Metabolism20(8), 1988–1993. Retrieved from: https://doi.org/10.1111/dom.13301

Kalowes, P., Messina, V., & Li, M. (2016). Five-Layered Soft Silicone Foam Dressing To Prevent Pressure Ulcers In The Intensive Care Unit. American Journal Of Critical Care : An Official Publication, American Association Of Critical-Care Nurses25(6), e108–e119. Retrieved from: https://doi.org/10.4037/ajcc2016875

Latimer, S., Chaboyer, W., Thalib, L., McInnes, E., Bucknall, T., & Gillespie, B. M. (2019). Pressure injury prevalence and predictors among older adults in the first 36 hours of hospitalisation. Journal of Clinical Nursing28(21-22), 4119–4127. Retrieved from: https://doi.org/10.1111/jocn.14967

Meaume, S., & Marty, M. (2018). Pressure ulcer prevention using an alternating-pressure mattress overlay: The MATCARP project. Journal Of Wound Care, 27(8), 488-494. Retrieved from: https://www.theotshow.com/__media/libraries/exhibitor-press-releases/1111A9D7-5056-B759-2A1105C14422D938-image.pdf

Richard‐Denis, A., Thompson, C., & Mac‐Thiong, J. M. (2017). Effectiveness of a multi‐layer foam dressing in preventing sacral pressure ulcers for the early acute care of patients with a traumatic spinal cord injury: Comparison with the use of a gel mattress. International Wound Journal, 14(5), 874-881. Retrieved from: https://onlinelibrary.wiley.com/doi/am-pdf/10.1111/iwj.12710

Riel, H., Vicenzino, B., Jensen, M. B., Olesen, J. L., Holden, S., & Rathleff, M. S. (2018). The effect of isometric exercise on pain in individuals with plantar fasciopathy: A randomized crossover trial. Scandinavian journal of medicine & science in sports28(12), 2643–2650. Retrieved from: https://doi.org/10.1111/sms.13296

Shih, D. F., Wang, J. L., Chao, S. C., Chen, Y. F., Liu, K. S., Chiang, Y. S., ... & Lai, C. S. (2020). Flexible Textile-Based Pressure Sensing System Applied in the Operating Room for Pressure Injury Monitoring of Cardiac Operation Patients. Sensors, 20(16), 4619. Retrieved from: https://www.mdpi.com/1424-8220/20/16/4619/pdf

Uttarachon, K., Sawattiganont, N., & Kovindha, A. (2019). A prototype of an automatic mattress turning device: A study of Interface pressure at bony prominences in normal subjects. Asia-Pacific Journal of Science and Technology, 24(2). Retrieved from: https://so01.tci-thaijo.org/index.php/APST/article/download/141527/138604

Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Nursing Assignment Help

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