Abstracts

S. Bale, H. Crook, R. lloyd-Jones, V. Banks, s. hagelstein, S. Rees-Mathews, K. G. Harding. Interim results of a randomized controlled trial of two pressure-releiving systems in the prevention of pressure sores in patients with a fractured neck of fumur.  7th European Conference on Advances in Wound Management, Harrogate, 18-20 November 1997.

The use of a new air filled mattress (Repose) in the prevention of pressure sores in high-risk patients

Presenter: S. Bale, Wound Healing Research Unit, University of Wales College of Medicine, Cardiff, UK Co-authors: H. Crook, R. Lloyd-James, S. Rees-Mathews, V.Banks and K.G. Harding, Wound Healing Research Unit, University of Wales College of Medicine, Cardiff, UK 

A prospective randomized study of two mattresses, Repose (Frontier Therapeutics Ltd) and Nimbus 11 (Huntleigh Healthcare), was performed on patients over the age of 60 admitted with a fractured neck of femur.  The patients had a Medley score of at least 25, indicating that they were at high risk of developing pressure sores.  Patients were recruited in the accident and emergency department and followed for up to 14 days post-operatively. 
Of the first 45 patients recruited to the study, 23 patients (five male, 18 female, mean age 84.9 years) were treated with a Nimbus 11 mattress and 22 patients (five male, 17 female, mean age 83.9 years) were treated with Repose.  Sixteen patients treated with Nimbus 11 completed the 14day post-operative period, two patients died within this time, four were withdrawn because of their clinical condition or requested to be removed from the mattress, and one was discharged home within this period.  Fifteen patients treated with Repose completed the 14-day post-operative period, one patient died, two were withdrawn because of their clinical condition, three were discharged home within this period, and in one case the mattress deflated. 
In the Nimbus 11 group, seven patients developed grade 1 pressure sores on sacrum, heels or ankles (non-blanching erythema).  In the Repose group, six patients developed grade 1 sores on sacrum, heels or elbows.  This study shows that there is no difference in the numbers of high-risk patients who develop pressure sores when they are treated with either of these two mattress systems 
This study was sponsored by Frontier Therapeutics Ltd. 

T. Defloor, M. Grypdonck. The effect of sitting position and cushion on the development of pressure ulcers. European Pressure Ulcer Advisory Panel Meeting. Oxford September 1997.

The effect of sitting position and cushion on the development of pressure ulcers.

Tom Defloor , Mieke Grypdonck 
Department of Nursing Science, University of Gent, Gent, Belgium 

Many patients spend more time in a chair than in bed. In a chair the pressure on the contact surface is very high and the risk of pressure ulcers increases considerably.

 
Research questions: what is the influence of body posture on the pressure at the seat surface? 
To what extent do different cushions reduce the maximum pressure in persons sitting in various positions in a hospital chair or on an armchair. 

Methods: Pressures were measured on 56 healthy volunteers in 7 positions: sitting upright or back in an armchair with feet on the ground or with lower legs on the ground, slid down, slouched at an angle of 15 degrees, sitting upright on a chair. Based on the pressure measurements of 29 different cushions, 4 cushions were selected for pressure reduction. The measuring system consisted of 342 sensors filled with air and connected to a computer system. 

Results: The pressure while sitting upright on a chair was 51.41+/- 3.4 mmHg and in an armchair 40.7 +/- 6.5 mmHg. The maximum pressure on persons lying in a semi-Fowler position on a traditional hospital mattress appears to be 30.3 +/- 5.5 mmHg. (4593) thus sitting on a chair or in an armchair increases the risk of pressure ulcers.  
The position in which the lowest maximum pressure was measured is the sitting back position with the lower legs on a rest (37.9 +/- 5.8 mmHg). If the seat can not be tilted back. The maximum pressure in the upright sitting position with the feet on the ground is significantly lower than sitting upright with the legs supported on a rest (t(280)= -9.5:p<0.0001: 95% CI=-3.69, -2.42). 

Sliding down and slouching caused the highest maximum pressure. Regular checking of the posture and using positioning cushions should form part of any pressure ulcer prevention protocol. 
The selected cushions each have different pressure reducing effects. A thick air cushion (Repose)) has the lowest maximum pressure (35.3 +/- 4.3 mmHg and is significantly better than the other cushions in reducing the high pressure when slouching or sliding. 
Conclusions: The risk of occurrence of pressure ulcers in sitting position is very high. Correctly positioning the patient reduces the pressure exerted on the tissue. In a slouched or slipped position very high pressures were measured. Thick air cushions perform best in reducing the pressure, especially in a slouched or slipped posture. 

Papers

S. Bale, H. Crook, R. lloyd-Jones, V. Banks, s. hagelstein, S. Rees-Mathews, K. G. Harding. Interim results of a randomized controlled trial of two pressure-releiving systems in the prevention of pressure sores in patients with a fractured neck of fumur. Proceedings of the 7th European Conference on Advances in Wound Management, Harrogate, 1997. Ed D. Leaper, C. deley, P. J. Franks D. Hofman, C. J. Moffatt. 1998 pages 127-128.