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Squirrel Medical® Class IIa Compliant Active Mattresses
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Squirrel Medical® Class IIa Compliant Active Mattresses
Improve Respositioning
Repositioningis one of the main pressure ulcer preventive measures. It is a current practice
in the intensive care units to turn the patient every 2h, however, this
frequency was reduced to 4h schedule as a standard protocol. A single-site open
label, parallel group randomised control trial involving 330 patients assessed
efficacy of each turning regime (2-h against 4-h) for the prevention of
pressure ulcer incidence (at least grade 2) in critical patients under invasive
mechanical ventilation.Active mattresses were used as a concomitant intervention in both groups
All repositioning was performed manually by the nursing stuff. The pressure ulcerincidence was 10.3% in the 3-h group and 13.4% in the 4-h group (P=0.73). Therewere no differences in the ICU mortality, hospital mortality, median mechanicalventilation duration or length of ICU. Significantly different was found adaily nursing workload, 21min/patient in the 2-h group versus 11min/ patient inthe 4-h group (P<0.001)
Assessmentof safety endpoints in the same study indicated that there was a significant
difference between 2 regimes with 47.9% for 2-h vs 36.6% for 4-h, P=0.02,For the composite end point of device-related adverseevents (all adverse events combined). Out of all adverse events assessed, only
endotracheal tube obstruction was different between the groups, 36.4% vs 30.5%
for 2-h and 4-h regimes respectively, P=0.065. All other adverse events
(unplanned extubation, loss of medical device, reintubation, cardiac arrest of
any cause, atelectasis, respiratory instability, clinical ventilator-associated
pneumonia) did not differ significantly between the groups.Asystematic comparative effectiveness review of Chou et al describes 6 trials
investigating the effect of repositioning on pressure ulcer incidence.One fair-quality cluster randomised trial with 213 participants found that
repositioning at a 30-degree tilt every 3 hours was associated with lower risk
for pressure ulcer incidence after 28 days compared to the standard of care (3%
vs 11%; RR 0.27, 95% CI 0.08 to 0.93). Another fair quality trial with 235
patients found no difference in risk of pressure ulcer development between
different repositioning intervals. Four other trials either found no effect of
repositioning on the pressure ulcer incidence or were susceptible to
confounding due to differential use of support surfaces .Aclinical trial involving 838 geriatric patients in nursing homes investigating
four different repositioning schemes in combination with pressure reducing
mattresses (viscoelastic foam) or standard institutional mattress followed up
for 28 days found no difference in the incidence of stage 1 pressure ulcers at
34.8 to 38.1% (all NS).The following repositioning regimes and mattresscombinations were evaluated: turning every 2h in combination with standard
institutional mattress, turning every 3h in combination with standard
institutional mattress, turning every 4h in combination with viscoelastic foam
mattress and turning every 6h in combination with viscoelastic foam mattresses.Whilethe difference in the incidence of stage 1 pressure ulcers was not significant,
development of the stage 2 and higher pressure ulcers was significantly reduced
in the group of 4h repositioning + viscoelastic foam mattress (3.0% vs 14.3% -
24.1% for other groups).References:
EPUAP. (2019). Prevention and treatment of pressure ulcers/injuries: Clinical practice guideline. Available at: https://www.epuap.org/guidelines/ [Accessed 19 June 2024].
Baker G, Bloxham S, Laden J, Gush R. Vascular endothelial function is improved after active mattress use. J Wound Care. 2019 Oct 2;28(10):676-682. doi: 10.12968/jowc.2019.28.10.676. PMID: 31600104.
Manzano, F. et al. (2014). Repositioning every 2 hours vs. every 4 hours. Journal of Critical Care, 29(4), pp.657.e1-657.e6. Available at: https://doi.org/10.1016/j.jcrc.2014.03.006 [Accessed 19 June 2024].
NICE. (2020). Pressure ulcers: Prevention and management. NICE guideline [NG179]. Available at: https://www.nice.org.uk/guidance/ng179 [Accessed 19 June 2024].
EPUAP. (2019). Prevention and treatment of pressure ulcers/injuries: Clinical practice guideline. Available at: https://www.epuap.org/guidelines/ [Accessed 19 June 2024].
NHS England. (2020). Pressure ulcer prevention guidance. Available at: https://www.nationalwoundcarestrategy.net/wp-content/uploads/2021/06/Pressure-ulcer-prevention-guidance[Accessed 19 June 2024].
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