These high-tech air
mattresses are also known as alternating-pressure mattresses, as these contain
air pockets that inflate and deflate alternately to continuously change the
pressure points exerted on the patient's skin.
The cost of these
high-end mattresses is around £1,000 or USD 1,217 each. In comparison,
specialist foam mattresses cost only £200 or USD 243 each and are made of
superior-quality polyurethane and viscoelastic foam, designed to reduce
pressure on the patient's skin.
foam mattresses are widely used in UK hospitals across the National Health
Service (NHS), the high-tech air mattresses are present in only 10 percent of
hospital beds under the NHS and are specifically reserved for patients at high
risk of developing pressure ulcers.
Since there has
been no study to evaluate the efficacy of these high-tech air mattresses, the
National Institute for Health and Care Excellence (NICE), under the UK
Government's Department of Health, called for a scientific trial of these
high-tech mattresses. This present study was conducted in response to the
recommendation by NICE.
That study was led by Dr. Jane
Nixon, PhD, MBE, who is a Professor of Tissue Viability and Clinical Trials
Research and Deputy Director at the Institute of Clinical Trials Research,
University of Leeds, UK. The study findings have been published in EClinicalMedicine
which is a constituent journal of The
Why are Pressure Ulcers Dangerous?
Pressure ulcers, also known as bed ulcers, are injuries to
the skin and underlying tissues that arise due to prolonged pressure exerted on
the skin. These usually occur in patients who are bedridden or immobile. The
cumulative pressure build-up causes distortion of the tissues, as a result of
which the blood supply to the affected area may be cut-off. This kills the
tissues due to reduced oxygenation, leading to the development of painful ulcers.
are graded on the basis of severity,
which ranges between 1 and 4. Grade 1
is the least severe, while grade 4 is the most severe. In very severe cases,
bacterial infections can lead to the development of gangrene, which requires
emergency medical care, as otherwise amputation may be required. Hence,
pressure ulcers can
have dangerous consequences.
The NHS in the UK
considers pressure ulcers to be a 'concerning and avoidable harm
.' Importantly, 2018
data indicate that treatment of pressure ulcers
costs the NHS a
staggering £3.8 million every day!
Key Features of the Study
- World's first large-scale study to compare the
efficacy of high-tech air mattresses vs
specialist foam mattresses for preventing pressure ulcers
- The study recruited 2,000 patients at high risk of
developing pressure ulcers
- Patients were mainly from hospitals and community
units run by the NHS, UK
- The majority of the patients were elderly (median
age: 81 years), with some aged over 100 years
- The patients were randomly allocated to either a high-tech air mattress group or specialist foam
- The study period was 2 months or until the time of
discharge, whichever was earlier
- The patients were followed-up for 1 month after the
end of the study
Nixon says: "The
professional guidelines tell healthcare staff that they should use specialist
foam for all at-risk patients and high-tech air mattresses for patients with an
existing pressure ulcer when adequate pressure distribution cannot be
She adds: "But in
practice, some nurses provide high-risk patients as well as those with existing
pressure ulcers with the high-tech air mattresses and there has not been any
evaluation of the effectiveness of one type of mattress over another."
Key Findings of the Study
- High-tech air mattresses were marginally better
than specialist foam mattresses
- Out of 50 patients allocated to high-tech air
mattresses, only one patient benefitted
- 6.9 percent of patients on high-tech air mattresses
developed Grade 2 pressure ulcers (blister or
- 8.9 percent of patients on specialist foam
mattresses developed Grade 2 pressure ulcers
- Median length of time taken for ulcer development
was 18 days in patients using high-tech air mattresses
- Median length of time taken for ulcer development
was 12 days in patients using specialist foam mattresses
- Total number of patients who developed pressure ulcers during the study period was lower than expected,
possibly arising from improvements in nursing practice
Benefits of High-Tech Air Mattresses
mattresses are beneficial for patients who are completely bedridden, confused,
and deep red skin coloration at the pressure point.
There are also economic benefits of using high-tech air mattresses. Although
they are costly to buy, they are capable of slightly decreasing the time of
hospitalization, thereby reducing the overall cost incurred for patient care.
However, there is a need for further research to evaluate how the mattress type
is correlated with the duration of hospital stay.
Drawbacks of High-Tech Air Mattresses
Some of the
drawbacks of high-tech air mattresses arise from patient dissatisfaction. Many
patients find these mattresses to be uncomfortable, unsafe (due to movement),
and noisy (due to the pump), which makes it difficult for them to fall asleep.
Moreover, patients undergoing rehabilitation often complain that they're unable
to move about by themselves or get in and out of bed without assistance,
thereby exacerbating their already existing limited mobility.
The research team indicates that although
there are some benefits of high-tech air mattresses, they advise nurses to use
specialist foam mattresses for most patients.
Nixon concludes: "The
outcome of this study provides the evidence that specialist foam mattresses are
appropriate for most patients who are at high risk of developing pressure
She adds: "But staff
should be free to exercise clinical discretion in provision of either mattress,
informed by patient preference, comfort or rehabilitation needs as well as
specific risk factors such as being completely immobile, being confused, having
nutritional deficits or early signs of pressure damage."
The study was
funded by the UK National Institute for Health Research (NIHR) Health
Technology Assessment Program. Additional support was provided by the Pressure
Ulcer Research Service User Network (PURSUN UK), which is located in the
Clinical Trials Research Unit (CTRU) at the University of Leeds, UK.
- Pressure Relieving Support Surfaces for Pressure Ulcer Prevention (PRESSURE 2): Clinical and Health Economic Results of a Randomized Controlled Trial - (https://doi.org/10.1016/j.eclinm.2019.07.018)