Specialty Bed

Abstract: Purpose The primary objective of this study was to compare facility-acquired pressure ulcer incidence and progression of pressure ulcers present on admission in critically ill patients, using 2 different support surfaces. Design We completed a comparison cohort study in a surgical intensive care unit (ICU). Subjects and setting The study setting was a 12-bed cardiovascular ICU in a university-based hospital in the Midwestern United States. The sample comprised 52 critically ill patients; 31 were placed on low air loss weight-based pressure redistribution-microclimate management system beds and 21 were placed on integrated powered air pressure redistribution beds. Methods Prior to the start of the study, 5 low airloss beds were placed in open rooms in the cardiovascular surgical ICU. Inclusion criteria were anticipated ICU stay of 3 days, and patients did not receive a speciality bed for pulmonary or wound issues. Initial assessment of the patients included risk assessment and prior events that would increase risk for pressure ulcer development such as extended time in operating room, along with skin assessment for existing pressure ulcers. Subjects in both groups had ongoing skin assessment every 3 to 4 days and a subjective evaluation of heel elevation and turning or repositioning by the researcher. Data were collected until the subjects were dismissed from the ICU. Patients admitted to the unit were assigned to open rooms following the usual protocols. Results The mean length of stay was 7.0 days, with an 8.1-day length of stay for subjects on "low air loss with microclimate management" beds (LAL-MCM) and 6.6 days on the integrated power pressure air redistribution (IP-AR) beds (P = NS). The incidence of pressure ulcers on the buttocks, sacrum, or coccyx was 0% (0/31) on the low air loss bed and 18% (4/21) on the IP-AR bed (P = .046). Five subjects had 6 pressure ulcers on admission. Two pressure ulcers on 2 patients worsened on the integrated power air redistribution beds, which required specialty bed rental costing the facility $4116. No subjects on the low air loss beds experienced worsening of existing pressure ulcer. One patient with a deep tissue injury present on admission improved on the LAL-MCM bed. The IP-AR beds were approximately 7 years old, and the LAL-MCM beds were new. Conclusions Critically ill subjects placed on low air loss beds with microclimate management in surgical ICUs had a lower pressure ulcer incidence than those placed on integrated powered air pressure redistribution beds. The clinical performance of the IP-AR surfaces may have been influenced by their age.

Abstract: Despite the widespread use of specialty bed products, the physiological mechanism of their benefit has not been evaluated. In this study, healthy subjects were used to study transcutaneous oxygen tension (TcPo2) and laser Doppler blood flow in pressure sore-prone areas on air-fluidized, low-air-loss, and adjustable air-mattress beds relative to a standard hospital mattress with and without an egg-crate mattress overlay. Measurements were obtained over the sacrum with the subject in the prone and supine positions, and over a greater trochanter with the subject in the prone and 90-degree lateral positions. Our results on healthy volunteers suggest that the specialty bed products maintain TcPo2 better than a standard bed when tissue is weighted. Further, the Clinitron had significantly higher TcPo2 when weighted than each of the other beds. Laser Doppler blood flow was much more variable. The weighted trochanter on the standard bed had the lowest blood flow, which is consistent with the TcPo2 readings. However, the variability made the laser Doppler flow data less valuable than the TcPo2. In conclusion, these data indicate that several products, particularly the Clinitron, maintain TcPo2 of weight-bearing tissue, which may be an important mechanism in protecting against pressure sores.

Abstract: Transport of critically ill patients for diagnostic and/or therapeutic management involves significant consumption of resources. In an effort to improve the delivery of care to these patients and decrease resource utilization, Hill-Rom (Batesville, IN, USA) have developed a self-contained device (CarePorterTM) designed to provide both intensive care unit (ICU) support and transport capability. We hypothesized that the use of the CarePorter when compared with a standard or specialty bed (with transfer to a stretcher) would decrease the number of personnel and time required for transport without altering the current ICU standards of care. Over a 3 month period, 35 ventilated patient transports were divided into the following groups: specialty bed to stretcher (n = 13), standard bed (n = 9) and CarePorter (n = 13). The APACHE II score at the time of transport was not different between the groups, nor was the ongoing care being delivered. The CarePorter group had a statistically greater fractional inspiration of oxygen and positive end expiratory pressure, when compared with the other two groups (P < 0.05). The use of the CarePorter device decreased the number of personnel required to transport a patient (2.1 ± 0.3 vs 3.6 ± 0.5 for the standard bed and and 3.2 ± 0.7 for the specialty bed; P = 0.0001). The CarePorter also decreased the number of resources utilized for the preparation of a patient for transport (P = 0.001) when compared to the other groups. This was primarily due to the transfer of patients from specialty beds to a stretcher. Overall respiratory therapy time was also much less with the CarePorter (5.9 ± 5.7 min), when compared with the standard (26 ± 10 min) or specialty bed (22 ± 11 min) (P = 0.0008). In addition, the CarePorter group also had a higher nursing satisfaction score with the overall transport (P = 0.008). Use of the CarePorter device resulted in maximization of the delivery of patient care, time savings, significantly improved utilization of escort personnel

Abstract: A survey of 788 patients on a specialty support surface, Pegasus Airwave System, in 119 hospitals or hospices in the United Kingdom during February and March 1991 provided the largest database on the current pattern of use of any pressure-relieving mattress. Fifty-four percent (n = 428) of the patients had established pressure ulcers. Seventy-nine percent (n = 261) of the patients on the specialty support surface for longer than five days showed visible signs of improvement. Nurses and patients expressed satisfaction with the support surface.(ABSTRACT TRUNCATED AT 250 WORDS)