[Table], Summary of included studies - The Prevention and Management of Pressure Ulcers in Primary and Secondary Care - NCBI Bookshelf

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Summary of included studies

Study	Intervention/comparison	Population	Outcomes	Length of study
Allman 1987⁶	Air-fluidised therapy (CLINITRON) repositioned every 4 hours versus conventional treatment (including 2-hourly turns, heel and elbow protectors, alternating-pressure mattresses).	People undergoing surgery aged 18 or over with pressure ulcers of all stages. Graded using the Shea staging system.	Median change in total surface area of ulcers; improvement in condition of pressure ulcer; pain response.	Mean 13 days follow-up (range 4-77 days).
Branom 2001²⁹	PressureGuard CFT (constant force therapy) (non-powered mattress) versus LAL mattress.	People in hospital from long term and sub-acute care centre specialising in ventilator-dependent adults and those with extensive wound care needs. Bedridden adults with a pressure ulcer at grade 3 or 4 on trunk or pelvis (classification system not reported).	Meeting the goals of pressure ulcer treatment as determined by medical team (including wound closure, maintenance of condition and preparation for flap). The rate of pressure ulcer healing over 8 weeks.	8-week follow-up.
Caley 1994³⁸	LAL bed (Monarch, Mediscus) versus LAL overlay.	People in acute care with existing pressure ulcers.	Median change in pressure ulcer area	Average 24-day follow-up.
Cassino 2013³⁹	Three-dimensional overlay (AIARTEX), made of 3-D macro-porous material vs dry viscoelastic polyurethane polymer overlay (AKTON)	Long-term care patients	Complete healing; improved; unchanged/worsened; suspension due to worsening; suspension due to intolerance; mortality; comfort	12 weeks
Clark 1998⁴⁴	ProActive 2 cushion (Pegasus) (cushion for day chairs and wheelchairs, seating automatically adjusts to an individual's weight) versus ROHO cushion (dry flotation system). All individuals had a Pegasus Airwave System in bed.	Elderly adults in 2 acute care hospitals and 2 nursing homes. Grade 2 pressure ulcers or above, classification system not reported.	Number of pressure ulcers healed completely; rate of healing (cm²/day); rate of healing (cm³/day).	Average 58.6 days (ProActive and 43.73 days (ROHO).
Day 1993⁵¹	Air suspension bed (Therapulse, Kinetic concepts); foam mattress overlay (Geomatt, SpanAmerica). Wound care standardised for 2 groups.	Hospitalised adults with existing grade 2-4 pressure ulcers, graded using the NPUAP classification system.	Mean pressure ulcer size (initial minus end) divided into grade 2 and grade 3/4 ulcers; mean comfort scores.	7-day follow-up.
Devine 1995⁵⁵	Alternating-pressure mattress (Nimbus I) (modular, with rows of figure-of-8 shaped cells; 2 sets of cells are inflated and deflated over 10 minute cycle) versus alternating-pressure mattress (Pegasus Airwave) (double layer mattress with a 3-cell alternating cycle lasting 7.5 minutes). All participants were subject to the standard hospital protocol for wound dressing; details of this were not provided.	Elderly adults in hospital with pressure ulcers of grade 2 or above. The classification system used was not specified.	Complete healing at 4 weeks; comfort; median rate of reduction in area (cm²/day); withdrawal rates by group and reasons for withdrawal.	4-week follow-up.
Evans 2000⁵⁶	Alternating-pressure mattress replacement system (APMRS) (Nimbus 3) versus alternating-pressure mattress replacement system (APMRS) for adults in hospital (P.Biwave, P.Airwave.P.Cairwave or AlphaXCell) or alternating-pressure mattress overlay (AlphaXCell or Quattro) for people in a nursing home. Turning and wound care was standardised for 2 groups.	People in a hospital or nursing home, aged over 65 years with either grade 2 or 3 pressure ulcer (classification system not reported), or grade 2 pressure ulcer and difficulty to reposition in bed, unable to tolerate 30 degree tilt, unable to move in bed, in bed for over 20 hours or 24 hours, over 108kg and bed-bound or who have undergone spinal anaesthetic.	Absolute and relative reduction in pressure ulcer surface area; comfort.	2-week follow-up period.
Ferrell 1993⁵⁹	LAL bed (KINAIR) versus 10cm convoluted foam overlay on top of standard foam mattress .Both groups had similar co-interventions as per standard care that is mobilisation as much as possible; 2-hourly turning during waking hours; avoidance of head-of-bed elevation; avoidance of dragging people on sheets; nutritional support; infection control.	Older adults in an elderly nursing home with multiple medical problems, and with trunk or trochanter pressure ulcers. Grade 2 pressure ulcers or above (Shea grading system).	Rate of healing; pressure ulcer surface area was traced twice/week on plastic film and area measured using planimetry; ulcers completely healed (covered with epithelium).	Median follow-up of 33 days (LAL group) and 40 days (foam mattress).
Groen 1999⁷³	Foam replacement mattress (3 layers of polyurethane foam designated as comfort, load-distributing and support layers) versus Secutex water mattress (placed on top of standard hospital mattress, 3 PVC sections holding 26 litres water each, with heating element).Standard turning protocol (every 2-3 hour) for both groups.	People in a nursing home, aged over 59 years with a pressure ulcer on trunk, grade 3 (superficial cutaneous or subcutaneous necrotic) or grade 4 (deep subcutaneous necrotic). The classification system used was not reported.	Proportion with healed pressure ulcers at 4 weeks; mean pressure ulcer severity score at 4 weeks.	4-week follow-up.
Keogh 2001⁸⁹	Profiling bed with a pressure reducing foam mattress or cushion versus flat-based bed with a pressure relieving or redistributing mattress or cushion.	People from 2 surgical and 2 medical wards; over 18 years old; Waterlow score of 15-25; tissue damage no greater than grade 1 (EPUAP grading system).	Proportion with healed grade 1 pressure ulcers.	5-10 days follow-up.
Makhsous 2009¹⁰⁸	Wheelchair cushion equipped with an individualised cyclic pressure-relief protocol versus regular wheelchair cushions. Treatment was specific to the individual and a variety of wound care modalities applied when required (topical wound dressings eg wound gel, hydrocolloid, alginate, foam and moisture barrier) also silver antimicrobial dressings and negative pressure wound therapy.	Wheelchair users with spinal cord injury (paraplegia or tetraplegia) with existing stage 2 or 3 pressure ulcers (classification system not specified) in the sacral and/or ischial area.	Healing of pressure ulcers; healing rate of pressure ulcers; PUSH score improvement; % surface area healing; % PUSH score improvement.	30 days follow-up.
Mulder 1994¹²³	Air suspension bed (Therapulse, Kinetic concepts) (a pulsating air suspension therapy – cushions alternatively inflate and deflate but classed as LAL rather than AP) versus convoluted foam mattress overlay. Wound care and repositioning standardised for both groups.	People in a nursing home with grade 3-4 pressure ulcers (International Association of Enterostomal Therapists staging system).	Wound closure; pressure ulcer improvement (pressure ulcer reduced by 1 grade or more, including healed completely).	Maximum 12-weeks' follow-up or until ulcers healed, whichever came first.
Munro 1989¹²⁶	Air-fluidised bed (Clinitron) versus standard care. The bed/mattress in the standard care group was not described. Sheepskins or gel pads were placed beneath ulcer areas. Standard care involved positioning and massage.	Males with grade 2 or 3 pressure ulcers (classification system not specified), expected to remain in hospital for at least 15 days.	Change in mean pressure ulcer area (mm²); individuals' perception of pain; patient satisfaction.	15-day follow-up.
Nixon 2006¹³⁶	Alternating-pressure overlay within 24 hours of admission versus alternating-pressure mattress within 24 hours of admission.	Adults over 55 years of age, from vascular, orthopaedic, medical or care of the elderly wards with an expected length of stay at least 7 days and Braden score of 1 or 2, or an existing grade 2 pressure ulcer (grading system not specified).	Proportion of people developing a new pressure ulcer of grade 2 or above; time to development of new pressure ulcers; proportion of participants developing a new pressure ulcer within 30 days; healing of existing pressure ulcers; patient acceptability; adverse events.	30-day follow-up.
Osterbrink 2005¹⁴⁵	Repose device versus small cell versus large cell.	Participants recruited from aged care facility, acute care hospitals and home care setting, over 18 years old, with at least 1 grade 2 pressure ulcer at any bony prominence (EPUAP classification). If recruited from hospital, must have been nursed on care of the elderly, neurological or surgical units.	Pressure ulcer healing success; weekly changes in pressure ulcer (ulcer size, grade, wound bed, edge appearance and local treatment).	Follow-up time as long as clinical circumstances allowed. Maximum duration 42 days.
Russell 2000¹⁶⁰	Two types of alternating cell mattress systems with pressure-relieving cushions: Huntleigh Nimbus 3 with Aura cushion and 4-hourly turning versus Pegasus Cairwave Therapy System with Proactive 2 seating cushion and 8-hourly turning.	Individuals from care of the elderly units with pressure ulcers of grade 2 and above (Torrance classification system). Average age 83.9 and 84.6 years in the 2 groups.	Pressure ulcer healing: all types, and divided into heel and sacral pressure ulcers at 12 and 18 months.	18-month follow-up.
Russell 2003¹⁶²	Alternating-pressure, multicell mattress with 10 minute cycle time (Nimbus 3) versus fluid overlay mattress (RIK static). All adults had standard 4-hourly repositioning, but could have additional turning at the individual's request.	Adults with grade 1 or 2 pressure ulcers (EPUAP classification) admitted to hospital. Mean age 80 years. Baseline Waterlow scores 21.8 and 21.3 in groups 1 and 2 respectively and baseline Burton scores 14.6 and 14.2.	Improved pressure ulcer response; length of hospital stay.	Length of follow-up unclear, but presumably until discharge from enrolment hospital.
Strauss 1991¹⁸⁰	Home air-fluidised therapy (CLINITRON) when grade 3 or 4 prsesure ulcers present, plus the consultative and technical services of a visiting nurse specialist versus conventional or standard therapy, individual specific and prescribed (n=50), but included alternating –pressure pads, air-filled mattresses, water-filled mattresses, high density foam pads.	People: with at least 1 grade 3 or 4 pressure ulcer (Shea classification); who would probably require future hospitalisation for the pressure ulcer; with severely limited mobility; for who home air-fluidised therapy was a practical option, likely to comply, live at least 1 year; aged 16 years or over.	Pressure ulcers classified by blinded observers as improved; unchanged; worse; or not accessible; pressure ulcer-related hospitalisations and costs per patient; pressure ulcer-related hospital days per person.	36-week follow-up

From: 6, Pressure redistributing devices

Cover of The Prevention and Management of Pressure Ulcers in Primary and Secondary Care

The Prevention and Management of Pressure Ulcers in Primary and Secondary Care.

NICE Clinical Guidelines, No. 179.

National Clinical Guideline Centre (UK).

London: National Institute for Health and Care Excellence (NICE); 2014 Apr.

Copyright © National Clinical Guideline Centre, 2014.

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