Review: alternative-foam mattresses and some operating-table overlays reduce pressure ulcers more than standard surfaces.

摘要

QUESTIONS Do pressure-relieving surfaces reduce pressure ulcers more than standard support surfaces? Are some types of pressure-relieving surfaces more effective than others? REVIEW SCOPE Included studies were randomised controlled trials (RCTs) that compared beds, mattresses, mattress overlays, and cushions in patients at risk of pressure ulcers and reported objective outcomes. Outcomes included incidence of new-pressure ulcers. REVIEW METHODS Medline, CINAHL, EMBASE/Excerpta Medica, CINAHL, Cochrane Wounds Group Specialised Register, CENTRAL, and Cochrane Library (all to Feb 2008), and reference lists were searched. Experts and manufacturers were contacted. 52 RCTs were included. MAIN BESULTS Constant low-pressure (CLP) supports. Of 8 RCTs comparing CLP supports with standard mattresses, 5 showed a benefit for alternative-foam mattresses (pooled risk reduction [RR] 60%, 95% CI 26 to 79). Water beds (1 RCT, RR 65%, CI 21 to 85) and Beaufort bead beds (1 RCT, RR 68%, CI 24 to 86) reduced pressure ulcers, but viscoelastic foam trolley mattresses did not (1 RCT). In 5 RCTs, a benefit for 1 type of alternative-foam mattress over another was found for Vaperm v Clinifloat (1 RCT, RR 64%, CI 41 to 78) and Maxifloat Foam Mattress replacement v Iris Foam Overlay (1 RCT, RR 58%, CI 4 to 82). In 11 often-underpowered or flawed RCTs, a benefit for 1 type of CLP support over another was found for Optima CLP mattress v standard hospital mattress (1 RCT, RR 94%, CI 1 to 100), foam body support v usual care (1 RCT, RR 85%, CI 53 to 95), and medical sheepskins v usual care (2 RCTs, pooled RR 58%, CI 19 to 78).