Patients with acute respiratory failure requiring prolonged intensive care have a high risk of pressure sore formation. These result from local circulatory failure in the skin and subcutaneous tissues. Hypoxaemia and impaired micro-circulation due to sepsis, shock, low cardiac output or use of sympathomimetic drugs may contribute to the pathogenesis. We tested in a randomised, controlled trial the prevention of pressure sores using a new antidecubitus mattress in patients requiring prolonged (more than five days) intensive care. Forty non-traumatised patients admitted to a multi-disciplinary intensive care unit (ICU) were randomised on day three to five of intensive care to be treated either on the antidecubitus mattress or on a standard hospital mattress. The final sample size was based on sequential analysis of the primary outcome variable (number of patients with pressure sore). Sixteen randomised patients were included only in the intention-to-treat analysis due to early death or discharge, or delayed availability of the antidecubitus mattress. None developed pressure sores. Twenty-four patients with 2.5 +/- 1.5 (range 1 to 7) organ failures at the start of study, all with acute respiratory failure, were actually treated (11 on the antidecubitus mattress, 13 on the standard mattress). No patient treated on the antidecubitus mattress developed pressure sores, whereas seven patients treated on the standard mattress developed a total of 13 pressure sores (p < 0.005 for both intention-to-treat and those actually treated). The pressure between skin and mattress, and the skin temperature at the area of pressure exposure were lower on the antidecubitus mattress. We conclude that the new antidecubitus mattress prevents pressure sores in intensive care patients with severe organ failures.

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