Static mattresses and pressure ulcers

The American College of Physicians has published two evidence-based guidelines covering prevention and treatment of pressure ulcers

The American College of Physicians has published two evidence-based guidelines covering prevention and treatment of pressure ulcers, in an attempt to help physicians improve the quality of care and reduce waste.
The guidelines make three key recommendations:
  • Clinicians should perform a risk assessment to identify patients who are at risk of developing pressure ulcers
  • Clinicians should choose advanced static mattresses or advanced static overlays in patients who are at an increased risk of developing pressure ulcers
  • Alternating-air mattresses or overlays should not be used in patients who are at increased risk of pressure ulcers
The guidelines identify risk factors, including older age, black race or Hispanic ethnicity, lower body weight, cognitive impairment, physical impairment and other comorbidities, such as urinary or faecal incontinence, diabetes, oedema, impaired microcirculation, hypoalbuminaemia and malnutrition.
The authors recommend multiple treatment tactics aimed at alleviating conditions contributing to ulcer development, protecting the wound from contamination, maintaining a clean wound environment, promoting tissue healing through local wound applications, debridement and wound cleansing, using adjunctive therapies, and considering surgical repair.
The guidelines also recommend that clinicians should use:
  • Protein or amino acid supplementation to reduce wound size
  • Hydrocolloid or foam dressings to reduce wound size
  • Electrical stimulation as an adjunct to accelerate healing
However, the authors characterise these recommendations as 'weak', because the evidence supporting them was of low or moderate quality.
Qaseem A, Mir T, Starkey M et al. Ann Int Med 2015; 162: 359-69; Qaseem A, Humphrey L, Forciea M et al. Ann Int Med 2015; 162: 370-9
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