Alternating pressure (active) air surfaces for preventing pressure ulcers
Journal article
Shi, C., Dumville, J. C., Cullum, N., Rhodes, S., Jammali-Blasi, A. and McInnes, E.. (2021). Alternating pressure (active) air surfaces for preventing pressure ulcers. Cochrane Database of Systematic Reviews. (5), pp. 1-164. https://doi.org/10.1002/14651858.CD013620.pub2
Authors | Shi, C., Dumville, J. C., Cullum, N., Rhodes, S., Jammali-Blasi, A. and McInnes, E. |
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Abstract | Background Objectives Search methods Selection criteria Data collection and analysis Main results Primary outcome: pressure ulcer incidence Alternating pressure (active) air surfaces may reduce the proportion of participants developing a new pressure ulcer compared with foam surfaces (risk ratio (RR) 0.63, 95% confidence interval (CI) 0.34 to 1.17; I2 = 63%; 4 studies, 2247 participants; low‐certainty evidence). Alternating pressure (active) air surfaces applied on both operating tables and hospital beds may reduce the proportion of people developing a new pressure ulcer compared with reactive gel surfaces used on operating tables followed by foam surfaces applied on hospital beds (RR 0.22, 95% CI 0.06 to 0.76; I2 = 0%; 2 studies, 415 participants; low‐certainty evidence). It is uncertain whether there is a difference in the proportion of people developing new pressure ulcers between alternating pressure (active) air surfaces and the following surfaces, as all these comparisons have very low‐certainty evidence: (1) reactive water surfaces; (2) reactive fibre surfaces; and (3) reactive air surfaces. The comparisons between different types of alternating pressure air surfaces are presented narratively. Overall, all comparisons suggest little to no difference between these surfaces in pressure ulcer incidence (7 studies, 2833 participants; low‐certainty evidence). Included studies have data on time to pressure ulcer incidence for three comparisons. When time to pressure ulcer development is considered using a hazard ratio (HR), it is uncertain whether there is a difference in the risk of developing new pressure ulcers, over 90 days' follow‐up, between alternating pressure (active) air surfaces and foam surfaces (HR 0.41, 95% CI 0.10 to 1.64; I2 = 86%; 2 studies, 2105 participants; very low‐certainty evidence). For the comparison with reactive air surfaces, there is low‐certainty evidence that people treated with alternating pressure (active) air surfaces may have a higher risk of developing an incident pressure ulcer than those treated with reactive air surfaces over 14 days' follow‐up (HR 2.25, 95% CI 1.05 to 4.83; 1 study, 308 participants). Neither of the two studies with time to ulcer incidence data suggested a difference in the risk of developing an incident pressure ulcer over 60 days' follow‐up between different types of alternating pressure air surfaces. Secondary outcomes The included studies have data on (1) support‐surface‐associated patient comfort for comparisons involving foam surfaces, reactive air surfaces, reactive fibre surfaces and alternating pressure (active) air surfaces; (2) adverse events for comparisons involving foam surfaces, reactive gel surfaces and alternating pressure (active) air surfaces; and (3) health‐related quality of life outcomes for the comparison involving foam surfaces. However, all these outcomes and comparisons have low or very low‐certainty evidence and it is uncertain whether there are any differences in these outcomes. Included studies have data on cost effectiveness for two comparisons. Moderate‐certainty evidence suggests that alternating pressure (active) air surfaces are probably more cost‐effective than foam surfaces (1 study, 2029 participants) and that alternating pressure (active) air mattresses are probably more cost‐effective than overlay versions of this technology for people in acute care settings (1 study, 1971 participants). Authors' conclusions Future studies should include time‐to‐event outcomes and assessment of adverse events and trial‐level cost‐effectiveness. Further review using network meta‐analysis adds to the findings reported here. |
Year | 2021 |
Journal | Cochrane Database of Systematic Reviews |
Journal citation | (5), pp. 1-164 |
Publisher | John Wiley & Sons |
ISSN | 1469-493X |
Digital Object Identifier (DOI) | https://doi.org/10.1002/14651858.CD013620.pub2 |
Scopus EID | 2-s2.0-85105664403 |
Open access | Published as ‘gold’ (paid) open access |
Research or scholarly | Research |
Page range | 1-164 |
Publisher's version | License File Access Level Open |
Output status | Published |
Publication dates | |
Online | 10 May 2021 |
Publication process dates | |
Deposited | 27 Aug 2021 |
https://acuresearchbank.acu.edu.au/item/8wqq5/alternating-pressure-active-air-surfaces-for-preventing-pressure-ulcers
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Publisher's version
OA_Shi_2021_Alternating_pressure_active_air_surfaces_for.pdf | |
License: CC BY-NC 4.0 | |
File access level: Open |
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