Patients with a spinal cord injury (SCI) have a higher risk to develop a pressure ulcer during a hospital stay. Combining real time pressure interface measurements with an alternating air-pressure seat cushion may be a feasible and superior option to decrease the development of pressure ulcers in SCI patients

Brotto, Marco

Pollack, DonnaLee A.

English

Sigma Repository

Leadership Connection 2018 (15-18 September) Literature Review: Combining Interface Pressure Measurements with an Air Cushion to Prevent Pressure Ulcers DonnaLee A. Pollack, MSN, MPH, CWOCN-AP Marco Brotto, PhD College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA Introduction: Pressure ulcers are wounds that result from tissue ischemia secondary to decreased perfusion when unrelieved pressure occurs on the skin and underlying tissue. Patients with pressure ulcers experience higher rates of morbidity and mortality. Pressure ulcers directly associate with longer and more costly hospital admissions. Patients with a spinal cord injury (SCI) have a higher risk to develop a pressure ulcer during a hospital stay. Higher sitting pressure measurements are associated with a higher incidence of pressure ulcers. Methods: We conducted a systematic literature review to determine current practices to decrease pressure ulcers in SCI patients. Results: The Braden Scale is the standard measurement tool used to assess risk factors for pressure ulcer development in patients. Current strategies to prevent pressure ulcers focus on recommendations based on the Braden Scale Score. These strategies include using a pressure reduction surface for sitting. The strategies for prevention of pressure ulcers for SCI patients include specific recommendations for seat cushions to prevent ischia and sacral pressure ulcers. Factors that need consideration for seat cushion fitting for SCI patients are the amount of time a patient spends in the wheelchair daily, whether or not the patient can independently change position, level of sensation over the ischia, muscle strength or atrophy, and any systemic co-morbidities that would affect circulation and healing. The standard of care includes proper fitting of the wheelchair to the patient and using computer modeling to determine interface pressure over the ischia. Alternating air-pressure seat cushions are superior to static foam seat cushions for pressure ulcer prevention. Real-time (RT) pressure mapping allows creating custom foam seat cushions, but our systematic review did not identify any studies testing whether combining RT pressure interface measurements with an alternating air-pressure seat cushion would decrease the development of pressure ulcers in SCI patients. Conclusion: In our systematic review, no studies tested whether combining RT interface measurements with an alternating air-pressure seat cushion would decrease the development of sacral and ischia pressure ulcers in patients with spinal cord injuries. We postulate that combining RT pressure interface measurements with an alternating air-pressure seat cushion may be a feasible and superior option to decrease the development of pressure ulcers in SCI patients. Our next step will be to conduct a RCT testing our hypothesis.   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Wound Repair and Regeneration, 23, 753-758. doi:10.1111/wrr.12335  Abstract Summary: Patients with a spinal cord injury (SCI) have a higher risk to develop a pressure ulcer during a hospital stay. Combining real time pressure interface measurements with an alternating air-pressure seat cushion may be a feasible and superior option to decrease the development of pressure ulcers in SCI patients.  Content Outline: Introduction I. Magnitude of Problem A. Prevalence of pressure ulcers B. Population description II. Impact of Problem A. Morbidity and mortality B. Financial impact III. Pressure Ulcer Etiology A. Mechanism of injury B. Staging of pressure ulcers IV. Factors related to pressure ulcer development A. Braden Scale 1. Sensory perception 2. Moisture 3. Activity 4. Mobility 5. Nutrition 6. Friction and shear V. Current strategies for pressure ulcer prevention A. Interventions based on Braden Scale score B. Interventions for Spinal Cord Injury patients 1. Custom seat cushion fitting 2. Cushion characteristics a. Interface pressure measurements b. Air cell cushions i. Static air cell cushions ii. Alternating air cell cushions VI. Recommendations for further study First Primary Presenting Author Primary Presenting Author DonnaLee A. Pollack, MSN, MPH, CWOCN-AP  University of Texas at Arlington College of Nursing and Health Innovation PhD student Arlington TX  USA  Professional Experience: 2016-present Nurse Practitioner, Wound Clinic, Central Texas Veterans Health Care System Certified Wound, Ostomy, Continence Nurse-Advanced Practice WOC Course, Emory University, 2014 University of Texas at Austin, MSN, 2013 University of Texas Health Science Center, MPH, 2013  Author Summary: Ms. Pollack holds a Master of Science Degree in Nursing as a Family Nurse Practitioner from the University of Texas at Austin, and a Master of Public Health in Epidemiology from the University of Texas Health Science Center. She is Board certified at the Advanced Practice Level in Wound, Ostomy and Continence Care. She practices as a Family Nurse Practitioner in the Wound Clinic at the Central Texas Veterans Health Care System in Temple, Texas. Second Author Marco Brotto, PhD  University of Texas at Arlington College of Nursing and Health Innovation George & Mary Hazel Jay Endowed Professor Director, Bone-Muscle Collaborative Sciences Director, Ph.D in Nursing Program Arlington TX  USA  Professional Experience: George & Mary Hazel Jay Endowed Professor Director, Bone-Muscle Collaborative Sciences Director, Ph.D in Nursing Program College of Nursing&Health Innovation University of Texas at Arlington (UTA) PhD in physiology and biophysics from Trinity College, Oxford  Author Summary: Dr. Brotto is the George & Mary Hazel Jay Endowed Professor, Director, Bone-Muscle Collaborative Sciences and Director of the PhD in Nursing Program at the College of Nursing & Health Innovation at the University of Texas at Arlington. Dr. Brotto is an internationally recognized expert on bone and muscle physiology.  

Literature review: Combining interface pressure measurements with an air cushion to prevent pressure ulcers

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Literature review: Combining interface pressure measurements with an air cushion to prevent pressure ulcers

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