Editor`s Opinion: Keeping the Pressure On Taking the Pressure Off
Every health care professional knows the mantra for pressure ulcer prevention in high-risk patients includes repositioning (if consistent with the overall goal of patient care) and the use of support surfaces and pressure-redistribution cushions. There is good evidence high-quality foam and other support surfaces reduce the risk of pressure ulcer development, but evidence to help clinicians decide which support surface and especially which foam mattress to use is less than robust.1,2 Considering the observations reported by Soppi and colleagues in this issue of OWM, this is not surprising. Specifically, they conclude their overview of polyurethane foams with the observation that definitive meanings and characteristics/qualifications designating standard/conventional foam mattresses and high specification foam mattresses are yet to be determined. Soppi and colleagues also observe the ability to reposition is an important characteristic of all support surfaces, but as observed by Quinzanos-Fresnedo and colleagues in this issue of OWM it can affect the wheelchair users’ ability to function. Quinzanos-Fresnedo et al postulate if users are not satisfied with the cushion and/or if it negatively affects daily functioning, they may discontinue using it altogether. They conclude wheelchair cushions often require customization, and studies should focus not just on pressure redistribution, but also should include many clinical variables, including functioning.
Another variable, skin temperature, was the subject of the research conducted by Lachenbruch and colleagues. Their work, which confirms the results of other laboratory studies, shows both pressure and temperature were highly significant predictors of the magnitude of reactive hyperemia as an index of ischemia. They postulate the skin is most likely to be warmed significantly, and subsequently more susceptible to ischemia, when it has been loaded mechanically over a sustained period. These observations were made in healthy volunteers; what about patients with hypoxemia, hypovolemia, or who have a fever? Could the observations from this study provide another small piece of evidence to help explain why not all pressure ulcers may be preventable in patients who are critically ill?3
So yes. There is good evidence-based guidance on pressure ulcer prevention for use in clinical practice.1,2,4 However, evidence regarding comparative efficacy of support surfaces, wheelchair cushions, and their optimal usage is lacking. Little by little, study by study, we are learning everything we need to know about the critical junction between skin and the surface on which it rests.
This article was not subject to the Ostomy Wound Management peer-review process.
References
1. van Rijswijk L, Beitz J. Creating a pressure ulcer prevention algorithm: systematic review and face validation. Ostomy Wound Manage. 2013;59(11):28–40.
2. McNichol L, Watts C, Mackey D, Beitz JM, Gray M. Identifying the right surface for the right patient at the right time: generation and content validation of an algorithm for support surface selection. J Wound Ostomy Continence Nurs. 2015;42(1):19–37.
3. Edsberg L, Langemo D, Baharestani MM, Posthauer ME, Goldberg M. Unavoidable pressure injury: state of the science and consensus outcomes. J Wound Ostomy Continence Nurs. 2014;41(4):313–334.
4. Bolton LL, Girolami S, Corbett, van Rijswijk L. The Association for the Advancement of Wound Care Venous and Pressure Ulcer Guidelines. Ostomy Wound Manage. 2014;60(11):24–66.
