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Mattresses for Decubitus Ulcer Prevention in Acute and Critical Care: Clinical and Cost-Effectiveness

Date: 14 December 2007

Context and policy issues:

In Canadian acute care facilities and in critical care units the pressure ulcer (PU) prevalence rate is reported to be 25.1%.1 Ulcers may be complicated by pain and infection, and in the elderly are associated with an increased risk of death.2,3 Numerous interventions to prevent the development of ulcers are available. These include nutritional support, skin care and management of incontinence, frequent repositioning, and specialized support surfaces.4 These surfaces are designed to reduce the pressure on bony sites, facilitating healthy capillary flow and preventing tissue necrosis leading to ulceration. They may be static (low-tech) or dynamic (high-tech). Static devices include sheepskin, air, foam, fiber, gel and fluid-filled overlays or mattresses. Different types of foam mattresses are available including high-specification foam, viscoelastic, convoluted foam or cubed foam.5 Dynamic devices mechanically vary the pressure on parts of the body. Examples of these include alternating pressure mattresses, low air loss beds or air-fluidized mattresses. 3,5

There are a growing number of new devices to prevent PUs. Moreover, the clinical and cost- effectiveness of well-known devices such as foam mattresses, foam overlays, air filled sacs and low air loss surfaces remains unclear. A review of more recent evidence may shed light on the current clinical and cost-effectiveness of these devices.

Research questions:

1. What is the clinical effectiveness of foam mattresses, foam overlays, air filled sacs and low air loss surfaces for prevention of decubitus ulcers for patients in acute care and critical care?

Disclaimer: The Health Technology Inquiry Service (HTIS) is an information service for those involved in planning and providing health care in Canada. HTIS responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources and a summary of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. HTIS responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report.

Copyright: This report contains CADTH copyright material. It may be copied and used for non-commercial purposes, provided that attribution is given to CADTH.

Links: This report may contain links to other information on available on the websites of third parties on the Internet. CADTH does not have control over the content of such sites. Use of third party sites is governed by the owners’ own terms and conditions.

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