Pressure relief, cold foam or static air? A single center, prospective, controlled randomized clinical trial in a Dutch nursing home

Objective: At present, the evidence regarding the type of mattress that is the best for preventing pressure ulcers is not convincing. In a single center, prospective, controlled trial we compared a static air overlay mattress (no electric pump needed) on top of a cold foam mattress with a cold foam mattress alone on pressure ulcer incidence in nursing home residents. Methods: 83 Patients were included in the study with a score lower than 12 points on the Norton scale and no pressure ulcer at the start of the study. 42 Patients received a cold foam mattress and 41 patients received a static air overlay on top of that cold foam mattress. Out of bed we standardized the pressure reduction in sitting position by using a static air cushion in both groups. Patients were checked weekly in both groups for pressure ulcers. Only when there were signs of developing a pressure ulcer grade 2 or higher, repositioning by our nursing home pressure ulcer protocol (PU protocol) was put into practice. Results: Seven patients (17.1%) on a cold foam mattress and two (4.8%) on a static air mattress developed a pressure ulcer grade 2 or more. There was no difference regarding pressure ulcer incidence between patients with a high risk (Norton 5-8) and patients with a medium risk (Norton 9-12). In 5 out of 7 patients who developed a pressure ulcer on a foam mattress the ulcers showed no healing using our PU protocol. In the static air group all pressure ulcers healed by regular treatment according to our PU protocol. Conclusions: In this study, static air overlay mattresses provided a better prevention than cold foam mattresses alone (4.8% versus 17.1%). The Norton scores of the patients in both groups did not change during the 6 month trial period. Our decision to use repositioning only when there were signs of a pressure ulcer seems to be acceptable when a static air overlay is in position. However, the score of 17.1% development (incidence) of pressure ulcers in the foam group may stress the need of repositioning when using only this type of mattress.

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