Effectiveness of specialised support surface modes in preventing pressure injuries in intensive care: A systematic review and meta-analysis

IF 4.9 2区医学 Q1 NURSING Intensive and Critical Care Nursing Pub Date : 2024-05-14 DOI:10.1016/j.iccn.2024.103713

Bethany Lane , Nicholas Woolfe Loftus , Ashley Thomas , Antonis Kalakoutas , John Wells

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Abstract

Background

Patients in intensive care units (ICU) are at an increased risk of pressure injuries. In ICUs, specialised support surfaces are an intervention often used to prevent pressure injuries. This systematic review and meta-analysis aimed to ascertain the effectiveness of different specialised support surface modes for preventing pressure injuries to adult ICU patients.

Methods

Ovid MEDLINE, Ovid Embase, EBSCO CINAHL, PEDro, Cochrane Library, Clinicaltrials.gov and eligible paper references were searched for appropriate studies. Studies were included if they investigated both dynamic support surface modes low-air-loss (LAL) and alternating pressure (AP), involved adult ICU patients (≥18 years old), and investigated pressure injury incidence. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Mixed Methods Appraisal Tool (MMAT) checklists were used for reporting and quality assessment. Risk ratios (RRs) with 95 % Confidence Intervals (CIs) were used to summarise pressure injury incidence. The pooled RR was calculated with the random-effects model using the Mantel-Haenszel method. Further secondary analysis examined length of stay (LoS) and severity of illness.

Results

The four included studies involved 3,308 patients. These studies were heterogeneous in design. When AP surface mode was compared with LAL surface mode, there was no significant difference in the occurrence of pressure injury (8.9 % versus 10.9 %, RR 0.64). Mattress mode also had no direct association with length of stay and severity of illness.

Conclusion

This systematic review and meta-analysis found no significant difference in the effectiveness of LAL and AP support surface modes in preventing pressure injuries in adult ICU patients.

Implications for clinical practice

Clinicians should remember that mattresses are just one element within strategies to prevent pressure injuries in ICUs. The equivocal findings of this systematic review highlight the complexity of preventing pressure injuries and underscore the importance of holistic nursing care.

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特制支撑面模式在重症监护中预防压力伤害的效果：系统回顾与荟萃分析

背景重症监护室（ICU）中的患者受压伤的风险较高。在重症监护室，专用支撑面是一种常用的预防压力伤的干预措施。本系统综述和荟萃分析旨在确定不同的专用支撑面模式在预防成人 ICU 患者压力损伤方面的有效性。方法检索了 Ovid MEDLINE、Ovid Embase、EBSCO CINAHL、PEDro、Cochrane Library、Clinicaltrials.gov 和符合条件的论文参考文献，以寻找合适的研究。纳入的研究必须同时调查了低空气损失（LAL）和交变压力（AP）两种动态支撑面模式，涉及成年 ICU 患者（≥18 岁），并调查了压力损伤的发生率。报告和质量评估采用了系统综述和荟萃分析首选报告项目（PRISMA）和混合方法评估工具（MMAT）清单。采用带有 95% 置信区间 (CI) 的风险比 (RR) 总结压伤发生率。采用曼特尔-海恩泽尔法（Mantel-Haenszel method）的随机效应模型计算了汇总的 RR。进一步的辅助分析检查了住院时间（LoS）和病情严重程度。这些研究的设计各不相同。当 AP 表面模式与 LAL 表面模式进行比较时，压伤发生率没有显著差异（8.9% 对 10.9%，RR 0.64）。床垫模式与住院时间和病情严重程度也没有直接关系。结论这项系统综述和荟萃分析发现，LAL 和 AP 支撑面模式在预防成人重症监护病房患者压力损伤方面的效果没有明显差异。本系统综述的结论模棱两可，凸显了预防压力损伤的复杂性，并强调了整体护理的重要性。

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来源期刊

Intensive and Critical Care Nursing NURSING-

CiteScore

6.30

自引率

15.10%

发文量

144

审稿时长

57 days

期刊介绍： The aims of Intensive and Critical Care Nursing are to promote excellence of care of critically ill patients by specialist nurses and their professional colleagues; to provide an international and interdisciplinary forum for the publication, dissemination and exchange of research findings, experience and ideas; to develop and enhance the knowledge, skills, attitudes and creative thinking essential to good critical care nursing practice. The journal publishes reviews, updates and feature articles in addition to original papers and significant preliminary communications. Articles may deal with any part of practice including relevant clinical, research, educational, psychological and technological aspects.