How pressure ulcers develop and how specialty beds help
Pressure ulcers, also known as bedsores or decubitus ulcers, are localized injuries to the skin and underlying tissue, typically over a bony prominence. They result from sustained pressure, which restricts blood flow and deprives the tissue of oxygen and nutrients. Immobile or bedridden individuals are at the highest risk, as they cannot consciously or subconsciously shift their weight to relieve this pressure. Other contributing factors include friction, shear, and excess moisture.
Specialty beds are engineered with features specifically designed to counteract these forces and prevent skin breakdown. Instead of a uniform, firm surface, these beds employ various methods to redistribute the patient's weight over a wider area and reduce the intensity of pressure on vulnerable spots like the sacrum, heels, and hips.
The mechanism of specialty beds for pressure relief
- Pressure Redistribution: The primary function of a specialty bed is to lower and disperse pressure. This is achieved by creating a support surface that conforms to the body's contours rather than resisting them.
- Microclimate Management: Some beds incorporate low air loss or other technologies to help manage skin temperature and moisture. Excess moisture, often caused by sweating or incontinence, can lead to skin maceration, making it more susceptible to damage. By regulating the microclimate, these beds keep the skin dry and healthy.
- Friction and Shear Reduction: Specialty beds often use smooth, multi-layered covers or surfaces that reduce friction and shear forces. Friction occurs when skin rubs against a surface, while shear happens when skin remains in place as underlying tissue moves, for example, when the head of the bed is raised.
Types of specialty beds that prevent pressure ulcers
Various types of specialty beds and support surfaces are available, with the choice depending on the patient's specific risk level, mobility, and condition. From simple foam mattresses to advanced powered air systems, each offers different levels of pressure relief.
Alternating pressure mattresses
These are powered air systems consisting of multiple air chambers, or bladders, that automatically inflate and deflate on a timed cycle. This constant inflation and deflation pattern mimics the natural movements of a person shifting in bed, continuously changing the pressure points on the body. This stimulates blood flow and provides therapeutic relief for high-risk patients who are unable to reposition themselves.
Low air loss mattresses
Low air loss mattresses feature many small holes in the air bladders that release a small amount of air directly beneath the patient. The air circulates, helping to control skin temperature and manage moisture, which prevents skin maceration. These mattresses are particularly beneficial for patients who have issues with skin moisture or who are prone to sweating excessively.
Lateral rotation beds
For patients with a very high risk of pressure ulcers or who are completely immobile, lateral rotation beds automatically and gently turn the patient from side to side. This continuous turning and repositioning relieve pressure on any single area, preventing prolonged tissue compression. These beds are often used in intensive care units for severely ill patients, including those on ventilators.
Static air and gel overlays
For lower-risk patients or as an addition to an existing mattress, static air and gel overlays can provide effective pressure redistribution. Gel-filled pads and advanced foam overlays conform to the body's shape, distributing pressure over a larger surface area. Some systems, like the Gravity 8 foam mattress, are specifically designed with zoned layers to provide targeted support and minimize pressure on bony prominences.
Comparison of specialty beds for pressure ulcer prevention
| Feature | Alternating Pressure Mattress | Low Air Loss Mattress | Lateral Rotation Bed | Static Air/Gel Overlay |
|---|---|---|---|---|
| Mechanism | Inflates and deflates air cells cyclically to shift pressure. | Circulates a small amount of air across the mattress surface. | Automatically turns the patient from side to side to reposition. | Uses foam or gel to conform to the body and redistribute pressure. |
| Primary Benefit | Active pressure relief and improved blood circulation. | Moisture and microclimate control for skin integrity. | Passive repositioning and comprehensive pressure relief. | Cost-effective pressure redistribution for lower-risk patients. |
| Best For | High-risk patients, especially those with some mobility but needing therapeutic relief. | Patients who are high-risk and have issues with excessive skin moisture. | Very high-risk or immobile patients, including critical care. | Low to medium-risk patients or as an enhancement to an existing mattress. |
| Technology | Powered system with an air pump and multiple air cells. | Powered system with a pump and perforated air cells. | Powered system with a rotating frame and integrated mattress. | Non-powered; uses advanced materials like specialized foam or gel. |
Important considerations for selection
When choosing a specialty bed, several factors should be evaluated alongside the type of bed itself. Patient assessment using a validated tool, such as the Braden Scale, can help determine the level of risk and guide the selection process.
- Risk Level: For patients with a high or very high risk of developing pressure ulcers, an advanced powered system like a low air loss or lateral rotation bed is often necessary. Lower-risk patients might benefit sufficiently from a high-quality foam or gel mattress.
- Mobility Status: A patient who is completely bedridden will need a more dynamic support surface than someone who is only chair-fast. Beds that automatically turn or shift pressure are ideal for immobile individuals.
- Patient Condition: A patient's overall health and comorbidities, such as diabetes or cardiovascular disease, must be considered. These conditions can impact circulation and skin health, increasing the risk of pressure ulcers.
- Cost and Setting: The cost of specialty beds can vary significantly. Simple overlays are more affordable, while advanced lateral rotation beds are more expensive. The setting (hospital, nursing home, or home care) can also influence the available budget and the need for specific features.
Conclusion
Specialty beds play a vital role in preventing pressure ulcers by addressing the primary causes of tissue damage: unrelieved pressure, friction, shear, and moisture. By redistributing pressure and managing the skin's microclimate, technologies like alternating pressure, low air loss, and lateral rotation provide crucial support for at-risk patients. The most effective choice depends on a careful assessment of the individual's needs, risk level, and medical condition. Consulting with a healthcare professional or wound care specialist is the best approach to ensuring a patient receives the right bed to maximize comfort and safety.
For more detailed clinical guidelines on pressure ulcer prevention, refer to the recommendations from the National Pressure Ulcer Advisory Panel (NPUAP).
What specialty beds prevent pressure ulcers?
- Alternating Pressure Mattresses: Use motorized pumps to cyclically inflate and deflate air cells, constantly shifting pressure points to promote blood flow and prevent pressure ulcers.
- Low Air Loss Mattresses: Maintain a cushion of circulating air to manage the skin's microclimate, reducing moisture and helping to prevent skin breakdown in high-risk patients.
- Lateral Rotation Beds: Automatically and intermittently turn the patient side-to-side, providing continuous repositioning to relieve pressure on specific areas for critically ill or immobile patients.
- Advanced Foam Mattresses: Utilize multi-layered, contoured foam to redistribute body weight over a larger surface area, especially in zoned designs that target high-pressure zones.
- Gel-Filled Overlays: Incorporate gel bladders between layers of foam to provide conforming pressure relief and cooling properties, effectively distributing weight.
- Static Air Mattresses: Use a series of interconnected air cells that disperse pressure evenly across the contact surface without active movement, providing comfort and prevention for lower-risk individuals.
- Hybrid Systems: Combine features of different systems, such as alternating pressure and low air loss, for comprehensive prevention and therapy.
FAQs
What are the primary causes of pressure ulcers? Pressure ulcers are primarily caused by unrelieved pressure that impedes blood flow to the skin and underlying tissue, often over bony areas. Other major contributing factors are friction, shear, and excessive moisture.
How does an alternating pressure mattress work to prevent pressure ulcers? An alternating pressure mattress works by using a pump to inflate and deflate a series of air cells on a timed cycle. This process continuously changes the pressure points on the patient's body, which promotes blood circulation and prevents sustained pressure on any single area.
What is the difference between a low air loss mattress and an alternating pressure mattress? A low air loss mattress focuses on microclimate control by releasing a small amount of air to regulate skin temperature and moisture, while an alternating pressure mattress focuses on pressure redistribution by cyclically inflating and deflating air cells. Many systems today combine both technologies.
Who needs a specialty bed for pressure ulcer prevention? Individuals who are bedridden, have limited mobility, or are otherwise at high risk of developing pressure ulcers can benefit from a specialty bed. This includes post-surgical patients, elderly individuals, and those with chronic medical conditions affecting skin health.
Are foam mattresses effective for preventing pressure ulcers? Yes, high-quality, multi-layered foam mattresses are effective for pressure ulcer prevention, particularly for patients at low to medium risk. They work by conforming to the body's shape to distribute pressure more evenly than standard mattresses.
How do lateral rotation beds help in preventing pressure ulcers? Lateral rotation beds automatically turn the patient from side to side. This automated repositioning continuously offloads pressure from vulnerable areas, significantly reducing the risk of developing pressure ulcers for immobile or high-risk patients.
Can a specialty bed prevent all pressure ulcers? While specialty beds are a critical part of a prevention strategy, they cannot guarantee the prevention of all pressure ulcers. Effective prevention also requires proper skin care, nutritional management, regular repositioning (if not using an automated bed), and careful monitoring by caregivers.
