The Effect of Using a Low-Air-Loss Surface on the Skin Integrity of Obese Patients: Results of a Pilot Study

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Author(s): 
Valerie Pemberton, RN, CWOCN; Vickie Turner, RN, CWOCN; and Catherine VanGilder, BS, MT, CCRA

Abstract Obese patients often are immobile, acutely ill, and at high risk for developing pressure ulcers when admitted to acute care facilities. Pressure-relieving mattresses are an integral part of a pressure ulcer prevention plan of care. Patients with a body mass index (BMI) >35, weight between 250 and 500 lb, and a minimum 3-day length of stay were recruited to participate in a pilot study to evaluate the safety and use of a new low-air-loss, continuous lateral rotation bariatric bed. Skin inspection was performed at the beginning and end of the study (maximum 7 days). Participants included 21 consecutively admitted patients (10 men, 11 women, average age 51.7 years [range 32 to 76], average BMI = 51.4 [range 37 to 71]) with an average Braden pressure ulcer risk score of 14.7 (range 9 to 21). Most (n = 11) were receiving treatment in the intensive care unit. Six patients had 10 pressure ulcers (six Stage I, four Stage II). Average length of stay on the surface was 4.8 days (range: 2 to 8 days); ulcers decreased from an average size of 5.2 cm2 to 2.6 cm2. No new pressure ulcers developed. Controlled clinical studies to assess the efficacy of pressure redistribution mattresses in this high-risk population are needed.

     One in 10 patients admitted to healthcare facilities in the United States is morbidly obese.1 Obesity is a condition that substantially raises the risk of comorbid conditions such as hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, stroke, gall bladder disease, osteoarthritis, sleep apnea, and respiratory problems.2-4 More than 250,000 deaths annually are attributed to obesity in the US.5

     Obese patients often are immobile and acutely ill when they present to the hospital.6 Unique factors such as poor vascularization of adipose tissue and a large amount of weight distribution over the entire supine surface area increase pressure ulcer risk in the bariatric patient.7,8 A recent analysis9 of 2006–2007 pressure ulcer prevalence survey data (N = 167,936) showed that patients >300 lb had overall pressure ulcer prevalence rates ranging from 11.4% to 28.6% compared to 10.7% to 13.1% in persons weighing 151 to 300 lb. Pressure ulcers have been associated with lengthened hospital stays, increased costs of care, 10-12 and higher mortality rates.13-15 The ability to manage these complex patients in the acute care facility is crucial in today’s hospital environment.

     Pressure-relieving mattresses are an important part of an overall pressure ulcer prevention plan of care. Low-air-loss surfaces have been used for patients at significant risk for pressure ulcer formation according to existing clinical protocols within facilities, which include the Braden Scale for Pressure Ulcer Risk for pressure ulcer formation, and for patients with existing pressure ulcers.16,17 Although evidence in the available literature may be limited,6 low-air-loss surfaces may assist in skin microclimate management by wicking excess moisture away from the skin, a specific concern for the bariatric patient.

     To assess the safety and clinical use of a new low-air-loss surface, a pilot study was conducted among obese inpatients in a tertiary care facility. Study patients were placed on the TotalCare® Bariatric Plus Therapy System (Hill-Rom, Inc., Batesville, IN) surface, which features Advanced MicroclimateTM Technology and provides continuous lateral rotation therapy (CLRT).

References: 

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