Meaume S, Marty M, Colin D
Rothschild Hospital - Geriatric Department and Wound Care Unit, Assistance Publique hôpitaux de Paris, Paris, France.
Nukleus, Clinical Research Department, Paris, France.
J Wound Care. 2017 Sep 2;26(9):537-544. doi: 10.12968/jowc.2017.26.9.537.
In patients with reduced mobility, specialised pressure-relieving supports (mattresses, beds and cushions) are widely used to reduce or relieve the interface pressure between the skin and support surfaces to prevent incidence of pressure ulcers (PUs). The primary objective of these two observational studies was to assess the incidence of PUs in patients at high risk of PUs, seated in a wheelchair using a single- or multi-compartment air cushion. The level of patient satisfaction with the comfort and the views of the care team that used the air cushions were considered as secondary objectives.
The PRESCAROH project was two prospective observational studies conducted in patients free of PUs at baseline and at high risk of PUs (Braden score ≤13 or ≤16 for people with spinal cord injury). Patients had to spend more than eight hours a day in a wheelchair and use either a single-compartment air cushion (patient without asymmetry of support) for the first study or a multi-compartment air cushion (patient with asymmetry of support) for the second study. The primary end point was the percentage of patients in whom a PU (sacrum and/or ischium) developed over a 35-day period. The analysis was performed on the full-analysis set (FAS) of patients included with at least a second assessment.
We recruited 152 patients, 78 seated on a single-compartment air cushion (SiCAC group) and 74 on a multi-compartment air cushion (MuCAC group), in the two independent studies. All patients were included in the FAS (n=152). Most patients had spinal cord injuries. The average time spent sitting was 10.2 (standard deviation (SD): 2.3) hours a day in the SiCAC group and 9.1 (SD: 1.9) hours a day in the MuCAC group. In the SiCAC group, 6.4% (5/78) of patients dropped out of the study (one patient because of pulmonary infection and four patients for cushion installation problems). In the MuCAC group, 8.1% (6/74) of patients dropped out of the study (three patients because of adverse events not related to cushions, two for onset of PU, one for cushion-related problem). Over the study period of 35 days, 2.6% (2/78) [95% confidence interval (CI): 0.3-9.0%] of patients in the SiCAC group and 4.0% (3/74) [95%CI: 0.8-11.4%] in the MuCAC group developed a PU.
These two observational studies showed that in patients at high risk of PUs and seated for more than eight hours a day in a wheelchair, the use of a single-compartment or multi-compartment air cushion with telescopic cells was associated with a low incidence of PUs.
在行动不便的患者中，专门的减压支撑物（床垫、床和靠垫）被广泛用于减少或缓解皮肤与支撑表面之间的界面压力，以预防压疮（PU）的发生。这两项观察性研究的主要目的是评估使用单腔或多腔气垫坐在轮椅上的PU高危患者中PU的发生率。患者对舒适度的满意度水平以及使用气垫的护理团队的看法被视为次要目标。
PRESCAROH项目是两项前瞻性观察性研究，针对基线时无PU且为PU高危（脊髓损伤患者的Braden评分≤13或≤16）的患者进行。患者每天必须在轮椅上坐超过8小时，并在第一项研究中使用单腔气垫（无支撑不对称的患者），在第二项研究中使用多腔气垫（有支撑不对称的患者）。主要终点是在35天内发生PU（骶骨和/或坐骨）的患者百分比。对至少进行了第二次评估的纳入患者的全分析集（FAS）进行分析。
在两项独立研究中，我们招募了152名患者，78名坐在单腔气垫上（SiCAC组），74名坐在多腔气垫上（MuCAC组）。所有患者均纳入FAS（n = 152）。大多数患者患有脊髓损伤。SiCAC组患者平均每天坐的时间为10.2（标准差（SD）：2.3）小时，MuCAC组为9.1（SD：1.9）小时。在SiCAC组中，6.4%（5/78）的患者退出研究（1名患者因肺部感染，4名患者因气垫安装问题）。在MuCAC组中，8.1%（6/74）的患者退出研究（3名患者因与气垫无关的不良事件，2名因PU发作，1名因与气垫相关的问题）。在35天的研究期间，SiCAC组2.6%（2/78）[95%置信区间（CI）：0.3 - 9.0%]的患者和MuCAC组4.0%（3/74）[95%CI：0.8 - 11.4%]的患者发生了PU。
这两项观察性研究表明，在PU高危且每天在轮椅上坐超过8小时的患者中，使用带有伸缩气室的单腔或多腔气垫与低PU发生率相关。
