Introduction
Pressure ulcers, often referred to as bedsores, remain a significant concern in healthcare settings, particularly among hospitalized adults who are immobile or have limited mobility. These wounds result from prolonged pressure on the skin, leading to tissue damage, pain, and increased risk of infection, thereby posing challenges to patient recovery and healthcare costs (National Institute for Health and Care Excellence [NICE], 2014). Preventive strategies, including the use of specialized mattresses, have been explored to mitigate this issue. Among these, air mattresses—designed to redistribute pressure through alternating air cells—are often promoted as a superior alternative to standard hospital mattresses. This literature review aims to evaluate the effectiveness of air mattresses compared to standard hospital mattresses in reducing the incidence of pressure ulcers in adult hospitalized patients. The essay will explore existing research, highlight key findings, critically assess the evidence, and identify limitations in current knowledge. By synthesizing these insights, this review seeks to inform nursing practice and contribute to improved patient outcomes.
Background and Context of Pressure Ulcers and Mattress Interventions
Pressure ulcers are a prevalent issue in acute and long-term care settings, with incidence rates ranging from 6% to 18.5% among hospitalized patients in the UK (NHS Improvement, 2018). Risk factors include immobility, poor nutrition, and comorbidities such as diabetes, which exacerbate skin fragility (Gorecki et al., 2009). Standard hospital mattresses, typically made of foam, provide limited pressure redistribution and may contribute to ulcer development in high-risk patients. In contrast, air mattresses, including alternating pressure mattresses (APMs) and low-air-loss systems, are engineered to reduce interface pressure by dynamically adjusting air distribution or maintaining low friction (McInnes et al., 2015). Given the clinical and economic burden of pressure ulcers, understanding the comparative effectiveness of these interventions is critical for nursing staff tasked with patient care and resource allocation.
Evidence Supporting the Effectiveness of Air Mattresses
Several studies suggest that air mattresses are more effective than standard foam mattresses in preventing pressure ulcers. A systematic review by McInnes et al. (2015) analyzed randomized controlled trials (RCTs) and found that alternating pressure mattresses significantly reduced the incidence of pressure ulcers compared to standard mattresses in high-risk patients. Specifically, the review reported a relative risk reduction of approximately 60% in some cohorts, particularly among elderly patients in intensive care units (ICUs). The mechanism behind this efficacy lies in the dynamic pressure redistribution, which prevents sustained compression of skin tissues over bony prominences—unlike static foam mattresses that offer limited relief (Gorecki et al., 2009). Furthermore, a study by Nixon et al. (2006) demonstrated that patients using APMs experienced a lower incidence of grade 2 or higher pressure ulcers compared to those on standard mattresses, highlighting the potential of air mattresses to address more severe outcomes. These findings suggest that, in certain contexts, air mattresses provide a valuable tool for pressure ulcer prevention, particularly for vulnerable populations.
Limitations and Contradictory Findings in the Literature
Despite the promising results, the evidence is not without limitations, and some studies present conflicting findings. For instance, while McInnes et al. (2015) reported overall benefits, the review also noted significant heterogeneity among studies regarding patient populations, mattress types, and outcome measures. This variability raises questions about the generalizability of results across diverse clinical settings. Additionally, a more recent RCT by Demarré et al. (2012) found no statistically significant difference in pressure ulcer incidence between patients using alternating pressure mattresses and those on high-specification foam mattresses, which are an advanced type of standard mattress. The authors argued that improvements in foam mattress technology might narrow the gap in effectiveness, particularly when combined with regular repositioning—a cornerstone of nursing care (NICE, 2014). Moreover, practical challenges, such as the higher cost of air mattresses and the need for maintenance, can limit their feasibility in resource-constrained settings (Demarré et al., 2012). Therefore, while air mattresses show potential, their superiority is not universally definitive, and context-specific factors must be considered.
Critical Analysis of Methodological Issues in the Evidence Base
A critical examination of the literature reveals methodological weaknesses that affect the reliability of findings. Many studies, including those reviewed by McInnes et al. (2015), suffer from small sample sizes and short follow-up periods, which may not capture the long-term impact of mattress interventions on pressure ulcer incidence. Additionally, blinding in RCTs is often impractical due to the visible nature of mattresses, potentially introducing bias in outcome assessments (Nixon et al., 2006). There is also a lack of consistency in defining what constitutes a “standard” hospital mattress, with some studies comparing air mattresses to basic foam while others use high-specification foam as the control. This inconsistency complicates direct comparisons and underscores the need for standardized protocols in future research. Arguably, these gaps highlight a broader limitation in the evidence base: while air mattresses appear beneficial in specific scenarios, the robustness of conclusions remains constrained by methodological variability. For nursing practice, this suggests a cautious approach, ensuring that mattress selection aligns with patient risk profiles and institutional capabilities.
Implications for Nursing Practice and Future Research
The reviewed literature has important implications for nursing staff tasked with preventing pressure ulcers. Air mattresses, particularly alternating pressure systems, may be prioritized for high-risk patients, such as those in ICU or with severe immobility, where evidence of benefit is strongest (McInnes et al., 2015). However, nurses must balance this with practical considerations, including cost and the need for staff training to operate and maintain these devices effectively. Equally, the potential parity of high-specification foam mattresses, as suggested by Demarré et al. (2012), indicates that upgrading standard mattresses could be a cost-effective alternative in some settings. From a research perspective, there is a clear need for larger, well-designed RCTs with longer follow-up periods and standardized definitions of mattress types. Furthermore, studies exploring patient comfort and compliance with air mattresses—often underreported—could provide a more holistic understanding of their utility. Indeed, integrating qualitative data on patient and staff experiences might enhance the applicability of findings to real-world nursing environments.
Conclusion
In summary, this literature review has evaluated the effectiveness of air mattresses compared to standard hospital mattresses in reducing pressure ulcer incidence among adult hospitalized patients. The evidence suggests that air mattresses, particularly alternating pressure systems, often outperform standard foam mattresses in high-risk settings, with studies like McInnes et al. (2015) demonstrating notable reductions in ulcer incidence. However, contradictory findings, methodological limitations, and practical challenges—such as cost and variability in mattress definitions—temper these conclusions, as highlighted by Demarré et al. (2012). For nursing practice, the findings advocate a tailored approach, prioritizing air mattresses for high-risk patients while considering advanced foam alternatives where resources are limited. Future research must address existing gaps through rigorous, standardized studies to provide clearer guidance. Ultimately, preventing pressure ulcers remains a complex challenge, requiring not only effective interventions like mattresses but also comprehensive nursing care strategies to optimize patient outcomes.
References
- Demarré, L., Beeckman, D., Vanderwee, K., Defloor, T., Grypdonck, M. and Verhaeghe, S. (2012) Multi-stage versus single-stage inflation and deflation cycle for alternating low pressure air mattresses to prevent pressure ulcers in hospitalised patients: a randomised-controlled clinical trial. International Journal of Nursing Studies, 49(4), pp. 416-426.
- Gorecki, C., Brown, J.M., Nelson, E.A., Briggs, M., Schoonhoven, L., Dealey, C., Defloor, T. and Nixon, J. (2009) Impact of pressure ulcers on quality of life in older patients: a systematic review. Journal of the American Geriatrics Society, 57(7), pp. 1175-1183.
- McInnes, E., Jammali-Blasi, A., Bell-Syer, S.E., Dumville, J.C., Middleton, V. and Cullum, N. (2015) Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic Reviews, (9), CD001735.
- National Institute for Health and Care Excellence (NICE) (2014) Pressure ulcers: prevention and management. NICE Guideline CG179.
- NHS Improvement (2018) Pressure ulcer core curriculum. NHS Improvement Report.
- Nixon, J., Cranny, G., Iglesias, C., Nelson, E.A., Hawkins, K., Phillips, A., Torgerson, D., Mason, S. and Cullum, N. (2006) Randomised, controlled trial of alternating pressure mattresses compared with alternating pressure overlays for the prevention of pressure ulcers: PRESSURE (pressure relieving support surfaces) trial. BMJ, 332(7555), p. 1413.
