An observational study of the maintenance of the 30° side-lying lateral tilt position among aged care residents at risk of developing pressure injuries when using the standard care pillow and a purpose-designed positioning device

Clinical and cost effectiveness of a system for turning and positioning intensive care unit patients, when compared to usual care turning and positioning devices, for the prevention of hospital-acquired pressure injuries. A randomised controlled trial

Pressure injuries affect 13.1% to 45.5% of patients in the intensive care unit and lead to pain and discomfort for patients, burden on healthcare providers, and unnecessary cost to the health system. Turning and positioning systems offer improvements on usual care devices, however the evidence of the effectiveness of such systems is still emerging. We conducted an investigator initiated, prospective, single centre, two group, non-blinded, randomised controlled trial to determine the effectiveness of a system for turning and positioning intensive care unit patients, when compared to usual care turning and positioning devices, for preventing PIs. The trial was prematurely discontinued after enrolment of 78 participants due to COVID-19 pandemic related challenges and lower than expected enrolment rate. The study groups were comparable on baseline characteristics and adherence to the interventions was high. Four participants developed a PI (in the sacral, ischial tuberosity or buttock region), n = 2 each in the intervention and control group. Each participant developed one PI. As the trial is underpowered, these findings do not provide an indication of the clinical effectiveness of the interventions. There was no participant drop-out or withdrawal and there were no adverse events, device deficiencies, or adverse device effects identified or reported. The results of our study (in particular those pertaining to enrolment, intervention adherence and safety) provide considerations for future trials that seek to investigate how to prevent PIs among ICU patients.

Repositioning mattress: how a lateral tilt position reshapes the prevention of pressure ulcers in bedridden patients

Pressure ulcers have been part of tissue damage without effectiveness in medical, surgical, and intensive care units. This study aims to focus on developing lateral tilt positions for effective pressure ulcer relief for bedridden patients. A repositioning mattress was placed in the side-lying left lateral tilt position (15°, 30°, 45°), sheering (0.680, 1.323, 1.870), interface pressure (2.550, 2.290, 2.830), and placed at 1.5 m long piece of polyethylene rubber. The design strength was set at 6000 N and 2100 mm x 1105 mm (σt,0,d = 42, σc,0,d = 34). The design shows the greatest supine position at 30°, 1.323, 2.290, pressure load (Δp0 = 1.125 (1820) ≈ 2050 psi, Δp3000 = 1.125 (620) ≈ 700 psi), tensile stress (σt,0,d (MPa) = 42), compressive stress (σc,0,d (MPa) = 34), and FOS (σt,0,d = 42, σc,0,d = 34). The factor of safety illustrated that the 30° lateral tilt position is more consistent in repositioning for pressure ulcer prevention compared to the supine-to-tilt region. Further, an application of repositioning mattresses was developed to test in bedridden patients with tissue ulcers in nursing homes.

Critical biomechanical and clinical insights concerning tissue protection when positioning patients in the operating room: A scoping review

An optimal position of the patient during operation may require a compromise between the best position for surgical access and the position a patient and his or her tissues can tolerate without sustaining injury. This scoping review analysed the existing, contemporary evidence regarding surgical positioning-related tissue damage risks, from both biomechanical and clinical perspectives, focusing on the challenges in preventing tissue damage in the constraining operating room environment, which does not allow repositioning and limits the use of dynamic or thick and soft support surfaces. Deep and multidisciplinary aetiological understanding is required for effective prevention of intraoperatively acquired tissue damage, primarily including pressure ulcers (injuries) and neural injuries. Lack of such understanding typically leads to misconceptions and increased risk to patients. This article therefore provides a comprehensive aetiological description concerning the types of potential tissue damage, vulnerable anatomical locations, the risk factors specific to the operative setting (eg, the effects of anaesthetics and instruments), the complex interactions between the tissue damage risk and the pathophysiology of the surgery itself (eg, the inflammatory response to the surgical incisions), risk assessments for surgical patients and their limitations, and available (including emerging) technologies for positioning. The present multidisciplinary and integrated approach, which holistically joins the bioengineering and clinical perspectives, is unique to this work and has not been taken before. Close collaboration between bioengineers and clinicians, such as demonstrated here, is required to revisit the design of operating tables, support surfaces for surgery, surgical instruments for patient stabilisation, and for surgical access. Each type of equipment and its combined use should be evaluated and improved where needed with regard to the two major threats to tissue health in the operative setting: pressure ulcers and neural damage.

Positioning immobile critically ill patients who are at risk of pressure injuries using a purpose-designed positioning device and usual care equipment: An observational feasibility study

The prevalence of pressure injuries in the intensive care unit (ICU) setting is high with rates ranging from 13.1% to 45.5%. Evaluation of interventions to prevent pressure injuries should be informed by preliminary research to identify factors that should be considered during the design of future trials. The study objectives were to evaluate the process of participant recruitment and monitoring in the ICU; measure the maintenance of body angle (in the side-lying lateral tilt position) and head and neck alignment angle (in the supine position) among immobile critically ill patients when using a purpose-designed positioning device and usual care equipment, and; ascertain the time required to position patients with the purpose-designed positioning device and the usual care equipment. A prospective, observational, feasibility study was conducted in an ICU in Victoria, Australia. The sample was immobile critically ill adults at high-risk of developing pressure injuries. The usual care interventions were pillows, foam wedges, and rolled towels, and the intervention device was the Z-Flo Fluidized Positioner. The body angle and head and neck alignment were measured on six occasions (at baseline, 1 hour, and 2 hours). The time required for positioning was also measured. The sample was predominately male (n = 5, 62%) with a mean age of 59 years. The majority of patients (n = 106, 92.2%) were not immobile and therefore were ineligible to participate. A total of 48 turning and positioning interventions were observed. For the side-lying lateral tilt position, the degree of difference from baseline to 2 hours was no more than three degrees for all the devices (the Fluidized Positioner 25°-26°, the foam wedge 29°-27°, and the pillow 23°-21°). For the head and neck position, the degree of difference from baseline to 2 hours was the greatest for the pillow and rolled towel (78°-71°, a difference of 7°) and the pillow alone (79°-74°, a difference of 5°). The degree of difference was the lowest for the Fluidized Positioner (84°-86°, a difference of 2°). Future research to evaluate positioning equipment in the ICU should consider patient eligibility characteristics, particularly immobility. The conduct of preliminary studies to inform the design of larger pressure injury prevention trials is recommended.

An observational study of the maintenance of the 30° side-lying lateral tilt position among aged care residents at risk of developing pressure injuries when using the standard care pillow and a purpose-designed positioning device

The aim of the study was to evaluate the maintenance of the 30° side-lying lateral tilt position among aged care residents at the risk of developing pressure injuries when using the standard care pillow and a purpose-designed positioning device. An observational study was conducted. Participants were monitored during positioning under two conditions, with pillows and with a fluidised positioner. Body angle measurements were taken at three time points (baseline, 1 hour, and 2 hours) on 10 occasions. Repeated-measures analysis assessed the difference in the degree of the angle of the body. The sample (n = 12) had an average age of 83 years, and the participants were immobile when in bed. The average angle with the pillow condition was 26.7° at baseline, 21.5° at 1 hour, and 16.6° at 2 hours. The average angle with the fluidised positioner condition was 30.7° at baseline, 29.3° at 1 hour, and 26.8° at 2 hours. The main effects of Condition and Time were significant: Condition: F(1,11) = 14.378, P < .001, Time: F(2,22) = 45.858, P < .001. There was a statistically significant interaction between the effects of Condition and Time on the average lateral tilt position, F(2,22) = 15.574, P < .001. The lateral tilt body position was better maintained with the positioning device than the pillow. Further research is required to determine the effectiveness of the fluidised positioner for pressure injury prevention.