| Sumario: | QUESTION: In patients who are at risk of pressure sores, are pressure relieving beds, mattresses, and cushions (support surfaces) effective for preventing and treating pressure sores? Data sources: Randomised controlled trials (RCTs) were identified by searching 19 databases from their inception to 1997, hand searches of 5 wound care journals, conference abstracts, bibliographies of relevant studies and review articles, and contact with experts and manufacturers. Unpublished data were also sought. Study selection: Interventions included standard or specialised foam mattresses or overlays; gel, fibre, or water filled mattresses or overlays; alternating pressure mattresses or overlays; air fluidised, bead, or low air loss beds; sheepskins; turning beds or frames; wheelchair cushions; or operating table overlays; and outcomes were incidence or healing rates of sores, cost, comfort, reliability, and acceptability. Data extraction: Data were extracted on study quality, inclusion and exclusion criteria, baseline characteristics, settings, interventions, follow up, outcomes, acceptability; and reliability. Main results: 37 RCTs met the inclusion criteria. Methodological quality was generally poor, many settings and products were studied, and sample size was often small. 29 RCTs studied patients without pre-existing pressure sores. Special mattresses had lower rates of incidence or severity of pressure ulcers: the Comfortex DeCube mattress, Beaufort Bead bed, Softform mattress, and a water filled mattress were better than standard hospital mattresses for high risk patients (relative risks [RR] ranged from 0.2-0.35); Clinifloat, Therarest, Transfoam, and Vaperm mattresses were better than standard foam mattresses for incidence of pressure sores for all patients and those with hip fractures (pooled RR 0.29. 95%) CI 0.19 to 0.43). Low technology products (eg, foams and water filled supports) did not differ from each other for the incidence of pressure ulcers. Only 1 RCT of 7 showed that alternating pressure devices were superior to low technology constant pressure products. The 1 RCT of low air loss beds showed that they were more cost effective than a standard bed in the intensive care unit. The 2 RCTs of kinetic turning tables did not show differences. 3 RCTs evaluated special products for the operating suite; 1 evaluated a polymer pad and showed a 47% reduction in pressure sores and 2 evaluated an alternating system and showed a pooled RR of 0.21 (CI 0.06 to 0.7). The role of seat cushions in pressure sore prevention is unclear. Air fluidised beds were superior to standard beds for healing of pressure sores. Conclusions: Special products designed to prevent or cure pressure sores are generally more effective than standard mattresses. Studies that evaluate specific products or types of product, are limited in size and quality. [Original article accession number: 2000029518 (research, systematic review, tables/charts)]
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