Authors

  1. Pompeo, Matthew MD

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To the Editor:

 

I read with great interest the article by Turpin and Pemberton on pressure mapping for patients on continuous lateral rotation therapy in the July/August edition. As a wound surgeon who sees daily the effects of pressure deep inside tissue, I was eager to see an article on such an important topic. I should add that I have personally mapped dozens of mattress systems on equipment identical to that used in the study.

 

I am fearful that the "message" (ie, these beds may make turning unnecessary) could be the most harmful message we could possibly propagate. My concern is that even if some patients do not need to be turned when on the most aggressive turning beds, this information will be dangerously extrapolated to all patients on all turning beds.

 

The idea of low air loss therapy is to produce a low interface pressure for the areas in contact with the bed. Every patient has a different critical closing pressure. Because we never know with certainty how much pressure an area over a boney prominence can tolerate, no pressure (as when a patient with ulcer is turned off the bed) is nearly always preferable to low pressure. Time is the factor besides pressure that determines if a tissue dies. Only group III therapy (air-fluidized) can consistently produce interface pressures that are low enough so that turning is usually not needed. All this study showed is that if a pillow is stuffed under a patient there may be higher pressure in that area. Of course there is, but the important point is that the pillow should be keeping the area of concern completely off the bed or rotating the pressure around so that no area stays in contact long enough to be critically compromised.

 

A similar corollary to this is seen in the beds with alternating cushions that intermittently inflate and deflate. When these systems are mapped there are rows of higher pressure interspersed with rows of no or very low pressure. When we see the map we do not fret that there are zones of higher pressure but realize that the areas with no pressure are receiving the therapy. Hence this study did not show the areas not touching the bed that were in fact benefiting from the turning.

 

So yes, pillows can increase pressure to localized areas on a low air loss bed, so keep turning the patients and rotating the areas of higher and lower pressure.

 

We must also remember that with every turn a patient with a sacral wound is (hopefully) visually checked to assess for incontinence and dressing adherence. While we must never fear challenging "the way we always did it," we should never succumb to just "giving them what they want to hear."

 

Matthew Pompeo, MD

 

Dallas, Texas

 

August 18, 2006