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acute care, comparative effectiveness research, ICU, PI, pressure injury, pressure redistribution mattress, repositioning



  1. Jiang, Qixia MSN, RN, ET
  2. Liu, Yuxiu MM
  3. Yu, Hui MSN, RN
  4. Song, Siping BSN, RN
  5. Li, Guohong MPH, RN
  6. Liu, Haiying BSN, RN
  7. Zhou, Yi BSN, RN
  8. Zhu, Yajun BSN, RN, ET
  9. Jia, Jing BSN, RN, ET
  10. Huang, Yunjuan MSN, RN
  11. Wang, Jiandong PhD, MD


OBJECTIVE: To compare the effectiveness of two protocols for preventing pressure injuries (PIs) in Chinese hospitals.


DESIGN AND SETTING: A multicenter, open-label, comparative study conducted in seven Chinese acute care hospitals.


PATIENTS AND INTERVENTION: In total, 1,654 eligible patients were identified, and 1,204 were enrolled in the study. Enrolled patients were randomly assigned into the trial group (4-hour repositioning combined with a viscoelastic foam mattress; n = 602) or the control group (2-hour repositioning combined with a powered air pressure redistribution mattress; n = 602). Participants received their respective protocols until they were discharged, died, or for at least 7 days.


MAIN OUTCOME MEASURES: The incidence of PIs, Braden Scale scores, and the time to development of PIs.


MAIN RESULTS: Ultimately, 596 trial group patients and 598 control group patients were analyzed. Thirteen patients had single new stage 2 or worse PIs. The total incidence of PIs was 1.1%. The difference between the two groups was significant (0.3% vs 1.8%). However, the difference between the groups' Braden Scale score median during the intervention was not significant (13 vs 13.5).


CONCLUSIONS: The 4-hour repositioning interval combined with a viscoelastic foam mattress did not increase PI incidence or risk. These findings could help providers select the right pressure redistribution mattresses and repositioning intervals for critical care patients.