![]() ![]() Alternating pressure (active) air surfaces may reduce pressure ulcer risk compared with foam surfaces and reactive gel surfaces used on operating tables followed by foam surfaces applied on hospital beds. Moderate‐certainty evidence suggests that alternating pressure (active) air surfaces are probably more cost‐effective than foam surfaces (1 study, 2029 participants) and that alternating pressure (active) air mattresses are probably more cost‐effective than overlay versions of this technology for people in acute care settings (1 study, 1971 participants).Ĭurrent evidence is uncertain about the difference in pressure ulcer incidence between using alternating pressure (active) air surfaces and other surfaces (reactive water surfaces, reactive fibre surfaces and reactive air surfaces). Included studies have data on cost effectiveness for two comparisons. ![]() However, all these outcomes and comparisons have low or very low‐certainty evidence and it is uncertain whether there are any differences in these outcomes. The included studies have data on (1) support‐surface‐associated patient comfort for comparisons involving foam surfaces, reactive air surfaces, reactive fibre surfaces and alternating pressure (active) air surfaces (2) adverse events for comparisons involving foam surfaces, reactive gel surfaces and alternating pressure (active) air surfaces and (3) health‐related quality of life outcomes for the comparison involving foam surfaces. Neither of the two studies with time to ulcer incidence data suggested a difference in the risk of developing an incident pressure ulcer over 60 days' follow‐up between different types of alternating pressure air surfaces. For the comparison with reactive air surfaces, there is low‐certainty evidence that people treated with alternating pressure (active) air surfaces may have a higher risk of developing an incident pressure ulcer than those treated with reactive air surfaces over 14 days' follow‐up (HR 2.25, 95% CI 1.05 to 4.83 1 study, 308 participants). When time to pressure ulcer development is considered using a hazard ratio (HR), it is uncertain whether there is a difference in the risk of developing new pressure ulcers, over 90 days' follow‐up, between alternating pressure (active) air surfaces and foam surfaces (HR 0.41, 95% CI 0.10 to 1.64 I 2 = 86% 2 studies, 2105 participants very low‐certainty evidence). Included studies have data on time to pressure ulcer incidence for three comparisons. Overall, all comparisons suggest little to no difference between these surfaces in pressure ulcer incidence (7 studies, 2833 participants low‐certainty evidence). The comparisons between different types of alternating pressure air surfaces are presented narratively. It is uncertain whether there is a difference in the proportion of people developing new pressure ulcers between alternating pressure (active) air surfaces and the following surfaces, as all these comparisons have very low‐certainty evidence: (1) reactive water surfaces (2) reactive fibre surfaces and (3) reactive air surfaces. Alternating pressure (active) air surfaces applied on both operating tables and hospital beds may reduce the proportion of people developing a new pressure ulcer compared with reactive gel surfaces used on operating tables followed by foam surfaces applied on hospital beds (RR 0.22, 95% CI 0.06 to 0.76 I 2 = 0% 2 studies, 415 participants low‐certainty evidence). ![]() ![]() Primary outcome: pressure ulcer incidenceĪlternating pressure (active) air surfaces may reduce the proportion of participants developing a new pressure ulcer compared with foam surfaces (risk ratio (RR) 0.63, 95% confidence interval (CI) 0.34 to 1.17 I 2 = 63% 4 studies, 2247 participants low‐certainty evidence). Of the 32 included studies, 25 (78.1%) presented findings which were considered at high overall risk of bias. We synthesised data for six comparisons in the review: alternating pressure (active) air surfaces versus: foam surfaces, reactive air surfaces, reactive water surfaces, reactive fibre surfaces, reactive gel surfaces used in the operating room followed by foam surfaces used on the ward bed, and another type of alternating pressure air surface. Participants were largely from acute care settings (including accident and emergency departments). The average age of participants ranged from 37.2 to 87.0 years (median: 69.1 years). Most studies were small (median study sample size: 83 participants). We included 32 studies (9058 participants) in the review. ![]()
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