Prolonged mechanical loading can lead to the breakdown of skin and underlying tissues which can, in turn, develop into a pressure ulcer. The benefits of pressure relief and/or redistribution to minimise risk have been well documented. Manufacturers have developed alternating air pressure mattresses (APAMs) to provide periodic relief for individuals on prolonged bed-rest. The present study describes the development of a control system, termed Pneumatic Manager which can vary the signature of an APAM, namely its pressure amplitude, cell profile and cycle period. An experimental array was designed to investigate the effects of varying these parameters, particularly with respect to its ability to maintain skin viability in a group of five healthy volunteers lying in a supine position. Transcutaneous gas (TcPO2/TcPCO2) tensions at the sacrum were monitored. In addition, pressures and microclimate parameters at the loaded support interface were also measured. In the majority of test conditions the alternating support produced sacral TcPO2 values, which either remained relatively high or fluctuated in concert with cycle period providing adequate viability. However, in 46% of cases at the extreme pressure amplitude of 100/0 mmHg, there was compromise to the skin viability at the sacrum, as reflected in depressed TcPO2 levels associated with an elevation of TcPCO2 levels above the normal range. In all cases, both the humidity and temperature levels increased during the test period. It is interesting to note that interface pressures at the sacrum rarely exceeded 60 mmHg. Although such studies need to be extended to involve bed-bound individuals, the results provide a design template for the optimum pressure signatures of APAM systems to ensure maintenance of skin viability during pronged loading.
Keywords: Alternating pressure signatures; Microclimate; Pressure ulcers; Supine lying; Tissue viability.
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