Microcirculatory responses of sacral tissue in healthy individuals and inpatients on different pressure-redistribution mattresses
2015 (English)In: Journal of Wound Care, ISSN 0969-0700, Vol. 24, no 8, 346-358 p.Article in journal (Refereed) Published
Objective: The aim of this study was to explore the interaction between interface pressure and pressure-induced vasodilation and reactive hyperemia with different pressureredistribution mattresses.
Method: A cross-sectional study was performed with a convenience sample of 42 healthy individuals between 18 and 64 years of age, 38 healthy individuals 65 years or older, and 35 inpatients 65 years or older at a university hospital in Sweden. Blood flow was measured at depths of 1 mm, 2 mm, and 10 mm using a combined system of laser Doppler flowmetry and photoplethysmography. The blood flow, interface pressure and skin temperature were measured in the sacral tissue before, during, and after load while lying on one standard hospital mattress and three different pressure-redistribution mattresses.
Results: There were significant differences between the three foam mattresses with regard to average sacral pressure, peak sacral pressure, and local probe pressure with the lowest values at the visco-elastic foam/air mattress (23.5 ± 2.5 mmHg, 49.3 ± 11.1 mmHg, 29.2 ± 14.0 mmHg respectively). A greater proportion of subjects had affected blood flow in terms of lack of pressure-induced vasodilation on the visco-elastic foam/air mattress compared to the alternating pressure mattress at tissue depths of 2 mm (39.0% vs. 20.0%, respectively) and 10 mm (56.9 % vs. 35.1%, respectively). Eleven individuals, including subjects in all three subject groups were identified with no pressure-induced vasodilation or reactive hyperemia in any mattress, and this was considered a high-risk blood flow response.
Conclusion: Interface pressure magnitudes considered not harmful during pressure-exposure lying on different pressure-redistribution mattresses can affect the microcirculation in different tissue structures. Despite having the lowest pressure values compared to the other mattresses, the visco-elastic foam/air mattress had the highest proportion of subjects with decreased blood flow indicating a more affected blood flow. Three young healthy individuals were identified with the high-risk blood flow response, indicating an innate vulnerability to pressure exposure and may not benefit from pressure-redistribution mattresses. Finally it was shown that the evaluation of pressure-redistribution support surfaces in terms of mean blood flow during and after tissue exposure is not feasible but assessment of pressure-induced vasodilation and reactive hyperemia could be a new possibility to assess individualized physiological measurements of mechanisms known to be related to pressure ulcer development.
Place, publisher, year, edition, pages
2015. Vol. 24, no 8, 346-358 p.
interface pressure, pressure-induced vasodilation, pressure ulcer, reactive hyperemia, tissue blood flow
Nursing Clinical Medicine
IdentifiersURN: urn:nbn:se:liu:diva-109951ISI: 000359210200004OAI: oai:DiVA.org:liu-109951DiVA: diva2:741851
Vid tiden för disputationen var publikationen ett manuskript ("Exploring pressure-induced microcirculatory responses in sacral tissue in healthy individuals and inpatients on different pressure-redistribution mattresses")
Funding text: None declared. The study was funded by the Swedish Research Council, the Faculty of Health Sciences at Linkoping University, Region of Ostergotland., King GustafV and Queen Victoria's Freemason Foundation, NovaMedTech, and the European Union Regional Development Fund.2014-08-292014-08-292015-09-08Bibliographically approved