Cost-effective strategy for managing pressure ulcers in critical care: a prospective, non-randomised, cohort study

Abstract

A prospective, clinical outcome study was undertaken in a critical care environment to provide evidence of the effectiveness of a unique pressure-relieving (PR) alternating mattress system in both the prevention and treatment of pressure ulcers in an extremely vulnerable population. In total, 160 critical care patients were recruited across five facilities within the United Kingdom. Despite the severity of the patients' condition (mean stay 8 days, mortality rate 24.7%) the incidence of new tissue damage was low (n = 6, 3.75%), predominantly superficial and occurring near to death, while 80% (n = 16/20) of pre-existing superficial ulcers healed. The study highlights the complexity of assessing differing levels of risk in this vulnerable population, where 87.5% of patients were ventilated and 93.1% were totally immobile. No correlation was found between the occurrence of pressure damage and Waterlow score, serum albumin, hypotension and the use of inotropic agents. Cost-effective patient management includes the allocation of effective resources to those patients who will benefit most. However, if complex risk assessment precludes the accurate assignment of resources, an alternative approach may be to provide a minimum, yet effective, standard of care to all patients. This strategy also avoids recourse to more costly interventions especially where there is little evidence of improved patient outcome.