Reducing the Incidence and Prevalence of Pressure Injury in Adult ICU Patients with Support Surface Use: A Systematic Review

To provide information on the effectiveness of active and reactive support surfaces in reducing the incidence and prevalence of pressure injuries (PIs) in adult ICU patients.This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.After participating in this educational activity, the participant will: 1. Distinguish features of active and reactive support surfaces used in the ICU.2. Compare the PI incidence in patients using a variety of support surfaces.3. Synthesize recommendations for the use of support surfaces to reduce the risk of PI in adult ICU patients.To identify and analyze scientific evidence on the effectiveness of active and reactive support surfaces in reducing the incidence and prevalence of pressure injury (PI) in adult ICU patients. PubMed, ProQuest, ScienceDirect, Wiley Online Library, ClinicalKey for Nursing, Cochrane Library, and secondary searches. Studies were included if they related to support surfaces, involved adult ICU patients aged ≥18 years, and the primary outcome measured was incidence or prevalence of PI. The initial search resulted in 8,357 articles; after exclusions, 31 complete texts were assessed for feasibility. A total of eight articles were included in this review. A bias risk assessment was performed using the Cochrane Risk of Bias Assessment Tool. Data were extracted by one reviewer and summarized in a table of study results that was examined and verified by two other reviewers. Reactive (constant low pressure) support surfaces included viscoelastic foam mattresses, static air mattresses, and low-air-loss mattresses, whereas the active support surface consisted of alternating-pressure air mattresses. Alternating pressure mattress and viscoelastic foam mattress use both resulted in significantly lower PI incidence. Support surface use is limited, and no particular type is proven to be superior to others. Clinicians should select support surfaces based on their therapeutic features and how well they meet the patient’s particular needs.