Sacral bone exposed | Figure 1

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Do beds, mattresses and mattress toppers with air‐filled surfaces that apply constant pressure to the skin prevent pressure ulcers?

Key messages

• Reactive, air‐filled surfaces that apply constant pressure to the skin may reduce people’s chances of developing pressure ulcers compared with foam surfaces.
• They may also be better at preventing pressure ulcers among people in nursing homes than air‐filled surfaces that regularly redistribute pressure under the body.
• More research is needed to strengthen the evidence. Future studies should focus on options and effects that are important to decision‐makers, such as:
  • Reactive, air‐filled surfaces that apply constant skin pressure, compared with air‐filled surfaces that regularly redistribute pressure; and
  • whether and when pressure ulcers develop, unwanted effects and costs.

What are pressure ulcers?

Pressure ulcers are also known as pressure sores or bed sores. They are wounds to the skin and underlying tissue caused by prolonged pressure or rubbing. They often occur on bony parts of the body, such as heels, elbows, hips and the bottom of the spine. People who have mobility problems or who lie in bed for long periods are at risk of developing pressure ulcers.

What did we want to find out?

There are beds, mattresses and mattress toppers specifically designed for people at risk of pressure ulcers. These can be made of a range of materials (such as foam, air cells or water bags) and are divided into two groups:

• Reactive (static) surfaces that apply a constant pressure to the skin, unless a person moves or is repositioned; and
• Active (alternating pressure) surfaces that regularly redistribute the pressure under the body.

We wanted to find out if reactive, air‐filled surfaces:

• prevent pressure ulcers;
• are comfortable and improve people’s quality of life;
• have health benefits that outweigh their costs; and
• have any unwanted effects.

What did we do?

We searched the medical literature for studies that evaluated the effects of beds, mattresses and mattress toppers with a reactive, air‐filled surface. We compared and summarised their results, and rated our confidence in the evidence, based on factors such as study methods and sizes.

What did we find?

We found 17 studies (2604 people, average age: 72 years) that lasted between five days and six months (average: 14 days). The studies compared reactive, air‐filled surfaces with:

• Foam surfaces;
• Active, air‐filled surfaces; and
• Reactive surfaces filled with water, gel or other materials.

Pressure ulcer prevention

The evidence suggests that fewer people may develop pressure ulcers when lying on a reactive, air‐filled surface compared with:

• Foam surfaces (four studies, 229 people); and
• An active, air‐filled surface (one study, 308 people in a nursing home, followed for 14 days).

It is unclear whether reactive, air‐filled surfaces prevent ulcers more than other types of reactive surfaces.

Other effects

The studies did not provide sufficiently robust and clear evidence for us to determine how reactive, air‐filled surfaces affect comfort and unwanted effects. No studies reported information about quality of life and cost.

What limited our confidence in the evidence?

Most studies were small (83 people on average). Seven studies used methods likely to introduce errors in their results. It was unclear whether the other 10 studies used robust methods.

How up‐to‐date is this review?

The evidence in this Cochrane Review is current to November 2019.