Impact of an alternating pressure mattress on skin injuries in patients with COVID-19 in a specialist respiratory intensive care unit.

Publication date: Jul 02, 2026

The primary objective was to establish the prevalence of newly acquired pressure ulcers (PUs) in a cohort of patients with COVID-19 admitted to a specialist respiratory intensive care unit (ICU) during the first ICU surge and who were allocated the Nimbus Professional Alternating Pressure Mattress System (Arjo AB, Sweden) for the entirety of their admission. Secondary objectives were to establish the prevalence of newly acquired PUs in the cohort of patients receiving extracorporeal membrane oxygenation (ECMO) who were aligned to a six-hourly repositioning protocol, as well as in the cohort of proned patients. A retrospective skin injury evaluation of the Surface, Skin Inspection, Keep moving, Incontinence/moisture and Nutrition (SSKIN) document bundle of every patient who tested positive for the COVID-19 virus, who was admitted to the ICU between 16 March 2020 and 26 June 2020 and allocated the Nimbus Professional mattress for the entirety of their admission. Of the 32 patients who were identified in this service evaluation, three (9. 4%) developed ≥1 PU while allocated to the alternating pressure mattress. Of the 23 patients treated with ECMO who were routinely repositioned every six hours, two (8. 7%) experienced a PU, and of the remaining nine patients not receiving ECMO, one (11. 1%) experienced a PU. Out of the 11 patients who were proned, one (9. 1%) experienced a PU, and in the 21 patients who were not proned, two (9. 5%) experienced a PU. No deep category 3 or 4 PUs, deep tissue injuries or unstageable PUs were recorded. All PUs were of a category 1 or 2 superficial depth ulceration. There were no newly acquired PUs to the chest, abdomen or knees when patients were in the proned position. The rate of deep PUs in patients allocated to the alternating pressure mattress was low when combined with a systematic approach to repositioning. The cohort of proned patients largely relied on the mattress function to provide pressure relief while in the prone position. The absence of any new PUs to the chest, abdomen, knees and feet in the proned cohort, indicated that allocating a dynamic mattress with cells that can be manually deflated under high-risk anatomical points, can be an effective method of protecting patients from skin injury. There was no link between an increased risk of PUs and an increased length of stay. A larger cohort requires studying to establish if these outcomes can be replicated consistently.

Semantics

Original Article