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January 27, 1993

A Randomized Trial of Low-Air-Loss Beds for Treatment of Pressure Ulcers

Author Affiliations

From the Department of Medicine, UCLA School of Medicine, Los Angeles, Calif (Drs Ferrell and Osterweil); the Geriatric Research Education and Clinical Center, Sepulveda (Calif) Veterans Affairs Medical Center (Dr Ferrell); the Jewish Home for the Aging of Greater Los Angeles, Reseda, Calif (Dr Osterweil); and the UCLA Department of Biomathematics, Los Angeles, Calif (Dr Christenson).

JAMA. 1993;269(4):494-497. doi:10.1001/jama.1993.03500040060037

Objective.  —To assess the effectiveness of low-air-loss beds for the treatment of pressure ulcers in nursing homes.

Design.  —Prospective, randomized, clinical trial.

Setting.  —Three teaching nursing homes in Los Angeles, Calif.

Subjects.  —Eighty-four nursing home residents with trunk or trochanter pressure ulcers (Shea stage ≥2).

Interventions.  —Subjects were randomly assigned to use either a low-air-loss bed (n=43) or a 10-cm corrugated foam mattress (n=41) throughout the healing of their ulcers.

Outcome Measures.  —Ulcers were assessed twice weekly using surface area and two observational scales (median follow-up, 37.5 days; range, 4 to 571 days).

Results.  —Groups were similar with respect to demographics, medical variables, wound care, and early dropouts. Results indicate more than a threefold improvement in median rate of healing for low-air-loss beds compared with foam mattresses (9.0 vs 2.5 mm2/d; P=.0002). This finding was true for deep as well as superficial ulcers (deep ulcers, 9.9 vs 0.7 mm2/d; P=.02; superficial ulcers, 9.0 vs 3.2 mm2/d; P=.004). Cox regression models revealed that the bed, ulcer depth, and fecal continence had independent effects on healing. After controlling for fecal continence, the deep and superficial subgroups using low-air-loss beds remained 2.5 times more likely to heal in a given length of time compared with those using foam mattresses (combined cure probability ratio, 2.66; 95% confidence interval, 1.34 to 5.17; P<.004).

Conclusion.  —Low-air-loss beds provide substantial improvement compared with foam mattresses despite other factors in pressure ulcer healing.(JAMA. 1993;269:494-497)