TY - JOUR
T1 - How patient migration in bed affects the sacral soft tissue loading and thereby the risk for a hospital-acquired pressure injury
AU - Lustig, Maayan
AU - Wiggermann, Neal
AU - Gefen, Amit
N1 - Publisher Copyright: © 2020 The Authors. International Wound Journal published by Medicalhelplines.com Inc (3M) and John Wiley & Sons Ltd.
PY - 2020/6/1
Y1 - 2020/6/1
N2 - Head-of-bed (HOB) elevation is a common clinical practice in hospitals causing the patient's body to slide down in bed because of gravity. This migration effect likely results in tissue shearing between the sacrum and the support surface, which increases the risk for pressure injuries. StayInPlace (HillRom Inc.) is a commercial migration-reduction technology (MRT) incorporated in intensive care bedframes. Yet, the effects of migration-reduction on tissue shear stresses during HOB elevation are unknown. We analysed relationships between migration and resulting sacral soft tissue stresses by combining motion analysis and three-dimensional finite element modelling of the buttocks. Migration data were collected for 10 subjects, lying supine on two bedframe types with and without MRT, and at HOB elevations of 45°/65°. Migration data were used as displacement boundary conditions for the modelling to calculate tissue stress exposures. Migration values for the conventional bed were 1.75- and 1.6-times greater than those for the migration-reduction bed, for elevations of 45° and 65°, respectively (P <.001). The modelling showed that the farther the migration, the greater the tissue stress exposures. Internal stresses were 1.8-fold greater than respective skin stresses. Our results, based on the novel integrated experimental-computational method, point to clear biomechanical benefits in minimising migration using MRT.
AB - Head-of-bed (HOB) elevation is a common clinical practice in hospitals causing the patient's body to slide down in bed because of gravity. This migration effect likely results in tissue shearing between the sacrum and the support surface, which increases the risk for pressure injuries. StayInPlace (HillRom Inc.) is a commercial migration-reduction technology (MRT) incorporated in intensive care bedframes. Yet, the effects of migration-reduction on tissue shear stresses during HOB elevation are unknown. We analysed relationships between migration and resulting sacral soft tissue stresses by combining motion analysis and three-dimensional finite element modelling of the buttocks. Migration data were collected for 10 subjects, lying supine on two bedframe types with and without MRT, and at HOB elevations of 45°/65°. Migration data were used as displacement boundary conditions for the modelling to calculate tissue stress exposures. Migration values for the conventional bed were 1.75- and 1.6-times greater than those for the migration-reduction bed, for elevations of 45° and 65°, respectively (P <.001). The modelling showed that the farther the migration, the greater the tissue stress exposures. Internal stresses were 1.8-fold greater than respective skin stresses. Our results, based on the novel integrated experimental-computational method, point to clear biomechanical benefits in minimising migration using MRT.
KW - deep tissue injury
KW - finite element modelling
KW - head of bed elevation
KW - motion capture analysis
KW - pressure ulcer prophylaxis
UR - http://www.scopus.com/inward/record.url?scp=85079394239&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/iwj.13316
DO - https://doi.org/10.1111/iwj.13316
M3 - مقالة
C2 - 32048476
SN - 1742-4801
VL - 17
SP - 631
EP - 640
JO - International Wound Journal
JF - International Wound Journal
IS - 3
ER -