Pressure Injury Mitigation in Prolonged Care: A Randomized Noninferiority and Superiority Trial

Area of Science:

• Biomedical Engineering
• Military Medicine
• Wound Care

Background:

• Combat casualties face elevated pressure injury (PI) risks during prolonged care.
• Limited research exists on operational PI risk mitigation strategies for military settings.

Purpose of the Study:

• To compare a prototype AirSupport mattress against the Talon litter and Warrior Evacuation Litter Pad (WELP) for PI risk factors.
• To determine if the AirSupport pad is non-inferior and superior to the WELP in reducing skin interface pressure.

Main Methods:

• Eighty-five healthy adults were stratified by body fat and randomized into three groups: Talon, Talon + AirSupport, and Talon + WELP.
• Participants lay supine for 1 hour, with outcomes including skin interface pressure, temperature, moisture, and discomfort measured at key body areas.
• The study was approved by the University of Washington Institutional Review Board.

Main Results:

• The Talon litter exhibited significantly higher peak skin interface pressures across multiple body areas compared to AirSupport and WELP.
• AirSupport was non-inferior and superior to WELP for peak interface pressure on the sacrum, occiput, and heels.
• While AirSupport and WELP reduced pressure, they showed higher skin temperature increases than the Talon, potentially increasing ischemic burden.

Conclusions:

• The Talon litter poses a significant PI risk due to high interface pressures; immediate intervention is needed.
• AirSupport and WELP are operationally feasible solutions for PI risk mitigation, with AirSupport showing superior pressure redistribution.
• Comprehensive evaluation of pressure redistribution interventions must consider skin interface pressure, temperature, and moisture to predict skin damage effectively.