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Bruce A. Ferrell, MD; Dan Osterweil, MD; Peter Christenson, PhD

JAMA. 1993;269(4):494-497.

Abstract
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)

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).

Footnotes
Reprint requests to Sepulveda Veterans Affairs Medical Center (11E), 16111 Plummer St, Sepulveda, CA 91343 (Dr Ferrell).

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