PubMed · 10349019
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C Laurent. Beating bedtime blues.. https://pubmed.ncbi.nlm.nih.gov/10349019/
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OBJECTIVES: To assess the effectiveness of pressure relieving beds, mattresses and cushions (support surfaces) in the prevention and treatment of pressure sores. SEARCH STRATEGY: Searches of 19 databases, hand searching of journals, conference proceedings, and bibliographies. SELECTION CRITERIA: Randomised controlled trials evaluating support surfaces for the prevention or treatment of pressure sores. There was no restriction on articles based on language or publication status. DATA COLLECTION AND ANALYSIS: Data extraction and assessment of study quality was undertaken by two reviewers independently. Trials with similar patients, comparisons, and outcomes were pooled. Where pooling was inappropriate, trials are discussed in a narrative review. MAIN RESULTS PREVENTION: 29 RCTs of support surfaces for pressure sore prevention were identified. Some high specification foam mattresses were more effective than 'standard' hospital foam mattresses in moderate-high risk patients. Pressure relieving mattresses in the operating theatre reduced the incidence of pressure sores post-operatively. The relative merits of alternating and constant low pressure, and of the different alternating pressure devices are unclear. Seat cushions and simple, constant low-pressure devices have not been adequately evaluated. Limited evidence suggests that low air loss beds reduce the incidence of pressure sores in intensive care. TREATMENT: 6 RCTs of support surfaces for pressure sore treatment were identified. There is good evidence that air-fluidised and low air loss beds improve healing rates. Seat cushions have not been adequately evaluated. 2 RCTs evaluated surfaces for both prevention and treatment in the same trial. REVIEWER'S CONCLUSIONS: PREVENTION - There is good evidence of the effectiveness of high specification foam over standard hospital foam, and pressure relief in the operating theatre. Treatment - There is good evidence of the effectiveness of air-fluidised and low air loss devices as treatments. Overall, however, it is impossible to determine the most effective surface for either prevention or treatment.
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PURPOSE: We describe modified patient positioning on the Cloward surgical saddle for use during percutaneous nephroscopic procedures. MATERIALS AND METHODS: The Cloward surgical saddle, which was designed for prone patient positioning, has been used primarily for lumbar surgery. We evaluated the use of the surgical saddle for ease of patient positioning during percutaneous nephroscopic procedures. RESULTS: We have used the surgical saddle in 10 patients to date, including 1 who was 5 feet 8 inches (173 cm.) tall and who weighed 370 pounds (168 kg.). In all cases pulmonary airway pressure was maintained at less than 30 cm. water. We have observed no incidence of pressure injury or other complications associated with position. CONCLUSIONS: Patient positioning during percutaneous nephroscopic surgery is important for preventing pressure injury and allowing adequate pulmonary ventilation. The surgical saddle is an excellent aid for secure patient positioning during percutaneous nephroscopic procedures that helps to minimize the risk of pressure injury and pulmonary compromise.