AUTHOR'S REPLY
The phrase "off-load capillary closing pressure" was used to describe how pressure ulcers develop. If capillary closing pressure is greater than 32 mmHg for greater than 2 hours on a bony prominence, then tissue damage will result. If the beds were able to reduce capillary closing pressure, then patients placed on these beds would not experience breakdown. Many manufacturers will market their lateral rotation beds as sufficient rotation to turn the patient; however, patients breakdown on lateral rotation on the sacrum heels and occiput.
The purpose of this article was to educate nursing staff that the bed alone is not sufficient to off-load pressure enough to prevent skin breakdown. The purpose of this case study was to enlighten others in the acute care setting on the use of lateral rotation beds.
The point is well taken that patients in the ICU setting are at unique pressure ulcer risk with hemodynamic instability, higher APACHE scores, and severe respiratory involvement; these factors are exactly the reason why the authors chose to monitor these patients to further prevent the occurrence of nosocomial pressure ulcers in their facility. Many times a patient will be admitted for a number of the above medical issues and will acquire a stage 3 or 4 pressure ulcer. Long after the original medical crisis has resolved, the patient will be left with a serious wound that is very slow to heal and will open that patient up to a host of other medical problems.
In this case study, the authors attempted to work with the manufacturers on a protocol, but the manufacturer refused to admit a problem existed. In this case, the bed company representative did instruct the nursing staff not to turn the patients on these beds. Because we noted a trend in pressure ulcer development on patients who were placed on these beds, we felt we needed to study the situation more closely. This is a case study and not based on any scientific evidence, just our own experience in the acute setting.
Finally, the advantages of lateral rotation on the prevention of nosocomial pneumonia, and other severe respiratory conditions are well recognized; however, it is the opinion of this author that lateral rotation is overused in the critical care setting and that its maximal benefit to the patient may not exceed 7-10 days, as studies indicate. I further believe that lateral rotation is misrepresented as a means to eliminate pressure on bony prominences and misleads the bedside nurse into thinking that this means of movement is sufficient. Nothing can take the place of traditional nursing care, which, in this case, is to turn the patient every 2 hours and off-load all bony prominences.