Guidelines recommend the use of support surfaces to prevent pressure injuries. In clinical practice, however, selecting the most appropriate surface for patients is difficult. A systematic review of randomized controlled trials was conducted to evaluate the effectiveness of alternating pressure air mattresses compared with other support surfaces (static air mattresses, viscoelastic foam mattresses, and high-specification foam mattresses) in preventing pressure injuries in adults admitted to hospitals and nursing homes.

Six studies published between 2009 and 2020 were selected for analysis. Risk of bias was rated as low for one of the studies, of some concern for another, and of high risk for the remaining four studies.

There was inconsistent evidence for this review's primary outcome: incidence of pressure injuries when using alternating pressure air mattresses. The incidence of pressure injuries when using alternating pressure air mattresses compared with static air mattresses was higher in one study but the same in two studies. The incidence of pressure injuries when using alternating pressure air mattresses compared with viscoelastic foam mattresses was lower in one study but higher in a more recent study. There was no difference in incidence when comparing alternating pressure air mattresses with high-specification foam mattresses.

Because all six studies were determined to have a risk of bias, no quantitative analysis was performed.

The findings suggest that it's difficult to prevent pressure injuries by applying a support surface alone. Support surfaces should be considered as part of a pressure injury prevention bundle, the authors conclude, adding that comprehensive pressure injury prevention nursing, including repositioning, is important.