Why Do Pediatric Population Need Specific Air Mattress for Pressure Injury Prevention?

Incidence rate of pressure injuries in Pediatric Intensive Care Units (PICUs) can be as high as 27%. Acutely ill and/or immobilized (E.g. cerebral palsy) neonates and children are at high risk for pressure injuries. Pro-care Auto Pediatric is designed to provide better pressure area care, greater comfort and improve quality of life for pediatric patients in high to very high risk of pressure injuries.

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 "Pressure injuries are a significant concern for the pediatric population."1

Incidence rate of pressure injuries in Pediatric Intensive Care Units (PICUs) can be as high as 27%.1,2,3 Acutely ill and/or immobilized (E.g. cerebral palsy) neonates and children are at high risk for pressure injuries. In addition, the extensive use of equipment and devices in PICUs, such as CPAP masks, tubes, catheters, pulse oximeters, wires, ECG or EEG electrodes, can potentially pose a threat to developing of pressure injuries in pediatric patients.2,3

 "A lack of awareness of the risk or a perception that pressure injuries are not of concern to this special population can lead health professionals and informal caregivers to overlook the importance of skin assessment and preventive care."1

 
Pressure injuries in pediatric population can be very different from those of adults based on their anatomical structure and physiological characteristics. For instance, with a much thinner and functionally immature epidermal layer, which is susceptible to excessive water loss, pediatric skin is less protective against prolonged pressure, friction and shear force.2,3 Hence, optima skin care is paramount.
 
Since more than half of pediatric pressure injuries are medical device-related pressure injuries (MDRPIs), studies have shown that a relatively softer muscle and fat tissue structures are one of the reasons for them to be less defenseless against deformation-related injuries.2,3 Especially when misplaced between the skin and mattress, these devices may fail to be noticed by nurses.
 
While sacrum and heels are the two most prevalent locations4,5 for pressure injuries in adults, the occiput, largest bony prominence in the pediatric population, is the most common location. Because a child has a proportionally larger and heavier head, occipital pressure injuries are frequently seen in younger patients.2,3,6
 
"Risk assessment is a central component of clinical practice and a necessary first step aimed at identifying individuals who are susceptible to pressure injuries."7

Braden Q Scale has been widely put into practice in terms of pressure injury risk assessment in pediatric population.8,9,10 Aside from the six subscales in Braden Scale, Tissue Perfusion and Oxygenation, an intrinsic aspect of tissue tolerance, was added to assess the patient’s condition. This subscale is evaluated according to the patient's pulse oximetry (SpO2) reading, blood studies, capillary refill or patient's physiologic response to a change in position.
 
A 2019 National Pressure Ulcer Advisory Panel White Paper2 concluded that:
"A surface needs to envelop the patient to redistribute the pressure, provide a low-friction interface to reduce shear, accommodate the patient’s mobility status, and be appropriate for the developmental age of the patient."
"Providers should take into consideration the frequent movements and growth requirements of pediatric patients."
"A support surface should conform to the misplacement of tubes and lines and decrease PI susceptibility."
 
Prof. Amit Gefen, an EPUAP Trustee, published a research study indicating that an air-cell-based (ACB) mattress can provide superior protection against increased soft tissue deformations around a misplaced tube comparing to a foam mattress. The envelopment offered by the ACB mattress increased contact area and diminished contact pressures between the mattress and the tube/skin.3
 
Taken the needs of both pediatric patients and caregivers, Pro-care Auto Pediatric is designed to provide better pressure area care, greater comfort and improve quality of life for pediatric patients in high to very high risk of pressure injuries.
 
  • TiniCell Technology empowers caregivers by providing an effective pressure relief while supporting the patient’s body contour in any position to prevent patient from sinking in between two air cells, such as semi-fowler position for pediatric patients in risk of respiratory problems or lateral position for patients who might be experiencing muscle contracture.
  • The system is built for professionals, aiding in pressure care plan set up for individual pediatric patients weighing from 5 to 95 kg by offering an excellent pressure relief through its extremely low pressure range within the purpose-built mattress, especially for patients who are susceptible to deformation-related injuries. 
  • Alternating Low Pressure (ALP) therapy for pediatric patients who cope less well with the perceived undulating feeling that traditional alternating therapy offers, it’s able to relieve prolonged pressure off patient’s body as effective as other therapy modes can. It’s exceptionally beneficial for cerebral palsy patients and patients with muscle paralysis during the treatment journey.
In conclusion, pediatric population are vulnerable to pressure injuries formation due to their differences in body proportions, tissue properties and physiological characteristics. Therefore, a comprehensive care plan including risk assessment, prevention or treatment strategies and the selection of adequate support surface is extremely important when providing care to pediatric patients.

References:

  1. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline. Emily Haesler (Ed.). EPUAP/NPIAP/PPPIA: 2019. Section 3: Special Populations. Page 31.
  2. Delmore B, Deppisch M, Sylvia C, Luna-Anderson C, Nie AM. Pressure Injuries in the Pediatric Population: A National Pressure Ulcer Advisory Panel White Paper. Adv Skin Wound Care. 2019;32(9):394-408. doi:10.1097/01.ASW.0000577124.58253.66
  3. Levy A, Kopplin K, Gefen A. Adjustability and Adaptability Are Critical Characteristics of Pediatric Support Surfaces. Adv Wound Care (New Rochelle). 2015;4(10):615-622. doi:10.1089/wound.2015.0639
  4. Li Z, Lin F, Thalib L, Chaboyer W. Global prevalence and incidence of pressure injuries in hospitalised adult patients: A systematic review and meta-analysis. Int J Nurs Stud. 2020;105:103546. doi:10.1016/j.ijnurstu.2020.103546
  5. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline. Emily Haesler (Ed.). EPUAP/NPIAP/PPPIA: 2019. Section 9: Heel Pressure Injuries. Page 145.
  6. Curley MA, Quigley SM, Lin M. Pressure ulcers in pediatric intensive care: incidence and associated factors. Pediatr Crit Care Med. 2003;4(3):284-290. doi:10.1097/01.PCC.0000075559.55920.36
  7. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline. Emily Haesler (Ed.). EPUAP/NPIAP/PPPIA: 2019. Section 4: Risk Factors and Risk Assessment. Page 38.
  8.  Quigley SM, Curley MA. Skin integrity in the pediatric population: preventing and managing pressure ulcers. J Soc Pediatr Nurs. 1996;1(1):7-18. doi:10.1111/j.1744-6155.1996.tb00050.x
  9. Curley MA, Razmus IS, Roberts KE, Wypij D. Predicting pressure ulcer risk in pediatric patients: the Braden Q Scale. Nurs Res. 2003;52(1):22-33. doi:10.1097/00006199-200301000-00004
  10. Noonan C, Quigley S, Curley MA. Using the Braden Q Scale to Predict Pressure Ulcer Risk in pediatric patients. J Pediatr Nurs. 2011;26(6):566-575. doi:10.1016/j.pedn.2010.07.006
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