Assessment of an Innovative Air Mattress On Critically Ill Infants (Prepicare)

The permanent bedding of critically ill neonates and infants in the pediatric intensive care unit (PICU) for an extended amount of time can result in the development of pressure injuries (PI). PIs can form due to high and permanent local interface pressure induced by contact with bed surfaces or other medical devices. The currently used state-of-the-art support systems consist of conventional foam mattresses. In this study, the investigators explore the effect of a newly developed air mattress with regard to contact are and reduction in the average interface pressure in infants assigned to the pediatric intensive care unit of the childrens hospital in Zurich.

Study Overview

• Status: Recruiting
• Conditions: Skin Abnormalities; Skin; Injury, Superficial; Skin; Ulcer, Decubitus
• Intervention / Treatment: Device: Exposure of the patient to a novel air mattress.; Device: Exposure of the patient to a conventional foam mattress.

Detailed Description

The permanent bedding of critically ill neonates and infants in the pediatric intensive care unit (PICU) for an extended amount of time can result in the development of pressure injuries (PI). This results in a further prolongation of the hospital stay, additional suffering of the patient, scarring, increased mortality and morbidity, and increased healthcare costs. Infants are at particular risk since their skin hasn't matured yet and is mechanically weak, and for example neonates lack a robust stratum corneum entirely. Furthermore, the thickness of their skin is reduced by 60% when compared to skin of adults. Thus, pressure cannot be equally absorbed leading to higher tissue internal stress. PIs can form due to high and permanent local interface pressure induced by contact with bed surfaces or other medical devices. Contact pressure can hamper blood flow in subcutaneous areas, increasing susceptibility for pressure injuries. While sophisticated equipment to manage the interface pressure and reduce the risk of developing pressure injuries is abundant for adults, very little is designed explicitly for neonates and infants. The currently available air mattresses are not being used due to safety concerns and impracticability. Furthermore, they are designed for infants from half a year of age and, thus, not considering the low body weight of premature babies or neonates. This is why the currently used conventional foam mattresses remain first choice. However, foam mattresses are designed for optimal support of a specific weight and, therefore, making them unsuitable for the use as a one-fits-all solution in a highly heterogenic patient cohort. In addition, compressed foam gets stiffer at compressed areas, increasing the local pressure impact and, thus, PI risk. On the other hand, the structures of the hereby-developed air mattress can freely move and optimally adjust to the patient's body shape. This increases contact area, reduces the average interface pressure and blunts local pressure peaks at the areas with the most indentation, ensuring a more homogenous pressure distribution at a lower level. This ultimately is expected to result in a lower PI incidence. As a side effect, lying comfort for the patient will be increased.

• Study Type: Interventional
• Enrollment (Estimated): 26
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Simon Annaheim, PhD; Phone Number: +41 58 765 77 68; Email: simon.annaheim@empa.ch
• Study Contact Backup: Name: Barbara Brotschi, Prof; Phone Number: +41 44 266 71 71; Email: barbara.brotschi@kispi.uzh.ch

Study Locations

• Switzerland
  • Zurich, Switzerland, 8032
    • Recruiting
    • University Children's Hospital Zurich
    • Contact: Barbara Brotschi, Prof; Phone Number: +41 44 266 71 71; Email: barbara.brotschi@kispi.uzh.ch

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Informed consent signed by the legal guardian
• Admitted to the pediatric intensive care unit (PICU)
• Age: late preterm (>34 gestational age) up to 6 months
• Admission at least 24 hours to PICU prior to intervention
• Presence/availability of at least one parent/legal guardian

Exclusion Criteria:

• Life threatening condition
• Patients who cannot be positioned in supine position
• Skin injury at body area in contact with support surface
• Patients with congenital skin disorders
• Patients with omphalocele or gastroschisis
• Newborns with peripartum asphyxia and hypothermia therapy
• Language communication difficulties with the legal guardians
• Surgical patients on the day of surgery
• birth weight <1250g

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Investigation of contact pressure distribution in a novel air mattress; Exposure of the patient to the novel air mattress. Recording of interface pressure and contact area between the patient and the air mattress for one hour. Regular measurement of vital signs and comfort and assessment of risk to develop side effects, particularly skin pressure injuries.	Device: Exposure of the patient to a novel air mattress.; see information provided in the "Arms" section (experimental)
Active Comparator: Investigation of contact pressure distribution in a conventional foam mattress; Exposure of the patient to the conventional foam mattress. Recording of interface pressure and contact area between the patient and the foam mattress for one hour. Regular measurement of vital signs and comfort and assessment of risk to develop side effects, particularly skin pressure injuries.	Device: Exposure of the patient to a conventional foam mattress.; see information provided in the "Arms" section (active comparator)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Interface pressure resulting from the exposure of patients to the supportive structures as measured by a pressure sensitive mat (xsensor, LX100:100.160.05, XSENSOR Technology Corporation, Calgary, Canada).	Quantification of interface pressure between the patient and the mattress surfaces with emphasis on data of highest pressures (median for top 25% of pressure data observed; 4th quartile of pressure data).	baseline
Interface pressure resulting from the exposure of patients to the supportive structures as measured by a pressure sensitive mat (xsensor, LX100:100.160.05, XSENSOR Technology Corporation, Calgary, Canada).	Quantification of interface pressure between the patient and the mattress surfaces with emphasis on data of highest pressures (median for top 25% of pressure data observed; 4th quartile of pressure data).	after 60 minutes of exposure to the mattress

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Contact area resulting from the exposure of patients to the supportive structures as detected by a pressure sensitive mat (xsensor, LX100:100.160.05, XSENSOR Technology Corporation, Calgary, Canada)	Quantification of contact are between the patient and the mattress surface.	baseline
Contact area resulting from the exposure of patients to the supportive structures as detected by a pressure sensitive mat (xsensor, LX100:100.160.05, XSENSOR Technology Corporation, Calgary, Canada)	Quantification of contact are between the patient and the mattress surfaces.	after 60 minutes of exposure to the mattress
Difference in stress assessment by means of heart rate	Measurement of heart rate obtained from clinical routine patient surveillance.	baseline
Stress assessment by means of heart rate	Measurement of heart rate obtained from clinical routine patient surveillance.	after 60 minutes of exposure to the mattress
Stress assessment by means of respiratory rate	Measurement of respiratory rate obtained from clinical routine patient surveillance.	baseline
Stress assessment by means of respiratory rate	Measurement of respiratory rate obtained from clinical routine patient surveillance.	after 60 minutes of exposure to the mattress
Stress assessment by means of blood pressure (mean arterial pressure)	Measurement of blood pressure obtained from clinical routine patient surveillance.	baseline
Stress assessment by means of blood pressure (mean arterial pressure)	Measurement of blood pressure obtained from clinical routine patient surveillance.	after 60 minutes of exposure to the mattress
Stress assessment by means of blood oxygen saturation	Measurement of blood oxygen saturation obtained from clinical routine patient surveillance.	baseline
Stress assessment by means of blood oxygen saturation	Measurement of blood oxygen saturation obtained from clinical routine patient surveillance.	after 60 minutes of exposure to the mattress
Stress assessment by means of body temperature	Measurement of body temperature obtained from clinical routine patient surveillance.	baseline
Stress assessment by means of body temperature	Measurement of body temperature obtained from clinical routine patient surveillance.	after 60 minutes of exposure to the mattress
Comfort assessment by means of a visual analogue scale	Quantification of comfort level ranging from 0 [very uncomfortable] to 10 [very comfortable].	baseline
Comfort assessment by means of a visual analogue scale	Quantification of comfort level ranging from 0 [very uncomfortable] to 10 [very comfortable].	after 60 minutes of exposure to the mattress
Stress assessment by means of a visual analogue scale	Quantification of stress level ranging from 0 [totally relaxed] to 10 [very stressed].	baseline
Stress assessment by means of a visual analogue scale	Quantification of stress level ranging from 0 [totally relaxed] to 10 [very stressed].	after 60 minutes of exposure to the mattress
Pain assessment by means of the questionnaire "Bern pain score for newborns - Revised (BSN-R)"	Assessment of pain indicators (crying, facial expression, body tension, heart rate) ranging from 0 points (no pain indication) to 3 points (high pain indication). Total values >5 points for premature babies and >3 points for term babies is indicative for pain.	baseline
Pain assessment by means of the questionnaire "Bern pain score for newborns - Revised (BSN-R)"	Assessment of pain indicators (crying, facial expression, body tension, heart rate) ranging from 0 points (no pain indication) to 3 points (high pain indication). Total values >5 points for premature babies and >3 points for term babies is indicative for pain.	after 60 minutes of exposure to the mattress
Unrest assessment by means of the Richmond Agitation-Sedation Scale (RASS) questionnaire	Values range from -1 (sleepy) to 0 (attentive and calm) to +4 (belligerent).	baseline
Unrest assessment by means of the Richmond Agitation-Sedation Scale (RASS) questionnaire	Values range from -1 (sleepy) to 0 (attentive and calm) to +4 (belligerent).	after 60 minutes of exposure to the mattress
Skin perfusion assessment by means of capillary refill time	Assessment of the capillary refill time according to Jevon and Gallier (2020).	baseline
Skin perfusion assessment by means of capillary refill time	Assessment of the capillary refill time according to Jevon and Gallier (2020).	after 60 minutes of exposure to the mattress
Skin assessment according to standard clinical procedure	Identification and localisation (nose, mouth, occipital, face, ear, back, leg, foot, heel, others) of skin irregularities and evaluation of severity of irregularity (redness, partial injury of skin layers, all skin layers affected, complete tissue loss) according to clinical routine	baseline
Skin assessment by means of questionnaire	Identification and localisation (nose, mouth, occipital, face, ear, back, leg, foot, heel, others) of skin irregularities and evaluation of severity of irregularity (redness, partial injury of skin layers, all skin layers affected, complete tissue loss) according to clinical routine	after 60 minutes of exposure to the mattress
Delirium assessment by means of the Cornell Assessment of Pediatric Delirium score (CAPD)	Assessment of delirium indicators (eye contact, purposeful actions, awareness of surroundings, communication of needs, restlessness, refusal to be comforted, hypoactivity, response time) ranging from 0 points (not indicative for delirium) to 4 points (highly indicative for delirium). A delirium state is considered from a total value of >8 points.	baseline
Delirium assessment by means of the Cornell Assessment of Pediatric Delirium score (CAPD)	Assessment of delirium indicators (eye contact, purposeful actions, awareness of surroundings, communication of needs, restlessness, refusal to be comforted, hypoactivity, response time) ranging from 0 points (not indicative for delirium) to 4 points (highly indicative for delirium). A delirium state is considered from a total value of >8 points.	after 60 minutes of exposure to the mattress
Withdrawal assessment by means of the Sophia Observation Withdrawal Symptoms scale (SOS)	Assessment of withdrawal indicators (autonomic dysfunction [4 aspects], overstimulation of the central nervous system [9 aspects], dysfunction of the gastrointestinal tract [2 aspects] ranging from 0 points (not detectable) to 1 point (detectable). A withdrawal state is considered from a total value of >3 points.	baseline
Withdrawal assessment by means of the Sophia Observation Withdrawal Symptoms scale (SOS)	Assessment of withdrawal indicators (autonomic dysfunction [4 aspects], overstimulation of the central nervous system [9 aspects], dysfunction of the gastrointestinal tract [2 aspects] ranging from 0 points (not detectable) to 1 point (detectable). A withdrawal state is considered from a total value of >3 points.	after 60 minutes of exposure to the mattress

Collaborators and Investigators

• Sponsor: Simon Annaheim
• Collaborators: University Children's Hospital, Zurich
• Investigators: Principal Investigator: Barbara Brotschi, Prof, Universitäts-Kinderspital Zürich, Zurich

Publications and helpful links

General Publications

• Jevon P, Gallier H. How to measure capillary refill time in patients who are acutely ill. Nursing Times [online]. 2020; 116(8): 29-30.

Study record dates

Study Major Dates

• Study Start (Actual): May 7, 2024
• Primary Completion (Estimated): July 1, 2024
• Study Completion (Estimated): July 1, 2024

Study Registration Dates

• First Submitted: April 11, 2024
• First Submitted That Met QC Criteria: May 17, 2024
• First Posted (Actual): May 22, 2024

Study Record Updates

• Last Update Posted (Actual): May 22, 2024
• Last Update Submitted That Met QC Criteria: May 17, 2024
• Last Verified: May 1, 2024

More Information

Terms related to this study

• Keywords: Air mattress; Skin interface pressure; Skin contact area; Lying comfort
• Additional Relevant MeSH Terms: Skin Diseases; Congenital Abnormalities; Skin Ulcer; Skin Abnormalities; Pressure Ulcer
• Other Study ID Numbers: Empa PSP 5211.02071

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: It is intended to publish the study in an open-access journal by December 2024. With this, the raw data of the interface pressure and contact area measurements will be made available upon request and fulfilling the access criteria as indicated below.
• IPD Sharing Time Frame: Data as indicated in the plan description will be available upon publication of the data Data will be available for an unlimited period of time.
• IPD Sharing Access Criteria: Data will be made available upon request for scientific analysis of the data. Research objectives and data analysis plan needs to be provided.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No