Effects of alternating pressure air mattresses on pressure injury prevention: A systematic review of randomized controlled trials

Background Pressure injury (PI) is a significant health problem among inpatients that affects their health, quality of life, and expenses. Aim This systematic review aimed to compare effects of alternating pressure air mattresses (APMs) with other types of supporting surfaces as a tool for PI prevention. Methods The literature published between 2009 and 2020 was searched using the databases PubMed, EMBASE, CINAHL, and Cochrane. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses process was followed, including independent study selection and data extraction. Quality appraisal was conducted using the Cochrane Risk of Bias Tool (RoB 2.0). Results A total of six randomized controlled trials (RCTs) were analyzed. The incidence of hospital‐acquired PIs at stage 1 or higher was reported in the APM group from 0.3% to 25%. In one study, APMs were found to be less effective than static air mattresses (SAMs); in contrast, two studies found no difference. In one study, the APM was reported to be more effective than the viscoelastic foam mattress (VFM). On the contrary, in a more recent study, the APM was reported to be less effective than the VFM, and there was no difference compared with high‐specification foam mattresses in another study. Using the RoB 2.0 tool, one study was evaluated at “low risk of bias,” another as “some concern,” and four as “high risk.” Linking Evidence to Action There is insufficient evidence to suggest that APM is more effective in preventing PIs than other supporting surfaces. Evidence to date suggests that APM can be used in patients at risk for PIs. It is important to change position regardless of the type of support surface used. Highly controlled RCTs with low risk of bias are needed to provide strong evidence for identifying the most effective PI prevention support surfaces.