Alternating Pressure Air Mattresses in the Intensive Care Unit: A Cost-Effective Strategy for Preventing Stage III–IV Pressure Injuries: A Retrospective Cohort Study

<p style="text-align:justify;line-height:150%"><strong><span style="font-size:11.0pt;mso-bidi-font-size:12.0pt;line-height:150%;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-fareast-theme-font:major-fareast">Abstract<o:p></o:p></span></strong> <p style="text-align:justify;line-height:150%"><strong><span style="font-size:11.0pt;mso-bidi-font-size:12.0pt;line-height:150%;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-fareast-theme-font:major-fareast">Background: Pressure injuries (PIs) arecommon, preventable complications in intensive care units (ICUs) that increasemorbidity, mortality, and healthcare costs. Alternating pressure air mattresses(APAMs) are proposed to reduce PI incidence, but real-world effectiveness dataremain limited.</span></strong><strong><span style="font-size:11.0pt;mso-bidi-font-size:12.0pt;line-height:150%;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-fareast-theme-font:major-fareast;font-weight:normal"><o:p></o:p></span></strong> <p style="text-align:justify;line-height:150%"><strong><span style="font-size:11.0pt;mso-bidi-font-size:12.0pt;line-height:150%;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-fareast-theme-font:major-fareast">Objectives: To evaluate the impact ofAPAM use on PI incidence, clinical outcomes, and cost-effectiveness incritically ill ICU patients.</span></strong><strong><span style="font-size:11.0pt;mso-bidi-font-size:12.0pt;line-height:150%;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-fareast-theme-font:major-fareast;font-weight:normal"><o:p></o:p></span></strong> <p style="text-align:justify;line-height:150%"><strong><span style="font-size:11.0pt;mso-bidi-font-size:12.0pt;line-height:150%;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-fareast-theme-font:major-fareast">Methods: This retrospective cohort studyin a tertiary 10-bed ICU compared patients before and after APAMimplementation. Multivariate logistic regression identified independent PI riskfactors. A cost-effectiveness model was developed based on NNT and treatment costs.</span></strong><strong><span style="font-size:11.0pt;mso-bidi-font-size:12.0pt;line-height:150%;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-fareast-theme-font:major-fareast;font-weight:normal"><o:p></o:p></span></strong> <p style="text-align:justify;line-height:150%"><strong><span style="font-size:11.0pt;mso-bidi-font-size:12.0pt;line-height:150%;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-fareast-theme-font:major-fareast">Results: APAM use was associated with a33% reduction in overall PI risk (RR 0.67; 95% CI 0.45–0.98) and an 84%reduction in Stage III–IV ulcers (RR 0.16; 95% CI 0.05–0.53). The NNT was 23 toprevent one PI, equating to an estimated net cost saving of approximately USD121,750 over five years for a 10-bed ICU. Length of stay (LOS) and prolongedmechanical ventilation were the strongest independent PI predictors, increasingrisk by 19% and 13% per day, respectively. APAMs’ protective effect wasattenuated in patients with prolonged LOS and ventilation. Sepsis andrespiratory failure increased PI risk in univariate analysis but lostsignificance after adjustment, suggesting mediation by LOS and ventilationduration. APAMs showed limited efficacy in septic patients, indicating the needfor multimodal prevention strategies.</span></strong><strong><span style="font-size:11.0pt;mso-bidi-font-size:12.0pt;line-height:150%;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-fareast-theme-font:major-fareast;font-weight:normal"><o:p></o:p></span></strong> <p style="text-align:justify;line-height:150%"><strong><span style="font-size:11.0pt;mso-bidi-font-size:12.0pt;line-height:150%;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-fareast-theme-font:major-fareast">Conclusions: APAMs significantly reducesevere PI incidence and related treatment requirements in critically illpatients, offering a cost-effective intervention for ICU pressure injuryprevention. Their benefit may be limited by factors such as prolongedhospitalization and ventilation. Future adequately powered multicenterrandomized trials are warranted to validate these findings, particularly indiabetic and septic subgroups.</span></strong><strong><span style="font-size:11.0pt;mso-bidi-font-size:12.0pt;line-height:150%;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-fareast-theme-font:major-fareast;font-weight:normal"><o:p></o:p></span></strong>