Alternating pressure air mattresses in the intensive care unit as a cost-effective strategy for preventing stage III-IV pressure injuries: a retrospective cohort study.

BACKGROUND

Pressure Injuries (PIs) are frequent, preventable complications in Intensive Care Units (ICUs), leading to morbidity, mortality, and increased healthcare costs. Alternating Pressure Air Mattresses (APAMs) have been proposed to reduce PI incidence, but real-world data remain scarce.

OBJECTIVES

To assess the effectiveness and cost-efficiency of APAMs in preventing PIs among critically ill patients.

METHODS

This retrospective cohort study was conducted in a 10-bed tertiary ICU, comparing patients before and after APAM implementation. Multivariate logistic regression identified independent PI risk factors, and a cost-effectiveness model was developed using Number Needed to Treat (NNT) and treatment costs.

RESULTS

APAM use reduced overall PI risk by 33% (RR = 0.67; 95% CI 0.45-0.98) and Stage III-IV ulcer risk by 84% (RR = 0.16; 95% CI 0.05-0.53). The NNT was 23, corresponding to net savings of USD 121,750 over five years for a 10-bed ICU, with cost recovery achieved within 4.3-months. Length of Stay (LOS) and prolonged mechanical ventilation independently increased PI risk by 19% and 13% per day, respectively. APAMs' benefit was attenuated in patients with extended LOS and ventilation. Sepsis and respiratory failure increased PI risk in univariate analysis but lost significance after adjustment, indicating mediation by LOS and ventilation. APAMs eliminated the need for negative pressure wound therapy in this cohort.

CONCLUSIONS

APAMs significantly reduced severe PI incidence and treatment requirements in critically ill patients, demonstrating cost-effectiveness. Their protective effect was limited in patients with prolonged ICU stay or ventilation. Multicenter randomized trials are warranted, especially in diabetic and septic populations.