Pressure Injury Prevention Using Low Air Loss in the Burn ICU
Low air loss support surfaces have been used for the prevention and
treatment of pressure injuries (PI), formerly pressure ulcers, for many
years1 . Incidence rates for an intensive care unit (ICU) may be as high as
38 percent1 . The risk factors and incidence of PI in the burn population
are not well known2 . There is some data to suggest burn patients and
possibly Stevens-Johnson syndrome (SJS) patients are at higher risk of
developing PI based on admission Braden Scale scores3.
Caring for burn patients is typically expensive—an average of more
than $88,000 per patient4. Additionally, the average hospital-acquired
pressure injury (HAPI) can cost a facility $70,0001. This amount may be
higher in the burn population due to multiple comorbidities, such as
immobility and protein loss. A clinically effective support surface is an
important tool in the care of the ICU burn patient. Air-fluidized therapy
(AFT) is the historical standard of care. The purpose of this study was to
examine—with the use of a high-volume low air loss immersion support
surface—PI incidence in a group of patients admitted to an acute burn
unit. The study was conducted in the southern part of the U.S.
After obtaining IRB approval, eligible consecutive adult patients were
admitted from Jan. 2016 to June 2017 and from Jan. to Sept. 2018 to
a regional burn center and enrolled. Subjects who would normally be
placed on air fluidized therapy were placed instead on a high-volume
low air loss immersion support surface. All other routine unit protocols
were followed. General demographic data included age, gender, height,
and weight. Medical history, major comorbidities, and pre-albumin
were also collected, as well as type, percentage, and degree of burn.
All subjects were assessed upon admission for pre-existing pressure
injuries. All subjects were followed the length of the admission and
reassessed upon discharge. For patients with a PI, the location and
stage of the PI was noted. Qualitative survey data was also collected
from the nursing staff who used the support surface.
193 patients were enrolled in the study (123 male and 70 female). Thirty
eight of the subjects were not burned but were followed because of
complex skin diagnoses such as necrotizing fasciitis and SJS. Of those
burned, the majority had 2nd to 4th-degree burns. The length of time
on the high-volume low air loss immersion support surface ranged
from one to 123 days. The average time was 13.47 days, with 2,600 total
patient days on the support surface. Twenty-six patients were admitted
with pre-existing PIs. Five patients received a HAPI; all had a Stage 2 PI
to the coccyx, for an incidence rate of 2.59 percent.
2.59% HAPI Rate
While this was a study of 193 patients, only five patients obtained a
pressure injury on the high-volume low air loss immersion support
surface, showing promise for reduction of HAPIs in the burn population.
This immersion support surface may reduce the number of HAPIs in the
burn population. The results of this study warrant further study with a
About the Authors
Annie Knight, BSN, RN, CCRN
Annie is director of the Burn ICU and Burn Step Down Unit at Merit Health Central in
Jackson, Miss. She also has specialty experience in the ICU, CCU, and CVR.
William C. Lineaweaver, M.D., FACS
Dr. Lineaweaver is medical director of the Joseph M. Still Burn and Reconstructive Center
in Jackson, Miss. He is a board-certified plastic surgeon and is fellowship trained in hand
Penney Cannon, MBA, BSN, RN
Penney is clinical coordinator of the Burn ICU and Burn Step Down Unit at Merit Health
Central in Jackson, Miss.
Erica Thibault, MS, RN, APN, CNS, CWON
Erica is clinical manager at Sizewise, and has more than two decades’ of bedside
nursing experience. She is a certified wound, ostomy, and continence nurse and
a clinical nurse specialist.