Abstract
Pressure ulceration, deep venous thromboembolism, and hospital-acquired pneumonia
are well-known complications of bed rest. This retrospective, single-center, observational
cohort study evaluated the effectiveness of instituting bed rest protocol that included
specific positioning, continuous heel off-loading, recumbent upper and lower body
bed exercises, scheduled incentive spirometry, frequent position changes, and thromboprophylaxis
(chemical, mechanical, or both), in reducing the incidence of pressure ulceration,
deep venous thromboembolism, and hospital-acquired pneumonia in consecutive patients
admitted for at least 7 days. A total of 29 patients (24 males, 5 females) were included
in this study, with a mean age of 62.5 (median 63, range 17 to 84) years. The mean
length of bed rest was 13.1 (median 10, range 7 to 31) days; and, the mean length
of hospital stay was 21.1 (median 17, range 8 to 72) days. During hospitalization,
2 (6.9%) patients developed one or more of the complications measured, with 1 developing
a posterior heel pressure ulcer that resolved with local care and another who developed
deep venous thrombosis without pulmonary embolism, managed with therapeutic anticoagulation,
and hospital-acquired pneumonia treated with antibiotic therapy. The results of this
analysis were favorable in comparison with previously reported incidence rates for
pressure ulcer, deep venous thrombosis, and hospital-acquired pulmonary complications
in patients with similar risk factors, and suggested that a prescribed bed protocol
reduces complications associated with bed rest.
Level of Clinical Evidence
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of Foot and Ankle SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- A review of the dangers of prolonged bed rest.Ala J Med Sci. 1968; 5: 434-440
- Respiratory physiotherapy to prevent pulmonary complications after abdominal surgery. A systematic review.Chest. 2006; 130: 1887-1899
- Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia.Am J Respir Care Med. 2005; 171: 388-416
- Understanding recent regulatory guidelines for hospital-acquired catheter-related urinary tract infections and pressure ulcers.Ostomy Wound Manage. 2007; 53: 34-42
Bergstrom, N, Allman RM, Alvarez OM, Bennett MA, Carlson CE, Frantz RA, Garber SL, Jackson BS, Kaminski MV, Kemp MG, Krouskop TA, Lewis VL, Maklebust J, Margolis DJ, Marvel EM, Reger SI, Rodeheaver GT, Salcido R, Xakellis GC, Yarkony GM. Treatment of pressure ulcers, clinical practice guideline, no. 15. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services, December 1994. AHCPR Publication No. 95–0652. Available at: www.ahrq.gov. Accessed July 13, 2009.
- Incidence of pressure ulcers in a neurologic intensive care unit.Crit Care Med. 2001; 29: 283-290
- Prevention and treatment of pressure sores.J Am Geriatr Soc. 1995; 43: 919-927
- National Pressure Ulcer Advisory Panel's updated pressure ulcer staging system.Urol Nurs. 2007; 27 (156): 144-150
- Decubiti prevention and treatment.Tech Orthop. 2004; 19: 214-222
- Are all pressure ulcers the result of deep tissue injury? A review of the literature.Ostomy Wound Manag. 2007; 53: 34-38
- Can loaded interface characteristics influence strain distributions in muscle adjacent to bony prominences?.Computer Methods in Biomed Engineer. 2003; 6: 171-180
- Multidisciplinary approaches to the pressure ulcer problem.Ostomy Wound Manag. 2007; 53: 26-32
- Support surface interface pressure, microenvironment, and the prevalence of pressure ulcers: an analysis of the literature.Ostomy Wound Manag. 2007; 53: 50-58
- Long term prevention of pressure ulcers in high-risk individuals: a single case study of the use of gluteal neuromuscular electrical stimulation.Arch Phys Med Rehabil. 2006; 87: 585-591
- Decreasing the incidence of heel pressure ulcers in long-term care by increasing awareness: results of a 1-year program.Ostomy Wound Manag. 2008; 54: 62-67
- EPUAP pressure ulcer prevalence survey in Sweden: a two-year follow-up of quality indicators.J Wound Ostomy Continence Nurs. 2006; 33: 258-266
- Reducing hospital-acquired pressure ulcer prevalence through a focused prevention program.Adv Skin Wound Care. 2008; 21: 75-78
- Severity stages determine pressure ulcer regimen.Biomechanics June. 2007; (Available at:) (Accessed July 13, 2009): 49-54
- Integrating wound care research into clinical practice.Ostomy Wound Manag. 2007; 53: 18-25
- Pressure ulcer tissue histology: an appraisal of current knowledge.Ostomy Wound Manag. 2007; 53: 40-49
- Developing a pressure ulcer risk assessment scale for patients in long term care.Ostomy Wound Manag. 2006; 52: 34-46
- Pressure ulcer risk factors among hospitalized patients with activity limitations.JAMA. 1995; 273: 865-870
- A conceptual schema for the study of the etiology of pressure sores.Rehabil Nurs 1987. 1987; 12: 8-12
- Predictive validity of the Braden scale among black and white subjects.Nurs Res. 2002; 51: 398-403
- Braden scale risk assessments and pressure ulcer prevention planning: what's the connection?.J Wound Ostomy Continence Nurs. 2009; 36: 622-634
- Predictive validity of the Braden scale for pressure sore risk in a nursing home population.Res Nurs Health. 1994; 17: 459-470
- Predicting pressure ulcer risk: a multisite study of the predictive validity of the Braden scale.Nurs Res. 1998; 47: 261-269
- The Braden scale for pressure ulcer risk: evaluation the predictive validity in black and Latino/Hispanic elders.Appl Nurs Res. 1999; 12: 60-68
- Predicting pressure ulcer risk with the modified Braden, Braden, and Norton scales in acute care hospitals in Mainland China.Appl Nurs Res. 2005; 18: 122-128
- An Investigation of Geriatric Problems in Hospital.ed 3. Churchill Livingstone, London1979
- Decubitus ulcers: catching patients lying down.Podiatry Today Dec. 1999; (Available at:) (no archives prior to 2001). Accessed July 13, 2009: 30-50
- the pressure ulcer prevention protocol interventions.Am J Nurs. 2007; 107: 44-52
- Pressure ulcer prevalence, incidence, risk factors, and impact.Clin Geriatr Med. 1997; 13: 421-436
- Underutilization of pressure ulcer risk assessment in hip fracture patients.Adv Wound Care. 1998; 11: 32-38
- Results of nine international pressure ulcer prevalence surveys: 1989 to 2005.Ostomy Wound Manag. 2008; 54: 40-54
- Pressure ulcer prevention in homecare: do Dutch homecare agencies have an evidence-based pressure ulcer protocol?.J Wound Ostomy Continence Nurs. 2006; 33: 273-280
- Reducing hospital-acquired heel ulcer rates in an acute care facility: an evaluation of a nurse driven performance improvement project.J Wound Ostomy Continence Nurs. 2008; 35: 79-83
- Implementing a pressure ulcer prevention program and enhancing the role of the CWOCN: impact on outcomes.Ostomy Wound Manag. 2006; 52: 48-59
- Surgical correction of pressure ulcers in an urban center: Is it efficacious?.Adv Wound Care. 1994; 7: 40-46
- Impact of an institution-specific hospital-acquired pneumonia protocol on the appropriateness of antibiotic therapy and patient outcomes.Pharmacotherapy. 2008; 28: 852-862
- The efficacy of incentive spirometers in post-operative protocols for low-risk patients.Can J Nurs Res. 1990; 22: 19-36
- Epidemiology of nosacomial pneumonia.Chest. 1995; 108: 1S-16S
- Complications of immobilization and bed rest. Part 2: other complications.Can Fam Physician. 1993; 39: 1440-1446
- Evaluation of kinetic therapy in the prevention of complications of prolonged bed rest secondary to stroke.Stroke. 1987; 18: 638-642
- Prevention of postoperative pulmonary complications with CPAP, incentive spirometry, and conservative therapy.Chest. 1985; 87: 151-157
- Comparison of continuous positive airway pressure, incentive spirometry, and conservative therapy after cardiac operations.Crit Care Med. 1984; 12: 969-972
- Strategies to reduce postoperative pulmonary complications after noncardiothoracic surgery: systematic review for the American College of Physicians.Ann Intern Med. 2006; 144: 596-608
- Venous thromboembolism prophylaxis for the general surgical patient: where do we stand?.Semin Respir Crit Care Med. 2008; 29: 83-89
- Burden of deep vein thrombosis in the outpatient setting following major orthopedic surgery.Ann Pharmacother. 2008; 42: 1216-1221
- Deep venous thrombosis in postoperative vascular surgical patients: a frequent finding without prophylaxis.J Vasc Surg. 2001; 34: 656-660
- Incidence of deep vein thrombosis in bedridden non-surgical patients.Acta Med Scand. 1987; 222: 409-414
- Thromboembolism following foot and ankle surgery: a case series and literature review.J Foot Ankle Surg. 2008; 47: 243-249
- Thromboembolic disease after foot and ankle surgery.Foot Ankle Int. 2006; 27: 693-695
Article info
Publication history
Published online: April 05, 2010
Footnotes
Disclaimer: The opinions or assertions contained herein are the private view of the author and are not to be construed as official or reflecting the views of the Department of the Army or the Department of Defense.
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2010 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
