Patients who are immobile are at risk for pressure ulcers. Obese hospital patients commonly suffer from congestive heart failure, obstructive pulmonary complications, and other co-morbid conditions that reduce tissue oxygenation. Poor nutrition combined with sweating, contributing to skin maceration, and immobility all combine to make the bariatric patient susceptible to pressure ulcer development.

This is an interim report for a pilot study for the new TotalCare® Bariatric Plus Therapy System. The bed system provides a low-air loss pressure redistribution surface, continuous lateral rotation, percussion and vibration pulmonary therapies and chair egress for early mobilization. Inclusion criteria included BMI >35, weight range of 250-500 lbs, a 3 day length of stay, and informed consent. Patients were excluded if they had multiple pressure ulcers with only one turning surface, an unstable spine or long bone fractures.

Ten of 20 expected patients have been enrolled which included 6 females and, 4 males, with an average age of 50.4 years, average weight of 344 lbs, (range: 305-397) and average BMI of 56 (range: 45-71). The average Braden risk score was 14 (range: 11-20). One patient was paraplegic, 6/10 were cognitively impaired (mostly due to sedation) and 4/10 required mechanical ventilation.

Skin inspection was performed upon enrollment and at the end of the study. Four patients had 6 pressure ulcers upon study entry with 4/6 pressure ulcers Stage I, and 2/6 Stage II. No nosocomial pressure ulcers developed during the study period. Three of the six ulcers remained the same size. One Stage II ulcer healed over the 5 days of study participation, one ulcer area decreased by 78%, and one decreased 81% of initial area.

Aggressive wound prevention and care is essential for the Bariatric patient. Having a low air loss mattress that provides a good skin microclimate has demonstrated early positive skin outcomes.