Document Detail


Measuring tissue perfusion during pressure relief maneuvers: insights into preventing pressure ulcers.
MedLine Citation:
PMID:  18092567     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND/OBJECTIVE: To study the effect on tissue perfusion of relieving interface pressure using standard wheelchair pushups compared with a mechanical automated dynamic pressure relief system.
DESIGN: Repeated measures in 2 protocols on 3 groups of subjects.
PARTICIPANTS: Twenty individuals with motor-complete paraplegia below T4, 20 with motor-complete tetraplegia, and 20 able-bodied subjects.
METHODS: Two 1-hour sitting protocols: dynamic protocol, sitting configuration alternated every 10 minutes between a normal sitting configuration and an off-loading configuration; wheelchair pushup protocol, normal sitting configuration with standard wheelchair pushup once every 20 minutes.
MAIN OUTCOME MEASURES: Transcutaneous partial pressures of oxygen and carbon dioxide measured from buttock overlying the ischial tuberosity and interface pressure measured at the seat back and buttocks. Perfusion deterioration and recovery times were calculated during changes in interface pressures.
RESULTS: In the off-loading configuration, concentrated interface pressure during the normal sitting configuration was significantly diminished, and tissue perfusion was significantly improved. Wheelchair pushups showed complete relief of interface pressure but incomplete recovery of tissue perfusion.
CONCLUSIONS: Interface pressure analysis does not provide complete information about the effectiveness of pressure relief maneuvers. Measures of tissue perfusion may help establish more effective strategies. Relief achieved by standard wheelchair pushups may not be sufficient to recover tissue perfusion compromised during sitting; alternate maneuvers may be necessary. The dynamic seating system provided effective pressure relief with sustained reduction in interface pressure adequate for complete recovery of tissue perfusion. Differences in perfusion recovery times between subjects with spinal cord injury (SCI) and controls raise questions about the importance of changes in vascular responses to pressure after SCI.
Authors:
Mohsen Makhsous; Michael Priebe; James Bankard; Diana Rowles; Mary Zeigler; David Chen; Fang Lin
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The journal of spinal cord medicine     Volume:  30     ISSN:  1079-0268     ISO Abbreviation:  J Spinal Cord Med     Publication Date:  2007  
Date Detail:
Created Date:  2007-12-20     Completed Date:  2008-01-08     Revised Date:  2013-06-06    
Medline Journal Info:
Nlm Unique ID:  9504452     Medline TA:  J Spinal Cord Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  497-507     Citation Subset:  IM    
Affiliation:
Department of Physical Therapy and Human Movement Sciences, Northwestern University, 645 N. Michigan Avenue, Suite 100, Chicago, IL 60640, USA. m-makhsous2@northwestern.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Blood Gas Monitoring, Transcutaneous
Buttocks / blood supply*
Carbon Dioxide / blood
Data Interpretation, Statistical
Humans
Male
Movement
Paraplegia / complications,  physiopathology
Posture / physiology
Pressure
Pressure Ulcer / etiology,  physiopathology,  prevention & control*
Quadriplegia / complications,  physiopathology
Regional Blood Flow / physiology
Spinal Cord Injuries / complications*,  physiopathology
Wheelchairs*
Grant Support
ID/Acronym/Agency:
R21 HD046844-01A1/HD/NICHD NIH HHS; R21 HD046844-01A1/HD/NICHD NIH HHS; R21 HD046844-01A1S1/HD/NICHD NIH HHS; R21 HD046844-02/HD/NICHD NIH HHS; R41 HD047959-01/HD/NICHD NIH HHS
Chemical
Reg. No./Substance:
124-38-9/Carbon Dioxide
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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