When is it time to discontinue a specialty mattress for a patient who has healed pressure ulcers?

Most post-acute and long-term care settings routinely use pressure-relieving mattresses, typically made with a foam core. These are typically adequate for most patients. 

Pressure ulcers happen more frequently in patients who are immobile or confined to bed, incontinent, have contractures or other movement restrictions, have a history of previous PUs, or have any of numerous other characteristics. Each patient should be assessed on admission or change of condition for risk factors for pressure ulcers.

Patients who are at particularly high risk and those with higher stage pressure ulcers (typically stage 3 or 4) require consideration of a specialty mattress surface such as an alternating pressure, low air-loss mattress to adequately relieve pressure and promote wound healing. These mattresses are better suited to redistribute pressure and retain a dry surface in contact with the patient’s skin. They are, however, more expensive than the traditional mattresses.

When a higher stage pressure ulcer has healed, the question arises of when to discontinue the low air-loss mattress and return to a typical pressure relief mattress. There are times when wound experts recommend continuing low air-loss mattresses longer term or indefinitely. 

Mattress choice should be determined on an individual, patient-centered basis.

Patients who have a history of higher stage or recurrent PUs, have permanent contractures, or are at the end of life with overall skin failure, should have careful consideration of the appropriate pressure-relieving mattress as part of their ongoing, post-acute or long-term care plans. 

Mary P. Evans, M.D., CMD, CWSP, Certified Medical Director and Certified Wound Specialist Physician