Modeling and comfort analysis of arrayed air cushion mattress for pressure ulcer prevention and assisted repositioning_Journal of Biomedical Engineering

Authors：

XIAO Yunxuan ^1,2,3 ,  LIU Teng ^1,2,3 , MENG Chuizhou ^1,2,3 , JIAO Zi’ ang ⁴ , MENG Fanchao ^1,2,3 , GUO Shijie ^1,2,3

1. Engineering Research Centre of the Ministry of Education for Intelligent Rehabilitation Devices and Testing Technology, Hebei University of Technology, Tianjin 300401, P. R. China;
2. State Key Lab of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin 300401, P. R. China;
3. School of Mechanical Engineering, Hebei University of Technology, Tianjin 300401, P. R. China;
4. School of Electrical Engineering, Hebei University of Technology, Tianjin 300130, P. R. China;

Corresponding author：

LIU Teng, Email: wuqiu-liu@163.com

Keywords：

Pressure sore prevention; Airbag mattress; Assisted turning; Human-machine coupling modelling; Comfort evaluation

DOI：

10.7507/1001-5515.202305016

Video：

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Assisting immobile individuals with regular repositioning to adjust pressure distribution on key prominences such as the back and buttocks is the most effective measure for preventing pressure ulcers. However, compared to active self-repositioning, passive assisted repositioning results in distinct variations in force distribution on different body parts. This incongruity can affect the comfort of repositioning and potentially lead to a risk of secondary injury, for certain trauma or critically ill patients. Therefore, it is of considerable practical importance to study the passive turning comfort and the optimal turning strategy. Initially, in this study, the load-bearing characteristics of various joints during passive repositioning were examined, and a wedge-shaped airbag configuration was proposed. The airbags coupled layout on the mattress was equivalently represented as a spring-damping system, with essential model parameters determined using experimental techniques. Subsequently, different assisted repositioning strategies were devised by adjusting force application positions and sequences. A human-mattress force-coupled simulation model was developed based on rigid human body structure and equivalent flexible springs. This model provided the force distribution across the primary pressure points on the human body. Finally, assisted repositioning experiments were conducted with 15 participants. The passive repositioning effectiveness and pressure redistribution was validated based on the simulation results, experimental data, and questionnaire responses. Furthermore, the mechanical factors influencing comfort during passive assisted repositioning were elucidated, providing a theoretical foundation for subsequent mattress design and optimization of repositioning strategies.

Citation： XIAO Yunxuan, LIU Teng, MENG Chuizhou, JIAO Zi’ ang, MENG Fanchao, GUO Shijie. Modeling and comfort analysis of arrayed air cushion mattress for pressure ulcer prevention and assisted repositioning. Journal of Biomedical Engineering, 2024, 41(1): 160-167. doi: 10.7507/1001-5515.202305016 Copy

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2.	Mao S, Ge Z, Zhao H, et al. Integrated emergency department and general intensive care unit management on health outcomes. Chin Med J, 2021, 134(21): 2553-2555.
3.	宋燕华. ICU危重患者压疮的预防和护理进展. 继续医学教育, 2021, 35(6): 138-141.
4.	Cortés O L, Herrera G M, Villar J C, et al. Frequency of repositioning for preventing pressure ulcers in patients hospitalized in ICU: protocol of a cluster randomized controlled trial. BMC Nurs, 2021, 20(1): 121.
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6.	Minteer D M, Simon P, Taylor D P, et al. Pressure ulcer monitoring platform—A prospective, human subject clinical study to validate patient repositioning monitoring device to prevent pressure ulcers. Adv Wound Care, 2020, 9(1): 28-33.
7.	Frances F L, Yu L, Wu Z J, et al. Pressure injury prevalence and risk factors in Chinese adult intensive care units: A multi-centre prospective point prevalence study. Int Wound J, 2021, 19(3): 493-506.
8.	Shi C, Dumville J C, Cullum N, et al. Alternative reactive support surfaces (non-foam and non-air-filled) for preventing pressure ulcers. Cochrane Database Syst Rev, 2021, 5(2): 150-157.
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11.	Al-Dorzi H M, Aldawood A S, Almatrood A, et al. Managing critical care during COVID-19 pandemic: The experience of an ICU of a tertiary care hospital. J Infect Public Health, 2021, 14(11): 1635-1641.
12.	Bakary D, Abdoulaye Z K, Yacouba L D, et al. Epidemiological profile of pressure ulcers in the emergency department of the university hospital center of Hospital du Mali. Clin Med Res, 2021, 10(4): 235-241.
13.	Julie S T, Emma L. Using the SSKIN care bundle to prevent pressure ulcers in the intensive care unit. Nurs Stand, 2020, 35(10): 452-458.
14.	Shi C, Dumville J C, Cullum N, et al. Foam surfaces for preventing pressure ulcers. Cochrane Database Syst Rev, 2021, 5(5): CD013621.
15.	Haavisto E, Stolt M, Puukka P, et al. Consistent practices in pressure ulcer prevention based on international care guidelines: A cross-sectional study. Int Wound J, 2022, 19(5): 1141-1157.
16.	De Oliveira K F, Nascimento K G, Nicolussi A C, et al. Support surfaces in the prevention of pressure ulcers in surgical patients: an integrative review. Int J Nurs Pract, 2017, 23(4): e12553.
17.	Dimitri B, Brecht S, Charlotte A, et al. A multicentre prospective randomised controlled clinical trial comparing the effectiveness and cost of a static air mattress and alternating air pressure mattress to prevent pressure ulcers in nursing home residents. Int J Nurs Stud, 2019, 97: 105-113.
18.	Minju S, Youngdae L, Chanwoo M. Medical robotic bed to prevent pressure sores. Appl Sci, 2021, 11(18): 2-13.
19.	Kang H L, Yang E K, Hyukjin L, et al. Active body pressure relief system with time-of-flight optical pressure sensors for pressure ulcer prevention. Sensors, 2019, 19(18): 38-62.
20.	Malindu E, Ishan S, Hishan W, et al. Towards the development of an alternating pressure overlay for the treatment of pressure ulcers using miniaturised air cells. Proceedings, 2020, 64(1): 33.
21.	Bacchin D, Pernice G F A, Pierobon L, et al. Co-design in electrical medical beds with caregivers. Int J Environ Res Public Health, 2022, 19(23): 16353.
22.	Ghersi I, Mariño M, Miralles M T. Smart medical beds in patient-care environments of the twenty-first century: a state-of-art survey. BMC Med Inform Decis Mak, 2018, 18(1): 63.
23.	John A, Kokot G. Identification of mechanical parameters of bone tissue as a base of numerical simulation in medicine. Arch Mater Sci Eng, 2017, 83(2): 235-241.
24.	Vest J R, Jung H Y, Wiley J, et al. Adoption of health information technology among US nursing facilities. J Am Med Dir Assoc, 2019, 20(8): 995-1000.
25.	Xiao Y, Liu T, Zhang Z, et al. Numerical simulation-based loaded inflation height modeling of nursing bed airbag. Med Biol Eng Comput, 2022, 60(1): 3231-3242.
26.	郭鑫星, 周瑾, 曹晓彦, 等. 叶片式阻尼器的参数辨识研究. 机械制造与自动化, 2021, 50(6): 37-40, 55.
27.	Liu Y Q, Yang S P, Liao Y Y. A new method of parameters identification for magnetorheological damper model. J Mech Eng, 2018, 54(6): 62-68.
28.	周祎, 张二亮. 低阻尼多变量系统频率响应函数的非参数辨识方法. 振动与冲击, 2020, 39(19): 182-186.
29.	Xiao Y, Liu T, Meng C, et al. Numerical simulation modeling and kinematic analysis onto double wedge-shaped airbag of nursing appliance. Sci Rep, 2023, 13: 14261.
30.	Winter D A. Biomechanics and motor control of human movement. 4th ed. New York: John Wiley & Sons Inc, 2009.

1. 陈德印. 探析长期老年卧床患者压疮的防治及康复管理. 临床医药文献电子杂志, 2020, 7(21): 187-188.
2. Mao S, Ge Z, Zhao H, et al. Integrated emergency department and general intensive care unit management on health outcomes. Chin Med J, 2021, 134(21): 2553-2555.
3. 宋燕华. ICU危重患者压疮的预防和护理进展. 继续医学教育, 2021, 35(6): 138-141.
4. Cortés O L, Herrera G M, Villar J C, et al. Frequency of repositioning for preventing pressure ulcers in patients hospitalized in ICU: protocol of a cluster randomized controlled trial. BMC Nurs, 2021, 20(1): 121.
5. Serrano Lima M, González Méndez M I, Carrasco Cebollero F M, et al. Risk factors for pressure ulcer development in Intensive Care Units: a systematic review. Med Intensiva (Engl Ed), 2017, 41(6): 339-346.
6. Minteer D M, Simon P, Taylor D P, et al. Pressure ulcer monitoring platform—A prospective, human subject clinical study to validate patient repositioning monitoring device to prevent pressure ulcers. Adv Wound Care, 2020, 9(1): 28-33.
7. Frances F L, Yu L, Wu Z J, et al. Pressure injury prevalence and risk factors in Chinese adult intensive care units: A multi-centre prospective point prevalence study. Int Wound J, 2021, 19(3): 493-506.
8. Shi C, Dumville J C, Cullum N, et al. Alternative reactive support surfaces (non-foam and non-air-filled) for preventing pressure ulcers. Cochrane Database Syst Rev, 2021, 5(2): 150-157.
9. 张宇虹. 中西医结合分期护理在骨科压疮患者中的应用效果观察. 中西医结合心血管病电子杂志, 2016, 4(35): 101-102.
10. Sturm Y, Delobbe V, Allaert F A, et al. Efficacy of a motorized air support to prevent pressure ulcers in at-risk patients hospitalized in rehabilitation departments: incidence and prevalence studies. Panminerva Med, 2019, 61(4): 449-456.
11. Al-Dorzi H M, Aldawood A S, Almatrood A, et al. Managing critical care during COVID-19 pandemic: The experience of an ICU of a tertiary care hospital. J Infect Public Health, 2021, 14(11): 1635-1641.
12. Bakary D, Abdoulaye Z K, Yacouba L D, et al. Epidemiological profile of pressure ulcers in the emergency department of the university hospital center of Hospital du Mali. Clin Med Res, 2021, 10(4): 235-241.
13. Julie S T, Emma L. Using the SSKIN care bundle to prevent pressure ulcers in the intensive care unit. Nurs Stand, 2020, 35(10): 452-458.
14. Shi C, Dumville J C, Cullum N, et al. Foam surfaces for preventing pressure ulcers. Cochrane Database Syst Rev, 2021, 5(5): CD013621.
15. Haavisto E, Stolt M, Puukka P, et al. Consistent practices in pressure ulcer prevention based on international care guidelines: A cross-sectional study. Int Wound J, 2022, 19(5): 1141-1157.
16. De Oliveira K F, Nascimento K G, Nicolussi A C, et al. Support surfaces in the prevention of pressure ulcers in surgical patients: an integrative review. Int J Nurs Pract, 2017, 23(4): e12553.
17. Dimitri B, Brecht S, Charlotte A, et al. A multicentre prospective randomised controlled clinical trial comparing the effectiveness and cost of a static air mattress and alternating air pressure mattress to prevent pressure ulcers in nursing home residents. Int J Nurs Stud, 2019, 97: 105-113.
18. Minju S, Youngdae L, Chanwoo M. Medical robotic bed to prevent pressure sores. Appl Sci, 2021, 11(18): 2-13.
19. Kang H L, Yang E K, Hyukjin L, et al. Active body pressure relief system with time-of-flight optical pressure sensors for pressure ulcer prevention. Sensors, 2019, 19(18): 38-62.
20. Malindu E, Ishan S, Hishan W, et al. Towards the development of an alternating pressure overlay for the treatment of pressure ulcers using miniaturised air cells. Proceedings, 2020, 64(1): 33.
21. Bacchin D, Pernice G F A, Pierobon L, et al. Co-design in electrical medical beds with caregivers. Int J Environ Res Public Health, 2022, 19(23): 16353.
22. Ghersi I, Mariño M, Miralles M T. Smart medical beds in patient-care environments of the twenty-first century: a state-of-art survey. BMC Med Inform Decis Mak, 2018, 18(1): 63.
23. John A, Kokot G. Identification of mechanical parameters of bone tissue as a base of numerical simulation in medicine. Arch Mater Sci Eng, 2017, 83(2): 235-241.
24. Vest J R, Jung H Y, Wiley J, et al. Adoption of health information technology among US nursing facilities. J Am Med Dir Assoc, 2019, 20(8): 995-1000.
25. Xiao Y, Liu T, Zhang Z, et al. Numerical simulation-based loaded inflation height modeling of nursing bed airbag. Med Biol Eng Comput, 2022, 60(1): 3231-3242.
26. 郭鑫星, 周瑾, 曹晓彦, 等. 叶片式阻尼器的参数辨识研究. 机械制造与自动化, 2021, 50(6): 37-40, 55.
27. Liu Y Q, Yang S P, Liao Y Y. A new method of parameters identification for magnetorheological damper model. J Mech Eng, 2018, 54(6): 62-68.
28. 周祎, 张二亮. 低阻尼多变量系统频率响应函数的非参数辨识方法. 振动与冲击, 2020, 39(19): 182-186.
29. Xiao Y, Liu T, Meng C, et al. Numerical simulation modeling and kinematic analysis onto double wedge-shaped airbag of nursing appliance. Sci Rep, 2023, 13: 14261.
30. Winter D A. Biomechanics and motor control of human movement. 4th ed. New York: John Wiley & Sons Inc, 2009.

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