FOURTEENTH ANNUAL EUROPEAN PRESSURE ULCER ...

Thursday September 1st
Hill Rom Workshop:
Developments in Microclimate Management
Dr. Roland de Roche, MD
Charlie Lachenbruch, PhD, Hill-Rom
The initial part of this two-part workshop will focus on new developments in microclimate management
(MCM), what microclimate management surfaces are intended to do, and how surface performance is
assessed. In part two, Dr. de Roche will discuss appropriate uses of MCM surfaces in specific clinical
situations.
Part 1
Microclimate management products are estimated to account for approximately 1/6 of hospital beds in the
US. 1 This is primarily due to the increasing appreciation of the effects of the skin’s microclimate in pressure
ulcer development and healing. Microclimate management consists of maintaining the temperature and
humidity of the skin / support surface interface in optimal ranges. Increased temperature has been shown
to increase the metabolic rate of the tissue 2 and increase the risk of ischemic breakdown for a given load. 3
When the skin is warmed beyond its perspiration threshold, local sweating is also stimulated and the
accumulation of moisture reduces the skin’s tensile strength and increases friction with adjacent materials.
Excessively cool temperatures cause patients to be uncomfortable and may cause vasoconstriction,
negating any metabolic benefit.
Products manage the microclimate through their ability to combat the accumulation of heat and humidity at
the skin surface. Methods of reliably assessing performance are currently being validated by the NPUAP’s
Support Surface Standard’s Initiative. 4 The intent of this presentation will be to discuss the issues that must
be considered in determining appropriate ranges of MCM product performance.
Part II
Excess moisture has been identified as a common risk for pressure ulcer development in Braden, Norton,
and Waterlow pressure ulcer risk scores. For specific patient types, moisture management is critical
to achieve successful clinical outcomes. The discussion will address specific patient characteristics
and situations that require adequate moisture management, and will speak to the clinical application of
Microclimate Management surfaces.
References
1. Lachenbruch C, VanGilder C, Janoff K. High Pressure Ulcer Risk Patients and Specialty Surface
Utilization: Data from the 2010 International Pressure Ulcer Prevalence Survey.Poster presentation at
Symposium on Advanced Wound Care (SAWC) Dallas, TX April 14-17, 2011.
2. Ruch RC, Patton HD, eds. Physiology and Biophysics, 19th ed. Philadelphia, Pa.: WB
Saunders;1965:1030–1049.
3. Kokate JY, Leland KJ, Held AM, et al. Temperature-modulated pressure ulcers: a porcine model. Arch
Phys Med Rehabil. 1995:76:666–673.
4. Support Surface Standards Committee (S3I). Minutes of NPUAP’s S3I committee meeting in Las Vegas,
NV, February 2011.
58