Kottner J, Black J, Call E, Gefen A, Santamaria N, et al.
Clinical biomechanics (Bristol, Avon). Date of publication 2018 Nov 1;volume 59():62-70.
1. Clin Biomech (Bristol, Avon). 2018 Nov;59:62-70. doi:
10.1016/j.clinbiomech.2018.09.010. Epub 2018 Sep 5.
Microclimate: A critical review in the context of pressure ulcer prevention.
Kottner J(1), Black J(2), Call E(3), Gefen A(4), Santamaria N(5).
Author information:
(1)Charité-Universitätsmedizin Berlin, Germany. Electronic address:
jan.kottner@charite.de.
(2)University of Nebraska Medical Center, Omaha, NE, USA.
(3)Weber State University, UT, USA.
(4)Tel Aviv University, Israel.
(5)University of Melbourne, Australia.
Pressure ulcers are caused by sustained mechanical loading and deformation of the
skin and subcutaneous layers between internal stiff anatomical structures and
external surfaces or devices. In addition, the skin microclimate (temperature,
humidity and airflow next to the skin surface) is an indirect pressure ulcer risk
factor. Temperature and humidity affect the structure and function of the skin
increasing or lowering possible damage thresholds for the skin and underlying
soft tissues. From a pressure ulcer prevention research perspective, the effects
of humidity and temperature next to the skin surface are inextricably linked to
concurrent soft tissue deformation. Direct clinical evidence supporting the
association between microclimate and pressure ulceration is sparse and of high
risk of bias. Currently, it is recommended to keep the skin dry and cool and/or
to allow recovery periods between phases of occlusion. The stratum corneum must
be prevented from becoming overhydrated or from drying out but exact ranges of an
acceptable microclimate are unknown. Therefore, vague terms like 'microclimate
management' should be avoided but product and microclimate characteristics should
be explicitly stated to allow an informed decision making. Pressure ulcer
prevention interventions like repositioning, the use of special support surfaces,
cushions, and prophylactic dressings are effective only if they reduce sustained
deformations in soft tissues. This mode of action outweighs possible undesirable
microclimate properties. As long as uncertainty exists efforts must be taken to
use as less occlusive materials as possible. There seems to be individual
intrinsic characteristics making patients more vulnerable to microclimate
effects.
Copyright © 2018 Elsevier Ltd. All rights reserved.
DOI: 10.1016/j.clinbiomech.2018.09.010
PMID: 30199821
