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Alternating Pressure and Low Air Loss Mattress

Alternating Pressure and Low Air Loss Mattress


Various health problems, especially those that affect blood flow or require constant bed rest, may lead to the formation of bedsores. These bedsores can negatively affect a person's quality of life, cause pain and discomfort. Management of pressure ulcers is crucial in bedridden patients, particularly in elderly persons and those in long-term facilities. An important segment of management and prevention of bedsores belongs to adequate choice of a mattress. Alternating pressure and low air loss mattresses are considered crucial in this department. How do they work, and what are the best options out there? Read on to find out.

What is a pressure ulcer?

Also known as bedsore or pressure sore, a pressure ulcer is defined as an injury to the skin and underlying tissues caused by prolonged pressure on the skin. Pressure ulcers, or decubitus ulcers, tend to develop on areas of the skin that cover bony parts of the body such as tailbone, hips, ankles, and heels.

The bedsores develop when prolonged pressure on the skin limits blood flow to that particular area. Lack of moment leaves skin vulnerable and prone to damage that paves the way to the formation of pressure ulcers. After all, blood circulation is crucial for delivering nutrients and oxygen to tissues, including the skin. When skin doesn't receive these nutrients, it weakens and becomes easily damaged. Eventually, it may die. For men and women with limited mobility, the constant pressure usually occurs in areas that aren't really padded with fat or muscle. These are the bone areas mentioned above.

Besides constant pressure, friction can also cause bedsores-friction results from the constant rubbing of the skin against bedding or clothing. Sensitive, fragile skin becomes more vulnerable to injuries due to friction. This is particularly the case when skin is moist due to perspiration, for example.

Additionally, shear can contribute to pressure ulcer formation too. Shear happens when two surfaces move in opposite directions. For instance, a person can slide down in bed when it's elevated at the head section. That means the tailbone moves downwards too, but the skin remains in the place and pulls in the opposite direction. This activity also poses a danger to vulnerable skin and may lead to the formation of bedsores.

Risk factors that make a person more likely to develop pressure ulcers include:

•     Immobility due to spinal cord injuries, poor health, or other reasons

•     Health conditions that affect or impair blood flow such as vascular disease and diabetes

•     Incontinence

•     Decreased (or lack) sensory perception such as an inability to feel pain or discomfort

•     Diet insufficient in fluids, calories, vitamins, protein, minerals, and other important nutrients

Pressure ulcers are not that difficult to notice. They appear as unusual changes in texture and color of the skin. There is also swelling involved and pus-like draining. Bedsores may appear warmer or cooler to the touch than other areas of the skin.

When left unmanaged, pressure ulcers can severely affect the quality of life in bedridden patients, particularly elderly men and women. The formation of bedsores involves four stages. In the first stage, the area looks red and feels warm to the touch, whereas in the second stage, the affected area looks more damaged and may have an open sore or blister. In stage three, damage below the surface of the skin is so damaged that pressure ulcers appear like craters. Stage four appears as a large wound due to severe damage.

What is an alternating pressure mattress?

Alternating pressure mattress is a type of mattress that features air-filled sacs that sequentially inflate and deflate in order to alleviate pressure for short periods at different sites.[i]. In other words, these mattresses rely on redistribution of pressure to promote blood flow primarily because blood nourishes the skin. That way, these mattresses may help prevent or manage bedsores. An alternating pressure mattress features air cells that inflate and deflate slowly under the patient. These inflating or deflating activities take place at adjustable or predetermined cycle times. Redistribution of pressure allows time for blood to reach the skin.

A study from the Journal of Wound Care showed alternating pressure mattresses are effective. The findings revealed this type of mattress was far superior to viscoelastic foam mattress for preventing pressure ulcers in elderly subjects who were bedridden for at least 15 hours a day. The subjects were severely dependent and at a moderate-to-high risk of developing pressure ulcers.[ii].

Additionally, the research from Age and Aging also found fewer patients developed heel pressure sores on alternating pressure mattresses.[iii].

What is a low air loss mattress?

A low air loss mattress is a type of mattress specifically designed for persons who are temporarily or permanently bedridden. These mattresses aid in the prevention or management, and treatment of pressure ulcers. This kind of device provides a flow of air that assists in regulating the microclimate of the patient's skin.

Basically, a low air loss mattress comes with inflatable air tubes that inflate/deflate periodically. The system is such a mattress ensures the patient's body is not in one specific position for a prolonged timeframe. Low air loss mattress works thanks to small laser-made holes on the top surface. These tiny holes blow out air, and a patient "floats." This action decreases skin interface pressure on the surface of the mattress. In turn, the patient remains dry as moisture wicks away. That way, a low air loss mattress creates a favorable therapeutic environment for the prevention of bedsores.

Evidence confirms low air loss mattress system decreases the size and facilitates the healing process of chronic pressure sores.[iv]. Of course, a lot more research is necessary to uncover the whole potential of these mattresses.[v].

Who needs alternating pressure or low air loss mattress?

Generally speaking, these types of a mattress are most suitable for persons who spend at least 15 hours a day in bed. They are also advised to men and women who are at moderate or high risk of developing pressure ulcers. These include persons who are immobile, seriously ill or have a spinal cord injury, wear a prosthesis, are incontinent of urine or stool, and have conditions such as Parkinson's disease, Alzheimer's disease, or have undergone hip surgery.

What is the difference between alternating pressure and a low air loss mattress?

As seen above, a low air loss mattress provides airflow to alleviate pressure and ensure skin stays dry. Both features can aid in the prevention of bedsores or pressure ulcers. The alternating pressure mattress can also help prevent the formation of bedsores. It does so by providing two sets of air cells that proceed to expand and contract in an alternating manner. That way, the pressure shifts continually.

Generally speaking, a low air loss mattress with alternating pressure is a good choice for the management or prevention of pressure wounds, and it works for patients regardless of their weight. For bariatric patients, higher volume of airflow is necessary to handle increased perspiration. In these patients, the higher airflow volume is necessary for an adequate supply of sufficient airflow for alternating pressure in the mattress, as well.

The biggest objective here is to choose a mattress that will not cause pressure ulcers. For that reason, reliability is one of the most crucial factors to consider. Caution is vital because low-quality blower motors can overheat and fail, while foam mattresses can break down. The quality of the mattress and the blower motor is crucial for long-term use. The latter should be able to hold up to the around-the-clock usage. At the same time, the mattress should be able to accept the patient, regardless of their weight, and allow for proper redistribution of pressure. To achieve that, a patient needs to be somewhat enveloped by the mattress, not just lie on the surface.

Many companies nowadays choose to combine low air loss and alternating pressure into a single mattress system to ensure the patient gets the maximum comfort and benefits both types of mattresses provide.

How much do alternating pressure and low air loss mattresses cost?

The costs of alternating pressure and low air loss mattresses depend on a few factors. The most important factor is the quality of a mattress. As mentioned above, not all mattresses will provide the much-needed results and prevent bedsores in patients. For that reason, the quality of a mattress plays a role in the total costs. The same applies to the manufacturers, materials, and dimensions.

It's difficult to pinpoint a specific price because the costs vary from one manufacturer to another. Plus, not all providers will have the same costs of their alternating pressure and low air loss mattresses. Your goal is to get a mattress with high quality, durability, and reasonable price.

Where to buy alternating pressure and low air loss mattress?

Alternating pressure and low air loss mattresses are available in some physical stores for medical equipment, but also online. The best place for purchasing these mattresses is a medical supply website, such as Betty Mills Company. Why? Well, medical supply companies online offer a wide selection of mattresses made by different brands. It's easier to find the brand of mattress that you want or deem the best option or most affordable choice. You get to do research and check out different options on a single site.

What are alternating pressure and low air loss mattress options?

The good thing is there are multiple brands and manufacturers with practical and effective alternating pressure and low air loss mattress options.

For example, Proactive Medical has several mattress options of different dimensions and weight capacities. These include:

•     Proactive Medical Protekt Aire 3000 - 8" alternating/low air loss mattress - dubbed ideal for buyers on a limited budget who also want a quality mattress. It is a combination of alternating and low air loss mattresses designed to treat pressure ulcers of I-IV stages. The mattress features 20 individual bladders allowing for deep submersion and redistribution of pressure. It alternates in 10-minute intervals and also comes with 16 laser air holes that keep the patient cool and dry. Dimensions of this mattress are 35x80x8" while weight capacity is 350lbs. Besides Aire 3000, the option Protekt Aire 3500 is also available and comes with a densified fiber support base. The densified fiber support base also comes in Protekt Aire 5000DX low air loss/alternating mattress, but capacity is larger and supports patients weighing up to 400lbs.

•     Proactive Medical Protekt Aire 4000DX - low air loss/alternating mattress - combines dual therapies in one unit. It is suitable for pressure ulcer patients of stages I to IV. It alternates every 10 minutes and comes with an adjustable LED digital airflow touch panel. The mattress has 18 laser holes to keep a patient cool and dry. The head section is static to prevent unnecessary movements of the head and neck. Dimensions of this mattress are 36x80x8" whereas weight capacity is 400lbs, just like those of Protekt Aire 4600DX and Protekt Aire 4600DXAB system with side air bolsters.

•     Proactive Medical Protekt Aire 6000 - alternating/low air loss mattress - preferred choice by clinicians who treat pressure ulcers in stages I-IV. Combined features allow for excellent pressure redistribution. Additionally, the cell-on cell bladder design makes sure the 4" air supply is always present even in cases of a power outage. Dimensions of this mattress are 80x35x8" while the weight capacity is 450lbs. The same type of Proactive Medical Protekt Aire 6000 mattress also comes with raised rails option. The mattress comes with a pump featuring an LED panel providing for easy access to four alternating cycles of 10, 15, 20, and 25 minutes. The four cycles allow clinicians to customize therapy to the specific needs of each patient. The mattress features 18 laser holes that keep the patient dry and cool.

•     Proactive Medical Protekt Aire 8000BA - low air loss/alternating mattress - designed to treat and prevent bariatric patients from developing pressure ulcers. Alternating pressure cycles of 10, 15, 20, 25 minutes allow for easier pressure redistribution. Dimensions of this mattress are 80x42x10," and the weight capacity is 650lbs.

•     Proactive Medical Protekt Aire 9900 - delivers 1000 liters per minute of true low air loss. It combines low air loss with alternating pressure. Dimensions of this mattress are 36x80x8" whereas weight capacity is up to 1000lbs.

Drive Medical is also a great choice for alternating pressure and low air loss mattresses, such as:

•     Med Aire Low Air Loss Mattress Replacement System with alternating pressure - designed for prevention, treatment, and management of pressure ulcers. The mattress features 20 air bladders and nine laser holes for better patient comfort and low air loss function. It can operate in static or alternating pressure mode, while the pillow function is in static mode only for better comfort. The size of the mattress is 80x36x8, and the weight capacity is up to 350lbs. The pump cycle time is 10 minutes. The same weight capacity is provided by Med Aire Assure 5" Air with 3" Foam Base alternating pressure and low air loss mattress system

•     Medical Gravity 7 Long Term Care Pressure Redistribution Mattress - relies on a multi-layered, high-density foam for optimal redistribution of pressure for patients in long-term care facilities. The heel section has a unique, ultra-soft design and provides low skin interface pressure to prevent bedsores. Dimensions of this mattress are 84x36x6" while weight capacity is 300lbs. On the other hand, Gravity 9 has a weight capacity of 450lbs, width 42" and length 80."

•     Med Aire Plus Low Air Loss Mattress Replacement System - for prevention and treatment of all stages of pressure ulcers, provides combined therapy of low air loss mattress and alternating pressure. It comes with a digital pump that allows clinicians to customize the bed to meet the patient's needs. Dimensions of this mattress are 84x36x8," and the weight capacity is 450lbs.

•     Harmony True Air Loss Tri-Therapy Mattress Replacement System - comes with 1300 liter per minute (LPM) pump for consistent airflow. The mattress has adjustable alternating cycle times of 5, 10, 15, and 20 minutes. Dimensions of the mattress are 80x36x8" whereas weight capacity is 400lbs.

Besides the abovementioned options for low air loss and alternating pressure mattresses, there are other alternatives, including Invacare with a microAIR line. This specific line features several models, including MA600 and MA800, with dimensions ranging from 36x80x8" to 36x80x10" as well as 42x80x10" or 42x84x10" whereas weight capacities go from 500lbs and 600lbs to 1000 lbs depending on the model. The mattresses come with an advanced 3-in-1 alternating function that inflates and deflates cells in a 3:1 cycle. The 60-second pulsation supports blood circulation in capillaries by readjusting to a level surface pressure continually.

Medline Industries mattresses also combine alternating pressure and low air loss therapy while their weight capacity is 400lbs. Most suitable for persons in long-term care facilities, these mattresses come with a pump and easy-to-use weight dials for customized therapy.


In this post, we focused on alternating pressure and low air loss mattresses that are specifically designed to prevent or treat pressure ulcers. Evidence shows they work. Effectiveness largely depends on the quality of a mattress. To choose the right option, you need to consider the patient's weight, the severity of pressure ulcers, and the redistribution of pressure.


[i] Pressure redistributing devices. The Prevention and Management of Pressure Ulcers in Primary and Secondary Care.

[ii] Sauvage, P., Touflet, M., Pradere, C., Portalier, F., Michel, J. M., Charru, P., Passadori, Y., Fevrier, R., Hallet-Lezy, A. M., Beauchêne, F., & Scherrer, B. (2017). Pressure ulcers prevention efficacy of an alternating pressure air mattress in elderly patients: E²MAO a randomised study. Journal of wound care26(6), 304-312.

[iii] Vanderwee, K., Grypdonck, M. H., & Defloor, T. (2005). Effectiveness of an alternating pressure air mattress for the prevention of pressure ulcers. Age and ageing34(3), 261-267.

[iv] Charles, M. A., Oldenbrook, J., & Catton, C. (1995). Evaluation of a low-air-loss mattress system in the treatment of patients with pressure ulcers. Ostomy/wound management41(5), 46-52.

[v] Shi, C., Dumville, J. C., & Cullum, N. (2018). Support surfaces for pressure ulcer prevention: A network meta-analysis. PloS one13(2), e0192707.