Seema Parikh, MD
Resident Physician
New-York Presbyterian Columbia/Cornell
Bridgewater, New Jersey, United States
Victoria Lent, MD
Spinal Cord Injury Rehabilitation Director
Helen Hayes Hospital / Columbia University
West Haverstraw, New York, United States
56-year-old male with traumatic cervical SCI, C1 AIS C incomplete tetraplegia with worsening sacral pressure injury
Case Description:
The patient sustained traumatic cervical cord compression and underwent C3-4 decompression.  He presented to acute rehab with stage II right ischial and stage III sacral pressure injuries where he was counseled on offloading techniques in his power wheelchair and was turned every two hours in bed by nursing staff. He received zinc, vitamin C, protein and nutritional supplements and was given a low-air-loss mattress to aid with wound healing and offloading. Initially, the right ischial wound healed completely, and the sacral wound was healing well. However, the sacral wound acutely worsened and became unstageable. With no other explanation, his air cushion was inspected and noted to be deflated. The cushion was re-inflated, and patient pressure mapped with subsequent improvement in his wound, but after a week, the sacral wound deteriorated yet again. Once again, his air cushion was discovered to be deflated—this time, the cushion was completely replaced.
Discussions:
About 1 of 3 patients with SCI will develop pressure injuries during the acute rehabilitation stage. Prevention of pressure injuries includes utilizing pressure-redistributing wheelchair cushions filled with air, foam or gel, frequent repositioning and offloading, and increasing protein consumption. While air-filled wheelchair cushions are frequently used and effectively distribute pressure, they must be checked frequently for air loss to prevent further worsening of pressure injuries. The root cause of pressure injuries should be investigated; once discovered (i.e., a deflated cushion), the best way to treat patients is to promptly respond to the inciting cause to prevent further deterioration of wounds.
Conclusions:
There should be high suspicion for deflated wheelchair cushions in SCI patients with acutely worsening pressure injuries. Air pressure in cushions should be frequently monitored to identify deflated cushions prior to worsening of pressure injuries.
