Development and bench evaluation of a smart support surface integrating multimodal sensing and localized low-flow oxygen delivery to support pressure injury prevention

For anyone who spends long hours lying in a hospital bed, the surface beneath them is more than just a place to rest; it is a critical part of their health. When the body remains still for too long, the weight of the body presses against the skin and the tissues underneath, cutting off the flow of blood and oxygen. This pressure, combined with heat and moisture that build up between the skin and the mattress, can cause the skin to break down, leading to painful and dangerous wounds known as pressure injuries. While moving a patient regularly is the standard way to prevent these injuries, it is not always possible to do so frequently enough, especially in busy hospitals or for patients with limited mobility. Scientists have long sought ways to create smarter beds that can not only sense when pressure is becoming dangerous but also actively improve the environment right against the skin to keep it healthy.

A team of researchers in Indonesia has taken a significant step toward this goal by building and testing a new type of smart mattress prototype. This device, which they call a smart bedding surface, is designed to do two things at once: it constantly monitors the conditions right where the patient's body touches the bed, and it gently pumps a small amount of oxygen into that same space. The idea is that by knowing exactly how much pressure is being applied and by keeping the skin cool and dry while adding a bit of oxygen, the bed might help prevent wounds from forming in the first place. However, the researchers were very careful to define what they were testing. They did not put this device on actual patients to see if it stopped wounds from happening. Instead, they treated the mattress like a piece of engineering equipment, putting it through a series of rigorous tests on a workbench to see if the sensors worked correctly and if the oxygen system could run smoothly without causing other problems.

The team built a prototype that looks like a standard mattress but is filled with hidden technology. Under the top layer, they embedded sensors that can feel the pressure, measure the temperature, and detect how humid the air is right against the surface. They also wove a network of tiny channels through the mattress to deliver a steady, low flow of oxygen. To test if this system worked, they placed the mattress under different weights to simulate a person lying on it. They applied specific amounts of pressure, equivalent to 40, 80, and 120 millimeters of mercury, which are common levels of pressure found in a hospital setting. The sensors reported back the pressure they felt, and the results were remarkably close to the actual weights applied. When the mattress was pressed with a force of 40 units, the sensors read an average of 41.2 units. At 80 units of force, they read 78.9, and at 120 units, they read 118.4. The difference between what the machine felt and what was actually there was very small, usually less than two units, suggesting the sensors were accurate and stable.

Next, the researchers tested the oxygen delivery system. They set the machine to pump oxygen at a rate of one liter per minute, a gentle flow intended to refresh the air without blowing the bedding around. They let the system run continuously for six hours, then twelve, and finally for a full day. Throughout this time, the flow remained steady, hovering right around the one-liter target. The researchers also watched closely to see if pumping this oxygen would accidentally heat up the mattress or make it too damp, which could be harmful. Over the course of 24 hours, the surface temperature of the mattress rose by only a tiny fraction of a degree, between 0.3 and 0.5 degrees Celsius, and the humidity increased by a similarly small amount. This indicated that the oxygen system could run for a long time without significantly altering the microclimate in a negative way.

The team also wanted to know if nurses could actually use this device in a real hospital. They asked healthcare workers to perform the basic tasks required to get the bed ready, check it during the day, and clean it. The workers found that setting up the bed took an average of six and a half minutes, checking it took just over two minutes, and cleaning it took about four and a half minutes. The only real difficulty they encountered was managing the cables that connect the device, which required a bit of careful routing to keep them out of the way. These tests showed that the device is practical enough to be handled by busy staff without taking up too much of their time.

Despite these promising results, the researchers are very clear about what this study does not prove. They emphasize that while the machine works well in the lab, they have not yet shown that it actually prevents pressure injuries in real people. The tests were done on a workbench, not on human skin, so they do not know exactly how much oxygen actually reaches the tissue or if the sensors can handle the complex curves of a human body moving in bed. Furthermore, because oxygen can increase the risk of fire, the team notes that much more safety testing is needed before this device could ever be used on a patient. The study confirms that the engineering concept is feasible—that a bed can sense pressure and deliver oxygen simultaneously without breaking down—but it stops short of claiming the device is ready for the hospital. The path forward involves more detailed safety checks, better testing of how the oxygen spreads across the surface, and eventually, carefully controlled studies with patients to see if this smart bedding can truly keep skin healthy.