Comparing pressure care mattresses is rarely straightforward. Clinicians are often asked to compare foam, air, alternating, or hybrid mattresses and pressure mapping is frequently presented as a way to “prove” which option is best.
However, the International Pressure Injury Guidelines do not recommend a single “best” mattress or a single test to guide selection. Instead, they emphasise individualised decision-making, based on the person’s needs, care context, and how a mattress performs in real use.
Pressure mapping can support mattress comparison, but only when it is interpreted alongside clinical reasoning, real-world trials, and reassessment.
Start With the Guideline Principle: Individualised Selection
The International Pressure Injury Guidelines recommend selecting support surfaces based on individual characteristics and needs, rather than mattress type alone.
Key considerations include:
- Pressure injury risk and observed skin response
- Mobility and ability to reposition
- Comfort, tolerance, and sleep quality
- Need for microclimate management heat and moisture
- Care setting and feasibility home, RACF, acute care
Pressure mapping may help compare options, but it should not override these clinical considerations.
What Is a Pressure Care Mattress Designed to Do?
According to the guidelines, full-body support surfaces are designed to:
- Redistribute pressure
- Reduce friction and shear
- Assist with microclimate management (heat and moisture at the skin surface interface)
No mattress optimises all of these elements equally for every person. This is why comparison should focus on performance characteristics, rather than marketing labels or isolated test results.
What Pressure Mapping Can Tell You
Pressure mapping measures interface pressure between the body and the mattress at a specific moment in time. When used appropriately, it can be helpful for:
- Comparing immersion, how much the body sinks into the mattress
- Comparing envelopment, how well the mattress contours to body shape
- Identifying obvious pressure peaks under bony prominences
- Comparing two mattresses for the same person, in the same position
Used this way, pressure mapping can support informed comparison but it is only one piece of the assessment.
What to Look for When Reviewing Pressure Maps
When reviewing pressure maps, it is important to look beyond colours or peak values.
1. Overall pressure distribution
Is pressure spread across a larger surface area, or concentrated in small regions? Effective pressure redistribution aims to reduce localised peak pressures, not simply change colour patterns.
2. Immersion
Does the person sink into the mattress in a controlled way, or remain largely on top of it?
- Too little immersion can result in high interface pressures
- Excessive immersion may compromise mobility, repositioning, and transfers
The guidelines support balancing pressure redistribution with function and safety.
3. Envelopment
Does the mattress contour around the body’s shape, particularly the pelvis and thighs, or are there gaps with isolated pressure points?
Greater envelopment increases contact area and helps distribute load more evenly, a key principle underpinning pressure redistribution.
4. Performance across positions
Pressure injury risk changes with position.
Pressure mapping should be reviewed:
- In realistic positions (e.g. side lying, or head of bed elevated)
- With consideration of how pressure shifts during movement
A single supine image rarely reflects real-world mattress use.
Comparing Pressure Maps: Reactive vs Alternating Air Mattresses
This is where pressure mapping is most commonly misunderstood.
Reactive (static) surfaces
Reactive surfaces, such as foam or reactive air mattresses, provide continuous pressure redistribution. Pressure patterns tend to remain relatively stable over time.
- Areas of higher pressure may be lower in magnitude
- However, these pressures may be sustained for long periods
- Pressure relief relies heavily on repositioning and movement
In this context, a single pressure map snapshot is usually representative for that moment.
Alternating (active) air surfaces
Alternating air mattresses work differently. They are designed to redistribute pressure over time by cyclically inflating and deflating air cells.
This means:
- Pressure in a specific area may be higher at certain points in the cycle
- That pressure is applied for a shorter duration
- It is then relieved as the cycle progresses
As a result, a pressure map captured at one moment may show a temporary peak, rather than the overall pressure experience.
To explore real-world examples across different models, you can review pressure mapping results for all Elata mattress models to better understand how reactive and alternating systems perform over time.
Pressure Magnitude vs Pressure Duration
Pressure injury risk is influenced by both:
- How much pressure is applied
- How long that pressure is applied
Alternating air mattresses accept brief periods of higher pressure in order to:
- Reduce the duration of sustained tissue loading
- Provide periodic offloading of vulnerable areas
This is why pressure maps of alternating surfaces can appear worse at certain moments, even when the mattress is functioning as intended.
A single snapshot cannot show:
- How long pressure is applied
- How frequently tissues are unloaded
- How pressure changes across the full cycle
For this reason, the International Pressure Injury Guidelines and NPIAP Support Surface Standards Initiative caution against using interface pressure measurements alone to judge the effectiveness of active support surfaces.
Next Generation Pressure Testing
We partnered with Flinders University to build a next generation test system.
Traditional mapping captures one static snapshot every 30 minutes. Our system records thousands of pressure points every second. This delivers a true picture of how weight shifts and movement affect support.
That depth of data underpins Elata’s range of mattress models; E300, E400, E500, E600 and E700. So you can trust the results.
If you would like to assess a specific client scenario, you can request Elata customised pressure mapping analysis to support clinical decision-making.
From the above image,
When reviewing the data, it is important to understand the difference between maximum pressure and average pressure over time.
The E700 may show a higher maximum pressure compared to the E300. For example, the E700 can reach a peak pressure of 70 mmHg, which is higher than the maximum recorded on the E300.
However, when looking at average pressure, the E700 records a lower overall value. This is because the E700 is an alternating air surface that provides periodic offloading. During its cycle, certain areas experience moments of near zero pressure. These regular offloading phases reduce the overall average pressure across time.
It is also important to note that although the E700 may reach a peak of 70 mmHg, this occurs for a short duration within the cycle. The pressure is not sustained. The tissue is then unloaded as the cycle progresses, reducing prolonged exposure to high pressure.
This highlights a key clinical principle. Maximum pressure alone does not reflect total tissue loading. Duration of pressure and regular offloading are equally important when interpreting support surface performance.
What Pressure Mapping Does Not Show
Pressure mapping has important limitations.
It does not capture:
- Tissue tolerance or deep tissue stress
- The effects of shear, particularly during movement or bed profiling
- Microclimate factors such as heat and moisture
- How a mattress performs over time including moisture build up
- Comfort, sleep quality, or adherence
Pressure injury development is multifactorial and cannot be predicted by interface pressure alone.
Why Clinical Reasoning Is Essential
Because no single test captures all relevant risk factors, mattress comparison relies on clinical reasoning.
Clinical judgement allows clinicians to weigh:
- Pressure redistribution alongside mobility and function
- Immersion benefits against transfer safety
- Skin protection against comfort and tolerance
- Mattress performance against care setting realities
A mattress that performs well on a pressure map may still be inappropriate if it limits mobility, increases shear risk, or is poorly tolerated.
The Importance of Trial and Reassessment
The International Pressure Injury Guidelines emphasise ongoing reassessment and changing support surfaces when needs or outcomes change.
Trialling a mattress in the real care environment allows clinicians to assess:
- Skin response over time
- Heat and moisture management
- Comfort and sleep quality
- Impact on transfers and daily function
- Feasibility for carers and staff
Pressure mapping may inform an initial comparison, but trial and review confirm whether the mattress is truly meeting the individual’s needs.
For complex cases, clinicians can request customised Elata pressure mapping to gain deeper insight into performance for individual presentations.
Key Takeaways for Clinical Practice
- The International Pressure Injury Guidelines support individualised mattress selection, not one-size-fits-all decisions
- Pressure mapping is a supporting tool, not a standalone decision maker
- When comparing reactive and alternating surfaces, consider pressure over time, not just peak values
- Always interpret pressure mapping alongside clinical reasoning, function, comfort, and reassessment
Choosing a pressure care mattress is not about finding the best mattress. It is about finding the best match for the person, in their context, at that time.
