Death in the air

BMJ 2008; 337 doi: (Published 05 September 2008) Cite this as: BMJ 2008;337:a845
  1. Colin Chu, foundation year 1 trainee
  1. 1Stoke Mandeville Hospital, Aylesbury
  1. colin.chu{at}

    Alternating pressure mattresses are being used with increasing frequency throughout the NHS. Each mattress is essentially an airbed with several compartments or cells, between which the air is cycled. Designed to minimise pressure damage to immobilised patients, they can present some unexpected challenges to doctors.

    As one manufacturer explains, the “individual cells, which gently inflate and deflate alternately, mimic natural body movement.” This can, however, be highly disconcerting when attempting to certify death and listen for the absence of breath sounds.

    I learnt this lesson on one of the first occasions I was asked to confirm death. Not only are there transmitted hisses of air, but the cells conveniently cycle to give the appearance of shallow thoracic movement at a rate of around 8-10 times per minute. Combine this with the high likelihood that the patient will have been given opiates, and one can feel slightly uncomfortable about declaring a patient dead. I have also had a relative complain that he could hear his dead father sighing and that it looked as though he was breathing.

    Of course, these mattresses are mainly supplied to bedbound patients, a subset of patients who generally are at a greater risk of in-hospital death than their more mobile counterparts.

    Those thinking of simply pulling the plug out should note there is a reasonable battery life that concludes with a piercing alarm. If possible, the best solution is to switch to a static (or transport) mode, which halts the movement of air and provides a more stationary platform.

    Several advertisements for these mattresses highlight the inbuilt emergency deflation tag. Primarily intended for use with cardiopulmonary resuscitation, the tags’ claimed ability to deflate the mattress in under 10 seconds does raise the unsettling prospect of a sudden excrescence of air and the patient rolling off the bed. This would generally be considered bad form, especially if grieving relatives are hovering outside the curtain.


    Cite this as: BMJ 2008;337:a845

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