Learning Objective #1: understand that the trial pillow has an excellent decompression ability and preventing pressure-related problems.

Learning Objective #2: know the risk regarding pressure on the face while in the lateral position.

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When patients remain in a lateral position for a prolonged period of time, e.g., in during intubation, patients often suffer from facial pressure ulcers, endotracheal intubation tube trouble and visual loss damage. To reduce the incidence of these problems, we considered the use of a trial pillow that would enable new design and pressure distribution. The pillow was a rectangular parallelepiped shape and a hole was located in the center to the mouth angle and for the eye. 521 Japanese adults were checked to determine the appropriate hole size and its position. A material called "EVERLIGHT® SF-EGN25" (Bridgestone Corporation) was selected for its ability to decrease pressure. We measured 31 adults recruited by using Xsensor™ for surface pressure when placed in the lateral position with lateral positioning devices, a trial pillow (TP), a horse shoe (HS) and a ring pillow (RP). Results of the lateral position average surface pressure on the face were less with the TP than with the HS and RP (17.41±1.15mmHg vs. 32.15±4.71mmHg, 25.12±4.58mmHg, respectively, p<0.01). The number of areas where pressure exceeded 30mmHg and 50mmHg was lower for the TP than the HS and RP (4.87±2.95cm² vs. 30.46±8.24cm², 23.26±8.22cm² > 30mmHg, p<0.01; 0.07±0.28cm² vs. 7.38±4.56cm², 1.43±2.72cm² > 50mmHg, respectively, p<0.01). It is suggested that use of the trial pillow with excellent decompression ability and an increase in contact area between head and pillow allowed a decrease in pressure and therefore avoided pressure ulcer development. In addition, the presence of a hole in the center enabled better facial observation as well as preventing pressure-related problems.