Wednesday, December 17, 2008

Treatment of Pressure Ulcers – an Article Review

Updated 3/2017-- all links (except to my own posts) removed as many no longer active. and it was easier than checking each one. 

In the United States,  pressure ulcers are now classified as “never events”.    So if we ever reach that goal, then perhaps all this information will be moot.  Until then, we need to continue to look for the best treatments possible to treat the ones that do occur. 
The first article in the reference below attempted to do just that – see if there is a best treatment.  The authors of the article noted that even though many treatments for pressure ulcers are used and  promoted, the relative efficacy of these treatments remain unclear.  They stated their objective as:
To systematically review published randomized controlled trials (RCTs) evaluating therapies for pressure ulcers.

Using a database search of  MEDLINE, EMBASE, and CINAHL, all relevant randomized controlled trails (RCT’s) in English language, published from inception through August 23, 2008 were reviewed by three of the investigators.
A total of 103 RCTs met inclusion criteria. Of these, 83 did not provide sufficient information about authors' potential financial conflicts of interest. Methodological quality was variable. Most trials were conducted in acute care (38 [37%]), mixed care (25 [24%]), or long-term care (22 [21%]) settings.

Then these were categorized into 3 groups to mirror the way wound specialist approach pressure ulcer management:
  • RCT investigated the management of underlying contributing factors (first:  reduce or eliminate underlying contributing factors – support surfaces and nutritional supplementation)
  • RCT investigated the effects of local wound care (second: provide local wound care – wound dressings and biological agents)
  • RCT investigated adjunctive therapies (third: consider adjunctive therapies – ie vacuum therapy, surgery)

Here are their conclusions:
Relatively few RCTs evaluating pressure ulcer treatments follow standard criteria for reporting non-pharmacological interventions.
High-quality studies are needed to establish the efficacy and safety of many commonly used treatments.
There is little evidence from RCTs to justify the use of 1 support surface or dressing over alternatives.
Similarly, there is little evidence to justify the routine use of nutritional supplements, biological agents, and adjunctive therapies compared with standard care.
Clinicians should make decisions regarding pressure ulcer therapy based on fundamental wound care principles, cost, ease of use, and patient preference.

Even though there does not seem to be evidence to justify the one support surface or dressings over the others, here are some other references you may find helpful in understanding the care of pressure ulcers should one occur.

Treatment of Pressure Ulcers: A Systematic Review; JAMA. 2008;300(22):2647-2662; Madhuri Reddy; Sudeep S. Gill; Sunila R. Kalkar; Wei Wu; Peter J. Anderson; Paula A. Rochon
Guidelines for the treatment of pressure ulcers; Wound Repair Regen. 2006;14(6):663-679; Whitney J, Phillips L, Aslam R; et al. (PubMed)
European Pressure Ulcer Advisory Panel; European guidelines for pressure ulcer treatment; Published in 1998.
Pressure Ulcers, Surgical Treatment and Principles; eMedicine Article, Aug 5, 2008; Brandon J Wilhelmi MD and Michael Neumeister MD
Pressure Ulcers and Wound Care; eMedicine Article, Aug 10, 2006; Richard Salcido MD and Adrian Popescu MD
Pressure Ulcers, Nonsurgical Treatment and Principles; eMedicine Article, Jul 8, 2008; Christian N Kirman MD and Joseph A Molnar MD

No comments: