For Pressure Ulcers, Air-fluidized Mattresses, Protein Supplements, Radiant Heat Dressings, or Electrical Stimulation May Improve Healing

EBM Focus - Volume 8, Issue 35

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Reference: (Ann Intern Med 2013 Jul 2;159(1):39), (level 2 [mid-level] evidence)

Pressure ulcers are common in hospitalized patients and may lead to further morbidity, increased costs, and death. A wealth of research has investigated numerous treatment and prevention strategies, but the relative efficacy of different approaches remains unclear. Two recent systematic reviews commissioned by the Agency for Healthcare Research and Quality (AHRQ) assessed the existing evidence for the benefits and harms of multiple strategies.

Pressure ulcer treatments were investigated in a review of a total of 174 randomized trials and observational studies. The quality of the randomized trials was limited, and both clinical and statistical heterogeneity limited the viability of meta-analyses. Follow-up times varied widely, and in many studies, were inadequate to assess complete wound healing. Categories of treatment strategies included support surfaces, nutritional supplements, local wound applications, and other adjunctive therapies.

There was no strong evidence in favor of any intervention, and no comparisons showed significant differences in rates of complete wound healing. However, a number of treatments had moderate evidence for partial healing assessed by reduction in wound size. Air-fluidized mattresses appeared more effective than standard mattresses in 5 studies with 908 patients followed for 4 days to 36 weeks. (The results of these studies were described as “highly consistent,” but no meta-analysis was performed), and protein supplements were more effective than no supplementation in 12 studies with 562 patients with 7 days to 10 months follow-up. Radiant heat dressings (noncontact dressings with heating elements to increase capillary blood flow) appeared to reduce wound size compared to other dressings in 4 studies with 160 patients (4-12 weeks follow-up), and electrical stimulation with surface electrodes to apply current directly to the ulcer was more effective than sham stimulation in 9 studies with 397 patients (3-16 weeks follow-up).

There were no significant differences in most other comparisons of treatment strategies. Hydrocolloid dressings were associated with greater reductions in wound size compared to standard care but were also associated with higher risks of skin reactions including inflammation, erythema, and wound deterioration. No comparisons showed significant differences in rates of complete wound healing. There was insufficient evidence to assess risk of harms in most comparisons.

In a companion systematic review of 62 trials evaluating pressure ulcer prevention strategies, advanced static support surfaces were associated with decreased risk of pressure ulcers compared to standard mattresses in 5 trials. Insufficient evidence was found regarding the efficacy of repositioning, nutritional support, and use of creams, dressings, or pads compared with usual care. No meta-analyses were performed for any interventions due to heterogeneity of treatment settings and comorbidities.

For more information, see the Pressure ulcer topic in DynaMed.