Amy A. Ernst, MD, FACEP
What is the evidence for different treatments for pressure ulcers?
Included studies were randomized controlled trials (RCTs) published in English that reported outcomes that included wound size or complete healing.
MEDLINE, EMBASE/Excerpta Medica, and CINAHL (all to Aug 2008) were searched for RCTs. Journals were hand-searched to find other articles. 103 RCTS (n = 5889) were included. Trials were assessed for study quality (“good” [score ≥ 4] vs “suboptimal” [score ≤ 2] based on methodological criteria [maximum score = 6]), clinical setting, and source of funding.
Clinical heterogeneity precluded valid pooling of study results. 12 RCTs (n = 1214) evaluated support surfaces. 4 lower-quality RCTs of 6 total RCTs reported a benefit for powered support surfaces compared with nonpowered support services. 5 RCTs compared different types of powered support services. 1 RCT showed that air-fluidized mattresses reduced wound surface area, whereas alternating pressure mattresses covered with foam increased wound surface area. 7 RCTs (n= 358) evaluated oral nutritional supplements. 1 placebo-controlled RCT showed that a collagen protein supplement improved healing. Results for other nutritional supplements were mixed. 63 RCTs (n = 3330) evaluated interventions involving local wound care. Of the 7 highest-quality RCTs, 5 showed no difference between types of dressings; 1 showed a greater reduction in wound surface area for calcium alginate than for dextranomer paste (2.39 vs 0.27 cm2, P < 0.001), and the other RCT showed that oxyquinolone improved wound healing more than lanolin or petrolatum (complete stage II healing 45% vs 22%, P < 0.05). 9 RCTs (n = 473) evaluated biological agents. 3 placebo-controlled RCTs showed that platelet-derived growth factors increased wound healing (1 did not report statistical significance). 1 placebo-controlled RCT showed that nerve growth factor improved healing. 21 RCTs (n = 987) evaluated adjunctive therapies. Among the good-quality studies, no benefit was found for electric current, laser, or ultrasound therapies. 2 suboptimal studies of vacuum therapy, compared with other local therapies, did not show improvement.
In persons with pressure ulcers, evidence is mixed for use of a specific support surface or dressing over other types. Evidence is also mixed for nutritional supplementation or adjunctive therapies compared with standard care.
Amy A. Ernst. Review: Little evidence exists for type of dressing or support surface or for nutritional supplements for pressure ulcers. Ann Intern Med. 2009;151:JC1–13. doi: 10.7326/0003-4819-151-2-200907210-02013
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Published: Ann Intern Med. 2009;151(2):JC1-13.
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