Hydrogel dressings for treating pressure ulcers

Background

Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are areas of injury to the skin or the underlying tissue, or both. Pressure ulcers can be painful, may become infected, and affect quality of life. Those at risk of pressure ulcers include those with spinal cord injuries and people who are immobile or who have limited mobility such as some elderly people and people with acute or chronic conditions. In 2004 the total annual cost of treating pressure ulcers in the UK was estimated as being GBP 1.4 to 2.1 billion, which was equivalent to 4% of the total NHS expenditure. Pressure ulcers have been shown to increase length of hospital stay and the associated hospital costs. Figures from the USA suggest that 'pressure ulcer' was noted as a diagnosis for half a million hospital stays in 2006; for adults, the total hospital costs of these stays was USD 11 billion.

Dressings are one treatment option for pressure ulcers. There are many types of dressings that can be used; these can vary considerably in cost. Hydrogel dressings are one type of available dressing. Hydrogel dressings contain a large amount of water that keeps ulcers moist rather than letting them become dry. Moist wounds are thought to heal more quickly than dry wounds. In this study we investigated whether there is any evidence that pressure ulcers treated with hydrogel dressings heal more quickly than those treated with other types of dressings or skin surface (topical) treatments.

What we found

In June 2014 we searched for as many relevant medical studies as we could find that had a robust design (randomised controlled trials) that had compared hydrogel dressings with other treatments for pressure ulcers. We found 11 studies involving a total of 539 participants. From the results of these studies we could not tell whether hydrogel wound dressings heal pressure ulcers more quickly or slowly than other types of dressing or topical treatments.

Generally, the studies we found were small and the results inconclusive. Some studies lacked information about how they were conducted and it was difficult to tell whether the results presented were robust. More research of better quality is needed before it can be determined whether hydrogel dressings are better or worse at healing pressure ulcers than other types of dressings or topical treatments.

Authors' conclusions: 

It is not clear if hydrogel dressings are more or less effective than other treatments in healing pressure ulcers or if different hydrogels have different effects, Most trials in this field are very small and poorly reported so that risk of bias is unclear.

Read the full abstract...
Background: 

Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying tissue, or both. Dressings are widely used to treat pressure ulcers and there are many different dressing options including hydrogel dressings. A clear and current overview of the current evidence is required to facilitate decision-making regarding dressing use for the treatment of pressure ulcers.

Objectives: 

To assess the effects of hydrogel dressings on the healing of pressure ulcers in any care setting.

Search strategy: 

We searched the following databases: the Cochrane Wounds Group Specialised Register (searched 19 June 2014); The Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 5); Ovid MEDLINE (1946 to June Week 2 2014); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, 23 June 2014); Ovid EMBASE (1974 to 20 June 2014); and EBSCO CINAHL (1982 to 18 June 2014). There were no restrictions based on language or date of publication.

Selection criteria: 

Published or unpublished randomised controlled trials (RCTs) comparing the effects of hydrogel dressings with alternative wound dressings or no dressing in the treatment of pressure ulcers (stage II or above).

Data collection and analysis: 

Two review authors independently performed study selection, risk of bias assessment and data extraction.

Main results: 

We included eleven studies (523 participants) in this review. Ten studies had two arms and one had three arms that were all relevant to this review. Three studies compared a hydrogel dressing with a basic wound contact dressing; three studies compared a hydrogel dressing with a hydrocolloid dressing; three studies compared a hydrogel dressing with another hydrogel dressing; one study compared a hydrogel dressing with a foam dressing; one study compared a hydrogel dressing with a dextranomer paste dressing and one study compared a hydrogel dressing with a topical treatment (collagenase). Limited data were available for analyses in this review: we conducted no meta-analyses. Where data were available there was no evidence of a difference between hydrogel and alternative treatments in terms of complete wound healing or adverse events. One small study reported that using hydrogel dressings was, on average, less costly than hydrocolloid dressings, but this estimate was imprecise and its methodology was not clear. All included studies were small, had short follow-up times and were at unclear risk of bias.

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