Negative pressure wound therapy for treating pressure ulcers

Background

Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are areas of injury to the skin, the tissue that lies underneath, or both. Pressure ulcers can be painful, may become infected, and affect people's quality of life. People at risk of developing pressure ulcers include those with spinal cord injuries, and those who are immobile or who have limited mobility.

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 National Health Service expenditure. People with pressure ulcers stay longer when admitted to hospital, and this increases hospital costs. Figures from the USA for 2006 suggest that half a million hospital stays had 'pressure ulcer' noted as a diagnosis; the total hospital costs of these stays was USD 11 billion.

There is a wide variety of treatment options available for pressure ulcers, such as dressings, creams, redistribution of pressure, and negative pressure wound therapy (NPWT). NPWT is a technology that is used widely and is promoted for use on wounds, including pressure ulcers. In NPWT a machine which exerts carefully controlled suction (negative pressure) is attached to a wound dressing that covers the pressure ulcer. This sucks any wound and tissue fluid away from the treated area into a canister. The researchers tried to discover whether NPWT works well as a treatment for pressure ulcers.

What we found

We searched the medical literature up to May 2015 for robust medical studies (randomised controlled studies) that compared NPWT with other treatments for pressure ulcers. We identified four studies involving a total of 149 participants. Two studies compared NPWT with dressings, one compared NPWT with a series of topical treatments and one study compared it with what was described only as 'moist wound healing'. The trials were small, and poorly described, of fairly short or unclear duration, and contained little in the way of useful data.

As a result of the limited amount of research evidence available, we were not able to draw any conclusions regarding the potential value (or harm) of NPWT as a treatment for pressure ulcers. More, better quality research is needed if this is an important and relevant question for decision makers.

This plain language summary is up-to-date as of May 2015.

Authors' conclusions: 

There is currently no rigorous RCT evidence available regarding the effects of NPWT compared with alternatives for the treatment of pressure ulcers. High uncertainty remains about the potential benefits or harms, or both, of using this treatment for pressure ulcer management.

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. Negative pressure wound therapy (NPWT) is a treatment option for pressure ulcers; a clear, current overview of the evidence is required to facilitate decision-making regarding its use.

Objectives: 

To assess the effects of negative pressure wound therapy for treating pressure ulcers in any care setting.

Search strategy: 

For this review, we searched the following databases in May 2015: the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. There were no restrictions based on language or date of publication.

Selection criteria: 

Published or unpublished randomised controlled trials (RCTs) comparing the effects of NPWT with alternative treatments or different types of NPWT 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: 

The review contains four studies with a total of 149 participants. Two studies compared NPWT with dressings; one study compared NPWT with a series of gel treatments and one study compared NPWT with 'moist wound healing'. One study had a 24-week follow-up period, and two had a six-week follow-up period, the follow-up time was unclear for one study. Three of the four included studies were deemed to be at a high risk of bias from one or more 'Risk of bias' domains and all evidence was deemed to be of very low quality. Only one study reported usable primary outcome data (complete wound healing), but this had only 12 participants and there were very few events (only one participant healed in the study). There was little other useful data available from the included studies on positive outcomes such as wound healing or negative outcomes such as adverse events.

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