Pressure ulcers: treatment

Unrelieved pressure or friction of the skin, particularly over bony prominences, can lead to pressure ulcers in up to one third of people in hospitals or community care, and one fifth of nursing home residents. Pressure ulcers are more likely in people with reduced mobility and poor skin condition, such as older people or those with vascular disease.

We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of treatments in people with pressure ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview).

At this update, searching of electronic databases retrieved 307 studies. After deduplication and removal of conference abstracts, 203 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 163 studies and the further review of 40 full publications. Of the 40 full articles evaluated, seven systematic reviews and two RCTs were added at this update. We performed a GRADE evaluation for 15 PICO combinations.

In this systematic overview, we categorised the efficacy for 15 interventions based on information about the effectiveness and safety of air-fluidised supports, alternating-pressure surfaces (including mattresses), debridement, dressings, electrotherapy, hyperbaric oxygen, low-air-loss beds, low-level laser therapy, low-tech constant-low-pressure supports, nutritional supplements, seat cushions, surgery, therapeutic ultrasound, topical negative pressure, and topical phenytoin.