Table 5 Summary of evidence for pressure ulcer management
From: Seeking effective interventions to treat complex wounds: an overview of systematic reviews
Outcome | Intervention | Systematic reviews with MA | Systematic reviews without MA | ||
|---|---|---|---|---|---|
High-quality* | Low/moderate quality | High-quality** | Low/moderate quality | ||
Wound area/size reduction | Air-fluidized support | NA | NA | NA | + |
Alternating pressure mattress, low-air-loss mattress, air-fluidized mattress | NA | NA | NA | – | |
|  | Collagenase | NA | NA | NA | +/− |
|  | Collagenase, hydrogel dressings | NA | NA | NA | – |
|  | Electric current, electromagnetic therapy | NA | NA | NA | – |
|  | Foam, calcium alginate, radiant heat dressing, dextranomer powder dressings | NA | NA | NA | – |
| Â | Hydrocolloid dressings | NA | NA | NA | + |
|  | Hydrocolloid, hydrogel wafer, hydrogel, occlusive polyurethane, transparent moisture-permeable dressings | NA | NA | NA | – |
|  | Hydrogel, cadexomer iodine, semelil gel, radiant heat, zinc salt spray, aluminum hydroxide, vitamin A ointment, streptokinase-streptodornase, dialysate, topical insulin, moist saline gauze and whirlpool, semelil dressings | NA | NA | NA | – |
|  | Low level laser therapy, laser and standard care | NA | NA | NA | – |
|  | Polarized light, monochromatic light and cadexomer iodine or hydrocolloid | NA | NA | NA | – |
|  | Ultrasound | NA | NA | NA | – |
|  | Vacuum therapy | NA | NA | NA | – |
|  | Vitamin C and ultrasound, consistent wound care and controlled nutritional support, vitamin C, zinc sulfate | NA | NA | NA | – |
Time to healing or rate of healing | Ascorbic acid, high-protein diet, concentrated, fortified, collagen protein hydrolysate supplement, disease-specific nutrition treatment | NA | NA | NA | +/− |
|  | Amorphous hydrogel dressing derived from Aloe vera wound dressings | NA | NA | +/− | NA |
|  | Electromagnetic therapy, low-intensity direct current, negative-polarity and positive-polarity electrotherapy, and alternating-polarity electrotherapy | NA | NA | NA | +/− |
|  | Hydrocolloid dressings | NA | NA | NA | +/− |
|  | Low air-loss beds | NA | NA | NA | +/− |
|  | Low level laser therapy | NA | NA | NA | +/− |
|  | Low-tech constant low-pressure supports | NA | NA | NA | +/− |
|  | Phenytoin ointment (topical) | NA | NA | NA | +/− |
|  | Seat cushions | NA | NA | NA | +/− |
|  | Topical negative pressure | NA | NA | NA | +/− |
|  | Triple antibiotic ointment, active cream dressings | NA | NA | NA | – |
|  | Ultrasound | NA | NA | NA | – |
Ulcer healing | Air-fluidized bed/supports | + | + | +/− | NA |
Air-fluidized beds, air suspension beds, foam replacement mattress | NA | NA | – | NA | |
|  | Alternating pressure surfaces | NA | NA |  | +/− |
|  | Alternating pressure surfaces (alternating pressure mattress + pressure relief cushion) | NA | NA | +/− | NA |
|  | Ascorbic acid, zinc sulfate | NA | NA | +/− | NA |
|  | Collagen protein, standard hospital diet and high protein, standard hospital diet and high protein and zinc and arginine and vitamin C | NA | NA | NA | – |
| Â | Collagenase (topical) | NA | NA | NA | + |
| Â | Fibroblast-derived dermal replacement | NA | NA | NA | + |
|  | Hydrocolloid, polyurethane, dextranomer, hydrogel, polyhydroxyethyl methacrylate, amino acid copolymer dressings | NA | NA | NA | – |
|  | Low air-loss mattress, alternating pressure mattress, air-fluidized mattress | NA | NA | NA | – |
|  | Phenytoin solution, antibiotics dressings | NA | NA | NA | – |
| Â | Protease-modulating matrix, recombinant platelet-derived growth factor BB, nerve growth factor, transforming growth factor beta, granulocyte-macrophage/colony stimulating factor, basic fibroblast growth factor (topical) | NA | NA | NA | + |
|  | Saline spray containing Aloe vera, silver chloride and decyl glucoside, saline, whirlpool | NA | NA | NA | – |
|  | Topical negative pressure | NA | NA | NA | – |
|  | Topical negative pressure (vacuum assisted wound closure) | NA | NA | NA | – |
| Â | Alternative foam mattress | + | NA | NA | NA |
| Â | Electrotherapy | + | NA | NA | NA |
|  | High protein, oral nutritional support, enteral tube feeding | – | NA | NA | NA |
| Â | Hydrocolloid dressings | + | NA | NA | NA |
|  | Polyurethane dressings | – | NA | NA | NA |
Proportion of patients with healed wounds | Collagenase debridement (topical) | NA | – | NA | NA |
Dextranomer (beads + dry dressing) | NA | – | NA | NA | |
Electrical stimulation | NA | – | NA | NA | |
|  | Electrotherapy | NA | – | NA | – |
|  | Growth Factors (topical) | NA | – | NA |  |
|  | Hydrocolloid dressings | NA | +/− | NA | – |
|  | Hydrogel (gel) | NA | + | NA | – |
|  | Hydropolymer dressing | NA | – | NA | NA |
|  | Low air-loss beds | – | – | NA | NA |
|  | Low level laser therapy | NA | – | NA | NA |
|  | Alternating pressure mattress | NA | +/− | NA | NA |
|  | Non-contact normothermic dressing | NA | – | NA | NA |
|  | Polyurethane dressings | NA | – | NA | – |
|  | Ultrasound | – | – | NA | +/− |
|  | Zinc supplement (oral) | NA | – | NA |  |
|  | Collagenase, dressings | NA | NA | NA | – |
|  | Laser therapy + moist saline gauze | NA | NA | NA | – |
|  | Monochromatic phototherapy, UV light | NA | NA | NA | – |
|  | Oxyquinoline, radiant heat, soft silicone, hydrogel or foam, active ointment with live yeast derivative, topical insulin (dressings) | NA | NA | NA | – |
|  | Resin salve absorbent dressings | NA | NA | NA | – |
|  | Specialized foam mattress, alternating pressure mattress | NA | NA | NA | – |