Moore ZE, Webster J, et al.
The Cochrane database of systematic reviews. Date of publication 2018 Dec 6;volume 12():CD009362.
1. Cochrane Database Syst Rev. 2018 Dec 6;12:CD009362. doi:
10.1002/14651858.CD009362.pub3.
Dressings and topical agents for preventing pressure ulcers.
Moore ZE(1), Webster J.
Author information:
(1)School of Nursing & Midwifery, Royal College of Surgeons in Ireland, 123 St.
Stephen's Green, Dublin, Ireland, D2.
Update of
Cochrane Database Syst Rev. 2013 Aug 18;(8):CD009362.
BACKGROUND: Pressure ulcers, localised injuries to the skin or underlying tissue,
or both, occur when people cannot reposition themselves to relieve pressure on
bony prominences. These wounds are difficult to heal, painful, expensive to
manage and have a negative impact on quality of life. Prevention strategies
include nutritional support and pressure redistribution. Dressing and topical
agents aimed at prevention are also widely used, however, it remains unclear
which, if any, are most effective. This is the first update of this review, which
was originally published in 2013.
OBJECTIVES: To evaluate the effects of dressings and topical agents on pressure
ulcer prevention, in people of any age, without existing pressure ulcers, but
considered to be at risk of developing one, in any healthcare setting.
SEARCH METHODS: In March 2017 we searched the Cochrane Wounds Group Specialised
Register, CENTRAL, MEDLINE, MEDLINE (In-Process & Other Non-Indexed Citations),
Embase, and EBSCO CINAHL Plus. We searched clinical trials registries for ongoing
trials, and bibliographies of relevant publications to identify further eligible
trials. There was no restriction on language, date of trial or setting. In May
2018 we updated this search; as a result several trials are awaiting
classification.
SELECTION CRITERIA: We included randomised controlled trials that enrolled people
at risk of pressure ulcers.
DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials,
assessed risk of bias and extracted data.
MAIN RESULTS: The original search identified nine trials; the updated searches
identified a further nine trials meeting our inclusion criteria. Of the 18 trials
(3629 participants), nine involved dressings; eight involved topical agents; and
one included dressings and topical agents. All trials reported the primary
outcome of pressure ulcer incidence.Topical agentsThere were five trials
comparing fatty acid interventions to different treatments. Two trials compared
fatty acid to olive oil. Pooled evidence shows that there is no clear difference
in pressure ulcer incidence between groups, fatty acid versus olive oil (2
trials, n=1060; RR 1.28, 95% CI 0.76 to 2.17; low-certainty evidence, downgraded
for very serious imprecision; or fatty acid versus standard care (2 trials,
n=187; RR 0.70, 95% CI 0.41 to 1.18; low-certainty evidence, downgraded for
serious risk of bias and serious imprecision). Trials reported that pressure
ulcer incidence was lower with fatty acid-containing-treatment compared with a
control compound of trisostearin and perfume (1 trial, n=331; RR 0.42, 95% CI
0.22 to 0.80; low-certainty evidence, downgraded for serious risk of bias and
serious imprecision). Pooled evidence shows that there is no clear difference in
incidence of adverse events between fatty acids and olive oil (1 trial, n=831; RR
2.22 95% CI 0.20 to 24.37; low-certainty evidence, downgraded for very serious
imprecision).Four trials compared further different topical agents with placebo.
Dimethyl sulfoxide (DMSO) cream may increase the risk of pressure ulcer incidence
compared with placebo (1 trial, n=61; RR 1.99, 95% CI 1.10 to 3.57; low-certainty
evidence; downgraded for serious risk of bias and serious imprecision). The other
three trials reported no clear difference in pressure ulcer incidence between
active topical agents and control/placebo; active lotion (1 trial, n=167; RR
0.73, 95% CI 0.45 to 1.19), Conotrane (1 trial, n=258; RR 0.74, 95% CI 0.52 to
1.07), Prevasore (1 trial, n=120; RR 0.33, 95% CI 0.04 to 3.11) (very
low-certainty evidence, downgraded for very serious risk of bias and very serious
imprecision). There was limited evidence from one trial to determine whether the
application of a topical agent may delay or prevent the development of a pressure
ulcer (DermalexTM 9.8 days vs placebo 8.7 days). Further, two out of 76 reactions
occurred in the DermalexTM group compared with none out of 91 in the placebo
group (RR 6.14, 95% CI 0.29 to 129.89; very low-certainty evidence; downgraded
for very serious risk of bias and very serious imprecision).DressingsSix trials
(n = 1247) compared a silicone dressing with no dressing. Silicone dressings may
reduce pressure ulcer incidence (any stage) (RR 0.25, 95% CI 0.16 to 0.41;
low-certainty evidence; downgraded for very serious risk of bias). In the one
trial (n=77) we rated as being at low risk of bias, there was no clear difference
in pressure ulcer incidence between silicone dressing and placebo-treated groups
(RR 1.95, 95% CI 0.18 to 20.61; low-certainty evidence, downgraded for very
serious imprecision).One trial (n=74) reported no clear difference in pressure
ulcer incidence when a thin polyurethane dressing was compared with no dressing
(RR 1.31, 95% CI 0.83 to 2.07). In the same trial pressure ulcer incidence was
reported to be higher in an adhesive foam dressing compared with no dressing (RR
1.65, 95% CI 1.10 to 2.48). We rated evidence from this trial as very low
certainty (downgraded for very serious risk of bias and serious imprecision).Four
trials compared other dressings with different controls. Trials reported that
there was no clear difference in pressure ulcer incidence between the following
comparisons: polyurethane film and hydrocolloid dressing (n=160, RR 0.58, 95% CI
0.24 to 1.41); Kang' huier versus routine care n=100; RR 0.42, 95% CI 0.08 to
2.05); 'pressure ulcer preventive dressing' (PPD) versus no dressing (n=74; RR
0.18, 95% CI 0.04 to 0.76) We rated the evidence as very low certainty
(downgraded for very serious risk of bias and serious or very serious
imprecision).
AUTHORS' CONCLUSIONS: Most of the trials exploring the impact of topical
applications on pressure ulcer incidence showed no clear benefit or harm. Use of
fatty acid versus a control compound (a cream that does not include fatty acid)
may reduce the incidence of pressure ulcers. Silicone dressings may reduce
pressure ulcer incidence (any stage). However the low level of evidence certainty
means that additional research is required to confirm these results.
DOI: 10.1002/14651858.CD009362.pub3
PMID: 30537080
