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Evid Based Nurs 11:115 doi:10.1136/ebn.11.4.115
  • Treatment

Review: evidence of the effectiveness of hydrocolloids for healing pressure ulcers is limited

A Heyneman

Mr A Heyneman, Ghent University, Ghent, Belgium; alexander.heyneman{at}ugent.be

QUESTION

Are hydrocolloids effective for healing pressure ulcers?

REVIEW SCOPE

Studies selected evaluated hydrocolloids for management of pressure ulcers. Outcomes included pressure ulcer healing and dressing-related outcomes.

REVIEW METHODS

PubMed, CINAHL, EMBASE/Excerpta Medica, and Cochrane Central Register of Controlled Trials (to Jan 2007); wound care manuals; and reference lists were searched for Dutch, English, French, or German language randomised controlled trials (RCTs). Companies that produced or distributed wound care products in Belgium or the Netherlands were also contacted. 28 RCTs (29 articles, n = 1626, study duration 30–112 d) met the selection criteria. 15 trials classified pressure ulcers and included European Pressure Ulcer Advisory Panel grade 1 (least tissue damage, 2 RCTs), grade 2 (12 RCTs), grade 3 (11 RCTs), and grade 4 (most damage, 3 RCTs) ulcers. Hydrocolloids were compared with saline gauze, polyurethane foam, other hydrocolloids, low-adherent dressings, and hydrogel in >1 RCT. Standard therapy {including hydrocolloids}* was compared with radiant heat therapy in 2 RCTs. 3 RCTs blinded outcome assessors, 5 had group differences at baseline, 4 provided power calculations, and 11 used intention-to-treat analysis.

MAIN RESULTS

Meta-analysis was not done because of variation among trial interventions. The main results of individual hydrocolloid trials are shown in the table.

Summary of main results from randomised controlled trials (RCTs) evaluating hydrocolloids for pressure ulcers*

CONCLUSION

Limited data are available to evaluate the effectiveness of hydrocolloids for healing pressure ulcers.

*Information provided by author.

ABSTRACTED FROM

Heyneman A, Beele H, Vanderwee K, et al. A systematic review of the use of hydrocolloids in the treatment of pressure ulcers. J Clin Nurs 2008;17:1164–73.

Clinical impact ratings: General/internal medicine 6/7; Home nursing 6/7; Wound care 6/7

Footnotes

  • Source of funding: no external funding.

Commentary

Much of the evidence for the effectiveness of treatments of pressure ulcers is weak, with multiple studies evaluating a variety of wound management products. Therefore, it is useful to have a systematic review that evaluates one type of dressing that is widely used for pressure ulcer management. A strength of the review by Heyneman et al is that it was not limited to English-language studies; such restrictions are a potential source of bias. Unfortunately, the authors only describe the search strategy in general rather than specific terms, which makes it difficult to judge the quality of the strategy.

Although a meta-analysis of the data might have strengthened the conclusions of the review, clinicians can still gain useful information from the results. The review provides a narrative summary of current evidence for the use of hydrocolloid dressings for pressure ulcer treatment, taking into consideration not just healing but also treatment pain, dressing absorbency, time for dressing change, and cost-effectiveness. This is all useful information for clinical decision making.

As with other reviews, lack of rigour in the conduct of many of the studies and incomplete reporting of results are sources of criticism. The authors stress the value of the CONSORT statement,1 especially the flowchart, for reporting trial characteristics and results. However, only 2 of 15 studies published after 1996 (when the original statement was prepared) used the CONSORT flowchart to guide reporting of their study.

The weak evidence for the use of hydrocolloid dressings to treat pressure ulcers will do little to reassure evidence-based practitioners. High-quality trial evidence is needed, and until such evidence is available, empirical judgment will still guide dressing selection.

References

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