Terapia de pressão negativa comparada a curativos convencionais em pacientes com feridas cutâneas complexas: parecer técnico-científico
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Data
2022-09-19
Autores
Anjos, Laís Martins Moreira dos
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Universidade Estadual Paulista (Unesp)
Resumo
Pergunta: Nos pacientes com feridas complexas, a Terapia de Pressão Negativa (TPN), em comparação aos outros tratamentos locais, apresenta melhor taxa de cicatrização, preservação do membro, diminui-ção do tempo de hospitalização e dos custos? População-alvo: Pacientes com feridas complexas. Tecnologia: Terapia de Pressão Negativa. Nomes comerciais, no Brasil: Carilex® e PICO®. A TPN é tecnologia para tratamento de feri-das de diversas etiologias. É composta por um curativo de interface colo-cado na ferida o qual se conecta a um aparelho que promove pressão subatmosférica (negativa) de forma controlada e localizada. Comparador: Curativos convencionais realizados conforme protocolo de cada instituição. Delineamento dos estudos elegíveis: Revisões sistemáticas (RS) com ou sem metanálise de ensaios clínicos randomizados (ECR) e ECR. Processo de busca e análise de evidências científicas: Rea-lizada busca nas bases de dados: The Cochrane Library, EMBASE, Pub-Med e Biblioteca Virtual da Saúde (BVS) até fevereiro de 2021. Resumo dos resultados dos estudos selecionados: Feridas do pé diabético e úlceras pós amputação em pacientes diabéticos (14 RS e 2 ECR) – evidências de baixa certeza de que a TPN comparada com tratamento padrão pode aumentar a proporção de feridas cicatrizadas, reduzir o tempo de cicatrização e ser uma terapia segura. A evidência que a TPN diminui o risco de amputação é incerta. Nenhum dos estudos in-cluídos forneceu evidências de maior qualidade quanto ao custo-efetividade e qualidade de vida. Úlceras venosas ou arteriais (1 RS com 60 participantes) – há evidências limitadas sobre o uso da TPN para o tratamento destas lesões. Feridas traumáticas sem fratura (1 RS com 509 participantes e 1 ECR com 174 participantes) – não houve evidências para utilização da TPN. Deiscências cirúrgicas (1 ECR com 507 participantes) – apresentou tempo médio para fechamento da ferida significativamente menor no braço TPN do que no controle, mas a evi-dência foi limitada por alto risco de viés deste ECR. Fasciíte necrosante (2 RS que incluíram participantes com esta ferida) – não houve evidências para utilização da TPN. Conclusões: em feridas complexas incluídas neste parecer, há evidências de baixa certeza para a eficácia em relação a cicatrização e segurança da TPN em comparação ao tratamento padrão apenas para feridas diabéticas e pós-amputação. Não há evidências que apoiam a TPN em úlceras venosas, arteriais, traumáticas sem fraturas, deiscências e fasciíte necrosante, com necessidade de mais estudos.
Question: In patients with complex wounds, does Negative Pressure Wound Therapy, in comparison to other local treatments, show a better healing rate, limb preservations and decrease both in hospitaliza-tion time and costs? Target population: patients with complex wounds. Technology: Negative pressure wound therapy.Trade names in Brazil: Carilex® and PICO®. NPWT is a technology developed for the treatment of wounds from different etiologies. It is constituted of an inter-face dressing placed in the wound, which is connected to a device that provides subatmospheric pressure (negative) in a controlled and localized way. Comparator: standard dressings used according to each insti-tution’s protocol. Design of eligible studies: Systematic Reviews (SRs) with or without meta-analysis of Randomized Controlled Trials (RCTs) and RCTs. Method of search and analysis of scientific evidences: it has been carried out a search in the following databases: The Cochrane Li-brary, Embase, PubMed and Virtual Health Library (BVS, from the acro-nym in Brazilian Portuguese) until February, 2021. Summary of results from selected studies: Diabetic foot wounds and post-amputation ulcers (14 SRs and 2 RCTs) – low certainty evidence that NPWT in comparison with the standard treatment may in-crease the proportion of healed wounds, diminish the healing time and become a safe therapy. The evidence that states that NPWT reduces the risk of amputation is uncertain. None of the included studies provided ev-idence of higher quality regarding the cost-effectiveness and life quality. Venous or arterial ulcers (1 SR with 60 participants) – there are limited evidence on the use of NPWT for the treatment of these wounds. Trau-matic wounds without fracture (1 SR with 509 participants and 1 RCT with 174 participants) – there were no evidence for the use of NPWT. Surgical dehiscences (1 RCT with 507 participants) – presented an average time for wound healing significantly lower in the NPWT branch in comparison to control group, but the evidence was limited due to high risk of bias of this RCT. Necrotizing fasciitis (2 SRs that included participants with this wound) – there were not evidence for the use of NPWT. Conclusions: In complex wounds included in this report, there is low certainty evidence for the efficacy regarded to healing and safety in NPWT in comparison to the standard treatment only for diabetic and post-amputation wounds. There is no evidence to support NPWT in venous, arterial, traumatic wounds nor in dehiscences and necrotizing fasciitis, which requires further research.
Question: In patients with complex wounds, does Negative Pressure Wound Therapy, in comparison to other local treatments, show a better healing rate, limb preservations and decrease both in hospitaliza-tion time and costs? Target population: patients with complex wounds. Technology: Negative pressure wound therapy.Trade names in Brazil: Carilex® and PICO®. NPWT is a technology developed for the treatment of wounds from different etiologies. It is constituted of an inter-face dressing placed in the wound, which is connected to a device that provides subatmospheric pressure (negative) in a controlled and localized way. Comparator: standard dressings used according to each insti-tution’s protocol. Design of eligible studies: Systematic Reviews (SRs) with or without meta-analysis of Randomized Controlled Trials (RCTs) and RCTs. Method of search and analysis of scientific evidences: it has been carried out a search in the following databases: The Cochrane Li-brary, Embase, PubMed and Virtual Health Library (BVS, from the acro-nym in Brazilian Portuguese) until February, 2021. Summary of results from selected studies: Diabetic foot wounds and post-amputation ulcers (14 SRs and 2 RCTs) – low certainty evidence that NPWT in comparison with the standard treatment may in-crease the proportion of healed wounds, diminish the healing time and become a safe therapy. The evidence that states that NPWT reduces the risk of amputation is uncertain. None of the included studies provided ev-idence of higher quality regarding the cost-effectiveness and life quality. Venous or arterial ulcers (1 SR with 60 participants) – there are limited evidence on the use of NPWT for the treatment of these wounds. Trau-matic wounds without fracture (1 SR with 509 participants and 1 RCT with 174 participants) – there were no evidence for the use of NPWT. Surgical dehiscences (1 RCT with 507 participants) – presented an average time for wound healing significantly lower in the NPWT branch in comparison to control group, but the evidence was limited due to high risk of bias of this RCT. Necrotizing fasciitis (2 SRs that included participants with this wound) – there were not evidence for the use of NPWT. Conclusions: In complex wounds included in this report, there is low certainty evidence for the efficacy regarded to healing and safety in NPWT in comparison to the standard treatment only for diabetic and post-amputation wounds. There is no evidence to support NPWT in venous, arterial, traumatic wounds nor in dehiscences and necrotizing fasciitis, which requires further research.
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Palavras-chave
Curativos, Cicatrização, Terapia de pressão negativa, Feridas complexas