From the Guidelines
The first line of treatment for decubitus (pressure) ulcers is pressure relief and wound care, which involves completely offloading pressure from the affected area and using specialized support surfaces such as air mattresses or foam cushions, as recommended by the American College of Physicians 1.
Key Components of Treatment
- Pressure relief: repositioning the patient every 2-3 hours to completely offload pressure from the affected area
- Wound care: gentle cleansing with saline or mild soap and water, debridement of necrotic tissue if present, and maintaining a moist wound environment using appropriate dressings (such as hydrocolloids, foams, or alginates depending on wound characteristics) 1
- Nutritional support: adequate protein intake (1.25-1.5 g/kg/day) and sufficient calories to promote healing, as protein or amino acid supplementation has been shown to reduce wound size 1
- Pain management: addressing pain as needed to improve patient comfort and adherence to treatment
Adjunctive Therapies
- Electrical stimulation: may be used as adjunctive therapy to accelerate wound healing, although it is associated with skin irritation and other adverse events, particularly in frail elderly patients 1
- Hydrocolloid or foam dressings: recommended to reduce wound size, with hydrocolloid dressings being superior to gauze dressings and equivalent to foam dressings for complete wound healing 1
Importance of Early Intervention
Prevention of further ulcers through regular skin assessment and early intervention is crucial in the comprehensive management approach, as pressure ulcers can have a significant impact on health status, quality of life, and health care costs 1.
From the Research
Decubitus Ulcer Treatment
The first line of treatment for decubitus (pressure) ulcers involves several key strategies:
- Relieving pressure on the affected area to prevent further damage 2, 3
- Using pressure-relieving systems such as foam plastic underlays, water-filled cushions, or pneumatic cushions to reduce pressure on the skin 2
- Implementing preventive measures, including regular position changes for patients at risk 2, 3
- Assessing individual risk factors for developing decubitus ulcers and adapting measures to the patient's needs 2, 3
Dressings and Topical Agents
For the treatment of existing pressure ulcers, various dressings and topical agents may be used, including:
- Protease-modulating dressings, which may increase the probability of ulcer healing compared to saline gauze 4
- Collagenase ointment, foam dressings, basic wound contact dressings, and polyvinylpyrrolidone plus zinc oxide, although the evidence for these treatments is of low certainty 4
- It is essential to note that the current evidence base is sparse and of low or very low certainty, making it difficult to determine the most effective dressings or topical agents for pressure ulcer treatment 4
Prevention and Management
Prevention and management of decubitus ulcers also involve:
- Encouraging movement and mobilization to avoid excessive pressure 3, 5
- Minimizing risk factors such as malnutrition, poor circulation, and underlying diseases that impair mobility 3, 5
- Implementing a team-focused approach to care, including pressure relief, infection control, nutrition, and surgery as needed 5