A systematic review of the use of hydrocolloids in the treatment of pressure ulcers.

AIMS AND OBJECTIVES The aim of this systematic literature review was to describe the current evidence in the field of pressure ulcer treatment with hydrocolloids and to give recommendations for clinical practice and further research. BACKGROUND Pressure ulcers are a common problem in clinical practice and generate substantial expense. A wide range of dressings is available but little is known about the effect on pressure ulcer healing. METHODS A Cochrane-based search strategy was used in four databases (PubMed, Embase, the Cochrane Central Register of Controlled Trials and the Cumulative Index to Nursing and Allied Health Literature), manuals and reference lists. Randomised controlled trials on the treatment of pressure ulcers with hydrocolloids, as defined by the British National Formulary, were systematically included and analysed. RESULTS Twenty-nine publications, dealing with 28 different studies, met the inclusion criteria and were included in the review. Hydrocolloids were most frequently used on pressure ulcers grade 2-3. Concerning the healing of the pressure ulcer, hydrocolloids are more effective than gauze dressings for the reduction of the wound dimensions. The absorption capacity, the time needed for dressing changes, the pain during dressing changes and the side-effects were significantly in favour of hydrocolloids if compared to gauze dressings. Based on the available cost-effectiveness data, hydrocolloids seemed to be less expensive compared with collagen-, saline- and povidine-soaked gauze but more expensive compared to hydrogel, polyurethane foam and collagenase. CONCLUSIONS This review demonstrates that hydrocolloids are to be preferred to gauze dressings in the treatment of pressure ulcers. Additional research is needed to confirm these results. RELEVANCE TO CLINICAL PRACTICE Based on the studies included in this review, hydrocolloids are frequently used in the treatment of grade 2 and 3 pressure ulcers and are more effective and less expensive than gauze dressings. Compared with alginates, polyurethane dressings, less-contact layers, topical enzymes and biosynthetic dressings, hydrocolloids are less effective.