Use of Negative Pressure Wound Therapy With Instillation in the Management of Complex Wounds in Critically Ill Patients

Luis Fernández, MD, KHS, KCOEG, FACS, FASAS, FCCP, FCCM, FICS; Cynthia Ellman, RN, BSN, CWOCN; Patricia Jackson, BSN, RN, CWOCN


Wounds. 2019;31(1):E1-E4. 

In This Article

Abstract and Introduction


Introduction: Negative pressure wound therapy with instillation and dwell time (NPWTi-d) cleanses wounds with cyclic delivery, dwell, and removal of topical solutions to solubilize infectious materials and wound debris.

Objective: In this 2-patient case study, the authors report their experiences using NPWTi-d on 2 critically ill patients requiring management of large, complex wounds.

Materials and Methods: In both cases, normal saline was instilled with 10- to 20-minute dwell times, followed by 2 hours of negative pressure wound therapy (NPWT) at -125 mm Hg.

Results: Patient 1 was a 67-year-old woman, with a history of Roux-en-Y gastric bypass surgery, who required emergency surgery about 36 hours after ischemic efferent limb detorsion. After damage control surgery, NPWTi-d was applied for about 2 weeks. Once the wound was granulating, treatment was switched to conventional NPWT. Definitive surgery was planned for once she became physiologically optimized. Patient 2 was a 45-year-old woman presenting with septic shock and complex, necrotic wounds due to Fournier's gangrene. She received appropriate debridement, antibiotics, and adjunctive nutritional and critical care support. Then, NPWTi-d and NPWT were applied for 68 days, after which split-thickness skin grafts were used to close the right thigh, inguinal area, perineum, suprapubic area, right superior buttocks region, and back. Conventional NPWT was applied over the grafts as a bolster, and the patient was discharged to a rehabilitation center 27 days later with a 95% graft take.

Conclusions: In the authors' clinical experience, NPWTi-d promoted wound healing in critically ill patients with large wounds.


Negative pressure wound therapy with instillation and dwell time (NPWTi-d) is a negative pressure wound therapy (NPWT) system with an instillation feature and specialized dressings that allow solutions to dwell in the wound for prolonged contact with and cleansing of the wound bed. Use of NPWTi-d has been shown to be an effective approach in difficult-to-treat cases. Several published reviews and recommendations exist for the use of NPWTi-d in both acute and chronic wounds.[1–3] In addition, NPWTi-d has been shown to provide better clinical outcomes overall than conventional NPWT when added to standard wound care.[4]

In this report, the authors describe the use of NPWTi-d to manage complex wounds in 2 critically ill patients.