Assessing the Need for Negative Pressure Wound Therapy Utilization Guidelines

An Overview of the Challenges With Providing Optimal Care

Robert S. Kirsner, MD, PhD; Theresa Hurd, PhD, MScN, ACNP, RN

Disclosures

Wounds. 2020;32(12):328-333. 

In This Article

Abstract and Introduction

Abstract

Negative pressure wound therapy (NPWT) has evolved beyond its original design as a stationary, reusable system (traditional NPWT [tNPWT]) and is now also available as a single-use, portable device (sNPWT). No established guidance exists for selecting the appropriate system to treat specific wound types in various settings. This article reviews the current practice and challenges associated with NPWT. Relevant literature was reviewed to provide a background on current practice. An online quantitative survey was performed during October and November 2018 among users of NPWT based in acute care settings across 6 countries (Australia, France, Germany, Italy, the United Kingdom, and the United States) to elucidate the operational and financial components considered in determining and/or thwarting efficacious use of NPWT. Data from recruited participants were collected, analyzed, and tabulated by an independent research company. All findings were reported as numbers/percentages. Wound size and depth, as well as the amount and/or type of exudate, were found to be among key factors in selecting NPWT; patient quality of life in terms of mobility, independence, and attitude toward treatment may be factors in adherence with prescribed care. Clinicians were not consistently knowledgeable about the financial and operational challenges of utilization presented by large fleets of NPWT pumps, nor were other institutional employees such as payers and discharge planners. Evidence-based recommendations are needed to guide decisions regarding NPWT systems, which in turn may improve therapy implementation, access to care, and patient quality of life, while driving operational and financial efficiencies for health care providers.

Introduction

From its inception, and given the evidence that it is an efficacious component in wound healing, negative pressure wound therapy (NPWT)—a wound care system that comprises a sealed dressing to which negative pressure is applied—has been utilized and studied in a variety of clinical and research scenarios. It has been shown to help foster a favorable environment for wound healing by promoting moist wound healing, improving tissue perfusion, stimulating tissue granulation and angiogenesis, and changing the bacterial environment.[1]

In its original or traditional design (tNPWT), NPWT is useful for a variety of wound types, per a wide-ranging review by Apelqvist et al.[2] It has been shown to be effective in acute wounds resulting from abdominal[3] and cardiac surgery,[4] and it is an important component of the armamentarium necessary to manage complex, nonhealing wounds such as diabetic foot ulcers (DFUs),[5] venous leg ulcers (VLUs),[5] pressure injuries,[6] complex orthopedic surgical and trauma wounds,[7] and burns.[8] A large retrospective study (N = 1107) has demonstrated that 2 available commercial systems were found to deliver comparable clinical outcomes in a broad range of chronic and acute wounds.[9] A further study in acute and chronic wounds also concluded that there were no significant differences between the 2 devices being studied.[10]

Over the years, improvements have been made to the way NPWT can be delivered, which enhanced the capabilities of NPWT devices, giving clinicians providing care more choices and improving the experiences of patients undergoing treatment. Traditional NPWT is considered to comprise a dressing system that includes a wound filler (that may be foam or gauze) applied to a wound that is then sealed with an adhesive drape to which subatmospheric pressure is delivered using a reusable powered pump. The clinician can choose a specific pressure setting to be delivered continuously or an upper and lower range that is delivered intermittently for predetermined defined periods of time. The fluid drawn from the wound using the "negative" pressure is collected into a canister by a tubing. Evolving incarnations of NPWT devices now include single-use disposable systems (sNPWT) and NPWT with instillation (NPWTi) in which a solution is infused and allowed to dwell in the wound for a determined time period. Negative pressure wound therapy also has been combined with other treatments such as silver-impregnated dressings,[11] dermal regenerated matrix dressings,[12] and skin grafts.[13]

Negative pressure wound therapy is often considered to be an expensive wound management option; however, its cost effectiveness can be measured in decreased length of hospital stay, less frequent dressing changes, and fewer complications and/or additional surgeries.[14] In addition, research has shown various forms of NPWT are cost-effective in wounds of various etiologies, as noted in a retrospective review[15] and a long-term care cost utilization study.[16]

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