目的:就有助于卫生专业人员在日常实践中选择合适的伤口敷料的建议达成共识,因为系统评价仅发现有限的证据支持现代伤口敷料的报告适应症。
方法:一个指导委员会从具有长期伤口护理经验的护理人员和医师(专家或全科医生)名单中选出了一个由27名没有声明利益冲突的专家组成的小组。这些名单是由15个法国学会提出的。
方法:小组成员收到了最近的文献系统综述,由工作组确定的适应症分类,和敷料的定义。
方法:指导委员会为两个小组中的每个小组设计了关于慢性伤口和急性伤口(包括烧伤)的问卷。共识方法来自RAND/UCLA采用的名义组技术。小组成员根据已发表的证据和他们自己的经验,对每种可能的敷料-适应症组合的相关性进行了评估。第一轮评级后,他们开会讨论结果并提出建议,然后参加第二轮评级。工作组同行审查了最终建议。
结论:对于以下组合的使用达成了强烈共识:对于慢性伤口,(1)清创阶段,水凝胶;(2)造粒阶段,泡沫和低粘附性敷料;和(3)上皮形成阶段,水胶体和低粘附性敷料;对于急性伤口的上皮形成阶段,低依从性敷料。对于具体情况,以下敷料是有利的:脆弱的皮肤,低粘附性敷料;用于出血性伤口,藻酸盐;和恶臭伤口,活性炭。
OBJECTIVE: To seek a
consensus on recommendations that would help health professionals choose appropriate wound dressings in daily practice, since a systematic review found only limited evidence to support reported indications for modern wound dressings.
METHODS: A steering committee selected a panel of 27 experts with no declared conflicts of interest from lists of nursing staff and physicians (specialists or general practitioners) with long-standing experience of wound care. The lists were put forward by 15 French learned societies.
METHODS: The panelists received a recent systematic review of the literature, a classification of indications established by a working group, and definitions for the dressings.
METHODS: The steering committee designed questionnaires on chronic wounds and on acute wounds including burns for each of the 2 panels. The
consensus method was derived from the nominal group technique adapted by RAND/UCLA. Panelists rated the relevance of each possible dressing-indication combination on the basis of the published evidence and their own experience. After the first round of rating, they met to discuss results and propose recommendations before taking part in a second round of rating. The working group peer reviewed the final recommendations.
CONCLUSIONS: A strong
consensus was reached for use of the following combinations: for chronic wounds, (1) debridement stage, hydrogels; (2) granulation stage, foam and low-adherence dressings; and (3) epithelialization stage, hydrocolloid and low-adherence dressings; and for the epithelialization stage of acute wounds, low-adherence dressings. For specific situations, the following dressings were favored: for fragile skin, low-adherence dressings; for hemorrhagic wounds, alginates; and for malodorous wounds, activated charcoal.