Clinical application and efficacy of negative pressure wound therapy with instillation and dwell time (NPWTi‐d): A systematic review and meta‐analysis

Abstract

This study evaluates the current clinical evidence of Negative Pressure Wound Therapy with Instillation and dwell time (NPWTi‐d) to establish its clinical application and efficacy. MEDLINE, EMBASE, and CENTRAL databases were searched from 1946 to July 2019 for studies reporting clinical outcomes on wounds treated with NPWTi‐d. The primary outcome was proportion of wounds with complete healing. The secondary outcomes were mean time for healing, NPWTi‐d settings, cost, length of stay, and adverse events. Thirteen articles were included with a total of 624 wounds in 542 patients involving wounds of various aetiology. The pooled proportion of wound that achieved complete healing was 93.65% (95%CI: 84.02‐99.04). Normal saline was the most commonly used instillation solution with the mean dwell time of 14.23 minutes (95%CI: 10.88‐17.59) and instillation cycle every 4.17 ± 2.32 hourly. The mean therapy duration was 10.69 days (95%CI: 10.46‐10.91) with daily cost of $194.80. The mean hospital stay was 18.1 days (95%CI: 17.20‐19.00). There were no severe adverse effects reported. NPWTi‐d is an adjuntive therapy to aid complete healing of the vast majority of wounds. However, the current data are limited by the lack of level 1 evidence.

Influence of 4 drain configurations on fluid dispersal and retrieval in an instillation model

“…A dwell period, where fluid remains in the wound bed undisturbed for 10‐20 min, is recommended to enhance fluid dispersion 9,10 . We found a higher surface area coverage by fluid following the dwell period for all configurations.…”

“…This effect may be a result of fluid viscosity; the greater viscosity of contrast agent may prevent further dispersion within the model following instillation. Saline, which is of low viscosity, is currently recommended for instillation therapy with no benefit reported with the use of antiseptic solutions for the purpose of lavage 4,5,10,13 …”

“…Patients that had wounds treated with NPWTi had shorter hospitalization periods, fewer surgical procedures prior to definitive closure, and shorter time to final surgical procedure compared with NPWT in humans 17 . The benefits for wound healing may therefore offset the cost of therapy 5,10 . Regardless, the use of low‐cost materials such as a wound soaker catheter and an JP active suction drain may increase cost efficiency and access to this treatment in the veterinary industry.…”

“…In a model, enhanced fluid distribution was seen with intermittent fluid boluses compared with continuous irrigation 9 . Allowing fluid to sit within the wound bed for 10‐20 min is recommended to improve fluid dispersal 10 …”

“…9 Allowing fluid to sit within the wound bed for 10-20 min is recommended to improve fluid dispersal. 10 The lack of availability of units for NPWTi such as the VAC Ulta (3 M, St Paul, MN) to the veterinary community, their cost, and lack of guidelines for their use may contribute to low utilization of this technique in veterinary medicine. Development of a novel, cost-effective wound instillation system using a wound infusion catheter and Jackson-Pratt (JP) drain may improve access to this therapy.…”