Скачать или смотреть High-volt electrical stimulation in treatment of pressure ulcers

Franek, A., Kostur, R., Polak, A., Taradaj, J., Szlachta, Z., Blaszczak, E., Kucio, C. 2012. Using high-voltage electrical stimulation in the treatment of recalcitrant pressure ulcers: results of a randomized, controlled clinical study. Ostomy/Wound Management, 58 3, 30–44.

• Level of evidence of the article
o Level 1b study – RCT with single blinding
• Target population
o All patients with lower extremity pressure ulcer stage II or stage III treated at Janusz Daab Surgery Hospital in Poland between January 1, 2005 and September 30, 2009
o Exclusion Criteria:
 ABI less than 0.9
 Diabetes mellitus
 Systemic sclerosis
 Cancer diagnosis
 Paresis
 Paralysis caused by injuries to CNS or PNS
 Patients whose pressure ulcers required surgical interventions
• Type of electrotherapy used in article
o High Volt Electrical Stimulation
• Specific electrotherapy parameters used in the article
o Voltage = 100-150 V
o Twin monophasic pulses
o Pulse duration = 100µs in total
o Frequency = 100 Hz
o Amplitude = evoked tingling sensation with NO motor effects induced up to subthreshold motor could be possible depending on individual tolerances
o Placement of electrodes:
 Active electrode placed on aseptic gauze pad saturated with physiological saline overlying wound site
 Passive electrode positioned at least 20cm from pressure ulcer proximal or distal depending on wound location
• Protocol used in the article
o Patients received 50-min procedures x 5 days/wk
 One procedure/day
 Treatment continued until healing or for a maximum of 6 weeks
 First 2 weeks patients received cathodic stimulation to facilitate granulation tissue formation
 Rest of time to healing or remaining 4 weeks used anode stimulation
• Outcome found with the protocol
o Study had 50 pts who completed protocol
 22 men, 28 women
 Age range 14-88
 11 obese patients, 39 normal BMI patients
o Treatment Group 26 people; Control Group 24 people
 Both groups received standard wound care
o Average wound area at baseline = 4.54cm2
 Decreased by 88.9% after 6 weeks
o Wound lengths
 A Treatment Group decreased by 74%
 B Control Group decreased by 36.1%
o Wound Widths
 A Treatment Group decreased by 79%
 B Control Group decreased by 36.3%
o Linear changes in total wound areas and wound volumes
 Suggested even wound healing
What do I think about this treatment?
Based on the results of this study and the reinforcement of previous studies that have produced similar, and sometimes more promising, data, I would most definitely use this treatment approach for patients with wounds that are reluctant to heal. I think that it is still necessary to follow all of the precautions you would when using any type of e-stim with regard to who is appropriate and who is not, but it is so important to acknowledge that research is showing again and again that wound healing is accelerated with the use of e-stim to supplement standard wound care techniques. I think of our body kind of like a battery, so why not hook it up to the charger in the wall for the hour charge time as opposed to waiting for solar power to get it charged?