Objectives: To compare the efficacy of a sequential strategy combining calcium alginate and hydrocolloid dressings treatment of grade III or IV pressure ulcers (PUs) and the efficacy of nonsequential strategy with hydrocolloids alone.
Design: An open, randomized, multicenter parallel-group trial.
Setting: Twenty geriatrics hospital wards.
Participants: One hundred ten older patients with grade III or IV PUs.
Intervention: The control strategy consisted of applying hydrocolloid dressings (DuodermE) for 8 weeks; the sequential strategy consisted of applying combined calcium alginate dressings (UrgoSorb) for the first 4 weeks and hydrocolloid dressings (Algoplaque) for the next 4 weeks.
Measurements: PU surface areas were measured weekly by ulcer tracing. The endpoints were the mean absolute surface area reduction (SAR) during the 8-week study period and the number of patients achieving a 40 or more SAR (SAR40).
Results: Fifty-seven and 53 patients were randomly allocated to sequential and control strategies respectively. Baseline patient characteristics and PU ulcer features at inclusion were similar in the two groups. Mean +/- standard deviation SAR was significantly larger in the sequential treatment group (5.4 +/- 5.7 cm2 and 7.6 +/- 7.1 cm2 at 4 and 8 weeks) than in the control group (1.6 +/- 4.9 cm2 and 3.1 +/- 7.2 cm2, P< .001). In the sequential treatment group, 68.4 of the patients reached SAR40 at 4 weeks and 75.4 at 8 weeks, proportions significantly larger than in the control group (22.6 and 58.5, respectively, P< .0001). Dressing tolerance was good in both strategies.
Conclusions: In grade III or IV PUs, treatment using first calcium alginate dressings and then hydrocolloid dressings promotes faster healing than treatment with hydrocolloid dressings alone.