title: Pulsatile lavage for the enhancement of pressure ulcer healing: a randomized controlled trial.
abstract: BACKGROUND
  Pressure ulcer development is a common, serious complication after spinal cord injury (SCI). Although many biophysical agents are available for treatment, few randomized controlled trials of their efficacy have been done.
  
  
  OBJECTIVE
  The study objective was to examine the efficacy of low-pressure pulsatile lavage treatment for stage III and IV pressure ulcers in people with SCI.
  
  
  METHODS
  This study was a randomized controlled trial. Participants and assessors were unaware of intervention assignments.
  
  
  METHODS
  This study was conducted in an SCI tertiary care center inpatient unit.
  
  
  METHODS
  Participants were 28 people with SCI and stage III and IV pelvic pressure ulcers; 14 participants each were randomly assigned to treatment and control (sham treatment) groups.
  
  
  METHODS
  Daily low-pressure pulsatile lavage treatment with 1 L of normal saline at 11 psi of pressure was applied to the treatment group along with standard dressing changes. The control group received only sham treatment and standard dressing changes.
  
  
  METHODS
  Linear and volume measurements of pressure ulcer dimensions were obtained weekly for 3 weeks.
  
  
  RESULTS
  Statistical analysis with the t test revealed no statistically significant difference in demographics between groups. Random-coefficient models for analysis of linear and volume measurements revealed improvements over time for both groups. Time trend analysis revealed greater measurement decreases for the treatment group. Differences in rates of change (with 95% confidence intervals) for treatment and control groups, respectively, were: depth, -0.24 (0.09 to -0.58) cm/wk; width, -0.16 (0.06 to -0.39) cm/wk; length, -0.47 (0.18 to -1.12) cm/wk; and volume, -0.33 (0.13 to -0.80) cm(3)/wk.
  
  
  CONCLUSIONS
  Study limitations were small sample size and inclusion of only one site. Additionally, participants were not queried about their group assignments.
  
  
  CONCLUSIONS
  Pulsatile lavage enhanced stage III and IV pelvic pressure ulcer healing rates in people with SCI relative to standard pressure ulcer treatment alone.
authors.affiliation: Division of Physical Medicine and Rehabilitation, Foothills Hospital, Calgary, Alberta, Canada.
authors.forename: Chester H
authors.initials: CH
authors.lastname: Ho
authors.forename: Toula
authors.initials: T
authors.lastname: Bensitel
authors.forename: Xiaofeng
authors.initials: X
authors.lastname: Wang
authors.forename: Kath M
authors.initials: KM
authors.lastname: Bogie
mesh_terms: D000704:Analysis of Variance; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D003668:Pressure Ulcer / Q000209:etiology / Q000628:therapy*; D011446:Prospective Studies; D011673:Pulsatile Flow; D013119:Spinal Cord Injuries / Q000150:complications*; D007507:Therapeutic Irrigation / Q000379:methods*; D016896:Treatment Outcome; D014728:Veterans; D014945:Wound Healing / Q000502:physiology