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.