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Dermatology and Therapy

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Open Access 06-12-2022 | Vacuum Therapy | Original Research

Application of Comfort Therapy under eCASH Concept in Acute and Chronic Wound Treatment

Authors: Shuting Shi, Jiayu Wei, Guozhong Lyu, Xiaohui Zhong, Minlie Yang, Lihong Zhu

Published in: Dermatology and Therapy | Issue 1/2023

Abstract

Introduction

Given the new ideas on wound care offered by the eCASH (early Comfort using Analgesia, minimal Sedatives, and maximal Humane care) and the substantial differences in clinical treatment between acute and chronic wounds, we aimed to investigate the effect of comfort therapy under the eCASH concept on analgesic sedation and accelerated wound healing in patients with acute or chronic wounds.

Methods

This randomized clinical study was conducted in two parts: acute wounds and chronic wounds. Patients with acute wounds were allocated into the acute wound control group (AWCG) and the acute wound experimental group (AWEG). Patients with chronic wounds were allocated into the chronic wound control group (CWCG) and two experimental groups, in which they received intermittent negative pressure therapy (IPTEG) and continuous negative pressure therapy (CPTEG). On the basis of the standard treatment for patients in the control group, eCASH therapy was used in the experimental groups. In addition, pain intensity and procedural anxiety were evaluated using the visual analogue score (VAS) and the Hamilton Anxiety Scale (HAM-A). In addition, clinical effects were assessed on the basis of the size of the surface area, rate of healing, and concentration of pro-inflammatory factors (IL-1, IL-6, TNF-α) and growth factors (VEGF, bFGF, TGF-β1).

Results

Compared with the control group, the VAS score and HAM-A score in the experimental groups were significantly decreased after intervention (P < 0.05). After intervention, the levels of IL-1β, IL-6, and TNF-α in AWEG, IPTEG, and CPTEG were significantly lower than those in AWCG. In addition, the levels of VEGF, bFGF, and TGF-β1 in IPTEG and CPTEG were significantly higher than those in CWCG (P < 0.05).

Conclusion

These results indicated that comfort therapy under the eCASH concept has a significant effect on ameliorating the pain and anxiety of patients, reducing the inflammatory reaction during the period of wound healing in the treatment of acute and chronic wounds.

Clinical Trial Registry

The trial has been registered in the Chinese Clinical Trial Registry (ChiCTR2200057981).

Guest JF, Vowden K, Vowden P. The health economic burden that acute and chronic wounds impose on an average clinical commissioning group/health board in the UK. J Wound Care. 2017;26(6):292–303. https://doi.org/10.12968/jowc.2017.26.6.292.CrossRefPubMed

Hasegawa M, Inoue Y, Kaneko S, et al. Wound, pressure ulcer and burn guidelines-1: guidelines for wounds in general, second edition. J Dermatol. 2020;47(8):807–33. https://doi.org/10.1111/1346-8138.15401.CrossRefPubMed

Martin P, Nunan R. Cellular and molecular mechanisms of repair in acute and chronic wound healing. Br J Dermatol. 2015;173(2):370–8. https://doi.org/10.1111/bjd.13954.CrossRefPubMedPubMedCentral

Van Koppen CJ, Hartmann RW. Advances in the treatment of chronic wounds: a patent review. Expert Opin Ther Patents. 2015;25(8):931–7. https://doi.org/10.1517/13543776.2015.1045879.CrossRef

Martinengo L, Olsson M, Bajpai R, et al. Prevalence of chronic wounds in the general population: systematic review and meta-analysis of observational studies. Ann Epidemiol. 2019;29:8–15. https://doi.org/10.1016/j.annepidem.2018.10.005.CrossRefPubMed

Naik S. Wound, heal thyself. Nat Med. 2018;24(9):1311–2. https://doi.org/10.1038/s41591-018-0179-3.CrossRefPubMed

Cheng B, Fu X. The focus and target: angiogenesis in refractory wound healing. Int J Lower Extrem Wounds. 2018;17(4):301–3. https://doi.org/10.1177/1534734618813229 (Epub 2018 Dec 03).CrossRef

Lindholm C, Searle R. Wound management for the 21st century: combining effectiveness and efficiency. Int Wound J. 2016;13:5–15. https://doi.org/10.1111/iwj.12623.CrossRefPubMedPubMedCentral

Gonzales K, Fuchs E. Skin and its regenerative powers: an alliance between stem cells and their niche. Dev Cell. 2017;43(4):387–401. https://doi.org/10.1016/j.devcel.2017.10.001.CrossRefPubMed

10.

Griggs C, Goverman J, Bittner EA, et al. Sedation and pain management in burn patients. Clin Plast Surg. 2017;44(3):535–40. https://doi.org/10.1016/j.cps.2017.02.026.CrossRefPubMedPubMedCentral

11.

Provencal SC, Bond S, Rizkallah E, et al. Hypnosis for burn wound care pain and anxiety: a systematic review and meta-analysis. Burns. 2018;44(8):1870–81. https://doi.org/10.1016/j.burns.2018.04.017.CrossRefPubMed

12.

Li YX, Huang KM, Cheng Y, et al. Pain management by nurses in level 2 and level 3 hospitals in China. Pain Manag Nurs. 2019;20(3):284–91. https://doi.org/10.1016/j.pmn.2018.08.002.CrossRefPubMed

13.

Poulsen MJ, Coto J. Nursing music protocol and postoperative pain. Pain Manag Nurs. 2018;19(2):172–6. https://doi.org/10.1016/j.pmn.2017.09.003.CrossRefPubMed

14.

Wang Y, Beekman J, Hew J, et al. Burn injury: challenges and advances in burn wound healing, infection, pain and scarring. Adv Drug Deliv Rev. 2018;1(123):3–17. https://doi.org/10.1016/j.addr.2017.09.018.CrossRef

15.

Vincent JL, Shehabi Y, Walsh TS, et al. Comfort and patient-centred care without excessive sedation: the eCASH concept. Intensive Care Med. 2016;42(6):962–71. https://doi.org/10.1007/s00134-016-4297-4.CrossRefPubMedPubMedCentral

16.

Kim PJ, Attinger CE, Constantine T, et al. Negative pressure wound therapy with instillation: international consensus guidelines update. Int Wound J. 2020;17(1):174–86. https://doi.org/10.1111/iwj.13254.CrossRefPubMed

17.

Thurber CA, Martin-Herz SP, Patterson DR. Psychological principles of burn wound pain in children. I: theoretical framework. J Burn Care Rehabilit. 2000;21(4):376–87. https://doi.org/10.1067/mbc.2000.102980.CrossRef

18.

Eming SA, Tomic-Canic M. Updates in wound healing: mechanisms and translation. Expe Dermatol. 2017;26(2):97–8. https://doi.org/10.1111/exd.13281.CrossRef

19.

Dalisson B, Barralet J. Bioinorganics and wound healing. Adv Healthc Mater. 2019. https://doi.org/10.1002/adhm.201900764.CrossRefPubMed

20.

Zhou XJ, Lyu GZ, Yang ML, et al. Efficacy of hierarchical medical mode path management on the continuous treatment for chronic wound patients. Chin J Burns. 2020;36(7):547–52. https://doi.org/10.3760/cma.j.cn501120-20190408-00170.CrossRef

21.

Yan R, Xia J, Yang RR, et al. Association between anxiety, depression, and comorbid chronic diseases among cancer survivors. Psychooncology. 2019;28(6):1269–77. https://doi.org/10.1002/pon.5078.CrossRefPubMed

22.

Jarrin S, Finn DP. Optogenetics and its application in pain and anxiety research. Neurosci Biobehav Rev. 2019;105:200–11. https://doi.org/10.1016/j.neubiorev.2019.08.007.CrossRefPubMed

23.

Hobbs K. Which factors influence the development of post-traumatic stress disorder in patients with burn injuries? A systematic review of the literature. Burns. 2015;41(3):421–30. https://doi.org/10.1016/j.burns.2014.10.018.CrossRefPubMed

24.

Olausson S, Fridh I, Lindahl B, et al. The meaning of comfort in the intensive care unit. Crit Care Nurs Q. 2019;42(3):329–41. https://doi.org/10.1097/CNQ.0000000000000268.CrossRefPubMed

25.

Howard MB, Gleeson A, Higgins S. Hospice patients’ and families’ preference for shared versus single rooms. Palliat Med. 2014;28(1):94–5. https://doi.org/10.1177/0269216313490437.CrossRefPubMed

26.

Minton C, Batten L. Rethinking the intensive care environment: considering nature in nursing practice. J Clin Nurs. 2016;25(1–2):269–77. https://doi.org/10.1111/jocn.13069.CrossRefPubMed

27.

Lindahl B, Bergbom I. Bringing research into a closed and protected place: development and implementation of a complex clinical intervention project in an ICU. Crit Care Nurs Q. 2015;38(4):393–404. https://doi.org/10.1097/CNQ.0000000000000087.CrossRefPubMed

28.

Johansson L, Bergbom I, Lindahl B. Meanings of being critically ill in a sound-intensive ICU patient room—a phenomenological hermeneutical study. Open Nurs J. 2012;6:108–16. https://doi.org/10.2174/1874434601206010108 (Epub 2012 Sep 06).CrossRefPubMedPubMedCentral

29.

Engel HJ, Needham DM, Morris PE, Gropper MA. ICU early mobilization: from recommendation to implementation at three medical centers. Crit Care Med. 2013;41(9):S69–80. https://doi.org/10.1097/CCM.0b013e3182a240d5.CrossRefPubMed

30.

Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg. 1997;38(6):563–76. https://doi.org/10.1097/00000637-199706000-00002.CrossRefPubMed

31.

Venturi ML, Attinger CE, Mesbahi AN, et al. Mechanisms and clinical applications of the vacuum-assisted closure (VAC) device—a review. Am J Clin Dermatol. 2005;6(3):185–94. https://doi.org/10.2165/00128071-200506030-00005.CrossRefPubMed

32.

Borgquist O, Ingemansson R, Malmsjo M. Individualizing the use of negative pressure wound therapy for optimal wound healing: a focused review of the literature. Ostomy Wound Manag. 2011;57(4):44–54. https://pubmed.ncbi.nlm.nih.gov/21512192/.

33.

Malmsjo M, Gustafsson L, Lindstedt S, et al. Ingemansson R. The effects of variable, intermittent, and continuous negative pressure wound therapy, using foam or gauze, on wound contraction, granulation tissue formation, and ingrowth into the wound filler. Eplasty. 2012 (Epub 2012 Jan 24) 2012;12:e5–e5. https://pubmed.ncbi.nlm.nih.gov/22292101/.

34.

WT W, F S, XC W. Effects of TGF-β1 on wound healing in diabetic rats with second-degree scald. J Shandong Univ 2011;49(7):19–23. https://doi.org/10.3977/j.issn.1005-8478.2011.11.11.

35.

Yuan P, Kang W, Li X. Pathogenesis of osteoarthritis and related cytokines. Orthop J China. 2016;24(11):1010–5. https://doi.org/10.3977/j.issn.1005-8478.2016.11.11.CrossRef

36.

Akhzari S, Rezvan H, Zolhavarieh SM. Expression of pro-inflammatory genes in lesions, spleens and blood neutrophils after burn injuries in mice treated with silver sulfodiazine. Iran J Basic Med Sci. 2017;20(7):769–75. https://doi.org/10.22038/IJBMS.2017.9008.CrossRefPubMedPubMedCentral

Title: Application of Comfort Therapy under eCASH Concept in Acute and Chronic Wound Treatment
Authors: Shuting Shi
Jiayu Wei
Guozhong Lyu
Xiaohui Zhong
Minlie Yang
Lihong Zhu
Publication date: 06-12-2022
Publisher: Springer Healthcare
Keywords: Vacuum Therapy
Vacuum Therapy
Vacuum Therapy
Care
Anxiety
Growth Factors
Growth Factors
Published in: Dermatology and Therapy / Issue 1/2023
Print ISSN: 2193-8210
Electronic ISSN: 2190-9172
DOI: https://doi.org/10.1007/s13555-022-00852-5

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Application of Comfort Therapy under eCASH Concept in Acute and Chronic Wound Treatment

Abstract

Introduction

Methods

Results

Conclusion

Clinical Trial Registry

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Abstract

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Results

Conclusion

Clinical Trial Registry

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