Międzynarodowa grupa robocza ekspertów, w skład której weszli wybitni polscy specjaliści w zakresie leczenia ran, opracowała wytyczne dotyczące profilaktyki i terapii ran ostrych i trudno gojących się z zastosowaniem urządzeń podciśnieniowych. O tym, dlaczego terapia NPWT jest szczególnie istotna w czasie epidemii, mówi prof. dr hab. n. med. Tomasz Banasiewicz, współautor zaleceń i członek zarządu Stowarzyszenia Naukowego Leczenia Ran.
Pandemia koronawirusa i związana z nią rosnąca liczba hospitalizacji sprawia, że należy wypracować nowe procedury leczenia i prewencji ran. Jak wskazują eksperci, w czasie epidemii optymalna strategia opieki nad pacjentami z ranami trudno gojącymi się powinna mieć trzy cele: minimalizację liczby przypadków wymagających hospitalizacji, zmniejszenie liczby zabiegów chirurgicznych oraz ograniczenie czasu przebywania pacjenta w szpitalu.
Jednym ze sposobów na osiągnięcie tych celów jest stosowanie w szerokim zakresie, począwszy od wczesnych etapów leczenia, urządzeń do podciśnieniowej terapii ran (NPWT).
Skrócenie i optymalizacja leczenia
W trakcie epidemii SARS-CoV-2 skracanie czasu hospitalizacji i leczenia rany poprzez wczesne i skuteczne leczenie powikłań oraz zmniejszanie ryzyka SSI jest szczególnie istotne, ponieważ zmniejsza ryzyko transmisji wirusa i zapewnia lepszą wydolność systemu ochrony zdrowia. Terapia NPWT ma w tym kontekście szczególne znaczenie. Podkreśla to prof. dr hab. n med. Tomasz Banasiewicz, członek zarządu Stowarzyszenia Naukowego Leczenia ran i jeden z autorów zaleceń:
– Punktem wyjścia do opracowania dokumentu, który opublikowaliśmy, były rozmowy z kierownikami klinik chirurgicznych z Włoch, Hiszpanii i Wielkiej Brytanii, gdzie w związku z epidemią występowały olbrzymie problemy z miejscami dla pacjentów w szpitalach. W wyniku tych rozmów doszliśmy do wniosku, że należy dążyć do jak najlepszych przebiegów operacyjnych, jak najwcześniejszego zwalniania pacjentów do domu, a jeżeli dojdzie do problemów z gojeniem rany, to należy leczyć je możliwie najbardziej efektywnie – tłumaczy ekspert. – Ten artykuł ma stanowić przypomnienie, że terapia podciśnieniowa pozwala nie tylko na jakościową poprawę gojenia, ale również na skrócenie czasu gojenia i hospitalizacji, co w realiach epidemii nabiera szczególnego znaczenia. W tym kontekście terapia NPWT służy przede wszystkim sprawnemu zarządzaniu pacjentami.
Ekspert wyjaśnia, że skuteczne i szybkie leczenie ran za pomocą terapii podciśnieniowej jest w trudnej sytuacji epidemiologicznej niezwykle istotne:
– Przedłużający się pobyt pacjenta w szpitalu zwiększa zagrożenie infekcji COVID-19. Z drugiej strony każda infekcja i utrzymujący się stan zapalny to zwiększone ryzyko gorszego przebiegu zakażenia COVID-19. Ponadto w przypadku krajów, gdzie sytuacja epidemiologiczna jest trudna, pobyt w szpitalu pacjenta, który mógłby być leczony ambulatoryjnie, może oznaczać, że inny pacjent może stracić szansę na uratowanie życia – podkreśla prof. dr hab. n. med. Tomasz Banasiewicz. – To jest miejsce terapii podciśnieniowej. Pozwala ona leczyć rany szybciej, optymalizować opiekę.
Trzy obszary działań
Autorzy zaleceń wskazują, że w terapii ran trudno gojących się można wyróżnić trzy główne etapy, w których terapia NPWT ma szczególne znaczenie podczas epidemii COVID-19.
Pierwszy obszar działań dotyczy leczenia ambulatoryjnego pacjentów z ranami. Na tym etapie leczenia zaleca się profilaktyczne stosowanie jednorazowych urządzeń do terapii podciśnieniowej, dzięki któremu możliwe jest zmniejszenie częstotliwości zmian opatrunków, a zarazem liczby wizyt pacjenta w placówce medycznej.
Drugie uwzględnione przez ekspertów zagadnienie to opieka nad pacjentami po zabiegach chirurgicznych. Specjaliści wskazują, że terapia NPWT pozwala w zakresie opieki pooperacyjnej na skuteczną kontrolę procesu terapeutycznego. Stosowanie zabiegów podciśnieniowych u pacjentów po zabiegach operacyjnych zmniejsza częstotliwość i zjadliwość zakażeń miejsca operowanego (SSI). Jeżeli dojdzie do rozwoju zakażenia, dzięki terapii NPWT możliwe jest wdrożenie skutecznego leczenia. Ponadto ogranicza się konieczność reoperacji, a proces rekonwalescencji w warunkach szpitalnych ulega skróceniu.
Ostatni etap terapii ran, na który zwracają uwagę autorzy zaleceń, to obserwacja kontrolna pacjentów ambulatoryjnych po zabiegach chirurgicznych. Stosowanie jednorazowych urządzeń do terapii podciśnieniowej zwiększa efektywność leczenia na tym etapie i pozwala zapobiegać rozwojowi zakażenia miejsca operowanego po zakończeniu terapii w warunkach szpitalnych.
W zaleceniach eksperci podkreślają, że terapię podciśnieniową należy połączyć z pogłębioną edukacją pacjenta zarówno w zakresie opieki nad raną, jak i sytuacją epidemiologiczną. Istotne jest także wdrożenie rozwiązań telemedycznych, które pozwolą na utrzymanie zdalnej kontroli nad procesem leczenia rany.
Pełny tekst zaleceń w wersji angielskiej można znaleźć na stronie: https://www.npwtj.com/index.php/npwtj
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