Fotobiomodulação no tratamento de lesões por pressão: revisão sistemática com metanálise

Abstract

Pressure sores (PS) are important causes of morbidity, especially in patients admitted to intensive care units. Besides having a high cost to the health system, it adds an additional risk for the patients because it imposes the loss of the skin constitutional barrier. Photobiomodulation (PBM) with low-level laser has been shown to be effective in the treatment of PS in different stages. There is no consensus on the protocols of irradiation parameters, wavelength, energy, dose, intervals between sessions. The objective of this study was to evaluate the effects of photobiomodulation in the treatment of pressure sores from a systematic review of literature and meta-analysis. This is a systematic review carried out according to the PRISMA guidelines, which included studies without restrictions on year and language of publication, published until January 2020. Randomized studies that compared the effects of low-level laser therapy with a control group in patients with pressure ulcers were included. The studies were analyzed, reported descriptively and combined in a meta-analysis, the heterogeneity of the studies was assessed and the combined Odds Ratio for total PS healing in the follow-up period and the combined mean percentage area reduction were calculated. Six randomized clinical trials were included in the qualitative analysis and five trials in the quantitative analysis. A total of 207 patients were randomized to either FBM or control. The studies reported PBM with low-level laser with different wavelengths within the therapeutic window, in the range of 600 nm (red), 800 nm and 900 nm (infrared). From these data, subgroup analysis was performed and the combined Odds Ratio for each band was calculated, and no statistically significant difference was found in the set of studies as a whole and in the subgroups (p> 0.05). Only two studies described the percentage of reduction of the PS area. Analysis of these combined data showed Odds Ratio values equal to 1.34 (95% CI 0.8 - 2.24; Z 1.11; p= 0.82) in favor of the PBM but without statistical significance (p> 0.05). Of the included studies, only PBM with low-level laser therapy using red laser (660 nm) promoted a significant difference in the reduction of PS (p< 0.05). It can be concluded that in the studies included, photobiomodulation with red low-level laser was effective in the healing process of pressure sores in stages 2 and 3. It is suggested to carry out other randomized clinical trials to analyze the parameters of photobiomodulation.