Prophylactic Interventions for Heel Pressure Ulcers in Critically Ill Patients Admitted to an Intensive Care Unit: A Systematic Review and Meta-Analysis.

Pressure ulcers are one of the most predictable adverse events, and nurses play a major role in their prevention. Patients receiving intensive care are at a particularly high risk of developing pressure ulcers. The heel is a common area for pressure ulcers, but the number of comparative studies on preventing pressure ulcers is small. Therefore, it is important to combine the evidence. This study aimed to investigate the effectiveness of interventions to prevent heel pressure ulcers by comprehensively extracting and quantitatively integrating the results of studies on preventive care for heel pressure ulcers in critically ill patients. Systematic reviews and meta-analyses were performed. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA) 2020. Eligible criteria were randomized controlled trials (RCTs) and non-RCTs examining interventions for the prevention of heel pressure ulcers as an adjunct to standard care in critically ill adult patients in intensive care units. According to the eligibility and exclusion criteria, two review authors independently screened and extracted data from the included literature. The risk of bias was assessed using the Mixed Methods Appraisal Tool (MMAT). Studies were grouped based on intervention type, and a random-effects meta-analysis was performed. A total of 2,800 studies were searched in four databases. In the primary screening, 122 met the eligibility criteria, and in the secondary screening, seven studies (1,412 patients) met the eligibility criteria. Of the seven studies, three (1,037 eligible patients) applied dressings to the heel, two (237 eligible patients) applied oil, and two (138 eligible patients) wore heel protectors. The risk of bias of the included studies was low. Preventive intervention for heel pressure ulcers significantly reduced the incidence of pressure ulcers compared with usual care (odds ratio (OR) = 0.16, 95% confidence interval (CI) = 0.08-0.33, I² = 0%) In the subgroup analysis, dressing was effective in preventing heel pressure ulcers (three studies, OR = 0.15, 95% CI = 0.05-0.45, I² = 0%). Protector was effective in preventing heel pressure ulcers (two studies, OR = 0.15, 95% CI = 0.05-0.45, I² = 0%). However, oil application was not significantly effective in preventing pressure ulcers (two studies, OR = 0.34, 95% CI = 0.06-1.90, I² = 0%). In this subgroup analysis, oil application alone was ineffective in preventing pressure ulcers. This number of studies is insufficient to draw firm conclusions, and further studies are required.