| Abstract | Terapija negativnim tlakom ili NPWT (negative pressure wound therapy) ima dugu povijest, ali je tek u devedesetim godinama 20. stoljeća ušla u široku medicinsku uporabu. Danas se koristi za liječenje različitih tipova rana, uključujući akutne, kronične i kirurške rane. U terapiji negativnim tlakom primjenjuje se subatmosferski tlak koji se kreće od 50 do 175 mmHg. Mehanizam djelovanja NPWT je izravan i neizravan. Terapija negativnim tlakom stvara vlažan i topao okoliš, odvodi eksudat iz rane te približava rubove rana, što ubrzava cijeljenje. Neizravno uzrokuje prolazno smanjenje lokalne cirkulacije, snižava aktivnost matriks metaloproteinaze i potiče povećano stvaranje proangiogenih faktora rasta i odlaganje kolagena u rani. Potrebno je pažljivo odabrati pacijenta za terapiju negativnim tlakom. Zdravstveno osoblje treba uzeti u obzir sve čimbenike rizika, vrstu operativnog zahvata, opće zdravstveno stanje pacijenta te mogućnost komplikacija. Europsko udruženje herniologa (EHS) preporučuje korištenje NPWT-a kao profilaksu postoperativne ventralne hernije. Također, EHS preporučuje profilaktičku terapiju negativnim tlakom nakon laparotomije i nakon dehiscencije rane. NICE (National Institute for Health and Care Excellence) smjernice upućuju na profilaktički učinak NPWT u sprečavanju infekcije rana i seroma. Profilaktička terapija negativnim tlakom (pNPWT) može smanjiti troškove zdravstvene skrbi, pod uvjetom da se pravilno indicira. Grane kirurgije u kojima profilaktička NPWT može smanjiti trošak zdravstvene skrbi su abdominalna, kardiotorakalna i vaskularna kirurgija. Ispravan odabir pacijenata i profilaktička primjena terapije negativnim tlakom mogu dovesti do smanjenja komplikacija, kraćeg boravka u bolnici i bržeg oporavka, što sve zajedno rezultira nižim ukupnim troškovima zdravstvene skrbi. |
| Abstract (english) | Negative pressure wound therapy (NPWT) has a long history, but it only came into widespread medical use in the 1990s. Today, it is used to treat various types of wounds, including acute, chronic, and surgical wounds. In NPWT, subatmospheric pressure ranging from 50 to 175 mmHg is applied. The mechanism of NPWT is both direct and indirect. Negative pressure wound therapy creates a moist and warm environment, removes exudate from the wound, and draws the edges of the wound closer together, which accelerates healing. Indirectly, it causes a transient reduction in local circulation, reduces matrix metalloproteinase activity, and promotes increased production of proangiogenic growth factors and collagen deposition in the wound. It is crucial to carefully select patients for NPWT. Healthcare professionals should consider all risk factors, the type of surgical procedure, the patient's overall health condition and a potential complications. European Hernia Society (EHS) recommends the use of NPWT as a prophylaxis for midline incisional hernias. Additionally, EHS recommends prophylactic NPWT after laparotomy and wound dehiscence. NICE (National Institute for Health and Care Excellence) guidelines point to the prophylactic effect of NPWT in preventing surgical site infections and seromas. Prophylactic negative pressure wound therapy (pNPWT) can reduce healthcare costs, provided it is properly indicated. Surgical fields in which pNPWT can reduce healthcare costs include abdominal, cardiothoracic, and vascular surgery. Proper patient selection and the prophylactic application of NPWT can lead to fewer complications, shorter hospital stays and faster recovery, all of which result in decreased overall healthcare costs. |
