Fotobiomodulação e terapia fotodinâmica antimicrobiana no manejo de lesões por pressão revisão de escopo e consenso Delphi modificado

Abstract

Pressure injuries represent an important public health problem, associated with pain, risk of infection, prolonged hospitalization, increased healthcare costs, and negative impact on quality of life. In this context, photonic therapies, such as photobiomodulation (PBM) and antimicrobial photodynamic therapy (aPDT), have been investigated as adjunctive resources for tissue repair and microbiological control. The objective of this study was to develop preliminary recommendations to support the safe and reproducible use of PBM and aPDT in the management of pressure injuries, based on the integration of a scoping review and expert consensus. The study was conducted in two stages: a scoping review, following PRISMA-ScR recommendations, and a modified Delphi consensus with specialists, using a 1-to-9-point Likert scale. Consensus was defined as at least 75% of valid responses within the agreement range. Sixteen studies were included in the scoping review, comprising primary clinical studies and literature reviews. Evidence predominantly addressed PBM, especially low-level laser therapy and LED therapy, whereas specific evidence on aPDT in pressure injuries was scarce. The studies suggested potential benefits of PBM in reducing wound area, supporting tissue repair, and improving clinical indicators, although substantial heterogeneity was observed in therapeutic parameters and outcomes. Based on the scoping review, 27 propositions were developed and submitted to the first Delphi round, of which 26 reached consensus. In the second round, five reformulated propositions were evaluated, all of which reached consensus. At the end of the process, ten preliminary consensus-based recommendations were consolidated, addressing the use of photonic therapies as adjunctive resources to conventional care, systematic clinical assessment, reporting of dosimetric and operational parameters, follow-up using standardized instruments, and specific training in Biophotonics. It is concluded that PBM presents stronger direct support for the adjunctive management of pressure injuries, although protocol heterogeneity still limits standardization of clinical conduct. aPDT appears to be a promising therapeutic possibility for situations related to microbiological control; however, its support in this context remains predominantly indirect and consensus-based. The recommendations developed are preliminary and may contribute to guiding clinical practice, professional training, protocol development, and future research on photonic therapies applied to the care of people with pressure injuries.