Pressure Ulcer and Nutrition

Seied Hadi Saghaleini, Kasra Dehghan, Kamran Shadvar, Sarvin Sanaie, Ata Mahmoodpoor, Zohreh Ostadi, Seied Hadi Saghaleini, Kasra Dehghan, Kamran Shadvar, Sarvin Sanaie, Ata Mahmoodpoor, Zohreh Ostadi

Abstract

Pressure ulcers can diminish global life quality, contribute to rapid mortality in some patients and pose a significant cost to health-care organizations. Accordingly, their prevention and management are highly important. Nutritional deprivation and insufficient dietary intake are the key risk factors for the development of pressure ulcers and impaired wound healing. Unplanned weight loss is a major risk factor for malnutrition and pressure ulcer development. Suboptimal nutrition interferes with the function of the immune system, collagen synthesis, and tensile strength. No laboratory test can exactly define an individual's nutritional status. Although serum albumin, prealbumin, transferrin, and retinol-binding protein as well as anthropometric measures such as height, weight, and body mass index and the other laboratory values may be suitable to establish the overall prognosis, still they might not well represent the nutritional status. Although the ideal nutrient intake to encourage wound healing is unknown, increased needs for energy, protein, zinc, and Vitamins A, C, and E and also amino acids such as arginine and glutamine have been documented. Hydration plays a vital role in the preservation and repair of skin integrity. Dehydration disturbs cell metabolism and wound healing. Adequate fluid intake is necessary to support the blood flow to wounded tissues and to prevent additional breakdown of the skin. The main aim of the present article is to review the current evidence related to hydration and nutrition for bedsore prevention and management in adults.

Keywords: Management; nutrition; pressure ulcer.

Conflict of interest statement

There are no conflicts of interest.

References

    1. Dorner B, Posthauer ME, Thomas D. National Pressure Ulcer Advisory Panel. The role of nutrition in pressure ulcer prevention and treatment: National Pressure Ulcer Advisory Panel white paper. Adv Skin Wound Care. 2009;22:212–21. doi: 10.1097/01.ASW.0000350838.11854.0a.
    1. Posthauer ME, Banks M, Dorner B, Schols JM. The role of nutrition for pressure ulcer management: National pressure ulcer advisory panel, European pressure ulcer advisory panel, and pan pacific pressure injury alliance white paper. Adv Skin Wound Care. 2015;28:175–88.
    1. Lyder CH, Yu C, Stevenson D, Mangat R, Empleo-Frazier O, Emerling J, et al. Validating the Braden scale for the prediction of pressure ulcer risk in blacks and Latino/Hispanic elders: A pilot study. Ostomy Wound Manage. 1998;44:42S–9S.
    1. Strategies for Preventing Pressure Ulcers, Joint Commission Perspectives on Patient Safety. 2008;8:5–7.
    1. Pressure ulcers in America: prevalence, incidence, and implications for the future. An executive summary of the National Pressure Ulcer Advisory Panel monograph. Adv Skin Wound Care. 2001;14:208–15.
    1. Lyder CH. Pressure ulcer prevention and management. JAMA. 2003;289:223–6.
    1. Thomas DR, Goode PS, Tarquine PH, Allman RM. Hospital-acquired pressure ulcers and risk of death. J Am Geriatr Soc. 1996;44:1435–40.
    1. Bennett G, Dealey C, Posnett J. The cost of pressure ulcers in the UK. Age Ageing. 2004;33:230–5.
    1. Whittington K, Patrick M, Roberts JL. A national study of pressure ulcer prevalence and incidence in acute care hospitals. J Wound Ostomy Continence Nurs. 2000;27:209–15.
    1. Graves N, Birrell F, Whitby M. Effect of pressure ulcers on length of hospital stay. Infect Control Hosp Epidemiol. 2005;26:293–7.
    1. Horn SD, Bender SA, Ferguson ML, Smout RJ, Bergstrom N, Taler G, et al. The national pressure ulcer long-term care study: Pressure ulcer development in long-term care residents. J Am Geriatr Soc. 2004;52:359–67.
    1. Guenter P, Malyszek R, Bliss DZ, Steffe T, O’Hara D, LaVan F, et al. Survey of nutritional status in newly hospitalized patients with stage III or stage IV pressure ulcers. Adv Skin Wound Care. 2000;13:164–8.
    1. Mathus-vliegen E. M.H. Nutritional status, nutrition and pressure ulcers. Nutr Clin Pract. 2001;16:286–91.
    1. Stratton RJ, Ek AC, Engfer M, Moore Z, Rigby P, Wolfe R, et al. Enteral nutritional support in prevention and treatment of pressure ulcers: A systematic review and meta-analysis. Ageing Res Rev. 2005;4:422–50.
    1. Fry DE, Pine M, Jones BL, Meimban RJ. Patient characteristics and the occurrence of never events. Arch Surg. 2010;145:148–51.
    1. Iizaka S, Okuwa M, Sugama J, Sanada H. The impact of malnutrition and nutrition-related factors on the development and severity of pressure ulcers in older patients receiving home care. Clin Nutr. 2010;29:47–53.
    1. Blanc G, Meier MJ, Stocco JG, Roehrs H, Crozeta K, Barbosa DA, et al. Effectiveness of enteral nutritional therapy in the healing process of pressure ulcers: A systematic review. Rev Esc Enferm USP. 2015;49:152–61.
    1. Cox J, Rasmussen L. Enteral nutrition in the prevention and treatment of pressure ulcers in adult critical care patients. Crit Care Nurse. 2014;34:15–27.
    1. Montalcini T, Moraca M, Ferro Y, Romeo S, Serra S, Raso MG, et al. Nutritional parameters predicting pressure ulcers and short-term mortality in patients with minimal conscious state as a result of traumatic and non-traumatic acquired brain injury. J Transl Med. 2015;13:305.
    1. Banks MD, Graves N, Bauer JD, Ash S. The costs arising from pressure ulcers attributable to malnutrition. Clin Nutr. 2010;29:180–6.
    1. Edsberg LE, Langemo D, Baharestani MM, Posthauer ME, Goldberg M. Unavoidable pressure injury: State of the science and consensus outcomes. J Wound Ostomy Continence Nurs. 2014;41:313–34.
    1. Thomas DR. Unintended weight loss in older adults. Aging Health. 2008;4:191–200.
    1. Ryan C, Bryant E, Eleazer P, Rhodes A, Guest K. Unintentional weight loss in long-term care: Predictor of mortality in the elderly. South Med J. 1995;88:721–4.
    1. Sullivan DH, Johnson LE, Bopp MM, Roberson PK. Prognostic significance of monthly weight fluctuations among older nursing home residents. J Gerontol A Biol Sci Med Sci. 2004;59:M633–9.
    1. McHoney M, Eaton S, Pierro A. Metabolic response to surgery in infants and children. Eur J Pediatr Surg. 2009;19:275–85.
    1. Lheureux O, Preiser JC. Role of nutrition support in inflammatory conditions. Nutr Clin Pract. 2017;32:310–7.
    1. Kennerly S, Batchelor-Murphy M, Yap TL. Clinical insights: Understanding the link between nutrition and pressure ulcer prevention. Geriatr Nurs. 2015;36:477–81.
    1. Evans WJ, Morley JE, Argilés J, Bales C, Baracos V, Guttridge D, et al. Cachexia: A new definition. Clin Nutr. 2008;27:793–9.
    1. MacIntosh C, Morley JE, Chapman IM. The anorexia of aging. Nutrition. 2000;16:983–95.
    1. Covinsky KE, Covinsky MH, Palmer RM, Sehgal AR. Serum albumin concentration and clinical assessments of nutritional status in hospitalized older people: Different sides of different coins? J Am Geriatr Soc. 2002;50:631–7.
    1. Ferguson RP, O’Connor P, Crabtree B, Batchelor A, Mitchell J, Coppola D, et al. Serum albumin and prealbumin as predictors of clinical outcomes of hospitalized elderly nursing home residents. J Am Geriatr Soc. 1993;41:545–9.
    1. Bluestein D, Javaheri A. Pressure ulcers: Prevention, evaluation, and management. Am Fam Physician. 2008;78:1186–94.
    1. Mathus-Vliegen EM. Old age, malnutrition, and pressure sores: An ill-fated alliance. J Gerontol A Biol Sci Med Sci. 2004;59:355–60.
    1. Todorovic V. Food and wounds: nutritional factors in wound formation and healing. Br J Community Nurs. 2002:43–4.
    1. Raffoul W, Far MS, Cayeux MC, Berger MM. Nutritional status and food intake in nine patients with chronic low-limb ulcers and pressure ulcers: Importance of oral supplements. Nutrition. 2006;22:82–8.
    1. Serpa LF, Santos VL. Validity of the Braden nutrition subscale in predicting pressure ulcer development. J Wound Ostomy Continence Nurs. 2014;41:436–43.
    1. Crowe T. Nutrition therapy in the prevention and treatment of pressure ulcers. Wound Practice Res. 2009;17:90–9.
    1. Hartgrink HH, Wille J, König P, Hermans J, Breslau PJ. Pressure sores and tube feeding in patients with a fracture of the hip: A randomized clinical trial. Clin Nutr. 1998;17:287–92.
    1. Breslow RA, Bergstrom N. Nutritional prediction of pressure ulcers. J Am Diet Assoc. 1994;94:1301–4.
    1. Chernoff R. Protein and older adults. J Am Coll Nutr. 2004;23:627S–30S.
    1. Langer G, Schloemer G, Knerr A, Kuss O, Behrens J. Nutritional interventions for preventing and treating pressure ulcers. Cochrane Database Syst Rev. 2003;4:CD003216.
    1. Ziegler TR, Benfell K, Smith RJ, Young LS, Brown E, Ferrari-Baliviera E, et al. Safety and metabolic effects of L-glutamine administration in humans. JPEN J Parenter Enteral Nutr. 1990;14:137S–46S.
    1. McCauley R, Platell C, Hall J, McCulloch R. Effects of glutamine infusion on colonic anastomotic strength in the rat. JPEN J Parenter Enteral Nutr. 1991;15:437–9.
    1. London: Royal College of Nursing (UK); 2005. Royal College of Nursing (UK). The Management of Pressure Ulcers in Primary and Secondary Care: A Clinical Practice Guideline [Internet]
    1. Collins N. The facts about vitamin C and wound healing. Ostomy Wound Manage. 2009;55:8–9.
    1. Vilter RW. Nutritional aspects of ascorbic acid: Uses and abuses. West J Med. 1980;133:485–92.
    1. Stephens P, Thomas DW. The cellular proliferative phase of the wound repair process. J Wound Care. 2002;11:253–61.
    1. Osland EJ, Ali A, Isenring E, Ball P, Davis M, Gillanders L. Australasian Society for Parenteral and Enteral Nutrition guidelines for supplementation of trace elements during parenteral nutrition. Asia Pac J Clin Nutr. 2014;23:545–54.
    1. Meaume S, Kerihuel JC, Constans T, Teot L, Lerebours E, Kern J, et al. Efficacy and safety of ornithine alpha-ketoglutarate in heel pressure ulcers in elderly patients: Results of a randomized controlled trial. J Nutr Health Aging. 2009;13:623–30.
    1. Haesler E. Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. 2014
    1. Gomes F, Schuetz P, Bounoure L, Austin P, Ballesteros-Pomar M, Cederholm T, et al. ESPEN guidelines on nutritional support for polymorbid internal medicine patients. Clin Nutr. 2018;37:336–53.

Source: PubMed

3
Abonner