What are pressure ulcers and how do they arise? Find out more

Pressure ulcers are considered to be one of the significant but underrated health problems worldwide. Their formation has a negative impact on the patient’s prognosis, use of medical resources and health care costs. Nutritional support is one of the elements of multidisciplinary patient care. Find out more about it.

Definition and factors contributing to the formation of pressure ulcers

A pressure ulcer (pressure ulcer) is defined as local damage to the skin and / or subcutaneous tissue resulting from pressure or pressure and abrasion. Compression can prevent proper blood circulation, resulting in hypoxia and cell death, and consequently tissue necrosis and ulceration.

Pressure ulcers are most often found above protruding bones, such as the elbows, heels, hips, ankles, shoulders, back, and the back of the head. Elderly patients, people who are immobilized or in wheelchairs are at a significantly increased risk of developing pressure ulcers and the related complications.

The risk factors for the development of pressure ulcers also include:

1. coexisting diseases, e.g. diabetes, respiratory system diseases, peripheral vascular diseases – atherosclerosis, cancer,
2. urinary and stool incontinence,
3. skin infections
4. inadequate clothing and footwear (too tight, made of synthetic materials),
5. nicotinism and alcoholism,
6. improper hygiene or the lack of it,
7. inadequate care of a patient who is immobilized, incl. not changing positions frequently enough.

Classification of pressure ulcers

In the initial stage of the formation of pressure ulcers, the skin becomes red, and over time, its condition deteriorates and blisters develop. The next stage is the appearance of an open wound.

According to the European Panel on Bedsores, there are four stages of advancement of the lesions:

1. The first degree manifests itself reddening of the skin located above the bone prominence. Pain and local temperature changes in the affected areas are possible.
2. In the second degree it comes to blistering. Second-degree pressure ulcers are also distinguished by a partial loss of the dermis.
3. The third degree is distinguished full loss of tissue thickness. Subcutaneous fat may be exposed.
4. In the fourth degree it comes to Exposure of bone, muscle or tendons. If the pressure ulcer is deep, it may become osteomyelitis. In the fourth degree, necrotic tissue is also observed.

Bedsores: treatment and prevention

In the case of treatment of pressure ulcers, it is necessary to treat the underlying disease that causes them. Additionally, you should:

1. minimize pressure in pressure ulcers by changing the position of the patient,
2. use anti-bedsore mattresses, thanks to which the pressure on specific parts of the body will be regularly changed. This will avoid the exclusive burden on the places where pressure ulcers most often occur,
3. contact a wound treatment specialist – a doctor or nurse – in order to select a dressing and determine the appropriate method of wound care,
4. take care to change the dressing regularly and check that the wound is healing properly.

The importance of diet in the treatment of pressure ulcers

Scientific research and recommendations clearly show the benefits of nutritional support during pressure ulcers. During this disease process, there is an increased demand for energy and protein, and any deficiencies should be replenished.

Nutritional recommendations for a patient with pressure ulcers:

1. recommended supply protein it is even by half higher than in the case of healthy people: 1,25-1,5 g / kg bw / day,
2. energy demand increases by up to 40%, up to 30-35 kcal / kg bw / day,
3. maintaining proper hydration of the body, which ensures the proper state of skin tension and blood flow through the cells,
4. additional nutritional support as the diet needs to be increased arginine, zinc and antioxidants (vitamins A, E and C).
5. Arginine is an amino acid for which the demand for which increases significantly during the occurrence of wounds (including bedsores) and diseases. Arginine supports tissue reconstruction. In addition, it increases blood flow and the proper response of the immune system.
6. Zinc in the human body has many functions, incl. structural and regulatory. It is part of over 300 enzymes, including those that are involved in protein synthesis. It is also responsible for the body’s immune defense.
7. Antioxidants (e.g. vitamins A, C and E) play many important roles in the body, including anti-inflammatory functions. In addition, it has been shown that vitamin C has a positive effect on the improvement of cellular immunity, as well as the synthesis of collagen – the key building block of the skin, which is extremely important in the process of healing pressure ulcers.

What to do when traditional nutrition is not able to cover the increased demand for nutrients?

In some cases, a normal diet may not be sufficient to cover the increased need during illness. In this case, oral nutritional supplements (ONS) may be a preferred choice.

An example of such a preparation is Nutridrink Skin Repair (formerly Cubitan). It is a food for special medical purposes, intended for the dietary management of bedsores and other difficult-to-heal wounds, to be used under medical supervision.

What is the preparation characterized by and why can it be an effective support in the treatment of pressure ulcers?

Nutridrink Skin Repair is a nutritional preparation with a composition tailored to the needs of patients with bedsores and other difficult to heal wounds, i.e .:

1. provides a large portion of energy,
2. is a source of a large amount of protein,
3. thanks to the content of arginine and specific micronutrients, it supports the healing process of bedsores and other difficult to heal wounds,
4. contains the necessary nutrients concentrated in a small volume,
5. it has a liquid form that facilitates consumption by sick people,
6. has a low glycemic index.

Researchers suggest that a significant percentage of patients with pressure ulcers may be malnourished or at risk of malnutrition. Therefore, nutritional support, early detection and risk assessment of malnutrition should be one of the inherent elements of interdisciplinary care for patients with wounds, especially with pressure ulcers. It is also worth remembering that patients qualified to the group of people at risk of pressure ulcers should not only take care of a proper diet, but also introduce physical rehabilitation.

Źródła:

1. Krasowski G., Treatment of pressure ulcers and chronic wounds, Warsaw 2018
2. Kottner J., Cuddigan J., Carville K, Katrin Balzer K.,Berlowitz D., Law S., Litchford M., Mitchell P., Moore Z., Pittman J, Sigaudo-Roussel D., Yee Yee C., Haesler E., Prevention and treatment of pressure ulcers/injuries: The protocol for the second update of the international Clinical Practice Guideline 2019, J Tissue Viability. 2019 May;28(2):51-58
3. Cereda E., Neyens J.C.L., Caccialanza R., Rondanelli M., Schols J.M., Efficacy of a Disease-Specific Nutritional Support for Pressure Ulcer Healing: A Systematic Review and Meta-Analysis J Nutr Health Aging 2017;21(6):655-661

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