Efficacy of nutritional support protocol for patients with pressure ulcer: comparison of before and after the protocol

Abstract

Objectives: Because most patients who develop pressure ulcer (PU) are malnourished, additional nutritional support is important for PU improvement. The aim of this study was to investigate the potential benefit of a simple nutritional support protocol in PU improvement. Methods: This study was a comparative before-and-after study, prospectively performed from May to December 2020. Participants were inpatients of Seoul National University Hospital (SNUH), South Korea. Among the patients who developed PU from May to December 2020, those on enteral nutrition were included in the protocol group. Application of the nutritional support protocol was established in May 2020 in SNUH. Serum levels of prealbumin, transferrin, cholesterol, and zinc were measured initially and 2 and 4 wk after protocol application to evaluate clinical course. A tailored regimen that adjusted the amount of protein and trace elements was provided according to consultation with the nutritional support team. Size and Pressure Ulcer Scale for Healing was evaluated every 2 wk by the same nurse in charge of PU. To validate the efficacy of the protocol, patients who developed PU from May to December 2018, were hospitalized for 2 wk, and who received enteral nutrition were selected as a control group. Results: Sixty-one patients were included in the protocol group and 100 were in the control group. The protocol group had a higher proportion of PU improvement (85.2 versus 50%; P < 0.001), daily protein intake (1.6 ?? 3.2 versus 0.9 ?? 0.4; P = 0.048), Braden scale (12.9 ?? 1.8 versus 12.3 ?? 1.8; P = 0.025), and baseline albumin level (3.1 ?? 0.5 versus 2.8 ?? 0.4; P = 0.001) when compared with the control group. Multivariate analysis showed that implementation of the nutritional support protocol was the most effective factor in improving PU (odds ratio, 0.18; 95% confidence interval, 0.089-0.366; P < 0.001). Conclusions: A simple nutritional support protocol was easy to develop and its application contributed significantly to the recovery of PU.