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Clinical Conditions: Pressure sore / bedsore

Decubitus ulcers or pressure sores / bedsores have a high predominance and incidence in hospitalized patients, both in primary and tertiary care centers or specialized institutions for elderly or disabled people (1).

The following are risk factors for the occurrence of oressure sores: malnutrition, presence of chronic diseases and immobility in bed. In this sense, nutritional care both in the prevention and treatment of pressure sores is relevant and also has impact on the control of other comorbidities. Prevention strategies involve six key elements: evaluate the admission, daily re-evaluate, inspect the skin, control skin moisture, adapt the nutrition and hydration and minimize pressure on body parts. In doing so, from a nutritional point of view, the following factors should be evaluated as risk for the development of pressure sores: anorexia (BMI 2), presence of hypoalbuminemia and anemia, immunological changes, association with gastrointestinal disease and cancer (2,3,4).

Nutritional condition is an independent risk factor for the emergence of pressure sore, which thus have a direct role in the prevention of this disease. All patients with pressure sore should be submitted to nutritional assessment at the start of treatment and reassessed when improvement in the lesion is not observed or when the sore closure is not obtained (5).

The nutritional recommendations for these patients should ensure an adequate nutritional contribution. 30 to 35 kcal/kg/day and 1.2 to 1.5 g/kg/day of protein are recommended (4).

References

1. Bours et al. Prevalence, prevention, and treatment of pressure ulcers: descriptive study in 89 institutions in the Netherlands. Res Nurs Health 2002;25:99-110.

2. Theilla et al. A diet enriched in eicosapentanoic acid, gamma-linolenic acid and antioxidants in the prevention of new pressure ulcer formation in critically ill patients with acute lung injury: a randomized, prospective, controlled study. Clin Nutr 2007;26:752-7.

3. Fontaine J, Raynaud-Simon A. Pressure sores in geriatric medicine: the role of nutrition. Presse Med 2008;37:1150-7.

4. Projeto diretrizes – DITEN. Terapia Nutricional para Portadores de Úlceras por Pressão. 2011. (http://www.projetodiretrizes.org.br/9_volume/terapia_nutricional_para_pacientes_portadores_de_ulceras_por_pressao.pdf) [Guideline Project – DITEN. Nutritional Therapy for Pressure Ulcers Carriers. 2011. (http://www.projetodiretrizes.org.br/9_volume/terapia_nutricional_para_pacientes_portadores_de_ulceras_por_pressao.pdf)]

5. 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.

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