Preview

Lechaschi Vrach

Advanced search

Pressure ulcers: new approaches to treatment

https://doi.org/10.51793/OS.2022.25.4.007

Abstract

The urgency of the problem of pressure ulcers does not decrease, despite the achievements of modern medicine. Pressure ulcers occur both in hospital patients and in patients receiving treatment at home or in long-stay institutions. The main reason for the high prevalence of pressure ulcers is the aging of the population and an increase in patients with comorbid pathology. A pressure sore is a localized injury to the skin and/or underlying tissue that typically occurs over a bony prominence, usually as a result of long-term pressure or pressure combined with shear or friction. The most common sites for pressure ulcers are the skin covering the sacrum, coccyx, heels, and thighs, although other areas may be affected: knees, ankles, back of the shoulders, or back of the skull. From a clinical point of view, a bedsore can be described as an ulcer resulting from pressure. It is believed that the most important factors contributing to the formation of pressure ulcers are continuous pressure, displacement forces, friction and moisture. A large role in the development of ulcers is also played by the limited motor activity of patients, inadequate nutrition and care. In this article, pressure ulcers are considered as a multidisciplinary problem that doctors of various specialties must face. The most effective method of dealing with pressure sores is preventive measures. Modern prevention of bedsores includes a number of areas and should take into account the patient's condition, as well as the capabilities and qualifications of medical personnel. The main goal of the treatment of bedsores is to restore the integrity of the skin, while the tactics of management are largely determined by the staging of the pathological process. Complex treatment of pressure ulcers depends on their stage and includes both pharmacological effects and surgical intervention. One of the components of the treatment of pressure ulcers is to provide nutritional support with integral mixtures enriched with arginine, vitamins, antioxidants, and the micronutrient zinc.

About the Authors

I. N. Pasechnik
Federal State Budgetary Institution of Additional Professional Education Central State Medical Academy of the Administrative Department of the President of the Russian Federation
Russian Federation

Igor N. Pasechnik, Dr. of Sci. (Med.), Professor, Head of department of Anesthesiology and Intensive Care

19 b.1A Marshal Timoshenko str., Moscow, 121359



T. V. Novikova
Nutricia Advanced LLC
Russian Federation

Tatiana V. Novikova, М.D., Adult Medical Manager Critical Care& Neurology Danone Specialized Nutrition CIS

block B BC Riga Land, 26 km Novorizhskoe highway, Krasnogorsky district, MR, 143421



References

1. Flaatten H., de Lange D. W., Artigas A., et al. The status of intensive care medicine research and a future agenda for very old patients in the ICU // Intensive Care Med. 2017, 43 (9): 1319-1328.

2. Belkin A. A. Syndrome of consequences of intensive care (PICS) // Vestnik intensivnoy terapii imeni A. I. Saltanova. 2018; 2: 12-23.

3. Grey J. E., Harding K. G., Enoch S. Pressure ulcers // BMJ. 2006; 7539 (332): 472-475.

4. Klimiashvili A. D. Prevention and treatment of bedsores // RMJ. 2004. T. 12, № 12. P. 40-45.]

5. Leigh I. H., Bennett G. Pressure Ulcers: Prevalence, Etiology, and Treatment Modalities: A Review // American J. Surgery. 1994; 167: 25S-30S. doi.org/10.1016/0002-9610(94)90007-8.

6. Norton D., McLaren R., Exton-Smith A. N. An Investigation of Geriatric Nursing Problems in Hospital. Churchill Livingstone, London, 1962. Р. 193-224.

7. Dibirov M. D. Bedsores: prevention and treatment. Stationary-replacing technologies // Ambulatory surgery. 2016. № 1-2. P. 55-63.

8. Klimiashvili A. D. Prevention and treatment of bedsores // Meditsina neotlozhnykh sostoyaniy. 2007; 5 (12): 99-103.

9. Hsu К.-F., Kao L. T., Chu P.-Y. et al. Simple and Efficient Pressure Ulcer Reconstruction via Primary Closure Combined with Closed-Incision Negative Pressure Wound Therapy (CiNPWT)-Experience of a Single Surgeon // J Pers Med. 2022; 12 (2): 182. DOI: 10.3390/jpm12020182.

10. Shlyapnikov S. A., Naser N. R., Borodina M. A. i soavt. Modern approaches to the treatment of bedsores // Zhurnal MediAl'. 2019; 1 (23): 40-41.

11. Yap J. W., Holloway S. Evidence-based review of the effects of nutritional supplementation for pressure ulcer prevention // Int Wound J. 2021; 18 (6): 805-821. DOI: 10.1111/iwj.13584.

12. Zhong J. X., Kang K., Shu X. L. Effect of nutritional support on clinical outcomes in perioperative malnourished patients: a meta-analysis // Asia Pac J Clin Nutr. 2015; 24 (3): 367-378. DOI: 10.6133/apjcn.2015.24.3.20.

13. Munoz N., Posthauer M. E., Cereda E. et al. The Role of Nutrition for Pressure Injury Prevention and Healing: The 2019 International Clinical Practice Guideline Recommendations // Adv Skin Wound Care. 2020; 33 (3): 123-136. DOI: 10.1097/01.ASW.0000653144.90739.ad.

14. Cox J., Rasmussen L. Enteral nutrition in the prevention and treatment of pressure ulcers in adult critical care patients // Crit Care Nurse. 2014; 34 (6): 15-27; quiz 28. DOI: 10.4037/ccn2014950.

15. Stratton R. J., Ek A. C., Engfer M., et al. Enteral nutritional support in prevention and treatment of pressure ulcers: A systematic review and meta-analysis // Ageing Res Rev. 2005; 4 (3): 422-450. DOI: 10.1016/j.arr.2005.03.005.

16. Prevention and Treatment of Pressure Ulcers/Injuries: Quick Reference Guide. Emily Haesler (Ed.). EPUAP/NPIAP/PPPIA: 2019.

17. Chu A. S., Delmore B. Arginine: What You Need to Know for Pressure Injury Healing // Adv Skin Wound Care. 2021; 34 (12): 630-636. DOI: 10.1097/01.ASW.0000795900.25030.5e.

18. Stechmiller J., Childress B., Cowan L. Arginine supplementation and wound healing // Nutr Clin Pract. 2005; 20 (1): 52-61. DOI: 10.1177/011542650502000152.

19. Luiking Y. C., Deutz N. E. P. Exogenous arginine in sepsis // Crit Care Med. 2007; 35 (9 Suppl): S557-563. DOI: 10.1097/01.CCM.0000279191.44730.A2.

20. Lin P.-H., Sermersheim M., Li H. et al. Zinc in Wound Healing Modulation // Nutrients. 2017; 10 (1): 16. DOI: 10.3390/nu10010016.

21. Ellinger S., Stehle P. Efficacy of vitamin supplementation in situations with wound healing disorders: results from clinical intervention studies // Curr Opin Clin Nutr Metab Care. 2009; 12 (6): 588-95. DOI: 10.1097/MCO.0b013e328331a5b5.

22. Desneves K. J., Todorovic B. E., Cassar A., Crowe T. C. Treatment with supplementary arginine, vitamin C and zinc in patients with pressure ulcers: a randomised controlled trial // Clin Nutr. 2005; 24 (6): 979-987. DOI: 10.1016/j.clnu.2005.06.011.

23. Cereda E., Gini A., Pedrolli C., Vanotti A. Disease-specific, versus standard, nutritional support for the treatment of pressure ulcers in institutionalized older adults: a randomized controlled trial // J Am Geriatr Soc. 2009; 57 (8): 1395-1402. DOI: 10.1111/j.1532-5415.2009.02351.x.

24. Cereda E., Neyens J. C. L., Caccialanza R. et al. 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. DOI: 10.1007/s12603-016-0822-y.


Review

For citations:


Pasechnik I.N., Novikova T.V. Pressure ulcers: new approaches to treatment. Lechaschi Vrach. 2022;(4):38-43. (In Russ.) https://doi.org/10.51793/OS.2022.25.4.007

Views: 580

JATS XML

ISSN 1560-5175 (Print)
ISSN 2687-1181 (Online)