LB069 - NUTRITIONAL SUPPLEMENTATION FOR PRESSURE INJURIES IN THE REHABILITATION SETTING: A REPORT OF TWO CASES.

LB069

NUTRITIONAL SUPPLEMENTATION FOR PRESSURE INJURIES IN THE REHABILITATION SETTING: A REPORT OF TWO CASES.

Y. Dionyssiotis¹, J. Apostolou¹, C. Kotsiopoulou^2,*

¹2nd PMR Department, ²Department of Clinical Nutrition and Dietetics, National Rehabilitation Center EKA, Athens, Greece

Rationale: Pressure injuries (PIs) are a prevalent complication in persons with spinal cord injury (SCI). Their presence may result in heightened spasticity, pain, infections, and maybe mortality. Nutrition is essential in the treatment of persons with neurological injuries. Therefore, it is crucial to fulfill the increased protein and specific nutritional needs of persons with SCI and pressure injuries. This study aimed to evaluate the efficacy of administering a particular supplement to SCIs with PIs. 

Methods: We present two cases, one male and one female, with complete spinal cord injuries (AIS A) at neurological levels Thoracic 12 and Thoracic 6, respectively. Both presented with pressure injuries upon admission to our Department. The male had a pressure injury (PI) in the sacrococcygeal region, classified as stage 3, whereas the female presented with PIs in both heels, classified as stage 2 (International NPUAP/EPUAP Classification). For the quantitative evaluation of the PIs dimensions the volume of the tissue deficit was quantified using paraffin oil, and the surface area of the pressure ulcer was ascertained using tracing and measurement on plotting paper. These measurements constitute elements of a protocol employed in our Department. We administered one bottle (60ml) of Expedite^TM daily. The sole alteration to the patients' dietary regimen was the introduction of Expedite^TM, while both adhered to a regular inpatient rehabilitation program. Expedite^TM is a hypercaloric meal including hydrolyzed collagen dipeptides, proline-hydroxyproline (PO), hydroxyproline-glycine (OG), and L-citrulline.

Results: Concerning the male SCI person, the initial primary injury (in admission) exhibited a volume and surface area of 1.5 cm³ and 5 cm² on 11/24, which improved to 1 cm³ and 1 cm², respectively, by the end of 5/25. In addition, the female's PI surface area improved from  4/25 to the end of 5/25, decreasing from 13 cm² on the left heel and 5.5 cm² on the right heel to 6 cm² on the left and 4 cm² on the right, respectively.

Conclusion: Expedite^TM is employed in the nutritional care of individuals with PIs as part of a holistic rehabilitation program to improve nutritional status and meet increased nutritional requirements associated with protein deficit, metabolic stress, and trauma. In individuals with spinal cord injury Expedite^TM effectively enhances quantitative measures in PIs of stages 2 and 3. The administration of Expedite^TM proceeded without any adverse events. 

References: 1) European Pressure Ulcer Advisory Panel, National Pressure Ulcer Advisory Panel, & PanPacific Pressure Injury Alliance. (2019). 2) Sugihara F, Inoue N, Kuwamori M, Taniguchi M. Quantification of hydroxyprolyl glycine (Hyp-Gly) in human blood after ingestion of collagen hydrolysate. J Biosci Bioeng. 2012 Feb;113(2):202-3. 3) Sugihara F, Inoue N, Venkateswarathirukumara S. Ingestion of bioactive collagen hydrolysates enhanced pressure ulcer healing in a randomized double-blind placebo-controlled clinical study. Sci Rep. 2018;8(1):11403. 

Disclosure of Interest: None declared