Correlation Between Wound Volume and Depth of Decubitus Ulcers And Resting Energy Expenditure

Adequate nutrition is an important aspect of wound healing because it provides an anabolic
environment necessary for tissue repair. Without proper nutrition support, healing can be
prolonged and even inhibited. Provision of adequate energy is essential in patients with
decubitus ulcers to maximize nitrogen retention and facilitate wound healing. (1,2) There
are few published studies that measure energy needs in patients with decubitus ulcers.
Spinal cord injured patients are one of the few populations where studies have utilized
indirect calorimetry to measure energy expenditure. Individuals with spinal cord injuries
are particularly at risk for developing pressure ulcers. Liu, et al. (3) measured energy
expenditure in 16 individuals with quadriplegia and pressure ulcers and in 16 individuals
with quadriplegia but no pressure ulcers. Measured energy expenditure was significantly
higher in subjects with quadriplegia and pressure ulcers. Additionally, pressure ulcer
surface area was significantly correlated with predicted resting energy expenditure. In a
study of paraplegic individuals, Alexander, et al. (4) found resting metabolic rate was
significantly higher in those individuals with pressure ulcers compared to those with
paraplegia without pressure ulcers. Additional research is needed to confirm these findings.

To determine nutrition requirements specific to each patient, energy needs must be
estimated, taking into account weight, height, age, activity level as well as the size of
the wound and the patient's co-morbidities. Although indirect calorimetry is the gold
standard for measuring metabolic rate, it is impractical and time consuming to use this
method to determine needs of every patient. Therefore, the clinician uses predictive
formulas for estimating energy needs. The most commonly cited guideline for energy
requirements for healing pressure ulcers is 30-35 kcal/kg (recommendation, National Pressure
Ulcer Advisory Panel).(1) The European Pressure Ulcer Advisory Panel has also recommended a
minimum of 30-35 kcal/kg.(2) Several equations have been derived to predict metabolic rate
based on age, height, weight, and sex. Two of these predictive equations are the Harris
Benedict (5) and the Mifflin-St. Jeor. (6) These equations can be adjusted for injury
factors, but it is unclear if they fully account for the size of wound in patients with
decubiti.

Inclusion Criteria:

- Admitted to the Saint Elizabeth Regional Burn and Wound Center

- Ulcer located in the Ischial, Sacral, Coccyx

Exclusion Criteria:

- Patient Has Signs of Infection

- Patient is receiving oxandrolone treatment or anabolic hormone treatment

- Is Patients receiving intermittent tube feedings