Nutritional Supplements for Critically Ill Patients: Efficient Tools to Improve Wound Healing

Reference work entry

Abstract

Critically ill patients frequently suffer from acute wounds which result from trauma, burns, elective surgery due to cancer, and from pressure ulcer due to long-term immobilization. Several nutrients which play a physiologic role for wound healing (arginine, glutamine, several micronutrients, long-chain n-3 fatty acids, and nucleotides) are key nutrients of dietary supplements which should improve wound healing. An overview on commercially available supplements for oral and enteral application is given. However, their efficacy on wound healing remains unclear. Thus, this chapter should summarize the results of randomized controlled trials which investigated the effect of nutritional supplements on wound healing in critically ill patients. For the formulation of recommendations on the use of specific nutritional supplements to improve wound healing in critical care, guidelines of medical societies on the overall outcome of several supplements are also considered as well as protocols on clinical practice.

Keywords

Zinc Glutathione Selenium Proline Arginine 

List of Abbreviations

NO

Nitric oxide

ONS

Oral nutritional supplements

RCT

Randomized controlled trials

References

  1. Al Balushi RM, Cohen J, Banks M, et al. The clinical role of glutamine supplementation in patients with multiple trauma: a narrative review. Anaesth Intensive Care. 2013;41:24–34.PubMedGoogle Scholar
  2. Arrigoni O, De Tullio MC. Ascorbic acid: much more than just an antioxidant. Biochim Biophys Acta. 2002;1569:1–9.CrossRefPubMedGoogle Scholar
  3. Barbosa E, Faintuch J, Machado Moreira EA, et al. Supplementation of vitamin E, vitamin C, and zinc attenuates oxidative stress in burned children: a randomized, double-blind, placebo-controlled pilot study. J Burn Care Res. 2009;30:859–66.CrossRefPubMedGoogle Scholar
  4. Berger MM. Antioxidant micronutrients in major trauma and burns: evidence and practice. Nutr Clin Pract. 2006;21:438–49.CrossRefPubMedGoogle Scholar
  5. Berger MM, Baines M, Raffoul W, et al. Trace element supplementation after major burns modulates antioxidant status and clinical course by way of increased tissue trace element concentrations. Am J Clin Nutr. 2007;85:1293–300.PubMedGoogle Scholar
  6. Blass SC, Goost H, Tolba RH, et al. Time to wound closure in trauma patients with disorders in wound healing is shortened by supplements containing antioxidant micronutrients and glutamine: a PRCT. Clin Nutr. 2012;31:469–75.CrossRefPubMedGoogle Scholar
  7. Bourdel-Marchasson I, Barateau M, Rondeau V, et al. A multi-center trial of the effects of oral nutritional supplementation in critically ill older inpatients. GAGE Group. Groupe Aquitain Geriatrique d’Evaluation. Nutrition. 2000;16:1–5.CrossRefPubMedGoogle Scholar
  8. Brolmann FE, Ubbink DT, Nelson EA, et al. Evidence-based decisions for local and systemic wound care. Br J Surg. 2012;99:1172–83.CrossRefPubMedGoogle Scholar
  9. Calder PC. Immunonutrition in surgical and critically ill patients. Br J Nutr. 2007;98 Suppl 1:S133–9.PubMedGoogle Scholar
  10. de Luis DA, Aller R, Izaola O, et al. Postsurgery enteral nutrition in head and neck cancer patients. Eur J Clin Nutr. 2002;56:1126–9.CrossRefPubMedGoogle Scholar
  11. de Luis DA, Izaola O, Cuellar L, et al. Clinical and biochemical outcomes after a randomized trial with a high dose of enteral arginine formula in postsurgical head and neck cancer patients. Eur J Clin Nutr. 2007;61:200–4.CrossRefPubMedGoogle Scholar
  12. De Luis DA, Izaola O, Cuellar L, et al. High dose of arginine enhanced enteral nutrition in postsurgical head and neck cancer patients. A randomized clinical trial. Eur Rev Med Pharmacol Sci. 2009;13:279–83.PubMedGoogle Scholar
  13. De Luis DA, Izaola O, Cuellar L, et al. A randomized double-blind clinical trial with two different doses of arginine enhanced enteral nutrition in postsurgical cancer patients. Eur Rev Med Pharmacol Sci. 2010;14:941–5.PubMedGoogle Scholar
  14. 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;12:588–95.CrossRefPubMedGoogle Scholar
  15. Grimble GK, Westwood OM. Nucleotides as immunomodulators in clinical nutrition. Curr Opin Clin Nutr Metab Care. 2001;4:57–64.CrossRefPubMedGoogle Scholar
  16. Guo S, Dipietro LA. Factors affecting wound healing. J Dent Res. 2010;89:219–29.CrossRefPubMedPubMedCentralGoogle Scholar
  17. Hall KL, Shahrokhi S, Jeschke MG. Enteral nutrition support in burn care: a review of current recommendations as instituted in the Ross Tilley Burn Centre. Nutrients. 2012;4:1554–65.CrossRefPubMedPubMedCentralGoogle Scholar
  18. Health Quality O. Pressure ulcer prevention: an evidence-based analysis. Ont Health Technol Assess Ser. 2009;9:1–104.Google Scholar
  19. Heyland DK, Dhaliwal R, Drover JW, et al. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. J Parenter Enteral Nutr. 2003;27:355–73.CrossRefGoogle Scholar
  20. Heyland D, Muscedere J, Wischmeyer PE, et al. A randomized trial of glutamine and antioxidants in critically ill patients. N Engl J Med. 2013;368:1489–97.CrossRefPubMedGoogle Scholar
  21. Kreymann KG, Berger MM, Deutz NE, et al. ESPEN guidelines on enteral nutrition: intensive care. Clin Nutr. 2006;25:210–23.CrossRefPubMedGoogle Scholar
  22. Lansdown AB, Mirastschijski U, Stubbs N, et al. Zinc in wound healing: theoretical, experimental, and clinical aspects. Wound Repair Regen. 2007;15:2–16.CrossRefPubMedGoogle Scholar
  23. Marik PE, Zaloga GP. Immunonutrition in high-risk surgical patients: a systematic review and analysis of the literature. J Parenter Enteral Nutr. 2010;34:378–86.CrossRefGoogle Scholar
  24. Martindale RG, McClave SA, Vanek VW, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition: executive summary. Crit Care Med. 2009;37:1757–61.CrossRefPubMedGoogle Scholar
  25. Montejo JC, Zarazaga A, Lopez-Martinez J, et al. Immunonutrition in the intensive care unit. A systematic review and consensus statement. Clin Nutr. 2003;22:221–33.CrossRefPubMedGoogle Scholar
  26. Oguz M, Kerem M, Bedirli A, et al. l-alanine-l-glutamine supplementation improves the outcome after colorectal surgery for cancer. Color Dis. 2007;9:515–20.CrossRefGoogle Scholar
  27. Pattanshetti VM, Powar RS, Godhi AS, et al. Enteral glutamine supplementation reducing infectious morbidity in burns patients: a randomised controlled trial. Indian J Surg. 2009;71:193–7.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Peng X, Yan H, You Z, et al. Clinical and protein metabolic efficacy of glutamine granules-supplemented enteral nutrition in severely burned patients. Burns. 2005;31:342–6.CrossRefPubMedGoogle Scholar
  29. Peterkofsky B. Ascorbate requirement for hydroxylation and secretion of procollagen: relationship to inhibition of collagen synthesis in scurvy. Am J Clin Nutr. 1991;54:1135S–40.PubMedGoogle Scholar
  30. Reddell L, Cotton BA. Antioxidants and micronutrient supplementation in trauma patients. Curr Opin Clin Nutr Metab Care. 2012;15:181–7.CrossRefPubMedPubMedCentralGoogle Scholar
  31. Reichrath J, Lehmann B, Carlberg C, et al. Vitamins as hormones. Horm Metab Res. 2007;39:71–84.CrossRefPubMedGoogle Scholar
  32. Reinke JM, Sorg H. Wound repair and regeneration. Eur Surg Res. 2012;49:35–43.CrossRefPubMedGoogle Scholar
  33. Rousseau AF, Losser MR, Ichai C, et al. ESPEN endorsed recommendations: nutritional therapy in major burns. Clin Nutr. 2013;32:497–502.CrossRefPubMedGoogle Scholar
  34. Rucker RB, Kosonen T, Clegg MS, et al. Copper, lysyl oxidase, and extracellular matrix protein cross-linking. Am J Clin Nutr. 1998;67:996S–1002.PubMedGoogle Scholar
  35. Sanchez Alvarez C, Zabarte Martinez de Aguirre M, Bordeje Laguna L, et al. Guidelines for specialized nutritional and metabolic support in the critically-ill patient: update. Consensus SEMICYUC-SENPE: gastrointestinal surgery. Nutr Hosp. 2011;26 Suppl 2:41–5.PubMedGoogle Scholar
  36. Scholl D, Langkamp-Henken B. Nutrient recommendations for wound healing. J Intraven Nurs. 2001;24:124–32.PubMedGoogle Scholar
  37. Schols JM, Heyman H, Meijer EP. Nutritional support in the treatment and prevention of pressure ulcers: an overview of studies with an arginine enriched oral nutritional supplement. J Tissue Viability. 2009;18:72–9.CrossRefPubMedGoogle Scholar
  38. Singer AJ, Clark RA. Cutaneous wound healing. N Engl J Med. 1999;341:738–46.CrossRefPubMedGoogle Scholar
  39. Soeters PB, Grecu I. Have we enough glutamine and how does it work? A clinician’s view. Ann Nutr Metab. 2012;60:17–26.CrossRefPubMedGoogle Scholar
  40. Soneja A, Drews M, Malinski T. Role of nitric oxide, nitroxidative and oxidative stress in wound healing. Pharmacol Rep. 2005;57(Suppl):108–19.PubMedGoogle Scholar
  41. Theilla M, Singer P, Cohen J, et al. A diet enriched in eicosapentaenoic 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.CrossRefPubMedGoogle Scholar
  42. Todd SR, Gonzalez EA, Turner K, et al. Update on postinjury nutrition. Curr Opin Crit Care. 2008;14:690–5.CrossRefPubMedPubMedCentralGoogle Scholar
  43. VanGilder C, Amlung S, Harrison P, et al. Results of the 2008–2009 International Pressure Ulcer Prevalence Survey and a 3-year, acute care, unit-specific analysis. Ostomy Wound Manage. 2009;55:39–45.PubMedGoogle Scholar
  44. Windle EM. Glutamine supplementation in critical illness: evidence, recommendations, and implications for clinical practice in burn care. J Burn Care Res. 2006;27:764–72.CrossRefPubMedGoogle Scholar
  45. Witte MB, Barbul A. Arginine physiology and its implication for wound healing. Wound Repair Regen. 2003;11:419–23.CrossRefPubMedGoogle Scholar
  46. Zhang XJ, Chinkes DL, Wolfe RR. The anabolic effect of arginine on proteins in skin wound and muscle is independent of nitric oxide production. Clin Nutr. 2008;27:649–56.CrossRefPubMedGoogle Scholar
  47. Zhou YP, Jiang ZM, Sun YH, et al. The effect of supplemental enteral glutamine on plasma levels, gut function, and outcome in severe burns: a randomized, double-blind, controlled clinical trial. J Parenter Enteral Nutr. 2003;27:241–5.CrossRefGoogle Scholar
  48. Zingg JM, Meydani M, Azzi A. Alpha-Tocopheryl phosphate-an activated form of vitamin E important for angiogenesis and vasculogenesis? Biofactors. 2012;38:24–33.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Faculty of Food, Nutrition and Hospitality SciencesHochschule Niederrhein, University of Applied SciencesMönchengladbachGermany

Personalised recommendations