Impact of a Nutritional Formula Enriched in Fish Oil and Micronutrients on Pressure Ulcers in Critical Care Patients

By Miriam Theilla, RN; Betty Schwartz, PhD; Jonathan Cohen, MBBCh, FCP; Haim Shapiro, MD; Ronit Anbar, RD; Pierre Singer, MD


Am J Crit Care. 2012;21(4):102e-109. 

In This Article


Characteristics of the Sample

A total of 40 patients, 20 in each treatment arm, were enrolled in the study. All patients completed at least 7 days of enteral or parenteral nutrition therapy and were therefore eligible for the intention-totreat analysis. A total of 2 patients in the control group and 1 patient in the study group had a visible pressure ulcer at the time of admission to the ICU; in the remaining patients ulcers developed after a mean of 6.7 days (SD, 2.1) in the control group and 6.1 days (SD, 2.0) in the study group. These differences were not significant (P = .07). Patients in the 2 groups did not differ significantly in age, body mass index, proportion of men and women, diagnostic category, or scores on the APACHE II ( Table 2 ). In each group, 5 patients had preexisting type 2 diabetes

Study Treatments

Nutritional data are summarized and presented in Figure 1. Mean energy requirements (as reflected by resting energy expenditure) and daily kilocalorie intake did not differ significantly between the 2 groups (P=.37). The number of patients who received enteral nutrition or parenteral nutrition in each group and the duration of nutritional support are depicted in Figure 1. The contribution to the energy load from added protein and fatty acids is shown in Figure 2. Protein intake did not differ significantly between the 2 groups.

Figure 1.

Number of patients in each group who received enteral or parenteral nutrition and duration of support. d, number of days; n, number of patients; REE, resting energy expenditure.

Figure 2.

The amount of protein and added fatty acids (eicosapentaenoic acid [EPA], docosahexaenoic acid [DHA], and ©-linoleic acid [GLA]) administered to patients in the 2 treatment groups. The amounts of all 3 fatty acids (but not the amounts of protein) differed significantly (P < .001) between control and study groups.

Outcome Data

On enrollment, the severity of pressure ulcers did not differ significantly (P = .02) between the control group (mean score, 9.25; SD, 2.12) and the study group (mean score, 9.10; SD, 2.84; Table 3 ). The grade of the pressure ulcers at enrollment also did not differ significantly (P = .02) between the control group (grade II in 13 patients and grade III in 7 patients) and the study group (grade II in 14 patients and grade III in 6 patients) During the study, the severity of pressure ulcers, as indicated by the PUSH score, increased significantly for the control group (P = .02) but not for the study group. Decreases in CRP concentrations ( Table 4 ) were significantly greater in the study group than in the control group (P = .02).


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