Background: Pressure ulcers are prevalent in nursing homes. They heal slowly, cause pain, impair quality of life, and are expensive to treat. Dehydration is a problem in some nursing home residents and under-perfusion a problem in others. Theoretically, providing supplemental fluid to under-hydrated residents should increase fluid in the various fluid compartments of the body, increase subcutaneous oxygen, pressure ulcer blood flow and pressure ulcer healing, including collagen production. This proposition has not been examined in nursing home residents with pressure ulcers.
Aims : The purpose of this randomized clinical trial (RCT) in which subjects serve as their own control is to determine whether administration of supplemental fluid to nursing home residents with Stage II to IV pressure ulcers enhances collagen deposition. Specifically, this study will determine whether oral administration of supplemental fluid given daily for 5 days to persons with Stage II to IV pressure ulcers enhances collagen deposition, increases total body water, augments subcutaneous tissue oxygen, increases pressure ulcer oxygenation, and is safe. Methods: The sample will be nursing home residents with pressure ulcers. After consent, baseline measures of collagen deposition, pressure ulcer oxygen, fluid intake, and body water in the various fluid compartments will be measured. Expanded polytetrafluorothlene (ePTFE) tubes will be used to measure collagen deposition. Bioelectrical impedance will be used to measure body water. In the treatment phase, subjects will be randomized to one of the two supplemental fluid regimes. Supplemental fluid will be administered for 5 days and collagen deposition, subcutaneous tissue oxygen, pressure ulcer oxygen, and body water in the various compartments again measured. Subjects will be monitored for fluid overload. Data will be analyzed with RMANOVA and logistic regression techniques. Significance: Findings from the study have the potential to significantly change how fluid is managed in nursing home residents and to lay the foundation for a major intervention study on pressure ulcer healing.
|Stotts, Nancy A; Hopf, Harriet W; Kayser-Jones, Jeanie et al. (2009) Increased fluid intake does not augment capacity to lay down new collagen in nursing home residents at risk for pressure ulcers: a randomized, controlled clinical trial. Wound Repair Regen 17:780-8|