The relevance of the problem of pressure sores is not diminishing, despite the achievements of modern medicine. Bedsores occur both in hospitalized patients and in patients treated at home or in long-term care facilities. The main reason for the high prevalence of pressure sores is the aging of the population and the increase in patients with comorbid pathology. The most common sites of decubitus development are the skin covering the sacrum, coccyx, heels, and hips, although other areas can also be affected: knees, ankles, back of the shoulders, or back of the neck. Clinically, bedsores can be defined as pressure ulcers.
Limited motor activity, inadequate nutrition, and care also play a major role in the development of ulcers. This article discusses bedsores as a multidisciplinary problem that physicians of different specialties have to deal with. The most effective method of combating bedsores is preventive measures. Modern prevention of bedsores includes a number of directions and should take into account the patient’s condition, as well as the capabilities and qualifications of medical personnel. One component of decubitus treatment is nutritional support with enteral mixtures enriched with arginine, vitamins, antioxidants, and zinc micronutrients.
The most effective method of combating bedsores is preventive measures. In this condition, the statement of Hippocrates, “It is easier to prevent than to cure” is fully realized (Cortés et al., 2021). In most countries with a high level of medical science, it is widely accepted that prevention of bedsores should be the responsibility of the nursing staff. Doctors most often do not properly address this issue. Modern prevention of bedsores includes a number of directions and must take into account the patient’s condition, as well as the capabilities and qualifications of medical personnel. Assessment of the risk of bedsores is mandatory.
The main goal of the decubitus treatment is to restore the integrity of the skin, and the management tactics are largely determined by the stage of the pathological process. At the I-II stages, there are no indications for surgical intervention. The main task of clinicians is the prevention of pathological process progression. One of the most important tasks of treatment at I-II stages is wound infection prevention. The occurrence of the inflammatory process in the pressure sore is fraught with the generalization of the infection process up to sepsis and PON.
An integral component of decubitus therapy not only in the early stages but also in the progressing process is the treatment of associated diseases and syndromes, related to risk factors: diabetes mellitus, obliterating arterial disease, heart failure, etc. In addition, it is necessary to eliminate water-electrolyte abnormalities, which are an important component of microcirculatory disorders, to adequately anesthetize patients. At the III-IV stages of bedsores, the treatment is aimed at removing the necrotic tissues. Various pharmacological means and methods of physical influence are used to stimulate rapid healing and wound cleansing. A promising method of decubitus treatment is the application of negative pressure in the wound area – vacuum therapy. Regardless of the method of decubitus treatment, close attention is paid to properly organized care: careful compliance with asepsis, changing the patient’s body position, and using anti-decubitus mattresses (Cortés et al., 2021). The problem of prevention and treatment of bedsores is far from being solved.
In my opinion, the main reasons for the continued high incidence of bedsores are the general aging of the population, the increase in the number of patients with comorbid pathology, and, accordingly, risk factors. In recent years, the results of studies proving the important role of nutritional support in the treatment of bedsores have been published (Sving, et al., 2016). The best results have been obtained with the use of specialized high-protein products for oral supplementary feeding and enteral probe feeding mixtures enriched with arginine, vitamins, antioxidants, and the micronutrient zinc. Therefore, a way to measure improvement can consist of evaluating the number of patients with bedsores before and after the nutritional support initiative.
References
Cortés, O. L., Herrera-Galindo, M., Villar, J. C., Rojas, Y. A., del Pilar Paipa, M., & Salazar, L. (2021). Frequency of repositioning for preventing pressure ulcers in patients hospitalized in ICU: Protocol of a cluster randomized controlled trial. BMC nursing, 20(121), 1-10. Web.
Sving, E., Högman, M., Mamhidir, A. G., & Gunningberg, L. (2016). Getting evidence‐based pressure ulcer prevention into practice: A multi‐faceted unit‐tailored intervention in a hospital setting. International Wound Journal, 13(5), 645-654.