Despite our knowledge of how to prevent pressure ulcers, and improvements in treatment, pressure ulcers remain prevalent and impose a significant burden on financial and labor resources in the healthcare industry. Although there is no known role for specific nutrients in the prevention of pressure ulcers, undernutrition is a risk factor, and nutrition therapy plays a crucial role in pressure ulcer treatment. Limitations in research make it difficult to develop evidence-based nutrition guidelines, so it is important that clinicians conduct a comprehensive assessment that includes weight and intake history, biochemical data, and comorbidities as well as symptoms that may affect the intake, absorption, or excretion of nutrients. These data, combined with clinical judgment, must be used to estimate energy and protein needs, considering the size and severity of the pressure ulcer. Micronutriture is difficult to assess; usual intake, comorbidities and disease symptoms must be considered in addition to biochemical data. Micronutrients should be replaced if depleted, but routine supplementation of vitamins and minerals in all pressure ulcer patients is not warranted.

Protein calorie malnutrition (PCM) is prevalent in the acute care setting, affecting up to 50% of hospitalized patients. PCM is associated with poor outcomes, including increased hospital and intensive care unit length of stay, hospital readmission rates, incidence of pressure injuries and nosocomial infections, and mortality. PCM is a financial burden on the healthcare system through direct costs related to treatment as well as indirect costs related to poorer outcomes and complications. Medical coding for malnutrition after a patient's hospital stay is poorly representative of the actual prevalence of malnutrition, as only a small percentage of these hospital stays are coded for PCM. Improvements in identification and coding of malnutrition can result in significant increases in hospital reimbursement, which can in part help defray increased costs associated with the condition. (Nutr Clin Pract. 2019;34:823-831)

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Enteral nutrition (EN) provides critical macro and micronutrients to individuals who cannot maintain sufficient oral intake to meet their nutritional needs. EN is most commonly required for neurological conditions that impair swallow function, such as stroke, amytrophic lateral sclerosis, and Parkinson’s disease. An inability to swallow due to mechanical ventilation and altered mental status are also common conditions that necessitate the use of EN. EN can be short or long term and delivered gastrically or post-pylorically. The expected duration and site of feeding determine the type of feeding tube used. Many commercial EN formulas are available. In addition to standard formulations, disease specific, peptide-based, and blenderized formulas are also available. Several other factors should be considered when providing EN, including timing and rate of initiation, advancement regimen, feeding modality, and risk of complications. Careful and comprehensive assessment of the patient will help to ensure that nutritionally complete and clinically appropriate EN is delivered safely.

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