The use of an oral mixture of arginine, glutamine and β-hydroxy-β-methylbutyrate (Hmb) for the treatment of high grade pressure ulcers: A randomized study

Abstract

Background/Purpose: Pressure ulcers are highly prevalent in health care facilities. Provision of nutritional support is considered as a modality for pressure ulcer management. The aim of this study is to investigate the effect of a commercial mixture of arginine, glutamine and β-hydroxy-β-methylbutyrate (HMB) on pressure ulcer healing among subjects with high-grade pressure sore. Methods: 87 subjects, mean age 82.5 (SD 12.15), with stage III-IV pressure sore, were randomized to a HMB, arginine and glutamine mixture twice daily or standard nutritional care for 4 weeks. Pressure ulcers were measured every 2 weeks for area, depth, undermine and PUSH (Pressure Ulcer Scale for Healing) scores. Laboratory parameters including haemoglobin and C-reactive protein level were measured every 2 weeks. Secondary outcomes were length of hospitalization, in-patients’ and 6-month mortality and number of hospital readmission. Results: Overall, there was a statistically significant improvement of pressure ulcer size and depth. A statistically significant reduction in pressure ulcer size (p=0.048) and depth (p=0.002) was observed in the intervention group while the PUSH score showed a significant improvement in the control group (p <0.001). However, there was no between group difference on pressure ulcer healing in term of pressure ulcer area, depth, undermine and PUSH score. Biochemical parameters, the median length of hospitalization and number of hospital readmission also showed no between group difference. Conclusion: Use of a nutritional formula enriched with arginine, glutamine and HMB does not improve late state pressure ulcer healing after 4 weeks.