Misconceptions about protein requirements for wound healing: results of a prospective study

The successful treatment of protein malnutrition is critical for patient healing but traditional estimates of the amount of calories and protein needed for wound patients have been empiric. In particular, only the presence of a wound, not its severity or extent, is currently included as a stratifying "stress factor." To 1) ascertain reasons for feeding failure, 2) evaluate a hypothesis that patients with wounds require more protein than is generally recommended in the literature, and 3) affirm that wound burden effects protein requirements, a 1-year, descriptive, prospective study was conducted involving 150 tube-fed patients with (n = 93) and without (n = 57) wounds admitted to a long-term, acute care facility. On admission, 11% of wound and 21% of non-wound patients had normal pre-albumin levels. Using an aggressive protein provision regimen, pre-albumin levels improved in 42% of wound patients (mean 36.9 days) and in 46% of non-wound patients (mean 29.7 days). The most common cause of feeding failure was inadequate provision or assimilation of protein. Signs and symptoms of overfeeding were not observed. The average maximum amount of protein provided to patients whose pre-albumin improved was significantly higher in the wound (1.85 g/Kg/day) than in the non-wound (1.47 g/Kg/day) group (P = .0002). Among wound patients whose pre-albumin improved, a trend between higher wound burden (defined by total Pressure Ulcer Scale for Healing score) and maximum amounts of protein provided was seen. In addition to the need for more research in this area, study findings suggest that commonly estimated protein requirements for wound patients are too low and that better tools and procedures for protein assessment and maintenance need to be implemented.