title: The use of a specialised amino acid mixture for pressure ulcers: a placebo-controlled trial.
abstract: OBJECTIVE
  To compare pressure ulcer healing rates in patients supplemented with a specialised amino acid mixture containing (beta)-hydroxy (beta)-methylbutyrate (HMB), arginine and glutamine, and standard oral nutritional supplements versus patients supplemented with oral nutritional supplements and a placebo mixture.
  
  
  METHODS
  Twenty-three inpatients with stage II, III or IV pressure ulcers in an acute care hospital were randomised to recieve (A) a HMB, arginine and glutamine mixture twice daily alongside oral nutritional supplements (n=11) or (B) standard nutritional care alongside oral nutritional supplements (n=12) for 2 weeks. Pressure ulcers were measured weekly for area, depth and Pressure Ulcer Scale for Healing (PUSH) scores. The proportion of viable tissue was determined based on area of wound tracing. Weekly laboratory tests were performed to measure C-reactive protein and pre-albumin levels. This trial is registered at http://ClinicalTrials.gov under NCT01090076.
  
  
  RESULTS
  There was no difference between anthropometrical measurements, biochemical parameters and nutritional intake pre- and post- study. Wound area did not decrease significantly in the short term for both groups. The proportion of viable tissues increased within 2 weeks on HMB, arginine and glutamine supplementation (p=0.02). PUSH scores showed significant improvement within 1 week of supplementation for the experimental group (p=0.013).
  
  
  CONCLUSIONS
  The use of specialised amino acid does not appear to reduce wound size and PUSH scores but may improve tissue viability after 2 weeks. Further confirmation on a larger scale is required to determine the benefits of supplementing additional HMB, arginine and glutamine in patients with pressure ulcers.
authors.affiliation: MSc, RD, Department of Dietetics and Food Services, Changi General Hospital, Singapore.
authors.forename: A
authors.initials: A
authors.lastname: Wong
authors.affiliation: BSc, RN, Department of Nursing, Case Management Unit, Changi General Hospital, Singapore.
authors.forename: A
authors.initials: A
authors.lastname: Chew
authors.affiliation: B Nursing, RN, Department of Nursing, Case Management Unit, Changi General Hospital, Singapore.
authors.forename: C M
authors.initials: CM
authors.lastname: Wang
authors.affiliation: B Nursing, RN, Department of Nursing, Case Management Unit, Changi General Hospital, Singapore.
authors.forename: L
authors.initials: L
authors.lastname: Ong
authors.affiliation: MSc, RD, Department of Dietetics and Food Services, Changi General Hospital, Singapore.
authors.forename: S H
authors.initials: SH
authors.lastname: Zhang
authors.affiliation: MD, Department of Rehabilitative Medicine, Changi General Hospital, Singapore.
authors.forename: S
authors.initials: S
authors.lastname: Young
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000418:Albumins / Q000378:metabolism; D001120:Arginine / Q000008:administration & dosage / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000378:metabolism; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D005973:Glutamine / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008297:Male; D010865:Pilot Projects; D010919:Placebos; D003668:Pressure Ulcer / Q000188:drug therapy*; D016896:Treatment Outcome; D014631:Valerates / Q000008:administration & dosage / Q000627:therapeutic use; D014945:Wound Healing / Q000187:drug effects*
chemical_list: D000418:Albumins; D010919:Placebos; D014631:Valerates; D005973:Glutamine; C004961:beta-hydroxyisovaleric acid; D002097:C-Reactive Protein; D001120:Arginine