Optimizing Wound care: Tailored Nutritional Strategies with Immune-Modulating Enteral Nutrients

FIJI ANTONY^1*Wafaa Helmi Reda²

• ¹NMC Healthcare, Abu Dhabi, United Arab Emirates
• ²Clayton State University, Morrow, United States

Abstract: Background Adequate nutrition and hydration are essential for maintaining skin integrity and supporting tissue repair in patients with pressure injuries, particularly in critically ill and long-term hospitalized populations. Pressure ulcers are associated with increased morbidity, prolonged hospitalization, and higher healthcare costs. ESPEN guidelines recommend individualized nutritional therapy within multidisciplinary care, emphasizing optimized energy and protein provision and, when appropriate, conditionally essential nutrients such as arginine, glutamine, and β-hydroxy-β-methylbutyrate (HMB). However, real-world implementation of these recommendations in complex clinical settings remains limited. This case series describes dietitian led personalized nutritional interventions in patients with advanced pressure ulcers receiving enteral nutrition. Case Summary: This descriptive case series includes four adult patients admitted to long-term care settings who required prolonged enteral nutrition and had advanced pressure injuries. All were at high nutritional risk due to critical illness, neurological impairment, prolonged immobility, or comorbid medical or psychiatric conditions. Each patient underwent comprehensive dietitian-led nutritional assessment addressing metabolic stress, wound burden, nutritional status, biochemical markers, and feeding tolerance. Interventions included early initiation and optimization of enteral feeding, progressive achievement of guideline-recommended energy and protein targets, micronutrient optimization, glycemic control, and selective use of immunonutrition enriched with arginine, glutamine, and HMB when clinically indicated. Nutritional plans were regularly reviewed and adjusted according to clinical response. Over prolonged follow-up, all patients demonstrated improved nutritional status and progressive wound healing. Within a multidisciplinary care bundle including pressure offloading, specialized wound care, infection control, and rehabilitation complete healing was achieved. This series illustrates practical application rather than causal efficacy. Inclusion and Exclusion Criteria: Adults aged ≥18 years with adequate length of stay, complete records, and receipt of individualized enteral nutrition were included. Exclusion criteria were age <18 years, pregnancy or lactation, exclusive parenteral nutrition, terminal or palliative care, hemodynamic instability precluding enteral feeding, significant metabolic disorders, incomplete records, or insufficient anticipated length of stay. Conclusion: Individualized, dietitian-led nutritional therapy integrated within multidisciplinary care was associated with improved nutritional status and favorable wound healing trajectories in patients with advanced pressure injuries. Causal inference is limited by the observational design, and prospective studies using standardized wound assessment tools are warranted.