Using a wiki platform for guideline development and dissemination is a successful method for producing high-quality resources that can undergo wide international stakeholder review and include open public consultation. This can replace conventional methods whereby guidelines can quickly become outdated.

The aim of this study is to review the current evidence for immunonutrition use in patients with burn injury. Nutrients of interest included glutamine, arginine, and omega-3 fatty acids (fish oil). A literature review was conducted to identify studies that evaluated the use of immunonutrients in pediatric and adult patients with burn injury. Search terms included burns, immunonutrition, pharmaconutrition, glutamine, arginine, omega-3, and fish oil. Glutamine: Nine randomized controlled trials (four represented in abstract only) investigating enteral supplementation and two trials investigating parenteral supplementation of glutamine were identified. Arginine: Five trials investigating the effect of arginine supplementation were identified (three represented in abstract only). Omega-3 fatty acids: Three studies investigating the effect of enteral fish oil supplementation were identified (one represented in abstract only). Combined immunonutrients: Six studies were identified that investigated immunonutrients as a combination of active dietary constituents (rather than as individual nutrients). Despite the semiessential nature of arginine after burn injury, there were surprisingly little data regarding nutritional supplementation. Literature around supplementation of omega-3 fatty acids is found to be lacking in the burn injury population. The combination of immunonutrients as a component of enteral formulae limits identification of the active nutrient and ideal dosage. Current evidence supports the use of enteral glutamine supplementation for patients with severe burn injuries. Questions remain regarding dosage, timing, and length of supplementation.

Trace elements have an important physiological role after severe burn injury with patients routinely receiving supplementation. Although commonly prescribed after burn injury, variation exists among supplement composition, frequency, and the dosage administered. This review aims to assess the effectiveness of trace element supplementation on clinically meaningful outcomes in patients who have sustained a severe burn injury. Supplementation of selenium, copper and zinc, either alone or combined, compared with placebo or standard treatment were eligible for inclusion. Predetermined primary outcome measures were mortality, length of stay, rate of wound healing, and complications. A comprehensive search strategy was undertaken. Methodological quality of eligible studies was appraised and relevant data extracted for meta-analysis. Eight studies met eligibility criteria for the review; four randomized controlled trials and four nonrandomized experimental trials, including a total of 398 participants with an age range of 6 to 67 years. Parenteral supplementation of combined trace elements was associated with a significant decrease in infectious episodes (weighted mean difference: -1.25 episodes, 95% confidence intervals: -1.70, -0.80; P < .00001). The results of this review indicate that the use of parentally administered combined trace elements after burn injury confer positive effects in decreasing infectious complications. Combined parenteral trace element supplementation and combined oral and parenteral zinc supplementation have potentially clinically significant findings on reducing length of stay. Oral zinc supplementation shows possible beneficial effects on mortality. Definitive studies are required to accurately define optimal trace element supplementation regimens, dosages, and routes after burn injury.

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