Influence of early post-burn enteral nutrition on clinical outcomes of patients with extensive burns

Abstract

Sepsis commonly occurs in severe post-burn patients, often resulting in death. We aimed to evaluate the influence of early enteral feeding on outcomes in patients with extensive burns, including infection incidence, healing and mortality. We retrospectively reviewed 60 patients with extensive burns, 35 who had received early enteral nutrition and 25 who had received parenteral nutrition. Average healing time, infection incidence and mortality were clinically observed. Hemoglobin and serum albumin were monitored weekly in both groups during treatment. Causative organisms were identified in patients with sepsis. Infection incidence was significantly less in the enteral nutrition group than the parenteral nutrition group (17.1% vs 44.0%; p = 0.023); and latency duration was longer in the enteral nutrition group than in the parenteral nutrition group (30.5 ± 4.7 days vs 14.5 ± 2.3 days; p<0.001). Duration of antibiotic therapy of the enteral nutrition group was significantly shorter than that of the parenteral nutrition group (12.5 ± 3.0 days vs 19.8 ± 3.6 days; p<0.001). Mean hemoglobin results (10.1 ± 1.3 g/L vs 8.3 ± 1.5 g/L; p<0.001) and serum albumin results (44.7 ± 5.7 g/L vs 36.2 ± 6.9 g/L; p<0.001) of enteral nutrition and parenteral nutrition groups, respectively, provided an overview of systemic nutrition and protein metabolism, suggesting higher systemic nutrition and protein synthesis in enteral nutrition group than in parenteral nutrition group. Risk of post-burn infection is reduced in burn patients who are supported by earliest possible enteral nutrition.

Early, High Quality Enteral Nutrition Significantly Improves Outcome in Head Trauma Patients

“…Thirty-five burn patients received EN within 24 h of burns, whereas 25 other patients received only parenteral nutrition. The early EN patients had a non-significant trend toward lower mortality in the first 24 h (5.7% vs. 20.0%, p = 0.117), significantly lower infection rates (17.1% vs. 44.0%, p = 0.023), and significantly higher hemoglobin and serum albumin than did the patients receiving parenteral nutrition (Lu et al, 2011).…”

“…Thirty-five burn patients received EN within 24 h of burns, whereas 25 other patients received only parenteral nutrition. The early EN patients had a non-significant trend toward lower mortality in the first 24 h (5.7% vs. 20.0%, p = 0.117), significantly lower infection rates (17.1% vs. 44.0%, p = 0.023), and significantly higher hemoglobin and serum albumin than did the patients receiving parenteral nutrition (Lu et al, 2011).A recent meta-analysis of six randomized controlled EN trials on ICU patients reported that patients receiving EN within 24 h of severe injury and/or ICU admission had significantly lower mortality (OR = 0.34, 95% CI 0.14-0.85; 234 patients) and significantly lower pneumonia rates (OR = 0.31, 95% CI 0.12-0.78; 80 patients) than did patients who did not receive EN within 24 h (Doig et al, 2009).The nutritional quality of the EN formulas may also be crucial for controlling nosocomial infections. Research suggests that the use of ''immunonutrition'' EN formulas that contain omega-3 fats, and extra levels of vitamins, minerals, and amino acids such as glutamine, may also significantly reduce rates of hospital-acquired infections.…”

“…Other recent studies have reported that early high-quality EN can reduce mortality and morbidity in burn patients and Intensive Care Unit (ICU) patients. A recent Chinese study examined outcomes of 60 patients with extensive ( ‡ 60% of body surface) burns (Lu et al, 2011). Thirty-five burn patients received EN within 24 h of burns, whereas 25 other patients received only parenteral nutrition.…”

Early versus late parenteral nutrition in the adult ICU: feeding the patient or our conscience?

“…These benefits have included lower mortality, reduced infection rates, decreased ventilator time, and shorter ICU stay. 2,[4][5][6][7] In contrast, the use and optimal timing for initiation of PN remains less well defined. While no clear difference in mortality has been shown when EN and PN are compared, there is evidence that EN is associated with less morbidity and lower cost.…”

“…Main results: The median [interquartile range] ICU stay was one day shorter in the late than in the early PN group (3 [2][3][4][5][6][7] vs 4 [2-9] days, respectively; P = 0.02). More late than early PN initiation patients were discharged alive from the ICU within eight days (75.2 vs 71.2%, respectively; P = 0.007), although mortality in the ICU, in the hospital, and at 90 days was not statistically different.…”