What, How, and How Much Should Patients with Burns be Fed?

Abstract

SYNOPSIS The hypermetabolic response to severe burn injury is characterized by hyperdynamic circulation, profound metabolic, physiologic, catabolic and immune system derangements. Failure to satisfy overwhelming energy and protein requirements after, and during severe burn injury, results in multi-organ dysfunction, increased susceptibility to infection, and death. Attenuation of the hypermetabolic response by various pharmacologic modalities is emerging as an essential component of the management of severe burn patients. This review focuses on the more recent advances in therapeutic strategies to attenuate the hypermetabolic response and its post-burn associated insulin resistance. Modulation of the response by early excision and grafting of burn wounds, environmental thermoregulation, early and continuous enteral feeding with high protein-high carbohydrate feedings and pharmacologic treatments that stimulate anabolism and oppose catabolism have markedly decreased morbidity in the acute phase post severe burn injury.

The Central Role of Glucose in Metabolism and Nutrition of Critically Ill Patients

“…Zajímavé je pozorování, že po podání plné parenterální výživy s obsahem glukózy dojde ke zdvojnásobení schopnosti ji oxidovat při porovnání s basálními hodnotami, což je dáno i do souvislosti se zdvojnásobením kapacity pro vychytávání glukózy z oběhu (80 (63). Na rozdíl od prostého hladovění, kdy lipolýza a ketogeneze slouží jako zdroj energie a šetří tak bílkovinné rezervy, je například u popálených pacientů popsaná významně snížená schopnost oxidovat lipidy (81,82). Pravděpodobně je u těchto pacientů preferována právě glukóza.…”

International observational study of nutritional support in mechanically ventilated patients following burn injury

“…The median time to starting enteral nutrition (if this was the first route of feeding or if the patient was fed at all) from admission was 17.4 [0-65] h. Eight patients received oral nutrition at some point during their ICU stay. The median day of initiation of oral intake was day 6 [2][3][4][5][6][7][8][9][10][11]. The amount of energy and protein received by the oral route in these eight patients was not recorded.…”

“…For this reason, administration of substantial energy and protein loads are recommended to limit metabolic 'debt' [2][3][4]. Indeed, it has been hypothesized that optimising nutrient provision to match the increased metabolic demand in this group will reduce mortality [5].…”

Burns

“…56 Attempting to overcompensate and provide excess calories and or protein is ineffective and likely to lead to increased complications, such as hyperglycemia, carbon dioxide retention (CO 2 ), and azotemia. 56 Patients treated with oral alimentation alone can lose up to 25% of their preadmission weight by 3 weeks after injury and is thus inadequate. 56 Total parenteral or enteral nutrition allows for elemental components that do not require digestion or a functioning alimentary tract.…”

“…56 Patients treated with oral alimentation alone can lose up to 25% of their preadmission weight by 3 weeks after injury and is thus inadequate. 56 Total parenteral or enteral nutrition allows for elemental components that do not require digestion or a functioning alimentary tract. 56 Today, most clinicians prefer to use enteral nutrition with a high carbohydrate diet consisting of 82% carbohydrate, 3% fat, and 15% protein.…”