An Overview of Nutritional Management in the Critically Ill Burned Patients
Wael Salah Eldin Abd Elrhman;
Abstract
Nutrition is an important component of treatment of patients with burns. Severely burned patients develop a number of physiological alterations including a markedly elevated metabolic rate, which persist over an extended period of time.
These factors must be considered when deciding an appropriate nutritional management of the burned patient. The goals of nutrition support are to defend lean body mass, promote immunocompetence, optimize wound healing and reduce subsequent duration of recovery.
Nutritional requirements must be assessed individually for each patient. The patient should be weighed on admission, as weight gain from fluid is common during the resuscitation period.
Enteral feeding should be initiated as early as possible post-burn. Many burn units now feed enterally within six hours of admission. Early enteral feeding increases gut blood flow and decreases gut mucosal atrophy and therefore may prevent bacterial translocation. Early enteral nutrition has been shown to reduce weight loss, improve nitrogen balance,
Summary
102
References
reduce hospital stay and decrease mortality. It is also effective in the prevention of stress hemorrhage in the upper gastrointestinal tract. Delayed enteral feeding is associated with gut mucosal atrophy, increased metabolic rate and an increased risk of post-burn malnutrition.
Parenteral nutrition (PN) is an alternative that is indicated in case of enteral feeding failure, or contraindication to the latter. PN implies an even stricter monitoring of glycemia and adherence to the patient's energy requirement to avoid overfeeding.
Protein requirements are significantly increased in burned patients. Protein is necessary for wound healing, enhancement of host defense mechanisms and replacement of losses. Protein requirements remain elevated until the burn wound is closed. Higher protein intakes have been associated with improved mortality in patients with major burns. Specific amino acids may also improve outcome.
High–carbohydrate, low–fat diets for burn patients result in less proteolysis and more improvement in lean body mass, compared with high–fat diets. However, the benefit of
Summary
103
References
a high– carbohydrate formula must be balanced against the risk for hyperglycemia, which can negatively influence the outcome of critically ill patients.
Micronutrient requirements must also be considered post-burn as protein and energy cannot be effectively utilized if micronutrient intakes are inadequate. Trace elements such as zinc and copper are lost in exudate from the burn wound and selenium may be lost during surgical procedures such as excision and grafting. Urinary losses of trace elements also increase. Early trace element supplementation appears beneficial after major burns. Certain vitamin requirements are also increased, for example:
Vitamin C is necessary for collagen synthesis and immune function
These factors must be considered when deciding an appropriate nutritional management of the burned patient. The goals of nutrition support are to defend lean body mass, promote immunocompetence, optimize wound healing and reduce subsequent duration of recovery.
Nutritional requirements must be assessed individually for each patient. The patient should be weighed on admission, as weight gain from fluid is common during the resuscitation period.
Enteral feeding should be initiated as early as possible post-burn. Many burn units now feed enterally within six hours of admission. Early enteral feeding increases gut blood flow and decreases gut mucosal atrophy and therefore may prevent bacterial translocation. Early enteral nutrition has been shown to reduce weight loss, improve nitrogen balance,
Summary
102
References
reduce hospital stay and decrease mortality. It is also effective in the prevention of stress hemorrhage in the upper gastrointestinal tract. Delayed enteral feeding is associated with gut mucosal atrophy, increased metabolic rate and an increased risk of post-burn malnutrition.
Parenteral nutrition (PN) is an alternative that is indicated in case of enteral feeding failure, or contraindication to the latter. PN implies an even stricter monitoring of glycemia and adherence to the patient's energy requirement to avoid overfeeding.
Protein requirements are significantly increased in burned patients. Protein is necessary for wound healing, enhancement of host defense mechanisms and replacement of losses. Protein requirements remain elevated until the burn wound is closed. Higher protein intakes have been associated with improved mortality in patients with major burns. Specific amino acids may also improve outcome.
High–carbohydrate, low–fat diets for burn patients result in less proteolysis and more improvement in lean body mass, compared with high–fat diets. However, the benefit of
Summary
103
References
a high– carbohydrate formula must be balanced against the risk for hyperglycemia, which can negatively influence the outcome of critically ill patients.
Micronutrient requirements must also be considered post-burn as protein and energy cannot be effectively utilized if micronutrient intakes are inadequate. Trace elements such as zinc and copper are lost in exudate from the burn wound and selenium may be lost during surgical procedures such as excision and grafting. Urinary losses of trace elements also increase. Early trace element supplementation appears beneficial after major burns. Certain vitamin requirements are also increased, for example:
Vitamin C is necessary for collagen synthesis and immune function
Other data
| Title | An Overview of Nutritional Management in the Critically Ill Burned Patients | Other Titles | نظرة على المعالجة الغذائية لمرضى الحروق ذوى الحالات الحرجة | Authors | Wael Salah Eldin Abd Elrhman | Issue Date | 2015 |
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