Elsevier

Burns

Volume 32, Issue 1, February 2006, Pages 83-86
Burns

The effectiveness of caloric value of enteral nutrition in patients with major burns

https://doi.org/10.1016/j.burns.2005.08.003Get rights and content

Abstract

Enteral nutrition as an important component of modern treatment is mandatory for patients suffering from major burns. Regardless of the initial estimation of caloric requirements, actual daily volume of energy consumption may vary depending on the general condition of the patient and the side effects of enteral nutrition. The aim of our study was to investigate the relation between caloric value of enteral nutrition and treatment course.

Methods

The prospective study involved 103 adult patients treated in the Hospital of Kaunas University of Medicine for 2°–3° burns of 10–80% body surface area from 1 January 2001 till 31 December 2003. All patients received enteral nutrition during the acute phase. After the completion of the treatment, caloric value of enteral nutrition was estimated, and patients were divided into two groups: group A received more than 30 kcal/(kg 24 h); and group B, received less than 30 kcal/(kg 24 h). We compared patients’ mortality, complication rate, and hospital stay time.

Results

The mortality of patients, who enterally received less than 30 kcal/(kg 24 h), was 32.6%, comparing to 5.3% mortality in patients who received 30 or more kcal/(kg 24 h) (p < 0.01). The caloric value of less than 30 kcal/(kg 24 h) increased the frequency of pneumonia by 2.0 times, and the frequency of sepsis by 1.8 times (p < 0.05). The duration of the treatment of survivors in this group was by 12.6 days longer (p = 0.01).

Conclusions

The caloric value of enteral nutrition seems to be associated with patient mortality, complication rate, and treatment duration. The results of the treatment of patients who received more or 30 kcal/(kg 24 h) were much better. Because determined relationship may not be directly causal, further study is needed to determine whether active intervention to improve nutrition could improve outcomes.

Introduction

Over time, the treatment of burns has changed: early excision and skin grafting, as well as early enteral nutrition, have been successfully introduced into clinical practice. These means of treatment allowed for a considerable reduction of the mortality rate. The majority of publications concerning the influence of early excision and enteral nutrition on the complication rate and mortality are of a descriptive character, the numbers of investigated patients are low, and there are no comparisons with the control groups [1], [2], [3]. Still, all authors recommend supplementary nutrition and enteral nutrition as the method of choice for patients suffering from major burns [4], [5], [6]. However, there are publications affirming that early excision and enteral nutrition do not prevent hypermetabolism following major burns [7]. There is a lack of evidence-based information, and there remains the question of what amount of energy should be enterally administered for patients suffering from major burns. Sobotka et al. recommended prescribing 30–40 kcal/(kg 24 h) [8]. Hart et al. in 2002 stated that the supererogatory amount of energy increased the rate of complications and the mortality of burnt patients [9]. In our routine clinical practice, we experienced situations when patients due to various circumstances fail to accomplish the administered nutrition regimen and do not consume all the prescribed feeding volume [10], [11].

The aim of the study was to determine the relation between the caloric value (30 kcal/(kg 24 h) or more) of enteral nutrition and the mortality rate, the frequency of complications, and the duration of inpatient treatment in patients with major burns.

Section snippets

Patients and methods

The study was designed, and the permission of the Ethical Committee of Biomedical Research of Kaunas Region for this research was obtained in 2001 (protocol No. 62/2001).

The prospectively followed patients aged 16–80 years were treated from 1 January 2001 till 31 December 2003 in the Hospital of Kaunas University of Medicine for 2°–3° burns of 10–80% body surface area. Patients with respiratory tract injury were excluded from the study.

We distributed the patients into two groups: one consisting

Results

The results are presented as mean and standard deviation (S.D.). There were no statistically significant differences in patients’ age or the total and deep burn area (Table 1).

In 32 patients (56.1%) of group A, enteral feeding was initiated through the nasogastric tube, and in 25 (43.9%), through the nasojejunal tube. In group B, in 22 (47.8%) patients, feeding was initiated through the nasogastric tube, and in 19 (41.3%) patients, through the nasojejunal tube. We found that there were no

Conclusions

The caloric value of enteral nutrition seems to be associated with patient mortality, complication rate, and treatment duration. The results of the treatment of patients who received more or 30 kcal/(kg 24 h) were much better than in those who received less than 30 kcal/(kg day). Because determined relationship may not be directly causal, further study is needed to determine whether active intervention to improve nutrition could improve outcomes. Questions for further study may be:

  • (1)

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Discussion

The discussed issue is what amount of energy patients suffering from major burns should require. The morbidity and mortality of severely burned patients is closely associated with hypermetabolism and catabolism with accompanying impairment of wound healing and an increased risk of infection. To overcome these natural clinical events, nutritional support has become a major focus in the care of severely burned patients. According to clinical literature, total enteral nutrition starting as early

References (13)

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