The effectiveness of caloric value of enteral nutrition in patients with major burns
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.
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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)
Would direct
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
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2022, Clinical Nutrition ESPENCitation Excerpt :The etiology of this malnutrition type includes burns and severe infections. Reportedly, burn patients with a depth of 2–3° and 10–80% of body surface area who received 30 kcal/kg of energy had a lower mortality rate than those who received less, and it is advisable to adopt aggressive nutrition therapy [21]. Critically ill patients should receive <70% of REE for the first week during intensive care unit (ICU) stay [22].
Efficacy of CMC supplementary burns feed (SBF) in burns patients: A retrospective study
2020, Burns OpenCitation Excerpt :We have to wait for the RE-ENERGIZE Trial [33]. Glutamine was not supplemented in our patients because of insufficient data to support its use [34]. Arginine another important supplement in post-burn metabolism has been associated with better wound healing [35].
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2018, BurnsCitation Excerpt :Within human patients, sufficient caloric intake in the setting of acute burns has been shown to translate to increased insulin secretion and protein retention [12], improved bowel mucosal integrity [13], and decreased incidence of stress gastritis [14]. In turn, improved patient nutritional status has ultimately been shown to decrease overall rates of adverse events including sepsis, pneumonia, and mortality, and decrease overall length of hospitalization [15,16]. However, the placement of nasoenteric feeding tubes is not without risk.
Impact of decreasing energy intakes in major burn patients: A 15-year retrospective cohort study
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