References

Williams FN, Herndon DN, Jeschke MG The hypermetabolic response to burn injury and interventions to modify this response. Clin Plast Surg. 2009; 36:(4)583-596 https://doi.org/10.1016/j.cps.2009.05.001

Kaddoura I, Abu-Sittah G, Ibrahim A Burn injury: review of pathophysiology and therapeutic modalities in major burns. Ann Burns Fire Disasters. 2017; 30:(2)95-102

Jaffer U, Wade RG, Gourlay T Cytokines in the systemic inflammatory response syndrome: a review. HSR Proc Intensive Care Cardiovasc Anesth. 2010; 2:(3)161-175

Akbulut G New perspective for nutritional support of cancer patients: enteral/parenteral nutrition. Exp Ther Med. 2011; 2:(4)675-684 https://doi.org/10.3892/etm.2011.247

Seres DS, Valcarcel M, Guillaume A Advantages of enteral nutrition over parenteral nutrition. Therap Adv Gastroenterol. 2013; 6:(2)157-167 https://doi.org/10.1177/1756283X12467564

Demling RH Nutrition, anabolism, and the wound healing process: an overview. Eplasty. 2009; 9

Haberal M, Abali AE, Karakayali H Fluid management in major burn injuries. Indian J Plast Surg. 2010; 43:(3 Suppl) https://doi.org/10.4103/0970-0358.70715

Williams FN, Branski LK, Jeschke MG, Herndon DN What, how, and how much should patients with burns be fed?. Surg Clin North Am. 2011; 91:(3)609-629 https://doi.org/10.1016/j.suc.2011.03.002

Clark A, Imran J, Madni T, Wolf SE Nutrition and metabolism in burn patients. Burns Trauma. 2017; 5:(1) https://doi.org/10.1186/s41038-017-0076-x

Herndon DN, Tompkins RG Support of the metabolic response to burn injury. Lancet. 2004; 363:(9424)1895-1902 https://doi.org/10.1016/S0140-6736(04)16360-5

Herndon DN, Hart DW, Wolf SE Reversal of catabolism by beta-blockade after severe burns. N Engl J Med. 2001; 345:(17)1223-1229 https://doi.org/10.1056/NEJMoa010342

Jeschke MG, Mlcak RP, Finnerty CC Burn size determines the inflammatory and hypermetabolic response. Crit Care. 2007; 11:(4) https://doi.org/10.1186/cc6102

Cuthbertson DP, Angeles Valero Zanuy MA, León Sanz ML Postshock metabolic response. 1942. Nutr Hosp. 2001; 16:(5)176-182

Mecott GA, Al-Mousawi AM, Gauglitz GG The role of hyperglycemia in burned patients: evidence-based studies. Shock. 2010; 33:(1)5-13 https://doi.org/10.1097/SHK.0b013e3181af0494

Tredget EE, Yu YM The metabolic effects of thermal injury. World J Surg. 1992; 16:(1)68-79 https://doi.org/10.1007/BF02067117

Mendonça Machado N, Gragnani A, Masako Ferreira L Burns, metabolism and nutritional requirements. Nutr Hosp. 2011; 26:(4)692-700

Trop M, Schintler M, Spendel S, Stockenhuber A Unhealed wounds, hypoalbuminaemia and cachexia in a burned child - where is the limit?. Ann Burns Fire Disasters. 2008; 21:(2)59-62

Ikeda H, Kobayashi K Pathophysiologic changes in patients with severe burns: role of hormones and chemical mediators. Nihon Geka Gakkai Zasshi. 1998; 99:(1)2-7

Nielson CB, Duethman NC, Howard JM Burns. J Burn Care Res. 2017; 38:(1)e469-e481 https://doi.org/10.1097/BCR.0000000000000355

De-Souza DA, Greene LJ Pharmacological nutrition after burn injury. J Nutr. 1998; 128:(5)797-803 https://doi.org/10.1093/jn/128.5.797

Jeschke MG, Chinkes DL, Finnerty CC Pathophysiologic response to severe burn injury. Ann Surg. 2008; 248:(3)387-401

Finnerty CC, Ali A, McLean J Impact of stress-induced diabetes on outcomes in severely burned children. J Am Coll Surg. 2014; 218:(4)783-795 https://doi.org/10.1016/j.jamcollsurg.2014.01.038

Cambiaso-Daniel J, Malagaris I, Rivas E Body composition changes in severely burned children during ICU hospitalization. Pediatr Crit Care Med. 2017; 18:(12)e598-e605 https://doi.org/10.1097/PCC.0000000000001347

Tapking C, Armenta AM, Popp D Relationship between lean body mass and isokinetic peak torque of knee extensors and flexors in severely burned children. Burns. 2018;

Przkora R, Barrow RE, Jeschke MG Body composition changes with time in pediatric burn patients. J Trauma Inj Infect Crit Care. 2006; 60:(5)968-971 https://doi.org/10.1097/01.ta.0000214580.27501.19

Edelman LS, McNaught T, Chan GM, Morris SE Sustained bone mineral density changes after burn injury. J Surg Res. 2003; 114:(2)172-178 https://doi.org/10.1016/S0022-4804(03)00275-0

Porter C, Hardee JP, Herndon DN, Suman OE The role of exercise in the rehabilitation of patients with severe burns. Exerc Sport Sci Rev. 2015; 43:(1)34-40 https://doi.org/10.1249/JES.0000000000000029

Porter C, Tompkins RG, Finnerty CC The metabolic stress response to burn trauma: current understanding and therapies. Lancet. 2016; 388:(10052)1417-1426 https://doi.org/10.1016/S0140-6736(16)31469-6

Wilmore DW, Long JM, Mason AD Catecholamines. Ann Surg. 1974; 180:(4)653-669 https://doi.org/10.1097/00000658-197410000-00031

Caldwell FT, Bowser BH, Crabtree JH The effect of occlusive dressings on the energy metabolism of severely burned children. Ann Surg. 1981; 193:(5)579-591 https://doi.org/10.1097/00000658-198105000-00007

Herndon DN, Rodriguez NA, Diaz EC Long-term propranolol use in severely burned pediatric patients: a randomized controlled study. Ann Surg. 2012; 256:(3)402-411 https://doi.org/10.1097/SLA.0b013e318265427e

Flores O, Stockton K, Roberts JA The efficacy and safety of adrenergic blockade after burn injury. J Trauma Acute Care Surg. 2016; 80:(1)146-155 https://doi.org/10.1097/TA.0000000000000887

Porro LJ, Herndon DN, Rodriguez NA Five-year outcomes after oxandrolone administration in severely burned children: a randomized clinical trial of safety and efficacy. J Am Coll Surg. 2012; 214:(4)489-502 https://doi.org/10.1016/j.jamcollsurg.2011.12.038

Gore DC, Chinkes D, Heggers J Association of hyperglycemia with increased mortality after severe burn injury. J Trauma Acute Care Surg. 2001; 51:(3)540-544 https://doi.org/10.1097/00005373-200109000-00021

Mandell SP, Gibran NS Early enteral nutrition for burn injury. Adv Wound Care. 2014; 3:(1)64-70 https://doi.org/10.1089/wound.2012.0382

Mosier MJ, Pham TN, Klein MB Early enteral nutrition in burns: compliance with guidelines and associated outcomes in a multicenter study. J Burn Care Res. 2011; 32:(1)104-109 https://doi.org/10.1097/BCR.0b013e318204b3be

Rodriguez NA, Jeschke MG, Williams FN Nutrition in burns. J Parenter Enteral Nutr. 2011; 35:(6)704-714 https://doi.org/10.1177/0148607111417446

Vicic VK, Radman M, Kovacic V Early initiation of enteral nutrition improves outcomes in burn disease. Asia Pac J Clin Nutr. 2013; 22:(4)543-547

Gottschlich MM, Jenkins ME, Mayes T The 2002 Clinical Research Award. An evaluation of the safety of early vs delayed enteral support and effects on clinical, nutritional, and endocrine outcomes after severe burns. J Burn Care Rehabil. 2002; 23:(6)401-415 https://doi.org/10.1097/00004630-200211000-00006

Andel D, Kamolz LP, Donner A Impact of intraoperative duodenal feeding on the oxygen balance of the splanchnic region in severely burned patients. Burns. 2005; 31:(3)302-305 https://doi.org/10.1016/j.burns.2004.10.011

Bittner EA, Shank E, Woodson L, Martyn JA Acute and perioperative care of the burn-injured patient. Anesthesiology. 2015; 122:(2)448-464 https://doi.org/10.1097/ALN.0000000000000559

Pérez-Guisado J, de Haro-Padilla JM, Rioja LF The potential association of later initiation of oral/enteral nutrition on euthyroid sick syndrome in burn patients. Int J Endocrinol. 2013; 2013:1-6 https://doi.org/10.1155/2013/707360

Hegazi RA, Wischmeyer PE Clinical review: optimizing enteral nutrition for critically ill patients - a simple data-driven formula. Crit Care. 2011; 15:(6) https://doi.org/10.1186/cc10430

Hodgman EI, Subramanian M, Arnoldo BD Future therapies in burn resuscitation. Crit Care Clin. 2016; 32:(4)611-619 https://doi.org/10.1016/j.ccc.2016.06.009

Prelack K, Dylewski M, Sheridan RL Practical guidelines for nutritional management of burn injury and recovery. Burns. 2007; 33:(1)14-24 https://doi.org/10.1016/j.burns.2006.06.014

Kross EK, Sena M, Schmidt K, Stapleton RD A comparison of predictive equations of energy expenditure and measured energy expenditure in critically ill patients. J Crit Care. 2012; 27:(3) https://doi.org/10.1016/j.jcrc.2011.07.084

Dickerson RN, Gervasio JM, Riley ML Accuracy of predictive methods to estimate resting energy expenditure of thermally-injured patients. JPEN J Parenter Enteral Nutr. 2002; 26:(1)17-29 https://doi.org/10.1177/014860710202600117

Lam YY, Ravussin E Analysis of energy metabolism in humans: A review of methodologies. Mol Metab. 2016; 5:(11)1057-1071 https://doi.org/10.1016/j.molmet.2016.09.005

Bursztein S, Glaser P, Trichet B Utilization of protein, carbohydrate, and fat in fasting and postabsorptive subjects. Am J Clin Nutr. 1980; 33:(5)998-1001 https://doi.org/10.1093/ajcn/33.5.998

McClave SA, Snider HL Use of indirect calorimetry in clinical nutrition. Nutr Clin Pract. 1992; 7:(5)207-221 https://doi.org/10.1177/0115426592007005207

Ireton-Jones CS, Turner WW, Liepa GU, Baxter CR Equations for the estimation of energy expenditures in patients with burns with special reference to ventilatory status. J Burn Care Rehabil. 1992; 13:(3)330-333 https://doi.org/10.1097/00004630-199205000-00005

Atiyeh BS, Gunn SW, Dibo SA Nutritional and pharmacological modulation of the metabolic response of severely burned patients: review of the literature (Part II)*. Ann Burns Fire Disasters. 2008; 21:(3)119-123

Owen OE, Reichard GA, Patel MS, Boden G Energy metabolism in feasting and fasting. Adv Exp Med Biol. 1979; 111:169-188 https://doi.org/10.1007/978-1-4757-0734-2_8

Arora SK, McFarlane SI The case for low carbohydrate diets in diabetes management. Nutr Metab (Lond). 2005; 2:(1) https://doi.org/10.1186/1743-7075-2-16

Hart DW, Wolf SE, Herndon DN Energy expenditure and caloric balance after burn: increased feeding leads to fat rather than lean mass accretion. Ann Surg. 2002; 235:(1)152-161 https://doi.org/10.1097/00000658-200201000-00020

Cree MG, Zwetsloot JJ, Herndon DN Insulin sensitivity and mitochondrial function are improved in children with burn injury during a randomized controlled trial of fenofibrate. Ann Surg. 2007; 245:(2)214-221 https://doi.org/10.1097/01.sla.0000250409.51289.ca

Campbell JM, Adanichkin N, Kurmis R, Munn Z Intensive insulin therapy, insulin sensitisers and insulin secretagogues for burns: a systematic review of effectiveness and safety. Burns. 2018; 44:(6)1377-1394 https://doi.org/10.1016/j.burns.2017.09.013

Pierre EJ, Barrow RE, Hawkins HK Effects of insulin on wound healing. J Trauma Inj Infect Crit Care. 1998; 44:(2)342-345 https://doi.org/10.1097/00005373-199802000-00019

Thomas SJ, Morimoto K, Herndon DN The effect of prolonged euglycemic hyperinsulinemia on lean body mass after severe burn. Surgery. 2002; 132:(2)341-347 https://doi.org/10.1067/msy.2002.126871

Demling RH, Seigne P Metabolic management of patients with severe burns. World J Surg. 2000; 24:(6)673-680 https://doi.org/10.1007/s002689910109

Mochizuki H, Trocki O, Dominioni L Optimal lipid content for enteral diets following thermal injury. J Parenter Enteral Nutr. 1984; 8:(6)638-646 https://doi.org/10.1177/0148607184008006638

Garrel DR, Razi M, Larivière F Improved clinical status and length of care with low-fat nutrition support in burn patients. J Parenter Enteral Nutr. 1995; 19:(6)482-491 https://doi.org/10.1177/0148607195019006482

Gottschlich MM, Jenkins M, Warden GD Differential effects of three enteral dietary regimens on selected outcome variables in burn patients. J Parenter Enteral Nutr. 1990; 14:(3)225-236 https://doi.org/10.1177/0148607190014003225

Alexander JW, Saito H, Ogle CK, Trocki O The importance of lipid type in the diet after burn injury. Ann Surg. 1986; 204:(1)1-8 https://doi.org/10.1097/00000658-198607000-00001

Wolfe RR Metabolic response to burn injury: nutritional implications. Semin Nephrol. 1993; 13:(4)382-390

Antonio J, Peacock CA, Ellerbroek A The effects of consuming a high protein diet (4.4 g/kg/d) on body composition in resistance-trained individuals. J Int Soc Sports Nutr. 2014; 11:(1) https://doi.org/10.1186/1550-2783-11-19

Williams FN, Jeschke MG, Chinkes DL Modulation of the hypermetabolic response to trauma: temperature, nutrition, and drugs. J Am Coll Surg. 2009; 208:(4)489-502 https://doi.org/10.1016/j.jamcollsurg.2009.01.022

Williams FN, Branski LK, Jeschke MG, Herndon DN What, how, and how much should patients with burns be fed?. Surg Clin North Am. 2011; 91:(3)609-629 https://doi.org/10.1016/j.suc.2011.03.002

Weijs PJ, Cynober L, DeLegge M Proteins and amino acids are fundamental to optimal nutrition support in critically ill patients. Crit Care. 2014; 18:(6) https://doi.org/10.1186/s13054-014-0591-0

Porter C, Hurren NM, Herndon DN, Børsheim E Whole body and skeletal muscle protein turnover in recovery from burns. Int J Burns Trauma. 2013; 3:(1)9-17

Dudrick PS, Souba WW Amino acids in surgical nutrition. Principles and practice. Surg Clin North Am. 1991; 71:(3)459-476 https://doi.org/10.1016/S0039-6109(16)45427-7

Wischmeyer P Nutritional pharmacology in surgery and critical care. Curr Opin Anaesthesiol. 2011; 24:(4)381-388 https://doi.org/10.1097/ACO.0b013e32834872b6

Ahuja RB, Gibran N, Greenhalgh D ISBI practice guidelines for burn care. Burns. 2016; 42:(5)953-1021 https://doi.org/10.1016/j.burns.2016.05.013

Garrel D, Patenaude J, Nedelec B Decreased mortality and infectious morbidity in adult burn patients given enteral glutamine supplements: a prospective, controlled, randomized clinical trial. Crit Care Med. 2003; 31:(10)2444-2449 https://doi.org/10.1097/01.CCM.0000084848.63691.1E

Windle EM Glutamine supplementation in critical illness: evidence, recommendations, and implications for clinical practice in burn care. J Burn Care Res. 2006; 27:(6)764-772 https://doi.org/10.1097/01.BCR.0000245417.47510.9C

Lin JJ, Chung XJ, Yang CY, Lau HL A meta-analysis of trials using the intention to treat principle for glutamine supplementation in critically ill patients with burn. Burns. 2013; 39:(4)565-570 https://doi.org/10.1016/j.burns.2012.11.008

Yan H, Peng X, Huang Y Effects of early enteral arginine supplementation on resuscitation of severe burn patients. Burns. 2007; 33:(2)179-184 https://doi.org/10.1016/j.burns.2006.06.012

Yu YM, Ryan CM, Castillo L Arginine and ornithine kinetics in severely burned patients: increased rate of arginine disposal. Am J Physiol Endocrinol Metab. 2001; 280:(3)E509-E517 https://doi.org/10.1152/ajpendo.2001.280.3.E509

Heyland DK, Samis A Does immunonutrition in patients with sepsis do more harm than good?. Intensive Care Med. 2003; 29:(5)669-671 https://doi.org/10.1007/s00134-003-1710-6

Sriram K, Lonchyna VA Micronutrient supplementation in adult nutrition therapy: practical considerations. JPEN J Parenter Enteral Nutr. 2009; 33:(5)548-562 https://doi.org/10.1177/0148607108328470

Adjepong M, Agbenorku P, Brown P, Oduro I The effect of dietary intake of antioxidant micronutrients on burn wound healing: a study in a tertiary health institution in a developing country. Burns Trauma. 2015; 3:(1) https://doi.org/10.1186/s41038-015-0012-x

Klein G The interaction between burn injury and vitamin D metabolism and consequences for the patient. Curr Clin Pharmacol. 2008; 3:(3)204-210 https://doi.org/10.2174/157488408785747647

Klein GL Disruption of bone and skeletal muscle in severe burns. Bone Res. 2015; 3:(1) https://doi.org/10.1038/boneres.2015.2

Klein GL Burns: where has all the calcium (and vitamin D) gone?. Adv Nutr. 2011; 2:(6)457-462 https://doi.org/10.3945/an.111.000745

Anand T, Skinner R Vitamin C in burns, sepsis, and trauma. J Trauma Acute Care Surg. 2018; 85:(4)782-787 https://doi.org/10.1097/TA.0000000000002042

Horton JW Free radicals and lipid peroxidation mediated injury in burn trauma: the role of antioxidant therapy. Toxicology. 2003; 189:(1-2)75-88 https://doi.org/10.1016/S0300-483X(03)00154-9

Rizzo JA, Rown MP, Driscoll IR Vitamin C in burn resuscitation. Critical Care Clinics. 2016; 32:(4)539-546 https://doi.org/10.1016/j.ccc.2016.06.003

Tanaka H, Matsuda T, Miyagantani Y Reduction of resuscitation fluid volumes in severely burned patients using ascorbic acid administration: a randomized, prospective study. Arch Surg. 2000; 135:(3)326-331 https://doi.org/10.1001/archsurg.135.3.326

Rollins C, Huettner F, Neumeister MW Clinician’s guide to nutritional therapy following major burn injury. Clin Plast Surg. 2017; 44:(3)555-566 https://doi.org/10.1016/j.cps.2017.02.014

Molnar JA, Underdown MJ, Clark WA Nutrition and chronic wounds. Adv Wound Care. 2014; 3:(11)663-681 https://doi.org/10.1089/wound.2014.0530

Tan BL, Norhaizan ME, Liew WP, Sulaiman Rahman H Antioxidant and oxidative stress: a mutual interplay in age-related diseases. Front Pharmacol. 2018; 9 https://doi.org/10.3389/fphar.2018.01162

Berger MM Antioxidant micronutrients in major trauma and burns: evidence and practice. Nutr Clin Pract. 2006; 21:(5)438-449 https://doi.org/10.1177/0115426506021005438

Häussinger D, Roth E, Lang F, Gerok W Cellular hydration state: an important determinant of protein catabolism in health and disease. Lancet. 1993; 341:(8856)1330-1332 https://doi.org/10.1016/0140-6736(93)90828-5

Nutrition

Burns: modified metabolism and the nuances of nutrition therapy

02 April 2023
Articles
02 April 2023
Volume 2023 · Issue 1

Abstract

Objective:

To review the effects of burn injury on nutritional requirements and how this can best be supported in a healthcare setting.

Method:

A literature search for articles discussing nutrition and/or metabolism following burn injury was carried out. PubMed, Embase and Web of Science databases were searched using the key search terms ‘nutrition’ OR ‘metabolism’ AND ‘burn injury’ OR ‘burns’. There was no limitation on the year of publication.

Results:

A total of nine articles met the inclusion criteria, the contents of which are discussed in this manuscript.

Conclusion:

Thermal injury elicits the greatest metabolic response, among all traumatic events, in critically ill patients. In order to ensure burn patients can meet the demands of their increased metabolic rate and energy expenditure, adequate nutritional support is essential. Burn injury results in a unique pathophysiology, involving alterations in endocrine, inflammatory, metabolic and immune pathways and nutritional support needed during the inpatient stay varies depending on burn severity and idiosyncratic patient physiologic parameters.

Thermal injuries are responsible for generating the greatest metabolic response of any disease process in critically ill patients.1 A number of alterations in inflammatory, immune and endocrine pathways are initiated upon injury.2 Immune cells are stimulated to secrete cytokines that can induce an unstable hypercatabolic state which, if left unregulated, may lead to multiple organ failure and systematic inflammatory response syndrome.3

Nutrition practice in burn injury requires a multifaceted approach aimed at providing metabolic support during a heightened inflammatory state, while accommodating surgical and medical needs of the patient. Nutritional assessment and determination of nutrient requirements is challenging, particularly given the metabolic disarray that frequently accompanies inflammation. Nutritional therapy requires careful decision making, regarding the safe use of enteral or parenteral nutrition and the aggressiveness of nutrient delivery given the severity of the patient’s illness and response to treatment.4,5 Nutritional support, defined as the provision of vital and ancillary nutrients to maintain or improve the patient’s nutritional status and permit wound healing,6 is essential in the management of burns.7 Treatment protocols should be evidence-based, originating from clinical and laboratory data.

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body composition
burn
metabolism
nutrients
nutrition
requirements