Evaluating nutritional support for moderate to severe burn patients
- Amalia Cochran, MD
Amalia Cochran, MD
- Associate Professor of Surgery
- University of Utah
Nutritional support represents one of the most important cornerstones in the management of patients with a moderate to severe burn injury. Clinical monitoring is the key tool for assessment of the adequacy of nutritional support. Laboratory markers for immune response, indirect calorimetry, and body weight and composition are also used.
This topic reviews assessment of the adequacy of nutritional support in burn patients. Patient selection, timing, delivery, and types of nutrition support, calculating caloric requirements for burn patients and selection of enteral formula are discussed elsewhere. (See "Overview of nutritional support for moderate to severe burn patients" and "Nutritional demands and enteral formulas for moderate to severe burn patients".)
CLINICAL MONITORING TOOLS
The adequacy of nutritional support is monitored by assessing the patient's clinical course and wound healing . Trends, rather than single measurements or point estimates, should be monitored.
Clinical course — Parameters used to evaluate the clinical course include:
- Saffle, JR, Graves, C. Nutritional support of the burned patient. In: Total Burn Care: 3rd Edition, Herndon, DN (Ed), Saunders Elsevier, Philadelphia, PA 2007. p.398.
- Fette, AM. A clinimetric analysis of wound measurement tools. Available online at: www.worldwidewounds.com (Accessed on March 10, 2010).
- Graves C, Saffle J, Cochran A. Actual burn nutrition care practices: an update. J Burn Care Res 2009; 30:77.
- Prelack K, Dylewski M, Sheridan RL. Practical guidelines for nutritional management of burn injury and recovery. Burns 2007; 33:14.
- Hart DW, Wolf SE, Herndon DN, et al. Energy expenditure and caloric balance after burn: increased feeding leads to fat rather than lean mass accretion. Ann Surg 2002; 235:152.
- Branski LK, Norbury WB, Herndon DN, et al. Measurement of body composition in burned children: is there a gold standard? JPEN J Parenter Enteral Nutr 2010; 34:55.
- Przkora R, Barrow RE, Jeschke MG, et al. Body composition changes with time in pediatric burn patients. J Trauma 2006; 60:968.
- Boullata J, Williams J, Cottrell F, et al. Accurate determination of energy needs in hospitalized patients. J Am Diet Assoc 2007; 107:393.
- Liusuwan RA, Palmieri TL, Kinoshita L, Greenhalgh DG. Comparison of measured resting energy expenditure versus predictive equations in pediatric burn patients. J Burn Care Rehabil 2005; 26:464.
- Liusuwan Manotok RA, Palmieri TL, Greenhalgh DG. The respiratory quotient has little value in evaluating the state of feeding in burn patients. J Burn Care Res 2008; 29:655.
- Dickerson RN. Estimating energy and protein requirements of thermally injured patients: art or science? Nutrition 2002; 18:439.
- Shields BA, Pidcoke HF, Chung KK, et al. Are visceral proteins valid markers for nutritional status in the burn intensive care unit? J Burn Care Res 2015; 36:375.
- Moghazy AM, Adly OA, Abbas AH, et al. Assessment of the relation between prealbumin serum level and healing of skin-grafted burn wounds. Burns 2010; 36:495.