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Nutritional demands and enteral formulas for moderate to severe burn patients

INTRODUCTION

Nutritional support represents one of the most important cornerstones in the management of patients with a moderate to severe burn injury. This topic covers determination of caloric requirements and selection of enteral formulas. The target goal of avoiding the extremes of starvation and overfeeding is defined by estimating energy requirements, and is subject to continued monitoring and revision based upon the metabolic characteristics of patients and their tolerance of enteral nutrition [1,2].

Information on patient selection and timing of nutritional support and evaluating nutritional support is discussed elsewhere. (See "Overview of nutritional support for moderate to severe burn patients" and "Evaluating nutritional support for moderate to severe burn patients".)

DETERMINING CALORIC REQUIREMENTS

The fundamental goal in nutritional support is to meet but not exceed the nutritional requirements of patients with moderate to severe burns. Assessment of nutritional support falls into two distinct categories: the initial requirements and the ongoing requirements. The assessment of caloric demands within the first 24 hours generates an initial goal so that nutritional support can be initiated. However, the most critical component is to make adjustments for the ongoing needs during what is often a prolonged recovery associated with a prolonged course of hypermetabolism [1,2]. The hypermetabolic response is likely more prolonged than previously thought, possibly extending for up to three years post-injury [3]. (See "Hypermetabolic response to severe burn injury: Recognition and treatment".)

Initial nutritional support goal — The target goal of avoiding the extremes of starvation and overfeeding is determined by estimating energy requirements, and is subject to revision based upon the metabolic characteristics of patients and their tolerance of enteral nutrition [1,2]. Initial estimates of energy expenditure in burn patients provides a particular challenge because of the variability of the hypermetabolic response and the factors that result in heterogeneity of energy expenditure in burn patients [4]. (See "Hypermetabolic response to severe burn injury: Recognition and treatment".)

Calculating energy requirements — The assessment of the energy requirements represents a composite of the following factors [5]:

                          

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Literature review current through: Oct 2014. | This topic last updated: Jul 3, 2013.
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