Measured total energy requirements of adult patients with burns

Adequate nutritional support is a primary concern in the treatment of patients with burns. Traditionally dietitians estimated energy requirements with the use of multifactorial equations that took into account anthropometric variables and burn severity. Recently, however, the availability of portable metabolic carts has reduced the need for dietitians to rely on predicted requirements. The use of metabolic carts, however, likely causes the underestimation of energy requirements because the carts do not always accurately measure the effects of surgery, dressing changes, and other related treatments. The aim of the current study was to determine the difference between resting energy expenditure and total daily energy expenditure. Seven adult patients whose burns ranged from 18% to 80% of their total body surface areas were studied. Total daily energy expenditure was measured with doubly labeled water, and resting energy expenditure was measured by studying respiratory gas exchange in the fed and fasted states. Total daily energy expenditure averaged 106% +/- 11% of average resting energy expenditure. Within the limits of the small data set studied, energy requirements could be measured with the use of the resting metabolic rate by allowing for an increase of 5% to 15% for nonrest activities and treatments.