Nutrition in burns: need for an aggressive dynamic approach

Extensive burns elicit a pronounced metabolic response causing physiological derangements leading to the hyper-metabolic state. The hyper-metabolic response is accompanied by severe catabolism and a loss of lean body mass and also by a progressive decline of host defenses that impairs the immunological response.

A study was conducted in our hospital to assess various aspects of nutritional management of burns considering the ground realities of general hospital. The main aim of the study was to assess the use of early naso-gastric tube insertion, charting out daily calorie intake and to appropriately decrease the deficit with use of low cost feeds taking in to consideration the local dietary habits.

A total 138 cases were studied prospectively during April 2003 to March 2005, which were compared with 206 controls taken retrospectively from April 2000 to March 2003. The cases and controls were compared regarding the mortality rate, average days of stay and number of procedure done after dividing them in to various categories (%Burns) using the Z-test and student t-test.

The use of early naso-gastric tube insertion, charting out daily calorie intake and using low cost feeds consistent with local dietary habits lead to a significant decrease in average number of days and the number of procedures in 20-39% TBSA burns; and caused the significant decrease in mortality, average number of days and the number of procedure in 40-59%TBSA burns.