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Nutrition support in burns--is there consistency in practice?
1McComb Foundation, Royal Perth Hospital, Burn Service of Western Australia.
Summary
Optimal nutrition support for burn patients requires high energy and protein, but practices vary. Research is inconclusive on specific formulas, parenteral nutrition, and immunonutrition, highlighting a need for standardized protocols.
Area of Science:
- Metabolic Response to Injury
- Nutritional Support in Critical Care
Background:
- Nutrition support is crucial in multidisciplinary burn management.
- Existing research presents inconsistencies in optimal feeding practices for burn patients.
- Burn injuries trigger significant hormonal and metabolic alterations impacting nutritional needs.
Purpose of the Study:
- To review and compare nutrition support practices in U.S. and Australian burn units.
- To assess practice consistency against current literature on burn nutrition.
- To identify areas of consensus and divergence in managing burn-related nutritional challenges.
Main Methods:
- Comparative review of nutrition support protocols across 13 burn units (6 U.S., 7 Australian).
- Analysis focused on hormonal/metabolic changes, energy/macronutrient requirements, specialized nutrition, optimization, and monitoring.
- Comparison of unit practices with established literature themes and options.
Main Results:
- General understanding of hypermetabolism and increased needs in burn patients was consistent.
- Inconsistencies observed in enteral formula composition (fat/carbohydrate), parenteral nutrition indications, immunonutrition use, and peri-operative feeding.
- Consistent techniques for energy estimation, though indirect calorimetry use could be expanded; high energy/protein enteral feeds recognized.
Conclusions:
- Variability in specific nutritional interventions reflects inconclusive research outcomes.
- Standardization is needed in areas like formula composition, parenteral nutrition, immunonutrition, and peri-operative feeding strategies.
- Awareness of nutritional marker limitations necessitates using multiple markers for effective patient monitoring.
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