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Published on: February 23, 2024
Body Composition Changes in Severely Burned Children During ICU Hospitalization
Janos Cambiaso-Daniel1,2,3, Ioannis Malagaris2,4, Eric Rivas1,2,5
1Department of Surgery, University of Texas Medical Branch, Galveston, TX.
Insights
Severe burn injury hospitalization causes significant lean mass loss, particularly in children's upper extremities. Early upper limb mobilization is crucial for recovery and function restoration.
Area of Science:
- Pediatric critical care medicine
- Burn injury research
- Body composition analysis
Background:
- Prolonged intensive care unit (ICU) stays post-burn injury lead to physical inactivity and muscle weakness.
- The specific distribution of body composition changes across different anatomical regions in pediatric burn patients is not well understood.
Purpose of the Study:
- To evaluate the regional body composition changes in severely burned children during ICU hospitalization.
- To identify specific areas of muscle and fat mass alteration.
Main Methods:
- Retrospective chart review of 24 severely burned children admitted between 2000 and 2015.
- Dual-energy x-ray absorptiometry (DXA) was used to assess bone mineral content, bone density, fat mass, and lean mass at admission and before discharge.
- Analysis focused on whole-body changes and differential changes between upper and lower extremities, without anabolic interventions.
Main Results:
- Patients experienced an average whole-body lean mass loss of 3% (p < 0.001).
- Upper extremities showed a significantly greater lean mass loss (17%) compared to lower extremities (7%) (p < 0.001).
- A significant whole-body increase in fat mass was observed, with greater accumulation in the truncal region and lower limbs.
Conclusions:
- ICU hospitalization following severe burns is associated with disproportionately greater lean mass loss in the upper limbs of children.
- Early mobilization programs should prioritize upper limb exercises to mitigate muscle loss and restore function.
Objectives:
Prolonged hospitalization due to burn injury results in physical inactivity and muscle weakness. However, how these changes are distributed among body parts is unknown. The aim of this study was to evaluate the degree of body composition changes in different anatomical regions during ICU hospitalization.
Design:
Retrospective chart review.
Setting:
Children's burn hospital.
Patients:
Twenty-four severely burned children admitted to our institution between 2000 and 2015.
Interventions:
All patients underwent a dual-energy x-ray absorptiometry within 2 weeks after injury and 2 weeks before discharge to determine body composition changes. No subject underwent anabolic intervention. We analyzed changes of bone mineral content, bone mineral density, total fat mass, total mass, and total lean mass of the entire body and specifically analyzed the changes between the upper and lower limbs.
Measurements And Main Results:
In the 24 patients, age was 10 ± 5 years, total body surface area burned was 59% ± 17%, time between dual-energy x-ray absorptiometries was 34 ± 21 days, and length of stay was 39 ± 24 days. We found a significant (p < 0.001) average loss of 3% of lean mass in the whole body; this loss was significantly greater (p < 0.001) in the upper extremities (17%) than in the lower extremities (7%). We also observed a remodeling of the fat compartments, with a significant whole-body increase in fat mass (p < 0.001) that was greater in the truncal region (p < 0.0001) and in the lower limbs (p < 0.05).
Conclusions:
ICU hospitalization is associated with greater lean mass loss in the upper limbs of burned children. Mobilization programs should include early mobilization of upper limbs to restore upper extremity function.
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