Measured and predicted calorie requirements of adults during recovery from severe burn trauma

Major burn trauma produces large elevations in metabolic energy expenditure (MEE) during acute care. However, overfeeding can occur and is detrimental to recovery. The formulae often used to estimate caloric support to meet MEE are based on body weight, predicted resting metabolic rate (RMR), body surface area, or the total body surface area burned (BSAB). These predictive equations originate from studies of less than or equal to 30 patients generally lacking measurements beyond the third week of convalescence. We report 565 measurements by indirect calorimetry for 122 adults between the burn day and day 149 postburn. A standardized protocol of nutritional support and early wound closure was followed. Predictions of MEE are compared in subcategories of BSAB (2-25%; 30-50%; 51-75%; and 76-98%). For major burns exceeding 30% BSAB, 2X the predicted RMR was consistently closest to the measured MEE, assuring adequate calorie provision while minimizing the risk of overfeeding.