Energy requirements for ICU burn patients in whom the total body surface area affected exceeds 50 percent: a practical equation

Energy requirement estimations are crucial for major burn patients' nutrition management. To find a practical equation for patients with burns over >50% of their total body surface area (TBSA)in an intensive care unit (ICU).

We conducted a six-week follow-up study of 21 ICU burn patients aged 17-28 years (second- and third-degree burns, TBSA: 50-90%) who were prescribed enteral nutritional support. The energy consumption ratio (ECR) was calculated by dividing the actual energy intake by the estimated energy requirement. Linear regression was used to evaluate the stability of each equation and the wound healing rate over time.

All included patients survived. On the fifth day, among the seven equations used, the ECRs of those dependent on the basal metabolic rate and body weight, namely, 35 kcal/kg BW, BMR × 1.5, and the Toronto formula, reached 74%, 71% and 69%, respectively. The ECRs for the abovementioned formulae achieved nutritional support goal sufficiency (0.9-1.1) from the third week. Additionally, with every 1% increase in the Energy Consumption Increase Rate per week, the wound healing rate increased from 0.35% to 0.80% per week. Both the 28 and 35 kcal/kg BW formulas had the smallest regression coefficients (0.46) over 6 weeks.

The 35 kcal/kg BW equation was suitable for young patients with burns over >50%TBSA in the ICU because it could be applied without equivocation, in time, and with acceptable wound healing rates. Additionally, it was well tolerated and contributed to stable management with feeding simplicity.