Adequacy of a modular tube feeding diet for burned patients

Recent research on nutrition needs following thermal injury suggests that carbohydrate and caloric excess must be avoided while an attempt is made to meet relatively large protein requirements. The nutrition regimen in this investigation for adult and pediatric burned patients provides calories at twice the predicted basal metabolic rate, protein at 2.5 gm/kg/day, and carbohydrate at 5 mg/kg/minute. Lipids are provided to meet the caloric deficit after protein and carbohydrate administration. Even though such nutrients are readily provided parenterally, the high carbohydrate content of standard tube feedings makes it difficult to provide adequate protein without excess of carbohydrate and calories. As a result, a modular tube feeding, containing appropriate macro- and micronutrients and tailored to the individual patient, has been used in our burn units. The adequacy of the diet was assessed by the effect on nitrogen balance, weight change, selected serum indexes of visceral metabolism, and compliance with planned dietary goals. Patients remained in positive nitrogen balance more than 80% of the time while the modular diet was used in conjunction with other modes of therapy (parenteral and/or oral). More than 90% of the time, positive balance was achieved when the modular diet was used as the sole source of nutrition. Compliance with the caloric goal and physicians' diet orders for the modular diet exceeded, on average, the 80% level, which has previously been the established lower limit. The results in this study suggest that the modular diet is an appropriate method of nutrition support.