The effect of burn wound size on resting energy expenditure

Numerous formulas have been used to estimate the calorie requirements of hypermetabolic burned patients. With the recent development of instrumentation for indirect calorimetric measurements, questions have been raised concerning the validity and accuracy of the early equations. Because metabolic rate decreases during the course of wound healing, we attempted to determine the magnitude of hypermetabolism and the accuracy of the Curreri formula in patients with various wound sizes. Twenty-eight patients with a mean initial burn size of 29% body surface area (BSA) had measurements of resting energy expenditure (REE) at regular intervals during their postburn course. Concomitantly, basal energy expenditure (BEE) was calculated from the Harris-Benedict equation; and the predicted energy needs were calculated using the Curreri formula adjusted for current wound size (ACEE). Three significantly different burn size (%BSA) groups were identified: Group 1, 1-10%; Group 2, 11-30%; and Group 3, 31-60% BSA. The measured REE was 27, 35, and 50% greater than the BEE in Groups 1, 2, and 3, respectively (p less than 0.001). The ACEE underestimated REE by 7% in Group 1, and overestimated REE by 13 and 35% in Groups 2 and 3, respectively (p less than 0.001). Resting energy expenditure should be measured at regular intervals in individuals with open burn wounds greater than 10% BSA in order to adjust nutritional support appropriately.