Prospective Study on Energy Expenditure in Patients With Severe Burns

Nutrition therapy is recognized as one of the most significant treatment aspects for burn patients. However, data were limited regarding the actual nutrition practices in patients with severe burn injury. This study aims to explore the measured energy expenditure (MEE) changes in severe burn patients and to evaluate the precision of commonly used predictive formulas for estimating predictive energy expenditure (PEE) in burn patients.

A prospective multicenter trial was conducted in the intensive care units in the hospitals enrolling the severely burned patients. Data on MEE and PEE were collected and analyzed.

Forty-three patients were enrolled from 3 hospitals. All the patients had severe burns. MEE was measured by metabolic cart, and the MEE on the seventh day after severe burns was as high as 65 kcal/kg, which was 267% of the basal metabolic rate. The presence of hypermetabolism was sustained throughout the 21-day afterburn and decreased gradually to 34 kcal/kg thereafter until 4 weeks after injury. Wound percentage after skin-grafting therapy, time course of burn injury, the existence of severe sepsis, and blood infection were significantly associated with higher MEE. Compared with PEE and MEE, Toronto formula could estimate patients' energy requirements with more accuracy; Curreri and Pennisi formula both significantly overestimated the patient's energy expenditure, whereas underestimation occurred with the Harris-Benedict formula.

Severe burn patients were hypermetabolic at the early stage and sustained this status over a long time. The Toronto formula was the unbiased method to predict energy expenditure.