[Metabolism and nutritional support after burn injury]

The nutritional status of the burn patient plays a major role in the ability to ward off an infectious challenge. The immune and inflammatory systems can be modulated by nutritional support, and therefore this article focuses on the nutritional support after burn injury. The hypermetabolic response that occurs after burn injury is characterized by a greater magnitude than that observed after any other form of trauma. The hypothesis that gut-or wound-derived bacterial translocation is one of the major triggers of the hypermetabolic response has attracted attention recently. The first set of goals of nutritional support is to prevent starvation and nutrient deficiencies, and the second is to provide the correct amount of nutrients prevent injury-related adverse physiologic complications. The route and timing of nutritional support are most important. Enteral alimentation appears to preserve the host immune function and to attenuate the hypermetabolic response by preserving the intestinal mucosal barrier. Immediate enteral feeding is superior to delayed enteral feeding, even though only limited amounts of enterally administered nutrients are absorbed during the early days postburn.