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Kiani Z, Khorsand N, Beigi F, Askari G, Sharma M, Bagherniya M. Coenzyme Q10 supplementation in burn patients: a double-blind placebo-controlled randomized clinical trial. Trials 2024; 25:160. [PMID: 38431600 PMCID: PMC10908042 DOI: 10.1186/s13063-024-08006-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 02/22/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Burn injuries are important medical problems that, aside from skin damage, cause a systemic response including inflammation, oxidative stress, endocrine disorders, immune response, and hypermetabolic and catabolic responses which affect all the organs in the body. The aim of this study was to determine the effect of coenzyme Q10 (CoQ10) supplementation on inflammation, oxidative stress, and clinical outcomes in burn patients. METHODS In a double-blind placebo-controlled randomized clinical trial, 60 burn patients were randomly assigned to receive 100 mg CoQ10 three times a day (total 300 mg/day) or a placebo for 10 days. Inflammatory markers including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), oxidative stress markers including total antioxidant capacity (TAC), malondialdehyde (MDA) and superoxide dismutase (SOD) activity, fasting blood glucose (FBG), blood urea nitrogen (BUN), creatinine, white blood cells (WBC), and body temperature were assessed as primary outcomes and albumin, prothrombin time (PT), partial thromboplastin time (PTT), international normalized ratio (INR), other hematological parameters, blood pressure, O2 saturation, ICU duration, and 28-mortality rate were assessed as secondary outcomes. RESULTS Fifty-two participants completed the trial. CRP and ESR levels were not significantly different between CoQ10 and placebo groups at the end of the study (P = 0.550 and P = 0.306, respectively). No significant differences between groups were observed for TAC (P = 0.865), MDA (P = 0.692), and SOD activity (P = 0.633) as well. Administration of CoQ10 resulted in a significant increase in albumin levels compared to placebo (P = 0.031). There was no statistically significant difference between the two groups in other measured outcomes (P > 0.05). CONCLUSION Results showed that in patients with burn injury, CoQ10 administration had no effect on inflammatory markers and oxidative stress, although serum albumin levels were improved after supplementation. Further studies with albumin as the primary outcome are needed to confirm this finding.
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Affiliation(s)
- Zahra Kiani
- Nutrition and Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nadereh Khorsand
- Department of Internal Medicine, Imam Musa Kazem Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fahimeh Beigi
- Pharmaceutical Biotechnology Department, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Science, Isfahan, Iran
- Research and Development Unit, Imam Muss Kazim Hospital, Isfahan University of Medical Science, Isfahan, Iran
| | - Gholamreza Askari
- Nutrition and Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
- Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Manoj Sharma
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Mohammad Bagherniya
- Nutrition and Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
- Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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Greenhalgh DG, Hill DM, Burmeister DM, Gus EI, Cleland H, Padiglione A, Holden D, Huss F, Chew MS, Kubasiak JC, Burrell A, Manzanares W, Gómez MC, Yoshimura Y, Sjöberg F, Xie WG, Egipto P, Lavrentieva A, Jain A, Miranda-Altamirano A, Raby E, Aramendi I, Sen S, Chung KK, Alvarez RJQ, Han C, Matsushima A, Elmasry M, Liu Y, Donoso CS, Bolgiani A, Johnson LS, Vana LPM, de Romero RVD, Allorto N, Abesamis G, Luna VN, Gragnani A, González CB, Basilico H, Wood F, Jeng J, Li A, Singer M, Luo G, Palmieri T, Kahn S, Joe V, Cartotto R. Surviving Sepsis After Burn Campaign. Burns 2023; 49:1487-1524. [PMID: 37839919 DOI: 10.1016/j.burns.2023.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION The Surviving Sepsis Campaign was developed to improve outcomes for all patients with sepsis. Despite sepsis being the primary cause of death after thermal injury, burns have always been excluded from the Surviving Sepsis efforts. To improve sepsis outcomes in burn patients, an international group of burn experts developed the Surviving Sepsis After Burn Campaign (SSABC) as a testable guideline to improve burn sepsis outcomes. METHODS The International Society for Burn Injuries (ISBI) reached out to regional or national burn organizations to recommend members to participate in the program. Two members of the ISBI developed specific "patient/population, intervention, comparison and outcome" (PICO) questions that paralleled the 2021 Surviving Sepsis Campaign [1]. SSABC participants were asked to search the current literature and rate its quality for each topic. At the Congress of the ISBI, in Guadalajara, Mexico, August 28, 2022, a majority of the participants met to create "statements" based on the literature. The "summary statements" were then sent to all members for comment with the hope of developing an 80% consensus. After four reviews, a consensus statement for each topic was created or "no consensus" was reported. RESULTS The committee developed sixty statements within fourteen topics that provide guidance for the early treatment of sepsis in burn patients. These statements should be used to improve the care of sepsis in burn patients. The statements should not be considered as "static" comments but should rather be used as guidelines for future testing of the best treatments for sepsis in burn patients. They should be updated on a regular basis. CONCLUSION Members of the burn community from the around the world have developed the Surviving Sepsis After Burn Campaign guidelines with the goal of improving the outcome of sepsis in burn patients.
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Affiliation(s)
- David G Greenhalgh
- Department of Burns, Shriners Children's Northern California and Department of Surgery, University of California, Davis, Sacramento, CA, USA.
| | - David M Hill
- Department of Clinical Pharmacy & Translational Scre have been several studies that have evaluatedience, College of Pharmacy, University of Tennessee, Health Science Center; Memphis, TN, USA
| | - David M Burmeister
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Eduardo I Gus
- Division of Plastic & Reconstructive Surgery, The Hospital for Sick Children; Department of Surgery, University of Toronto, Toronto, Canada
| | - Heather Cleland
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Alex Padiglione
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Dane Holden
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Fredrik Huss
- Department of Surgical Sciences, Plastic Surgery, Uppsala University/Burn Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Michelle S Chew
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - John C Kubasiak
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Aidan Burrell
- Department of Epidemiology and Preventative Medicine, Monash University and Alfred Hospital, Intensive Care Research Center (ANZIC-RC), Melbourne, Australia
| | - William Manzanares
- Department of Critical Care Medicine, Universidad de la República (UdelaR), Montevideo, Uruguay
| | - María Chacón Gómez
- Division of Intensive Care and Critical Medicine, Centro Nacional de Investigacion y Atencion de Quemados (CENIAQ), National Rehabilitation Institute, LGII, Mexico
| | - Yuya Yoshimura
- Department of Emergency and Critical Care Medicine, Hachinohe City Hospital, Hachinohe, Japan
| | - Folke Sjöberg
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Wei-Guo Xie
- Institute of Burns, Tongren Hospital of Wuhan University (Wuhan Third Hospital), Wuhan, China
| | - Paula Egipto
- Centro Hospitalar e Universitário São João - Burn Unit, Porto, Portugal
| | | | | | | | - Ed Raby
- Infectious Diseases Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | | | - Soman Sen
- Department of Burns, Shriners Children's Northern California and Department of Surgery, University of California, Davis, Sacramento, CA, USA
| | - Kevin K Chung
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Chunmao Han
- Department of Burn and Wound Repair, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
| | - Asako Matsushima
- Department of Emergency and Critical Care, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Moustafa Elmasry
- Department of Hand, Plastic Surgery and Burns, Linköping University, Linköping, Sweden
| | - Yan Liu
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Carlos Segovia Donoso
- Intensive Care Unit for Major Burns, Mutual Security Clinical Hospital, Santiago, Chile
| | - Alberto Bolgiani
- Department of Surgery, Deutsches Hospital, Buenos Aires, Argentina
| | - Laura S Johnson
- Department of Surgery, Emory University School of Medicine and Grady Health System, Georgia
| | - Luiz Philipe Molina Vana
- Disciplina de Cirurgia Plastica da Escola Paulista de Medicina da Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Nikki Allorto
- Grey's Hospital Pietermaritzburg Metropolitan Burn Service, University of KwaZulu Natal, Pietermaritzburg, South Africa
| | - Gerald Abesamis
- Alfredo T. Ramirez Burn Center, Division of Burns, Department of Surgery, University of Philippines Manila - Philippine General Hospital, Manila, Philippines
| | - Virginia Nuñez Luna
- Unidad Michou y Mau Xochimilco for Burnt Children, Secretaria Salud Ciudad de México, Mexico
| | - Alfredo Gragnani
- Disciplina de Cirurgia Plastica da Escola Paulista de Medicina da Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Carolina Bonilla González
- Department of Pediatrics and Intensive Care, Pediatric Burn Unit, Clinical Studies and Clinical Epidemiology Division, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Hugo Basilico
- Intensive Care Area - Burn Unit - Pediatric Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Fiona Wood
- Department of Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - James Jeng
- Department of Surgery, University of California, Irvine, CA, USA
| | - Andrew Li
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Mervyn Singer
- Department of Intensive Care Medicine, University College London, London, United Kingdom
| | - Gaoxing Luo
- Institute of Burn Research, Southwest Hospital, Army (Third Military) Medical University, Chongqing, China
| | - Tina Palmieri
- Department of Burns, Shriners Children's Northern California and Department of Surgery, University of California, Davis, Sacramento, CA, USA
| | - Steven Kahn
- The South Carolina Burn Center, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Victor Joe
- Department of Surgery, University of California, Irvine, CA, USA
| | - Robert Cartotto
- Department of Surgery, Sunnybrook Medical Center, Toronto, Ontario, Canada
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Kuvvet Yoldaş T, Atalay A, Demirağ K, Uyar M, Çankayalı İ. Changes in Energy Expenditure Determined by Indirect Calorimetry in Severe Burn Patients During the Acute Phase. Cureus 2023; 15:e46705. [PMID: 37818121 PMCID: PMC10560960 DOI: 10.7759/cureus.46705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Severe burn injuries are a major health problem globally. A profound and prolonged hypermetabolic response develops in severe burn injuries and it is crucial to monitor the patients' energy requirements in order to meet them adequately. The aim of the present study was to examine the energy changes during the acute phase using the indirect calorimetry (IC) method in severe burn patients. METHODS The study included 15 severe burn patients. Patients with FiO2 >60%, tube thoracostomy, closed underwater drain (CUWD) and air leakage were excluded from the study. Patients' demographic data, burn percentages, burn types, duration of stay in intensive care, mortality and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were recorded. Indirect calorimeter measurements were taken once from the patients upon their first arrival and during the following four weeks. Resting energy expenditure (REE), basal metabolic rate (BMR), oxygen consumption (VO₂), carbon dioxide production (VCO₂), body temperatures, presence of sepsis, Sequential Organ Failure Assessment (SOFA) and Modified Nutrition Risk in Critically Ill (mNUTRIC) scores were recorded. The data were analysed using SPSS 24 and p-values <0.05 were considered statistically significant. RESULTS In the study, 13 (86.67%) of the patients were male. Patients' mean age was 45.27±18.16 years, and mean BMI 25.99±4.22 kg/m2. Five patients (33.33%) had chronic diseases. The average burn percentage was 45%, with 7 (46.67%) patients having a burn percentage of ≤40%, while 8 (53.33%) had a burn percentage of >40%. A total of 14 (93.33%) had flame burns; 3 (20.00%) patients deceased, and 12 (80.00%) were discharged. The mean APACHE II score was 11.53±6.83. The measured mean values of REE, VO₂, VCO₂ and fever were seen to be the highest in the first week after admission and decreases were observed in the subsequent weeks. SOFA score averages were the highest at admission, and decreased in the following weeks. CONCLUSION Severe burn patients were observed to go through the hypermetabolic process in the acute phase and their energy requirements were high particularly in the first week. It was concluded that regular IC monitoring can be beneficial to fully meet the energy requirements of severe burn patients due to the prolonged hypermetabolic process.
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Affiliation(s)
- Tuba Kuvvet Yoldaş
- Clinic of Anesthesiology and Reanimation, University of Health Sciences, Tepecik Education and Research Hospital, İzmir, TUR
| | - Alev Atalay
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ege University, İzmir, TUR
| | - Kubilay Demirağ
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ege University, İzmir, TUR
| | - Mehmet Uyar
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ege University, İzmir, TUR
| | - İlkin Çankayalı
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ege University, İzmir, TUR
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Isci G. Determination of nitrate and nitrite levels in enteral nutrition formula marketed in Turkey: A risk assessment study. Food Chem Toxicol 2023; 177:113832. [PMID: 37225034 DOI: 10.1016/j.fct.2023.113832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/06/2023] [Accepted: 05/11/2023] [Indexed: 05/26/2023]
Abstract
In this study, the nitrite and nitrate levels of 37 enteral nutrition formulas of three different international brands marketed in Turkey were evaluated using high-performance liquid chromatography with diode-array detection (HPLC-DAD). Also, risk assessment of non-carcinogenic was calculated by models including hazard quotient (HQ) and hazard index (HI) in the deterministic model. Enteral nutrition formula consumption amounts obtained from individuals between the ages of 6-36 volunteers voluntarily participated in the study, and health risk assessments were calculated. The range of concentration of nitrate levels in enteral formulas of brands (B1, B2, and B3) was determined as 11.08 ± 2.88 (2.90-15.79), 11.64 ± 3.39 (2.92-22.93), and 10.66 ± 3.46 (4.92-15.37) mg/kg, respectively. The range of concentration of nitrite levels in enteral formulas of brands (B1, B2, and B3) was determined as 4.18 ± 1.10 (1.86-5.82), 3.70 ± 1.25 (1.29-5.26), and 3.38 ± 1.67 (2.00-5.29) mg/kg, respectively. The mean nitrate and nitrite levels of exposure from consumption of enteral nutrition formulas were determined as 0.14 and 0.11, 0.06 and 0.07 mg/kg bw/day for females and males, respectively. Nitrate and nitrite exposure levels calculated in the study did not exceed the ADI threshold values given by JECFA. The average HQ value calculated for the exposure of nitrate to male and female individuals was less than 1. Still, the P95 values calculated for nitrate were greater than 1.00 except for female and male individuals (24-36 ages). The HI value was found to be greater than 1.00 in all age groups of both genders. The presence of nitrites and nitrates in enteral nutrition formulas may lead to health problems in sensitive groups.
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Affiliation(s)
- Gursel Isci
- Department of Nutrition and Dietetics, Agri Ibrahim Cecen University, 04100, Agri, Turkey.
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Żwierełło W, Styburski D, Maruszewska A, Piorun K, Skórka-Majewicz M, Czerwińska M, Maciejewska D, Baranowska-Bosiacka I, Krajewski A, Gutowska I. Bioelements in the treatment of burn injuries - The complex review of metabolism and supplementation (copper, selenium, zinc, iron, manganese, chromium and magnesium). J Trace Elem Med Biol 2020; 62:126616. [PMID: 32739827 DOI: 10.1016/j.jtemb.2020.126616] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/03/2020] [Accepted: 07/06/2020] [Indexed: 12/20/2022]
Abstract
Appropriate nutrition is a key component of burn treatment and should be regarded as an integral part of the therapeutic process in burn patients. A nutritional intervention plan should not only allow for adequate quantities of energy and protein but also carefully consider the supply of macro- and micronutrients. As a result of the severe inflammatory response, oxidative stress, and hypermetabolic state, accompanied by often extensive exudation in burn patients, there is a considerable loss of macro- and micronutrients, including essential trace elements. This leads to certain complications, involving e.g. more frequent infections and impaired wound healing. Our current body of knowledge is still insufficient, and the studies carried out to date focus for the most part on the imbalances in trace elements, such as copper (Cu), selenium (Se), and zinc (Zn). Nevertheless, there are many other trace elements involved in immune functions, regulating gene expression or antioxidant defense, and many of those have not been properly investigated in a clinical setting. Due to the insufficient amount of unambiguous literature data and relatively few, often dated, studies carried out with small patient groups, further evaluation of macro- and microelements in burn patients seems indispensable, e.g. to bring up to date local nutritional protocols.
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Affiliation(s)
- Wojciech Żwierełło
- Department of Medical Chemistry, Pomeranian Medical University in Szczecin, Powstancow Wlkp 72street, 70-111 Szczecin, Poland
| | - Daniel Styburski
- Department of Medical Chemistry, Pomeranian Medical University in Szczecin, Powstancow Wlkp 72street, 70-111 Szczecin, Poland
| | - Agnieszka Maruszewska
- Institute of Biology, University of Szczecin, Felczaka 3c St, 71-412, Szczecin, Poland
| | - Krzysztof Piorun
- West Pomeranian Center of Treating Severe Burns and Plastic Sugery, Niechorska 27 Street, 72-300, Gryfice, Poland
| | - Marta Skórka-Majewicz
- Department of Medical Chemistry, Pomeranian Medical University in Szczecin, Powstancow Wlkp 72street, 70-111 Szczecin, Poland
| | - Maja Czerwińska
- Department of Human Nutrition and Metabolomic, Pomeranian Medical University in Szczecin, Powstancow Wlkp 72street, 70-111, Szczecin, Poland
| | - Dominika Maciejewska
- Department of Human Nutrition and Metabolomic, Pomeranian Medical University in Szczecin, Powstancow Wlkp 72street, 70-111, Szczecin, Poland
| | - Irena Baranowska-Bosiacka
- Department of Biochemistry, Pomeranian Medical University in Szczecin, Powstancow Wlkp 72street, 70-111, Szczecin, Poland
| | - Andrzej Krajewski
- West Pomeranian Center of Treating Severe Burns and Plastic Sugery, Niechorska 27 Street, 72-300, Gryfice, Poland
| | - Izabela Gutowska
- Department of Medical Chemistry, Pomeranian Medical University in Szczecin, Powstancow Wlkp 72street, 70-111 Szczecin, Poland.
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Geometric framework reveals that a moderate protein, high carbohydrate intake is optimal for severe burn injury in mice. Br J Nutr 2020; 123:1056-1067. [PMID: 31983360 DOI: 10.1017/s0007114520000276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Nutritional therapy is a cornerstone of burns management. The optimal macronutrient intake for wound healing after burn injury has not been identified, although high-energy, high-protein diets are favoured. The present study aimed to identify the optimal macronutrient intake for burn wound healing. The geometric framework (GF) was used to analyse wound healing after a 10 % total body surface area contact burn in mice ad libitum fed one of the eleven high-energy diets, varying in macronutrient composition with protein (P5-60 %), carbohydrate (C20-75 %) and fat (F20-75 %). In the GF study, the optimal ratio for wound healing was identified as a moderate-protein, high-carbohydrate diet with a protein:carbohydrate:fat (P:C:F) ratio of 1:4:2. High carbohydrate intake was associated with lower mortality, improved body weight and a beneficial pattern of body fat reserves. Protein intake was essential to prevent weight loss and mortality, but a protein intake target of about 7 kJ/d (about 15 % of energy intake) was identified, above which no further benefit was gained. High protein intake was associated with delayed wound healing and increased liver and spleen weight. As the GF study demonstrated that an initial very high protein intake prevented mortality, a very high-protein, moderate-carbohydrate diet (P40:C42:F18) was specifically designed. The dynamic diet study was also designed to combine and validate the benefits of an initial very high protein intake for mortality, and subsequent moderate protein, high carbohydrate intake for optimal wound healing. The dynamic feeding experiment showed switching from an initial very high-protein diet to the optimal moderate-protein, high-carbohydrate diet accelerated wound healing whilst preventing mortality and liver enlargement.
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Houschyar M, Borrelli MR, Tapking C, Maan ZN, Rein S, Chelliah MP, Sheckter CC, Duscher D, Branski LK, Wallner C, Behr B, Lehnhardt M, Siemers F, Houschyar KS. Burns: modified metabolism and the nuances of nutrition therapy. J Wound Care 2020; 29:184-191. [PMID: 32160092 DOI: 10.12968/jowc.2020.29.3.184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To review the effects of burn injury on nutritional requirements and how this can best be supported in a healthcare setting. METHOD A literature search for articles discussing nutrition and/or metabolism following burn injury was carried out. PubMed, Embase and Web of Science databases were searched using the key search terms 'nutrition' OR 'metabolism' AND 'burn injury' OR 'burns'. There was no limitation on the year of publication. RESULTS A total of nine articles met the inclusion criteria, the contents of which are discussed in this manuscript. CONCLUSION Thermal injury elicits the greatest metabolic response, among all traumatic events, in critically ill patients. In order to ensure burn patients can meet the demands of their increased metabolic rate and energy expenditure, adequate nutritional support is essential. Burn injury results in a unique pathophysiology, involving alterations in endocrine, inflammatory, metabolic and immune pathways and nutritional support needed during the inpatient stay varies depending on burn severity and idiosyncratic patient physiologic parameters.
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Affiliation(s)
- Madeline Houschyar
- 1 Institute of Agricultural and Nutrition Sciences, Martin Luther University of Halle-Wittenberg, Germany
| | - Mimi R Borrelli
- 2 Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, US
| | - Christian Tapking
- 3 Department of Surgery, Shriners Hospital for Children-Galveston, University of Texas Medical Branch, Galveston, US.,4 Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany
| | - Zeshaan N Maan
- 2 Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, US
| | - Susanne Rein
- 5 Department of Plastic and Hand Surgery, Burn Center, Sankt Georg Hospital, Leipzig, Germany
| | - Malcolm P Chelliah
- 2 Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, US
| | - Clifford C Sheckter
- 2 Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, US
| | - Dominik Duscher
- 2 Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, US
| | - Ludwik K Branski
- 3 Department of Surgery, Shriners Hospital for Children-Galveston, University of Texas Medical Branch, Galveston, US
| | - Christoph Wallner
- 7 Department of Plastic Surgery and Burn Centre, BG University Hospital Bergmannsheil GmbH, Ruhr University Bochum, Bochum, Germany
| | - Bjö Behr
- 7 Department of Plastic Surgery and Burn Centre, BG University Hospital Bergmannsheil GmbH, Ruhr University Bochum, Bochum, Germany
| | - Marcus Lehnhardt
- 7 Department of Plastic Surgery and Burn Centre, BG University Hospital Bergmannsheil GmbH, Ruhr University Bochum, Bochum, Germany
| | - Frank Siemers
- 8 Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost Halle, Germany
| | - Khosrow S Houschyar
- 7 Department of Plastic Surgery and Burn Centre, BG University Hospital Bergmannsheil GmbH, Ruhr University Bochum, Bochum, Germany
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Cork M, McArthur A, Douglas H, Wood F. Effectiveness and safety of perioperative enteral feeding in patients with burn injuries: a systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2019; 17:1607-1615. [PMID: 30889069 DOI: 10.11124/jbisrir-2017-004013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review is to determine whether perioperative enteral feeding improves outcomes in patients with burns. INTRODUCTION Literature has identified many positive benefits of nutrition support for patients with burn injuries, including preservation of lean body mass, improved wound healing, reduced gastrointestinal permeability and enhanced immunity. Fasting for surgery can undermine the nutritional care of these patients by causing nutrient deficits. It may also negatively affect patient well-being and insulin resistance. Perioperative fasting is intended to protect patients from regurgitation and pulmonary aspiration. This research aims to investigate whether perioperative feeding impacts outcomes in patients with burn injuries. INCLUSION CRITERIA This systematic review will consider studies whose participants have a burn injury. The intervention is perioperative enteral feeding (either intragastric or post-pyloric). Patients who received perioperative feeding will be compared with patients who had enteral nutrition withheld during the perioperative period. A number of outcome measures will be investigated, including mortality, length of stay, wound infection, wound healing rate and aspiration pneumonia. METHODS The key databases searched will be PubMed, CINAHL, Embase, Web of Science and Cochrane Central Register of Controlled Trials and Scopus. Only studies published in English will be considered. There will be no date limits. Full texts of selected studies will be retrieved and assessed against inclusion criteria. Studies that do not meet the inclusion criteria will be excluded, with reasons provided. Data synthesis will be pooled in a statistical meta-analysis. Subgroup analysis will be conducted where possible. Where statistical pooling is not possible, the findings will be presented in narrative form. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42018119034.
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Affiliation(s)
- Michelle Cork
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Australia
| | - Alexa McArthur
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Helen Douglas
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Australia
| | - Fiona Wood
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Australia
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Grammatikopoulou MG, Theodoridis X, Gkiouras K, Stamouli EM, Mavrantoni ME, Dardavessis T, Bogdanos DP. AGREEing on Guidelines for Nutrition Management of Adult Severe Burn Patients. JPEN J Parenter Enteral Nutr 2018; 43:490-496. [PMID: 30320409 DOI: 10.1002/jpen.1452] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 09/11/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Severe burns are associated with a plethora of profound metabolic, immunologic, and physiologic responses, demanding prompt and adequate management. The objective of the present study was to review, compare, and critically appraise medical nutrition therapy guidelines for adult patients with severe burns, and produce salient points for the future update of relevant guidelines. METHODS A total of 8 clinical practice guidelines developed by the American Burn Association (ABA), the European Burn Association (EBA), the European Society for Parenteral and Enteral Nutrition (ESPEN), the Midlands National Health Service, the Society for Critical Care Medicine (SCCM)/American Society for Parenteral and Enteral Nutrition (ASPEN), the Spanish Society of Intensive Care Medicine and Coronary Units and Spanish Society of Parenteral and Enteral Nutrition, the Indian Association for Parenteral and Enteral Nutrition (IAPEN), and the International Society for Burn Injury regarding medical nutrition therapy in burn patients was independently reviewed by a team of 4 multidisciplinary researchers using the Appraisal of Guidelines for Research & Evaluation (AGREE II) instrument. RESULTS From the appraised guidelines, the SCCM/ASPEN guidelines received the greatest scoring in the majority of AGREE domains compared with ABA, EBA, and IAPEN, which obtained the lowest scores. On the other hand, the ESPEN guidelines provided the majority of information concerning nutrition support and medical nutrition therapy. CONCLUSION Our study identified gaps in most nutrition guidelines and emphasized methodologic issues that could improve the quality of future guidelines concerning nutrition support among adult severe burn patients.
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Affiliation(s)
- Maria G Grammatikopoulou
- Department of Nutrition and Dietetics, Alexander Technological Educational Institute, Thessaloniki, Greece.,Department of Medicine, Faculty of Health Sciences, University of Thessaly, Larissa, Greece.,Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Xenophon Theodoridis
- Department of Medicine, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
| | - Konstantinos Gkiouras
- Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni-Maria Stamouli
- Department of Pharmacy, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Myrsini-Eleni Mavrantoni
- Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodore Dardavessis
- Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios P Bogdanos
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.,Division of Transplantation, Immunology and Mucosal Biology, MRC Centre for Transplantation, King's College London Medical School, London, UK
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