Nutritional management of the burn patient

Impact of Adding Protein Supplementation to Exercise Training on Lean Body Mass and Muscle Strength in Burn Patients

Protein catabolism is a common complication after burn injury leading to loss of muscle mass and a decrease in muscle strength. The present study aims to evaluate the efficacy of combining exercise training with protein supplementation on lean body mass and muscle strength in patients with severe burn. Sixty participants with severe burn > 30% of total body surface area were randomly distributed into 4 equal groups of 15 participants per group. Group A (Exercise & Protein) received oral protein supplementation (Inkospor X-TREME; 1.5-2.0 g/kg/day), exercise program and traditional burn care, group B (Protein) received oral protein supplementation and traditional burn care, group C (Exercise) received exercise program and traditional burn care, group D (Control) received traditional burn care. Lean body mass was measured using Dual-energy x-ray absorptiometry whereas muscle strength was measured using Biodex 3 Dynamometer System before treatment and 12 weeks after treatment. A significant increase in lean body mass was found in group A compared with that of group B, group C and group D post-treatment (p < 0.001). Also, a significant increase was recorded in peak torque of group A compared with that of group B, group C and group D post-treatment (p < 0.001). Exercise training can significantly increase lean body mass and peak torque. Protein supplementation can significantly increase lean body mass but cannot significantly increase muscle strength whereas, protein +exercise group has a great impact on lean body mass and muscle power than exercise group and protein group in burn patients.

The role of antioxidant micronutrients in the rate of recovery of burn patients: a systematic review

Burn injury can be detrimental to the health of individuals, meanwhile victims lose proteins and micronutrients in wound exudates. Victims also experience extensive protein catabolism. These make them prone to malnutrition. Burn patients also suffer a lot of emotional trauma that reduce nutrient intake. The aim of this paper was to review primary evidence on the effect of antioxidant micronutrients on the recovery rate of burn patients. Electronic databases such as PubMed, BioMed, and Cochrane were systematically searched between January 1, 2014, and January 30, 2014. Keywords include vitamin A, vitamin C, vitamin E, ascorbic acid, zinc, copper, selenium, tocopherol, carotenoids, dietary intake, supplementation, wound healing, infection, recovery rate, and burn patients. The systematic search was done to retrieve all published data from 1990 to 2013. A total of 518 journal articles were obtained, and after the removal of duplicates, reviews, commentaries, and studies with non-human subjects, 11 papers were accepted for review. The review considered only papers that were published, and there might be some unpublished data that may have been omitted. Generally, the wound healing time and infection rates were reduced by the administration of the antioxidant micronutrients. The review revealed that there was no such published work in developing countries and children were excluded from most studies. It was also stated clearly that there was no uniformity in burn management; hence, there is a need for more studies on burn management in various populations.

The effect of dietary intake of antioxidant micronutrients on burn wound healing: a study in a tertiary health institution in a developing country

Background

Burn injury results in emotional stress affecting dietary intake and antioxidant micronutrient intake, which is known to have effects on recovery outcomes. The study aimed to assess dietary intake of antioxidant micronutrients and recovery outcomes of burn patients.

Methods

Questionnaires were administered to 40 burn patients at Komfo Anokye Teaching Hospital (Ghana) from January 1, 2014 to May 30, 2014. The data taken include anthropometric measurements and dietary assessment. Their nutrient intakes were assessed with the Nutrient Analysis Template. The average intakes were compared to the recommended daily allowance. Assessment of recovery was based on records of wound healing assessments and infection rates from the health practitioners.

Results

A cross-sectional study of 40 patients revealed an average total burn surface area (TBSA) of 31.4 %, where 70.0, 35.0, 75.0, 52.5, 12.5 and 32.5 % patients were deficient in vitamins A, C and E, zinc, copper and selenium, respectively and adequate amounts of vitamin C intake were related with significantly better wound healing progress. Positive wound healing outcomes were observed for patients with adequate vitamins A and E and zinc intake. Less infection presented among patients with adequate amount of vitamins A and C and zinc, but this was not observed for patients with adequate vitamin E, copper and selenium.

Conclusions

Most burn patients did not meet their dietary requirements for antioxidant micronutrients and this was due to meals not tailored to suit individual requirements. Adequacy of the antioxidants especially vitamin C resulted in positive wound healing outcomes. Hence, there is need for planned well-balanced meals of high vitamin C.

Care for the patient with burns in the trauma rehabilitation setting

Caring for patients who are recovering from severe burns is not common in most rehabilitation settings. Nursing challenges include patients' physical and psychological changes and their high care demands. Harborview Medical Center, a regional level 1 burn and trauma center in Seattle, Washington, accepted these nursing challenges and developed a successful plan of care consistent with current evidence. This article describes Harborview Medical Center's trauma rehabilitation nursing experiences while caring for patients with burns. Our experiences may assist other rehabilitation units that serve patients with burns. Says one burn survivor: "Nurses make a huge difference in recovery, as they are there 24 hours a day. It is their touch, their caring, and their listening that aid the patient in his journey from fire victim to burn survivor."