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Dimander J, Andersson A, Lindqvist C, Miclescu A, Huss F. Documented nutritional therapy in relation to nutritional guidelines post burn injury - a retrospective observational study. Clin Nutr ESPEN 2023; 56:222-229. [PMID: 37344077 DOI: 10.1016/j.clnesp.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/04/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND & AIMS Intensive nutritional therapy is an essential component of burn care. Regarding post-minor burn injuries, the literature is lacking. The aim of this study was to evaluate documented nutritional therapy in relation to international guidelines after both minor and major burn injuries. The secondary aim of this study was to evaluate the adequacy of energy and protein intake compared to individual nutritional goals post-burn injury. METHODS A retrospective observational single-centre study including patients admitted between 2017 and 2019 at a burn centre in Sweden was performed. The patients included in the study were ≥18 years old and in need of hospital care for ≥72 h post-burn injury. Information about patients' demographics, nutritional therapy, and clinical characteristics of burn injury was collected. The patients were divided according to total body surface area burnt (TBSA %) into minor burn injuries (TBSA <20%) and major burn injuries (TBSA ≥20%). Descriptive statistics were used to analyse data. Adherence to guidelines was established by comparing 24 nutritional therapy recommendations to documented treatment. If documented nutritional treatment were in accordance with guidelines, adherence was considered high (≥80%), moderate (60-79.9%) or low (<59.9%). RESULTS One hundred thirty-four patients were included, 90 patients with minor burn injuries and 44 patients with major burn injuries. Documented adherence to the nutritional guideline was overall low. After minor burn injury, 8% (2/24) of nutritional therapy recommendations had a high adherence (fat intake <35% of total energy intake and enteral nutrition as prioritized feeding route), 17% (4/24) a moderate adherence, and 75% (18/24) a low adherence. In patients treated after a major burn injury, there were two recommendations with documented high adherence (Vitamin C and Zinc); 25% (6/24) had moderate adherence, and 67% (16/24) had low adherence. In addition, quite a large amount of missing data was found. Adequacy of documented nutritional intake, compared to the individual documented goal, was 78% (±23%) for energy and 66% (±22%) for protein after minor burn injury. After major burn injury, the adequacy was 89% (±21%) for energy and 78% (±19%) for protein, respectively. CONCLUSIONS This study revealed low adherence to nutritional guidelines in patients treated for minor and major burn injuries. Compared to major burn injuries, lower documented adequacy for both energy and proteins was found in minor burn injuries. Given the disparity between guidelines and documented nutritional therapy, and the lack of specific guidelines for minor burn injuries, there could be a considerable risk of inadequate nutritional therapy post-burn injury.
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Affiliation(s)
- Josefin Dimander
- Department of Surgical Sciences, Plastic Surgery, Uppsala University, 751 85, Uppsala, Sweden.
| | - Agneta Andersson
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, 751 22, Uppsala, Sweden.
| | - Catarina Lindqvist
- Department of Medicine Huddinge, Karolinska Institutet, 141 52, Stockholm, Sweden.
| | - Adriana Miclescu
- Multidisciplinary Pain Centre, Department of Surgical Sciences, Uppsala University, 751 85, Uppsala, Sweden.
| | - Fredrik Huss
- Department of Surgical Sciences, Plastic Surgery, Uppsala University, 751 85, Uppsala, Sweden
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Kurmis R, Nicholls C, Singer Y, Edgar DW, Wood FM, Gabbe BJ, Tracy LM. An investigation of early enteral nutrition provision in major burn patients in Australia and New Zealand. Nutr Diet 2022; 79:582-589. [PMID: 35765237 PMCID: PMC9796319 DOI: 10.1111/1747-0080.12746] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/04/2022] [Accepted: 05/11/2022] [Indexed: 01/01/2023]
Abstract
AIMS Early enteral nutrition (provided within 24 h of admission) is the optimal form of nutritional support for major burn injuries. The aim of this study was to (i) audit early enteral nutrition practices, (ii) identify characteristics of patients who received early enteral nutrition, and (iii) investigate whether early enteral nutrition was associated with in-hospital outcomes. METHODS An analysis of prospectively collected data from the Burns Registry of Australia and New Zealand was conducted. Specifically, this study focused on major burns patients (defined as burns affecting more than 20% and 15% total body surface area for adult paediatric patients, respectively) admitted to a specialist burn service between 1 July 2016 and 30 June 2019. RESULTS Data from 474 major burns patients (88 paediatric patients) revealed 69% received early enteral nutrition. Paediatric patients who received early enteral nutrition were younger than their counterparts who did not receive the same support (p = 0.04). Adult patients who received early enteral nutrition sustained larger burns (p < 0.001). Early enteral nutrition was not associated with in-hospital mortality following major burn injury in adult patients in either unadjusted (p = 0.77) or confounder-adjusted (p = 0.69) analyses. CONCLUSIONS Approximately two-thirds of patients with major burn injuries received early enteral nutrition. Early enteral nutrition was not associated with in-hospital mortality following major burn injury. Further research should focus on modifiable reasons why major burns patients do not receive enteral nutrition within 24 h of admission.
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Affiliation(s)
- Rochelle Kurmis
- Adult Burns ServiceRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Caroline Nicholls
- Department of Nutrition and DieteticsConcord Repatriation General HospitalConcordNew South WalesAustralia
| | - Yvonne Singer
- Victorian Adult Burns ServiceAlfred HospitalMelbourneVictoriaAustralia
| | - Dale W. Edgar
- State Adult Burn UnitFiona Stanley HospitalMurdochWestern AustraliaAustralia,Burn Injury Research NodeThe University of Notre DameFremantleWestern AustraliaAustralia,Burn Injury Research UnitUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Fiona M. Wood
- State Adult Burn UnitFiona Stanley HospitalMurdochWestern AustraliaAustralia,Burn Injury Research UnitUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Belinda J. Gabbe
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia,Health Data Research UK, Swansea University Medical SchoolSwansea UniversitySwanseaUK
| | - Lincoln M. Tracy
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
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Effects of Different Ratios of Carbohydrate-Fat in Enteral Nutrition on Metabolic Pattern and Organ Damage in Burned Rats. Nutrients 2022; 14:nu14173653. [PMID: 36079913 PMCID: PMC9460118 DOI: 10.3390/nu14173653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/21/2022] Open
Abstract
(1) Background: Nutritional support is one of the most important cornerstones in the management of patients with severe burns, but the carbohydrate-to-fat ratios in burn nutrition therapy remain highly controversial. In this study, we aimed to discuss the effects of different ratios of carbohydrate–fat through enteral nutrition on the metabolic changes and organ damage in burned rats. (2) Methods: Twenty-four burned rats were randomly divided into 5%, 10%, 20% and 30% fat nutritional groups. REE and body weight were measured individually for each rat daily. Then, 75% of REE was given in the first week after burns, and the full dose was given in the second week. Glucose tolerance of the rats was measured on days 1, 3, 7, 10 and 14. Blood biochemistry analysis and organ damage analysis were performed after 7 and 14 days of nutritional therapy, and nuclear magnetic resonance (NMR) and insulin content analysis were performed after 14 days. (3) Results: NMR spectra showed significant differences of glucose, lipid and amino acid metabolic pathways. The energy expenditure increased, and body weight decreased significantly after burn injury, with larger change in the 20%, 5% and 30% fat groups, and minimal change in the 10% fat group. The obvious changes in the level of plasma protein, glucose, lipids and insulin, as well as the organ damage, were in the 30%, 20% and 5% fat groups. In relative terms, the 10% fat group showed the least variation and was closest to normal group. (4) Conclusion: Lower fat intake is beneficial to maintaining metabolic stability and lessening organ damage after burns, but percentage of fat supply should not be less than 10% in burned rats.
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Feng H, Pan H, Yao W, Mei C. Analysis of Resting Energy Consumption and Its Influencing Factors in Stroke Patients with Severe Neurological Diseases: A Retrospective Clinical Study. Neuroimmunomodulation 2022; 29:460-467. [PMID: 35613544 DOI: 10.1159/000524719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 04/20/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND This study aimed to observe the changes of resting energy metabolism in patients with severe neurological diseases, and to explore the effects of tracheostomy status, stroke severity, and complications on resting energy expenditure (REE) and respiratory quotient (RQ). METHODS A retrospective study was conducted in 105 patients with neurological rehabilitation who were hospitalized in the Rehabilitation Department of the Affiliated Jiangning Hospital of Nanjing Medical University from August 2018 to October 2021. REE was measured by Italian Cosmed k4b2 indirectly, and white blood cell count and C-reactive protein (CRP) were collected. RESULTS Among the 105 patients, there were 18 cases of mild stroke, 45 cases of moderate stroke, and 42 cases of severe stroke. The difference between predicted REE and actual REE among different degrees of stroke patients was statistically significant (p < 0.05); there was no significant difference in RQ values among different degrees of stroke patients (p > 0.05). Hemoglobin, albumin, and body mass index were significantly and positively correlated with predicted REE and actual REE, while CRP was significantly negatively correlated with predicted REE and actual REE. There was no significant difference in predicted REE, actual REE, and RQ between renal insufficiency, type 2 diabetes mellitus, and chronic obstructive pulmonary disease (p > 0.05). The CRP level could affect the REE of stroke patients. CONCLUSION Metabolic vehicle assay has a certain clinical value in accurately evaluating the metabolic needs and feeding level of patients.
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Affiliation(s)
- Hui Feng
- Department of Rehabilitation, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Huaping Pan
- Department of Rehabilitation, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Yao
- Department of Rehabilitation, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Chengyao Mei
- Department of Rehabilitation, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
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Alfonso Ortiz L, Jiang X, Turgeon AF, Wibbenmeyer L, Pollack J, Mandell SP, Day AG, Heyland DK. Validation of the modified NUTrition Risk Score (mNUTRIC) in mechanically ventilated, severe burn patients: A prospective multinational cohort study. Burns 2021; 47:1739-1747. [PMID: 34119373 DOI: 10.1016/j.burns.2021.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Whether nutrition therapy benefits all burn victims equally is unknown. To identify patients who will benefit the most from optimal nutrition, the modified Nutrition Risk in Critically Ill (mNUTRIC) Score has been validated in the Intensive Care Unit. However, the utility of mNUTRIC in severe burn victims is unknown. We hypothesized that a higher mNUTRIC (≥5) will be associated with worse clinical outcomes, but that greater nutritional adequacy will be associated with better clinical outcomes in patients with higher mNUTRIC score. METHODS This prospective study included data from mechanically ventilated, severe burn patients (n = 359) from 51 Burn Units worldwide included in a randomized trial. Our primary and secondary outcomes were hospital mortality and the time to discharge alive (TTDA) from hospital. We described the association between nutrition performance and clinical outcomes. RESULTS Compared to low mNUTRIC (n = 313), the high mNUTRIC group (n = 46) had higher mortality (61% vs. 19%, p = 0.001), and longer TTDA (>90 [87->90] vs. 64 [38-90] days, p = <0.0001). Only in the high mNUTRIC group, increased calorie intake (per 20% increase) was associated with lower mortality and a faster TTDA. CONCLUSIONS The mNUTRIC score identifies those with poor clinical outcomes and may identifies those mechanically ventilated, severe burn patients in whom optimal nutrition therapy may be more advantageous.
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Affiliation(s)
- L Alfonso Ortiz
- Clinical Evaluation Research Unit, Queen's University, Kingston, ON, K7L 2V7, Canada; Department of Critical Care Medicine, Queen's University, Kingston, ON, K7L 2V7, Canada.
| | - Xuran Jiang
- Clinical Evaluation Research Unit, Queen's University, Kingston, ON, K7L 2V7, Canada.
| | - Alexis F Turgeon
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, QC, G1V 0A6, Canada; CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Québec City, QC, G1V 0A6, Canada.
| | - Lucy Wibbenmeyer
- University of Iowa Hospital and Clinics, Iowa City, IA, 52242, USA.
| | - Jonathan Pollack
- Mercy Research Institute, St. John's Mercy Hospital, St. Louis, MO, 63141, USA.
| | - Samuel P Mandell
- UW Medicine Regional Burn Center, Harborview Medical Center, Seattle, WA, 98104, USA.
| | - Andrew G Day
- Clinical Evaluation Research Unit, Queen's University, Kingston, ON, K7L 2V7, Canada; Research Institute, Kingston Health Sciences Centre, Kingston, ON, K7L 2V7, Canada.
| | - Daren K Heyland
- Clinical Evaluation Research Unit, Queen's University, Kingston, ON, K7L 2V7, Canada; Department of Critical Care Medicine, Queen's University, Kingston, ON, K7L 2V7, Canada; Research Institute, Kingston Health Sciences Centre, Kingston, ON, K7L 2V7, Canada.
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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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Shields BA, VanFosson CA, Pruskowski KA, Gurney JM, Rizzo JA, Cancio LC. High-Carbohydrate vs High-Fat Nutrition for Burn Patients. Nutr Clin Pract 2019; 34:688-694. [PMID: 31441112 DOI: 10.1002/ncp.10396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Nutrition is an essential component of the healing and recovery process after severe burn injury. For many burn patients, nutrition support is necessary to meet nutrition goals. The ratio of carbohydrates and fat is particularly important for burn patients, as an essential fatty acid deficiency can contribute to poor wound healing. However, there is evidence to suggest that diets containing more carbohydrates and less fat may result in better patient outcomes. A literature search was conducted to identify studies related to nutrition support and macronutrient ratios in burn patients. Eleven published papers were found that considered macronutrient use in enteral and parenteral nutrition therapies among 9 different burn patient samples. No negative outcomes associated with lower fat, higher carbohydrate nutrition for severely burned patients were found in the literature. Conversely, the literature review revealed improved outcomes among severely burned patients receiving lower fat, higher carbohydrate nutrition to include fewer incidences of pneumonia, wound infections, acute respiratory distress syndrome, fatty liver, and sepsis. These patients also experienced shorter hospital length of stay and shorter wound healing times, as well as lower spleen and kidney weights, lower urinary nitrogen losses, improved nitrogen balance, higher insulin levels, higher insulin-like growth factor-1, lower cortisol, and less muscle protein breakdown. The evidence available to date supports the clinical use of nutrition support providing ≤15% fat and ≥60% carbohydrate for critically ill burn patients.
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Affiliation(s)
- Beth A Shields
- United States Army Institute of Surgical Research, Joint Base San Antonio, Texas, USA
| | | | - Kaitlin A Pruskowski
- United States Army Institute of Surgical Research, Joint Base San Antonio, Texas, USA
| | - Jennifer M Gurney
- United States Army Institute of Surgical Research, Joint Base San Antonio, Texas, USA
| | - Julie A Rizzo
- United States Army Institute of Surgical Research, Joint Base San Antonio, Texas, USA
| | - Leopoldo C Cancio
- United States Army Institute of Surgical Research, Joint Base San Antonio, Texas, USA
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Leung J, Ridley EJ, Cleland H, Ihle JF, Paul E, King SJ. Predictive energy equations are inaccurate for determining energy expenditure in adult burn injury: a retrospective observational study. ANZ J Surg 2019; 89:578-583. [DOI: 10.1111/ans.15119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/16/2019] [Accepted: 01/28/2019] [Indexed: 12/24/2022]
Affiliation(s)
- James Leung
- Victorian Adult Burns ServiceThe Alfred Hospital Melbourne Victoria Australia
| | - Emma J. Ridley
- Nutrition DepartmentThe Alfred Hospital Melbourne Victoria Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive MedicineMonash University Melbourne Victoria Australia
| | - Heather Cleland
- Victorian Adult Burns ServiceThe Alfred Hospital Melbourne Victoria Australia
- Department of Surgery, Central Clinical SchoolMonash University Melbourne Victoria Australia
| | - Joshua F. Ihle
- Department of Intensive Care MedicineThe Alfred Hospital Melbourne Victoria Australia
- School of Public Health and Preventive MedicineMonash University Melbourne Victoria Australia
| | - Eldho Paul
- School of Public Health and Preventive MedicineMonash University Melbourne Victoria Australia
| | - Susannah J. King
- Victorian Adult Burns ServiceThe Alfred Hospital Melbourne Victoria Australia
- Nutrition DepartmentThe Alfred Hospital Melbourne Victoria Australia
- Department of Dietetics, Human Nutrition and SportLa Trobe University Melbourne Victoria Australia
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Chen LR, Yang BS, Chang CN, Yu CM, Chen KH. Additional Vitamin and Mineral Support for Patients with Severe Burns: A Nationwide Experience from a Catastrophic Color-Dust Explosion Event in Taiwan. Nutrients 2018; 10:1782. [PMID: 30453517 PMCID: PMC6266218 DOI: 10.3390/nu10111782] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 11/09/2018] [Accepted: 11/12/2018] [Indexed: 12/28/2022] Open
Abstract
Major burn injuries, which encompass ≥20% of the total body surface area (TBSA), are the most severe form of trauma because of the stress response they provoke, which includes hypermetabolism, muscle wasting, and stress-induced diabetes. In 2015, a color-dust explosion disaster occurred in the Formosa Fun Coast of Taiwan and injured 499 people, who were transferred via a nationwide emergency delivery system. Some recommendations are currently available regarding vitamin and mineral support for wound healing and recovery in severe burns, but there is a lack of evidence to confirm the benefits. Thus, the current study aimed to investigate the effects of additional vitamin and mineral support for patients with severe burn injuries. Sixty-one hospitalized individuals with major burns (full thickness and ≥20% TBSA) were classified into the supplement (n = 30) and control (n = 31) groups, according to whether they received supplementation with additional vitamins, calcium, and magnesium. There were significant differences between the supplement and control groups in the incidence of wound infection (30.0% vs. 77.4%, p < 0.001), sepsis (13.3% vs. 41.9%, p = 0.021), and hospitalization days (51.80 vs. 76.81, p = 0.025). After adjustment, logistic regression analysis revealed that, compared to those in the control group, patients in the supplement group had a lower risk for wound infection (OR 0.11; 95% CI 0.03⁻0.43; p = 0.002) and sepsis (OR 0.09; 95% CI 0.01⁻0.61; p = 0.014). Supplementation of multiple vitamins, calcium, and magnesium reduced the risk of wound infection and sepsis, shortened the time of hospitalization, and can be considered for use in major burns.
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Affiliation(s)
- Li-Ru Chen
- Department of Physical Medicine and Rehabilitation, Mackay Memorial Hospital, Taipei 10449, Taiwan.
- Department of Mechanical Engineering, National Chiao-Tung University, Hsinchu 300, Taiwan.
| | - Bing-Shiang Yang
- Department of Mechanical Engineering, National Chiao-Tung University, Hsinchu 300, Taiwan.
| | - Chih-Ning Chang
- Department of Physical Medicine and Rehabilitation, Mackay Memorial Hospital, Taipei 10449, Taiwan.
| | - Chia-Meng Yu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, MacKay Memorial Hospital, Taipei 10449, Taiwan.
| | - Kuo-Hu Chen
- Department of Obstetrics and Gynecology, Taipei Tzu-Chi Hospital, The Buddhist Tzu-Chi Medical Foundation, Taipei 970, Taiwan.
- School of Medicine, Tzu-Chi University, Hualien 970, Taiwan.
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Improving Nutritional Support of Burn Service Patients by Increasing the Number of Days When 100% of Prescribed Formula Is Given. J Burn Care Res 2017; 38:379-389. [DOI: 10.1097/bcr.0000000000000554] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Xi P, Kaifa W, Yong Z, Hong Y, Chao W, Lijuan S, Hongyu W, Dan W, Hua J, Shiliang W. Establishment and assessment of new formulas for energy consumption estimation in adult burn patients. PLoS One 2014; 9:e110409. [PMID: 25330180 PMCID: PMC4199722 DOI: 10.1371/journal.pone.0110409] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 09/05/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE An accurate knowledge of energy consumption in burn patients is a prerequisite for rational nutrition therapy. This study sought to create a formula that accounts for the metabolic characteristics of adult burn patients to accurately estimate energy consumption of patients with different areas and extents of burn and at different times after injury. METHODS Resting energy expenditure (REE) data on 66 burn patients, with total body surface area (TBSA) of burns ranging from 4% to 96%, were evaluated at different times after injury. REE values were determined in patients using indirect calorimetry at days 1, 2, 3, 7, 14, 21, and 28 after injury. We then constructed a mathematical model of REE changes post-burn. Next, established two new formulas (one non-linear and the other linear) for energy consumption estimation using model-based analytical solution and regression analysis. The new formulas were compared with measured REE and commonly used formulas including those of Carlson, Xie, Curreri, and Milner to determine accuracy and reliability. RESULTS Comparative analysis showed that the new formulas offered significantly higher accuracy and reliability than the Milner formula, which is considered the most accurate of commonly used burn energy consumption estimate formulas. The accuracy of the new nonlinear formula (94.29%) and that of the linear formula (91.43%) were significantly higher than that of Milner formula (72.86%) when compared to measured REE (χ2 = 11.706, P = 0.001; χ2 = 8.230, P = 0.004, respectively). The reliabilities of the new estimation formulas were both 100% and that of Milner formula was 74.24% (χ2 = 19.513, P = 0.000). CONCLUSION The new formulas constructed in this study provide reliable simulation of the impact of the degree of burn and post-burn days on energy consumption and offer notably higher accuracy and reliability than other formulas. These formulas will help determine nutritional needs of burn patients. TRIAL REGISTRATION The study was registered on Chinese Clinical Trial Registry as ChiCTR-TRC-13003806.
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Affiliation(s)
- Peng Xi
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burns of PLA, Southwest Hospital, Third Military Medical University, Chongqing, P.R. China
| | - Wang Kaifa
- Department of Mathematics, School of Biomedical Engineering, Third Military Medical University, Chongqing, P.R. China
| | - Zhang Yong
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burns of PLA, Southwest Hospital, Third Military Medical University, Chongqing, P.R. China
| | - Yan Hong
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burns of PLA, Southwest Hospital, Third Military Medical University, Chongqing, P.R. China
| | - Wang Chao
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burns of PLA, Southwest Hospital, Third Military Medical University, Chongqing, P.R. China
| | - Song Lijuan
- Department of Mathematics, School of Biomedical Engineering, Third Military Medical University, Chongqing, P.R. China
| | - Wang Hongyu
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burns of PLA, Southwest Hospital, Third Military Medical University, Chongqing, P.R. China
| | - Wu Dan
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burns of PLA, Southwest Hospital, Third Military Medical University, Chongqing, P.R. China
| | - Jiang Hua
- Department of Computational Mathematics and Biostatistics, Metabolomics and Multidisciplinary Laboratory for Trauma Research, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu, China
| | - Wang Shiliang
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burns of PLA, Southwest Hospital, Third Military Medical University, Chongqing, P.R. China
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Hoffer LJ, Bistrian BR. Appropriate protein provision in critical illness: a systematic and narrative review. Am J Clin Nutr 2012; 96:591-600. [PMID: 22811443 DOI: 10.3945/ajcn.111.032078] [Citation(s) in RCA: 134] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Widely varying recommendations have been published with regard to the appropriate amount of protein or amino acids to provide in critical illness. OBJECTIVE We carried out a systematic review of clinical trials that compared the metabolic or clinical effects of different protein intakes in adult critical illness and comprehensively reviewed all of the available evidence pertinent to the safe upper limit of protein provision in this setting. DESIGN MEDLINE was searched for clinical trials published in English between 1948 and 2012 that provided original data comparing the effects of different levels of protein intake on clinically relevant outcomes and evidence pertinent to the safe upper limit of protein provision to critically ill adults. RESULTS The limited amount and poor quality of the evidence preclude conclusions or clinical recommendations but strongly suggest that 2.0-2.5 g protein substrate · kg normal body weight⁻¹ · d⁻¹ is safe and could be optimum for most critically ill patients. At the present time, most critically ill adults receive less than half of the most common current recommendation, 1.5 g protein · kg⁻¹ · d⁻¹, for the first week or longer of their stay in an intensive care unit. CONCLUSION There is an urgent need for well-designed clinical trials to identify the appropriate level of protein provision in critical illness.
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Affiliation(s)
- L John Hoffer
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Canada.
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De Backere F, Moens H, Steurbaut K, Colpaert K, Decruyenaere J, De Turck F. Towards automated generation and execution of clinical guidelines: Engine design and implementation through the ICU Modified Schofield use case. Comput Biol Med 2012; 42:793-805. [DOI: 10.1016/j.compbiomed.2012.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 06/07/2012] [Accepted: 06/13/2012] [Indexed: 10/28/2022]
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Windle EM. Dietetic service provision for burn care in the United Kingdom: are nutrition support standards being met? J Hum Nutr Diet 2009; 22:317-23. [PMID: 19486261 DOI: 10.1111/j.1365-277x.2009.00965.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Catabolism and lean body mass losses in severe burn injury present an extreme challenge to the dietitian. A high level of nutritional intervention is often required, but service levels have not been described in the UK. This study aimed to identify levels of current dietetic services with respect to burns and to assess adequacy against existing nutrition support standards. METHODS A postal survey of 34 UK dietetic departments known to provide care to burned adult and paediatric admissions was undertaken. Data were collected on burns settings, hospital service characteristics, staffing and caseload issues, and absence cover. Comparison was made between funding and activity to National Health Service standards for the nutritional care of inpatients. RESULTS The response rate was 71% and data were analysed for 20 departments Clinical settings were either burn units or plastic surgery wards. Dietetic care was provided to critically ill burned patients in 16 hospitals. Most hospitals had no dietetic funding assigned for burn care. The funding deficit for critical care compared to recommendations was 5.9 full-time equivalents and no individual hospital met funding standards. Thirty-seven percent of dietitians were unable to provide daily follow up for critically ill patients. Absence cover was limited in 60% of cases. Approximately one-third of dietitians were members of a nutrition support team. CONCLUSIONS Compared to national guidelines for nutrition support, deficiencies of dietetic service provision exist within UK burns settings. This is further reinforced when practice is compared with existing multi-professional burns management standards.
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Affiliation(s)
- E M Windle
- Department of Nutrition & Dietetics, Pinderfields General Hospital, Wakefield, West Yorkshire, UK.
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Abstract
Major burn injury remains a significant cause of morbidity and mortality in pediatric patients. With advances in burn care and with the development of experienced multi-disciplinary teams at regionalized burn centers, many children are surviving severe burn injury. As members of the multi-disciplinary care team, anesthesia providers are called upon to care for these critically ill children. These children provide several anesthetic challenges, such as difficult airways, difficult vascular access, fluid and electrolyte imbalances, altered temperature regulation, sepsis, cardiovascular instability, and increased requirements of muscle relaxants and opioids. The anesthesia provider must understand the physiologic derangements that occur with severe burn injury as well as the subsequent anesthetic implications.
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Affiliation(s)
- Gennadiy Fuzaylov
- Department of Anesthesia and Critical Care, Pediatric Anesthesia Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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