Rousseau AF, Losser MR, Ichai C, Berger MM, et al.
Clinical nutrition (Edinburgh, Scotland). Date of publication 2013 Aug 1;volume 32(4):497-502.
1. Clin Nutr. 2013 Aug;32(4):497-502. doi: 10.1016/j.clnu.2013.02.012. Epub 2013 Mar
14.
ESPEN endorsed recommendations: nutritional therapy in major burns.
Rousseau AF(1), Losser MR, Ichai C, Berger MM.
Author information:
(1)Burn Centre and General Intensive Care Department, University Hospital, Liège,
Belgium.
Erratum in
Clin Nutr. 2013 Dec;32(6):1083.
BACKGROUND & AIMS: Nutrition therapy is a cornerstone of burn care from the early
resuscitation phase until the end of rehabilitation. While several aspects of
nutrition therapy are similar in major burns and other critical care conditions,
the patho-physiology of burn injury with its major endocrine, inflammatory,
metabolic and immune alterations requires some specific nutritional
interventions. The present text developed by the French speaking societies, is
updated to provide evidenced-based recommendations for clinical practice.
METHODS: A group of burn specialists used the GRADE methodology (Grade of
Recommendation, Assessment, Development and Evaluation) to evaluate human burn
clinical trials between 1979 and 2011. The resulting recommendations, strong
suggestions or suggestions were then rated by the non-burn specialized experts
according to their agreement (strong, moderate or weak).
RESULTS: Eight major recommendations were made. Strong recommendations were made
regarding, 1) early enteral feeding, 2) the elevated protein requirements (1.5-2
g/kg in adults, 3 g/kg in children), 3) the limitation of glucose delivery to a
maximum of 55% of energy and 5 mg/kg/h associated with moderate blood glucose
(target ≤ 8 mmol/l) control by means of continuous infusion, 4) to associated
trace element and vitamin substitution early on, and 5) to use non-nutritional
strategies to attenuate hypermetabolism by pharmacological (propranolol,
oxandrolone) and physical tools (early surgery and thermo-neutral room) during
the first weeks after injury. Suggestion were made in absence of indirect
calorimetry, to use of the Toronto equation (Schoffield in children) for energy
requirement determination (risk of overfeeding), and to maintain fat
administration ≤ 30% of total energy delivery.
CONCLUSION: The nutritional therapy in major burns has evidence-based
specificities that contribute to improve clinical outcome.
Copyright © 2013. Published by Elsevier Ltd.
DOI: 10.1016/j.clnu.2013.02.012
PMID: 23582468 [Indexed for MEDLINE]
