Malnutrition in Burns: A Prospective, Single-Center Study.

The hypermetabolic response from a burn injury is the highest of the critically ill patient population. When coupled with the hypermetabolic response, preexisting malnutrition may increase the hospital resources used. The goal of this study was to evaluate the rate of malnutrition in burn patients and the associated hospital resource utilization. We collected prospective data on burn patients 18 years or older with a burn at least 10% TBSA admitted to a regional burn center. Demographics, %TBSA, comorbidities, length of stay (LOS), and standardized LOS (LOS/%TBSA) were evaluated on 49 patients. A multivariable regression model was constructed. Nutrition assessment was completed within 24 to 48 hours of admission including an SGA (Subjective Global Assessment) classification. SGA A (well-nourished) was compared to SGA B and C (malnourished). Fourteen patients (28.6%) in this study were malnourished. Malnourished patients were not statistically different with respect to median age (50 vs 39; P = .08) and body mass index (22.9 vs 26.5; P = .08) compared to the well-nourished group. However, malnourished patients had significantly longer median LOS (21.0 vs 11.0 days, P = .01) and LOS/%TBSA (1.69 vs 0.83, P = .001) than the well-nourished group. Being malnourished was a significant independent predictor of above-median LOS/%TBSA (P = .027) with an odds ratio of 5.61 (95% CI 1.215-25.890). The rate of malnutrition is important given the high metabolic demands of these patients. Malnutrition increased the resource requirements via higher standardized LOS. This underscores the importance of completing SGA on admission to identify malnutrition early on to optimize nutrition intervention during the patients' hospital stay.

Interrupted Nutrition Support in Patients With Burn Injuries: A Single-Centre Observational Study.

BACKGROUND: Enteral nutrition (EN) is essential to meet the increased metabolic requirements of burn-injured patients. However, feeds are often suspended for care. This study examines the interruptions in EN (IEN). OBJECTIVE: To determine the frequency and duration of IEN and whether these interruptions are predictable or unpredictable. DESIGN: This retrospective chart review of 27 adult burn patients examined age, sex, body mass index, percentage of total body surface area, length of hospital stay, predicted energy requirements from equations and indirect calorimetry, EN start time, time EN reached goal rate, and interruptions to EN. RESULTS: Predictable interruptions accounted for 74.5% (frequency) and 81.6% (duration) of total interruptions. The most frequent and time-consuming interruptions were perioperative period, extubation, and tests/procedures (predictable) versus high gastric residual volume, emesis/nausea, and feeding tube displacement (unpredictable). CONCLUSIONS: Most IEN were due to predictable events. Based on these findings, compensating for predictable interruptions to meet nutritional requirements in burn patients is recommended.

HISTORIQUE: L'alimentation entérale (AE) est essentielle pour répondre aux besoins métaboliques accrus des patients brûlés. Cependant, elle est souvent suspendue pour procéder aux soins. La présente étude se penche sur les interruptions de l'AN (IAN). OBJECTIF: Déterminer la fréquence et la durée de l'IAN et établir si elles sont prévisibles ou non. MÉTHODOLOGIE: La présente analyse rétrospective des dossiers de 27 patients adultes brûlés a porté sur l'âge, le sexe, l'indice de masse corporelle (IMC), le pourcentage de la surface corporelle totale, la durée d'hospitalisation, les besoins énergétiques prévus à partir d'équations et de la calorimétrie indirecte, l'heure de début de l'AN, le temps pour parvenir au taux d'atteinte des objectifs d'AN et les interruptions à l'AN. RÉSULTATS: Les interruptions prévisibles représentaient 74,5 % (fréquence) et 81,6 % (durée) des interruptions totales. La période périopératoire, l'extubation et les tests et interventions (prévisibles) étaient les interventions les plus fréquentes et les plus chronophages, par rapport au volume gastrique résiduel élevé, aux nausées et aux vomissements, de même qu'au déplacement de la sonde gastrique (imprévisibles). CONCLUSIONS: La plupart des interruptions d'AN étaient attribuables à des événements prévisibles. D'après ces observations, il est recommandé de compenser les interruptions prévisibles pour répondre aux besoins nutritionnels des patients brûlés.

Zinc supplementation in burn patients.

Micronutrient supplementation is a common practice throughout many burn centers across North America; however, uncertainty pertaining to dose, duration, and side effects of such supplements persists. The authors prospectively collected data from 23 hospitalized patients with burn sizes ranging from 10 to 93% TBSA. Each patient received a daily multivitamin and mineral supplement, 50 mg zinc (Zn) daily, and 500 mg vitamin C twice daily. Supplements were administered orally or enterally. Albumin, prealbumin, C-reactive protein, serum Zn, and serum copper were measured weekly during hospital admission until levels were within normal reference range. Our study concluded that 50 mg daily dose of Zn resulted in normal serum levels in 19 of 23 patients at discharge; 50 mg Zn supplementation did not interfere with serum copper levels; and Zn supplements, regardless of administration route, did not result in gastrointestinal side effects.