A new concept of nutrition in treatment of burn injury: from nutrition support to nutrition therapy / 中华烧伤杂志

ABSTRACT

For many years, the major concerns in the treatment of a major burn injury have always been shock resuscitation, infection control, and wound treatment, while nutrition has been considered as a subordinate concern. The concept of nutrition in the treatment of a major burn has been recognized as "nutrition support", only with the purpose of restraining negative nitrogen balance through administration of energy and protein, in order to prevent malnutrition in patients with severe burn. In recent 10 years, however, increasing evidences have showed that optimal nutritional management could improve the outcome of severe burn patients. Now it is recognized that nutrition is not only to provide exogenous nutrients to improve nutritional status of the patients, but also to regulate cell metabolism, enhance cell activity, maintain and uphold the structure and function of the gastrointestinal mucosa, thus to improve patient's outcome. Therefore, the term of "nutrition support"seems to be far from comprehensiveness to reflect the purpose and the aim of this important treatment strategy. Medical literatures especially those in nutritional guidelines have begun to use the term of "nutrition therapy" instead of "nutrition support", which typifies the changes in nutritional concept, aim, means, and clinical evaluation. The aim of nutrition has changed from simply "providing nutritional substrate and improving nutritional status of patients" to "regulating cell metabolism, maintaining organ structure and function, and ultimately improving outcome of patient". Meanwhile, nutritional means has been more consummate, including special nutrients, hormones, and growth factors, in addition to use of conventional nutrients, in order to enhance therapeutic effect of nutrition in treatment of massive burn injury. Burn nutrition is no longer confined to maintenance of positive nitrogen balance, it should also consider the regulation of cell activity, metabolic status, immune and organ function. The purpose of the article is to analyze and discuss the important issues concerning nutrition therapy in treatment of burn injury, including risk screening, optimal energy supply and ratio of different nutritional ingredients, the choice of special nutrient, as well as the determination of optimal time for giving various nutritional supplements.