Nutrition in burns: Galveston contributions

Abstract

Aggressive nutrition support is recommended following severe burn injury. Initially, such injury results in a prolonged and persistent hypermetabolic response mediated by a 10- to 20-fold elevation in plasma catecholamines, cortisol, and inflammatory mediators. This response leads to twice-normal metabolic rates, whole-body catabolism, muscle wasting, and severe cachexia. Thus, it is relevant to review the literature on nutrition in burns to adjust/update treatment. Failure to meet the increased substrate requirements may result in impaired wound healing, multiorgan dysfunction, increased susceptibility to infection, and death. Therefore, aggressive nutrition support is essential to ensure adequate burn care, attenuate the hypermetabolic response, optimize wound healing, minimize devastating catabolism, and reduce morbidity and mortality. Here, the authors provide nutrition recommendations gained from prospective trials, retrospective analyses, and expert opinions based on the authors' practices in Galveston, Texas, and Vienna, Austria.

Figure 1

Metabolic response postburn. Severe burn injury leads to profound hypermetabolic response mediated by catecholamines, cortisol, and glucagon. Stress hormones lead to significant physiologic and metabolic derangements in every organ system. Reprinted with permission from Annals Surgery. 2008;248:387-401; Figure 1, Nutrition in Burns.