Early Enteral Nutrition for Burn Injury

Overview

Journal Adv Wound Care (New Rochelle)

Date 2014 Apr 25

PMID 24761346

Citations 8

Authors

Samuel P Mandell

Nicole S Gibran

Affiliations

Soon will be listed here.

Abstract

Nutrition has been recognized as a critical component of acute burn care and ultimate wound healing. Debate remains over the appropriate timing of enteral nutrition and the benefit of supplemental trace elements, antioxidants, and immunonutrition for critically ill burn patients. Pharmacotherapy to blunt the metabolic response to burn injury plays a critical role in effective nutritional support. Further evidence is demonstrating long-term benefits from pharmacologic immunomodulation given the prolonged metabolic response to injury that may last for over a year following the initial insult. The majority of evidence regarding early enteral feeding comes from mixed populations and smaller studies. However, on balance, available evidence favors early feeding. Data regarding immunonutrition does not support the routine use of these products. Limited data regarding use of antioxidants and trace elements support their use. Further evaluation of anti-inflammatory mediators of the immune response, such as statins, will likely play a role in the future. Further data are needed on the dosing and route of micronutrients as well as the utility of immunonutrition. Finally, little is known about nutrition in the obese burn patient making this an important area for investigation.

Citing Articles

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References

Liusuwan Manotok R, Palmieri T, Greenhalgh D . The respiratory quotient has little value in evaluating the state of feeding in burn patients. J Burn Care Res. 2008; 29(4):655-9. DOI: 10.1097/BCR.0b013e31817db9e3. View

Wasiak J, Cleland H, Jeffery R . Early versus delayed enteral nutrition support for burn injuries. Cochrane Database Syst Rev. 2006; (3):CD005489. DOI: 10.1002/14651858.CD005489.pub2. View

Khorasani E, Mansouri F . Effect of early enteral nutrition on morbidity and mortality in children with burns. Burns. 2010; 36(7):1067-71. DOI: 10.1016/j.burns.2009.12.005. View

Jain M, Heyland D, Dhaliwal R, Day A, Drover J, Keefe L . Dissemination of the Canadian clinical practice guidelines for nutrition support: results of a cluster randomized controlled trial. Crit Care Med. 2006; 34(9):2362-9. DOI: 10.1097/01.CCM.0000234044.91893.9C. View

Kurmis R, Parker A, Greenwood J . The use of immunonutrition in burn injury care: where are we?. J Burn Care Res. 2010; 31(5):677-91. DOI: 10.1097/BCR.0b013e3181eebf01. View

Nathens A, Neff M, Jurkovich G, Klotz P, Farver K, Ruzinski J . Randomized, prospective trial of antioxidant supplementation in critically ill surgical patients. Ann Surg. 2002; 236(6):814-22. PMC: 1422648. DOI: 10.1097/00000658-200212000-00014. View

Jeschke M, Mlcak R, Finnerty C, Norbury W, Gauglitz G, Kulp G . Burn size determines the inflammatory and hypermetabolic response. Crit Care. 2007; 11(4):R90. PMC: 2206482. DOI: 10.1186/cc6102. View

Cui X, Iwasa M, Iwasa Y, Ogoshi S . Arginine-supplemented diet decreases expression of inflammatory cytokines and improves survival in burned rats. JPEN J Parenter Enteral Nutr. 2000; 24(2):89-96. DOI: 10.1177/014860710002400289. View

Dominioni L, Trocki O, Fang C, Mochizuki H, Ray M, Ogle C . Enteral feeding in burn hypermetabolism: nutritional and metabolic effects of different levels of calorie and protein intake. JPEN J Parenter Enteral Nutr. 1985; 9(3):269-79. DOI: 10.1177/0148607185009003269. View

10.

Deitch E . Intestinal permeability is increased in burn patients shortly after injury. Surgery. 1990; 107(4):411-6. View

11.

Crimi E, Liguori A, Condorelli M, Cioffi M, Astuto M, Bontempo P . The beneficial effects of antioxidant supplementation in enteral feeding in critically ill patients: a prospective, randomized, double-blind, placebo-controlled trial. Anesth Analg. 2004; 99(3):857-863. DOI: 10.1213/01.ANE.0000133144.60584.F6. View

12.

Deitch E, Shi H, Lu Q, Feketeova E, Skurnick J, Xu D . Mesenteric lymph from burned rats induces endothelial cell injury and activates neutrophils. Crit Care Med. 2004; 32(2):533-8. DOI: 10.1097/01.CCM.0000109773.00644.F4. View

13.

Berger M, Binnert C, Chiolero R, Taylor W, Raffoul W, Cayeux M . Trace element supplementation after major burns increases burned skin trace element concentrations and modulates local protein metabolism but not whole-body substrate metabolism. Am J Clin Nutr. 2007; 85(5):1301-6. DOI: 10.1093/ajcn/85.5.1301. View

14.

Gottschlich M, Jenkins M, Mayes T, Khoury J, Kagan R, Warden G . The 2002 Clinical Research Award. An evaluation of the safety of early vs delayed enteral support and effects on clinical, nutritional, and endocrine outcomes after severe burns. J Burn Care Rehabil. 2002; 23(6):401-15. DOI: 10.1097/01.BCR.0000036588.09166.F1. View

15.

Porro L, Herndon D, Rodriguez N, Jennings K, Klein G, Mlcak R . Five-year outcomes after oxandrolone administration in severely burned children: a randomized clinical trial of safety and efficacy. J Am Coll Surg. 2012; 214(4):489-502. PMC: 3412530. DOI: 10.1016/j.jamcollsurg.2011.12.038. View

16.

Sallam H, Kramer G, Chen J . Gastric emptying and intestinal transit of various enteral feedings following severe burn injury. Dig Dis Sci. 2011; 56(11):3172-8. DOI: 10.1007/s10620-011-1755-2. View

17.

Kreymann K, Berger M, Deutz N, Hiesmayr M, Jolliet P, Kazandjiev G . ESPEN Guidelines on Enteral Nutrition: Intensive care. Clin Nutr. 2006; 25(2):210-23. DOI: 10.1016/j.clnu.2006.01.021. View

18.

Williams F, Branski L, Jeschke M, Herndon D . What, how, and how much should patients with burns be fed?. Surg Clin North Am. 2011; 91(3):609-29. PMC: 3255093. DOI: 10.1016/j.suc.2011.03.002. View

19.

Lu G, Huang J, Yu J, Zhu Y, Cai L, Gu Z . Influence of early post-burn enteral nutrition on clinical outcomes of patients with extensive burns. J Clin Biochem Nutr. 2011; 48(3):222-5. PMC: 3082077. DOI: 10.3164/jcbn.10-91. View

20.

Fan J, Meng Q, Guo G, Xie Y, Li X, Xiu Y . Effects of early enteral nutrition supplemented with arginine on intestinal mucosal immunity in severely burned mice. Clin Nutr. 2009; 29(1):124-30. DOI: 10.1016/j.clnu.2009.07.005. View