Abstract
Introduction
Nutrition support is an important component of the care of the critically ill burn patient. The European Society for Parenteral and Enteral Nutrition recommends less than 35% of calories from fat and less than 60% from carbohydrate (CHO); however, favorable clinical outcomes have been found in randomized controlled trials when burn patients were given 12–27% fat and 46–65% CHO. These benefits include lower rates of pneumonia and mortality. The purpose of this research was to examine macronutrient intake of critically ill burn patients and the association with wound healing.
Methods
A retrospective study was approved by the Institutional Review Board and included patients admitted to our burn intensive care unit over an 11 year period who were ≥18 years of age, had ≥20% total body surface area burns. Subjects who required hospitalization for ≥8 days and required nutrition support were included in this analysis. Subjects who were admitted over a week after injury and those who underwent limb amputations were excluded. Caloric intake from CHO, fat, and protein was obtained from enteral nutrition, parenteral nutrition, and oral intake for the first eight days following hospitalization. Wound healing was defined as achieving < 10% TBSA open wound. Univariate analysis was used to identify factors significantly associated with wound healing. Variables found to be significant (p< 0.05) were subjected to logistic regression.
Results
A total of 309 patients (89% male) were included. Patients were 37 ± 17 years old and had 46 ± 18% TBSA burns. Wound healing was achieved by 77% of patients, with 26% mortality. Those who healed were significantly younger (34 ± 15 vs. 47 ± 19 years, p< 0.001), were taller (70 ± 3 vs. 68 ± 4 inches, p< 0.001), with smaller burns (44 ± 16% vs. 54 ± 20% TBSA, p< 0.001), predominantly male (92% vs. 77%, p< 0.001), received a higher amount of CHO (1166 ± 465 vs. 902 ± 494 kcals, p< 0.001), and received a higher amount of fat (455 ± 234 vs. 360 ± 220 kcals, p=0.003). After logistic regression, factors negatively associated with wound healing included increased age (p< 0.001), female gender (p=0.032), and larger burn size (p< 0.001); a positive association was seen with 8-day average calories from CHO (p=0.027).
Conclusions
This study identified several factors significantly associated with healing in burn patients; however, higher CHO intake was the only modifiable factor. Further research is needed to determine the optimal CHO intake to improve patient outcomes.
Applicability of Research to Practice
Consideration should be made for high-CHO enteral nutrition in critically ill burn patients.
Parenteral Vs Enteral Nutrition as an Improvement in Wound Healing in the Severely Burned Patient in the ICU
