From the Guidelines
Early enteral nutrition, preferably within 24 hours of injury, is vital in the treatment plan of a burn patient for attenuation of the hypermetabolic state and to decrease infections. This approach has been shown to decrease muscle protein catabolism, improve wound healing, decrease ICU and hospital length of stay, diminish rates of sepsis, decrease infectious load, and decrease the risk of Curling ulcer formation 1. Patients require high-calorie, high-protein diets with approximately 25-30 kcal/kg/day and 1.5-2 g/kg/day of protein.
- Key components of the nutritional support include:
- Early enteral feeding to maintain gut integrity and reduce bacterial translocation
- High-calorie, high-protein diets to support wound healing and immune function
- Supplementation with specific nutrients like glutamine, arginine, and omega-3 fatty acids to enhance immune function and wound healing
- Micronutrients including zinc, vitamin C, and vitamin A to support collagen synthesis and immune function
- Additionally, tight glycemic control maintaining blood glucose between 80-110 mg/dL helps reduce infection rates, and pharmacologic interventions such as propranolol can blunt the catecholamine surge and reduce resting energy expenditure by 15-20% 1.
- The most recent and highest quality study 1 suggests that evaluation of the evolving metabolic needs in these patients is imperative, with serial indirect calorimetry regarded as the best option to fully meet energy targets.
- It is also important to note that excess carbohydrate provision after thermal injuries can propagate hyperglycemia with subsequent exacerbation of inflammation, muscle breakdown, and excess fat production 1.
- Administering insulin can improve lean body mass, bone mineral density, donor site healing, and decrease overall length of stay in patients with severe burned injuries, although careful monitoring is required to avoid hypoglycemia 1.
From the FDA Drug Label
Prompt institution of appropriate regimens for care of the burned patient is of prime importance and includes the control of shock and pain. The answer is: control of shock and pain are vital in the treatment plan of a burn patient, however the text does not directly mention attenuation of the hyper metabolic state and to decrease infections as the primary goal of the treatment plan with silver sulfadiazine cream, USP 1% 2.
From the Research
Treatment Plan for Burn Patients
To attenuate the hypermetabolic state and decrease infections in burn patients, the following are vital:
- Early enteral nutrition with high-carbohydrate formulas 3, 4, 5
- Individualized nutritional support, monitored and adjusted throughout recovery 3
- Adequate assessment and provision of nutritional needs 3, 6
- Nutrition management to promote wound healing while minimizing loss of lean body mass 5
- Early institution of enteral feeding to attenuate the stress response, abate hypermetabolism, and improve patient outcome 5
Nutritional Support
Nutritional support is crucial in the treatment plan of burn patients, as it helps to:
- Fulfill increased energy requirements 3, 4, 6
- Support the stress and immune responses 4
- Reduce infection, recovery time, and long-term sequelae 6
- Improve wound healing 3, 5
Timing and Route of Nutritional Support
The optimal timing, route, amount, and composition of nutritional support for burn patients are still being researched, but most clinicians advocate for: