Nutrition and Metabolism in Burns, Trauma, and Sepsis 220

Pathophysiology and Metabolic Response to Injury and Stress 220

Cytokine Response to Trauma and Surgery 221

Energy Requirements 224

Factors Influencing Energy Requirements 224

Methods for Determining Energy Requirements 225

Risks of Underfeeding 227

Risks of Overfeeding 227

Protein and Amino Acid Metabolism 228

Glutamine 229

Arginine 231

Lipid Metabolism 234

Carbohydrate Metabolism 237

Provision of Nutrients — Gut Barrier Function 241

Enteral vs. Parenteral Nutrition 242

Route and Access of Enteral Feeding 242

Positioning during Enteral Feeding 243

Timing of Enteral Feeding 244

Continuous vs. Intermittent Feeding 244

Growth Factors 245

Current Recommendations for Nutrition Support of the Burn and Critically Ill Patient 245

Conclusions 246

Acknowledgments 246

References 246

FIGURE 11.1 Relationship between age, total body surface area burn, inhalation injury, and mortality.

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