Table 114

Nutrition Support Recommendations for Critically Ill and Burn-Injured Patients current recommendations for nutrition support of the burn and critically ill patient

Critically Ill

Burns

Energy — predictive BMI < 20 kg/m2: 37 kcal/kg equations

Harris-Benedict equation: BEE x Injury/Activity Factor 1.5 to 2 depending on TBSA

BMI 20-25 kg/m2: 30 kcal/kg BMI 25-30 kg/m2: 25 kcal/kg BMI > 30 kg/m2 : 20 kcal/kg

Energy — indirect calorimetry Protein

Measured resting energy expenditure (REE)

Measured REE x Activity Factor 10 to 20%

20 to 25% of total calories glutamine: 0.5 g/kg/d up to 40 g/d 50 to 60% of total calories

(actual body weight, unless obese, then adjusted body weight is used)

Carbohydrate

Include fiber except in patients at risk of small bowel obstruction/ischemia

2G to 25% of total calories immune-modulating nutrition should not be used. Fiber-free enteral formulas should be used in patients at risk of small bowel obstruction. Positioning patients in an upright supine position is important in promoting gastric emptying and preventing aspiration pneumonia. In those who develop high gastric residuals, a promotility agent, such as metoclopramide, should be used [177], and if feeding intolerance continues, postpyloric access should be obtained. Concomitant use of parenteral nutrition should be avoided.

conclusions

Nutrition is an integral component of the care for patients with burns, trauma, or sepsis, as it influences morbidity and mortality. Significant alterations in metabolism and immune function that occur and their interaction with nutrition support continue to be investigated. Continued progress in studying the roles of various nutrients and drug and treatment interventions in ameliorating the effects of burn injury and sepsis will result in improved wound healing and survival outcomes.

acknowledgments

The authors would like to thank Cathy Alberda, R.D., MSc for her review and comments, as well as Heather Shankowsky, R.N., for her assistance with organizing and formatting the references. This project was funded by the Alberta Heritage Foundation for Medical Research (AHFMR), Canadian Institutes of Health Research (CIHR), and the Firefighters' Burn Trust Fund of the University of Alberta (FFBTF).

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