Increased mortality with intravenous supplemental feeding in severely burned patients

Patients with large cutaneous burns are characterized by an elevated metabolic rate and lose up to 25% of their body weight within 3 weeks. A previous study suggested that intravenous supplementation to attain nutritional requirements was of no benefit in patients with cutaneous burns covering >50% of their total body surface area. In this study 39 patients with burns >50% of their total body surface area were randomly assigned to receive intravenous supplementation of enterai calories (n = 16) or enterai calories alone (n = 23). Intravenous supplementation decreased the amount of enterai calories that patients with burns could tolerate. The mortality rate was significantly higher (p < 0.05) in the intravenously supplemented group at 63% as compared with 26% in the group receiving enterai calories alone. Both groups showed significant decrease in natural killer cell activity when compared with controls at both 0 to 7 and 7 to 14 days after injury. T cell helper/suppressor ratios were depressed in both groups when compared with controls; however, the intravenously supplemented group was significantly depressed at 7 to 14 days after burn. Both groups demonstrated hepatomegaly, moderate fatty infiltration, and cholestasis. It is suggested that intravenous supplementation should be carefully evaluated and used only in patients widi total enterai failure.