Nutritional Needs and Support for the Burned Patient

Burns involving more than 20% of the total body surface area represent a massive metabolic injury. This metabolic response to massive burns creates an immediate, intense, and persistent strain on the patient's nutritional status. The systemic response to burn injury alters essentially all aspects of energy-substrate metabolism. Given the immense metabolic challenges created by burn injury, optimizing nutritional support is essential to improving outcomes in this patient population. Total calories provided should be based on ongoing assessment of energy expenditure, ideally using indirect calorimetry. Providing calories in excess of the patient's needs (i.e., overfeeding) is counterproductive. Enteral nutrition is the first line of nutritional support in the burn patient, and enteral feeding should be administered as soon as possible. Accurate serial assessment of nutritional status and body composition is central to identifying patient needs, trajectory, and efficacy of care. Changes in lean body mass and body composition represent the ultimate reflection of cumulative nutritional status, and evolving applications of imaging technology have made routine serial evaluation of lean body mass feasible. The physiologic response to massive thermal injury represents an enormous nutritional insult. The consequences of this intense acute malnutrition include compromises in immune function, wound healing, and mobility—all major drivers of morbidity and mortality in thermal trauma. As such, thoughtful and comprehensive nutritional support based on continuous assessment is essential.