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Nutrition in burn injury: any recent changes?

Berger, Mette M.; Pantet, Olivier

Current Opinion in Critical Care: August 2016 - Volume 22 - Issue 4 - p 285–291
doi: 10.1097/MCC.0000000000000323
METABOLIC SUPPORT: Edited by Paul E. Wischmeyer
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Purpose of review After major progress in the 1980s of burn resuscitation resulting, the last years’ research has focused on modulation of metabolic response and optimization of substrate utilization. The persisting variability of clinical practice is confirmed and results in difficult comparisons between burn centers.

Recent findings Recent research explores intracellular mechanisms of the massive metabolic turmoil observed after burns: very early alterations at the mitochondrial level largely explain the hypermetabolic response, with a diminished coupling of oxygen consumption and ATP production. The metabolic alterations (elevated protein and glucose turnover) have been shown to be long lasting. Modulating this response by pharmacological tools (insulin, propranolol, and oxandrolone) results in significant clinical benefits. A moderate glucose control proves to be safe in adult burns; data in children remain uncertain as the risk of hypoglycemia seems to be higher. The enteral feeding route is confirmed as an optimal route: some difficulties are now clearly identified, such as the risk of not delivering sufficient energy by this route.

Summary Major burn patients differ from other critically ill patients by the magnitude and duration of their inflammatory and metabolic responses, their energy and substrate requirements. Pieces of the metabolic puzzle finally seem to fit together.

Service of Adult Intensive Care Medicine and Burns, CHUV University Hospital, Lausanne, Switzerland

Correspondence to Professor Mette M. Berger, MD, PhD, Service of Adult Intensive Care Medicine and Burns Centre, CHUV BH-08.612, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland. Tel: +41 21 31 42 095; fax: +41 21 31 43 045; e-mail: Mette.Berger@chuv.ch

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