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Effects of Early Excision and Aggressive Enteral Feeding on Hypermetabolism, Catabolism, and Sepsis after Severe Burn

Hart, David W. MD; Wolf, Steven E. MD; Chinkes, David L. PhD; Beauford, Robert B. MD; Mlcak, Ronald P. RRT; Heggers, John P. PhD; Wolfe, Robert R. PhD; Herndon, David N. MD

Journal of Trauma and Acute Care Surgery: April 2003 - Volume 54 - Issue 4 - p 755-764
doi: 10.1097/01.TA.0000060260.61478.A7
Original Articles

Background  Severe burn induces a systemic hypermetabolic response, which includes increased energy expenditure, protein catabolism, and diminished immunity. We hypothesized that early burn excision and aggressive enteral feeding diminish hypermetabolism.

Methods  Forty-six burned children were enrolled into a cohort analytic study. Cohorts were segregated according to time from burn to transfer to our institution for excision, grafting, and nutritional support. No subject had undergone wound excision or continuous nutritional support before transfer. Resting energy expenditure, skeletal muscle protein kinetics, the degree of bacterial colonization from quantitative cultures, and the incidence of burn sepsis were measured as outcome variables.

Results  Early, aggressive treatment did not decrease energy expenditure; however, it did markedly attenuate muscle protein catabolism when compared with delay in aggressive treatment. Wound colonization and sepsis were diminished in the early treatment group as well.

Conclusion  Early excision and concurrent aggressive feeding attenuate muscle catabolism and improve infectious outcomes after burn.

From the Department of Surgery, The University of Texas Medical Branch, and Department of Surgery, Shriners Hospitals for Children, Galveston, Texas.

Submitted for publication October 28, 2000.

Accepted for publication January 23, 2003.

Supported by Shriners Hospital for Children grants 8660 and 8490, National Institutes of Health (NIH) training grant 2T32GM0825611, NIH center grant 1P50GM60338-01, NIH grant GM56687-02, and NIH grant M01-RR-00073 (General Clinical Research Center).

Presented at the 60th Annual Meeting of the American Association for the Surgery of Trauma, October 11–14, 2000, San Antonio, Texas.

Address for reprints: Steven E. Wolf, MD, Department of Surgery, Shriners Hospitals for Children, 815 Market Street, Galveston, TX 77550; email:

© 2003 Lippincott Williams & Wilkins, Inc.