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Body Composition Changes in Severely Burned Children During ICU Hospitalization*

Cambiaso-Daniel, Janos MD1,2,3; Malagaris, Ioannis MSc2,4; Rivas, Eric PhD1,2,5; Hundeshagen, Gabriel MD1,2,6; Voigt, Charles D. MD1,2; Blears, Elizabeth MD1,2; Mlcak, Ron P. PhD1,2; Herndon, David N. MD, FACS1,2; Finnerty, Celeste C. PhD1,2,7; Suman, Oscar E. PhD1,2

Pediatric Critical Care Medicine: December 2017 - Volume 18 - Issue 12 - p e598-e605
doi: 10.1097/PCC.0000000000001347
Online Clinical Investigations
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Objectives: Prolonged hospitalization due to burn injury results in physical inactivity and muscle weakness. However, how these changes are distributed among body parts is unknown. The aim of this study was to evaluate the degree of body composition changes in different anatomical regions during ICU hospitalization.

Design: Retrospective chart review.

Setting: Children’s burn hospital.

Patients: Twenty-four severely burned children admitted to our institution between 2000 and 2015.

Interventions: All patients underwent a dual-energy x-ray absorptiometry within 2 weeks after injury and 2 weeks before discharge to determine body composition changes. No subject underwent anabolic intervention. We analyzed changes of bone mineral content, bone mineral density, total fat mass, total mass, and total lean mass of the entire body and specifically analyzed the changes between the upper and lower limbs.

Measurements and Main Results: In the 24 patients, age was 10 ± 5 years, total body surface area burned was 59% ± 17%, time between dual-energy x-ray absorptiometries was 34 ± 21 days, and length of stay was 39 ± 24 days. We found a significant (p < 0.001) average loss of 3% of lean mass in the whole body; this loss was significantly greater (p < 0.001) in the upper extremities (17%) than in the lower extremities (7%). We also observed a remodeling of the fat compartments, with a significant whole-body increase in fat mass (p < 0.001) that was greater in the truncal region (p < 0.0001) and in the lower limbs (p < 0.05).

Conclusions: ICU hospitalization is associated with greater lean mass loss in the upper limbs of burned children. Mobilization programs should include early mobilization of upper limbs to restore upper extremity function.

1Department of Surgery, University of Texas Medical Branch, Galveston, TX.

2Shriners Hospitals for Children - Galveston, Galveston, TX.

3Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.

4Division of Rehabilitation Sciences, Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston, TX.

5Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX.

6Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany.

7Institute for Translational Sciences and Sealy Center for Molecular Medicine, University of Texas Medical Branch, Galveston, TX.

*See also p. 1186.

Supported, in part, by the National Institutes of Health (P50GM060338, R01HD049471, R01GM056687, T32GM008256, R01GM112936, R01HD049471-12S1), Shriners Hospitals for Children (SHC 84080, SHC 80100, SHC 71008), a Clinical and Translational Science Award (UL1TR001439), and National Institute on Disability, Independent Living, and Rehabilitation Research (90DP0043-01-00). None of the study sponsors had any role in the study design; in the collection, analysis, or interpretation of the data; in the writing of the report; or in the decision to submit the article for publication.

Presented, in part, at conference on Shock, Fort Lauderdale, FL, June 3–6, 2017.

Drs. Cambiaso-Daniel, Malagaris, Hundeshagen, Voigt, Blears, Mlcak, and Herndon received support for article research from the National Institutes of Health (NIH). Dr. Mlcak’s institution received funding from the NIH (P50GM060338, RO1HD049471, RO1GM056687, T32GM008256, RO1GM112936), Shriners Hospitals for Children (84080, 80100, 71008), and a Clinical and Translational Science Award (UL1TR001439). Dr. Finnerty’s institution received funding from the NIH, Shriners Hospitals for Children, National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), and the Department of Defense (DoD); and she received support for article research from NIH, Shriners Hospitals for Children, NIDILRR, and the DoD. Dr. Herndon’s institution received funding from NIH (P50GM060338, R01HD049471, R01GM056687, T32GM008256, R01GM112936, UL1TR001439), Shriners of North America (SHC 84080, SHC 80100, SHC 71008), NIDILRR, DoD, and Gillson-Longenbaugh Foundation; and he received funding from Elsevier (royalties, ongoing). Dr. Suman’s institution received funding from the NIH, DoD, and Shriners Hospitals for Children; and he received support for article research from the NIH, DoD, NIDILRR, and Shriners Hospitals for Children. Dr. Rivas disclosed that he does not have any potential conflicts of interest.

For information regarding this article, E-mail: oesuman@utmb.edu

Copyright © 2017 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies