[Enteral feeding in burn patients].
The deleterious effects of denutrition, both generally and locally, in the development of extensive burns are widely known. These can be corrected either by reducing the nutritional loss or by increasing the intake. As far as the loss is concerned, the burned area may lead to a veritable "calorific haemorrhage", arising in cases where more than 30 to 40% of the body surface is affected. Nitrogen loss occurs in the urine, from the digestive tract, or from the burn itself, and in a 70 kg subject with a 40% burn, it can reach 40 g of nitrogen. This loss can be compensated in four ways: -- though this presents difficulties the oral route; -- the parenteral route; but intravenous feeding is often insufficient or dangerous; -- discontinuous enteral feeding; but this is poorly supported by the patient, badly assimilated, and dangerous; -- low-rate continuous enteral feeding (LRCEF) which is the preferred method. Use is made of continuous flow-rate pumps, which can be regulated and refrigerated (fig. 1). The solutions (fig. 2) are prepared as required and 2 to 3 litres are administered continuously throughout the 24 hour periods. Regular observations are made: -- daily for weight, urine output, blood and urine electrolytes, blood nitrogen and sugar; -- weekly, for protein and lipid electrophoresis. The results obtained during 3 periods (1973, 1975 and 1977) are reviewed.  -- 1973 (19 patients, fig. 3). A cautious attitude prevailed and only one case of a positive cumulative result was noted. The total quantity ingested was never greater than 4 000 calories or 224 g of protein. There were quite a few incidents (fig. 4), and 45 "accident days" were reported. -- 1975 (13 patients). The nitrogen balance was occasionally positive. Cumulative results were obtained in 8 cases. There were 26 "accident days". Improvement was due to: . prompter recourse to LRCEF, . a more rapid progression in the amount given, . an increase in the maximum quantity, . increased water intake. These results led to the development of the present-day procedure which includes: . a preliminary tolerance-testing period of 8 days, during which intake is increased to 4 000 calories and 25 g of nitrogen, . a second period during which intake is adjusted to losses, with supplementary feeding by the parenteral or oral routes. -- 1977 (36 patients including 18 on water-beds). Better tolerance to the increase in the amounts ingested was recorded in the patients treated on a water-bed. This led to an increase in calories and nitrogen being given to these patients, who also seemed to have a greater ability to make use of the supplementary nitrogen. The use of LRCEF and water-beds, combined, needless to say, with the earliest possible covering of the burned skin area, make a substantial contribution to the reduction of losses in burn patients.
D000328:Adult; D001513:Beds; D002056:Burns / Q000378:metabolism / Q000628:therapy*; D003967:Diarrhea / Q000209:etiology; D002149:Energy Intake; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D009584:Nitrogen / Q000378:metabolism; D011506:Proteins / Q000378:metabolism; D014508:Urea / Q000378:metabolism; D014839:Vomiting / Q000209:etiology
D011506:Proteins; D014508:Urea; D009584:Nitrogen
L'alimentation entérale chez les brûlés.