[Nutritional support for the large burn patient].
Large burn patients make up a subgroup of critical patients in whom the nutro-metabolic support reaches its maximum importance, due to the fact thermal aggression induces a hypermetabolic response which is prolonged until the wounds heal. In fact, there are few deubt with regard to the importance of nutritional support tin the management of these patients for reducing the complications and facilitating the closing of the wounds and the recovery of the patients. Thermal trauma induces the release of counter-regulatory hormones and of other mediators which favor proteineic catabolism, mainly muscular, lipolysis, and gluconeogenesis; as well, there is an alteration of thermoregulation, raising the equilibrium point. The estimate of the energetic requirements may be done by means of predictive equations, although these tend to over-estimate it; indirect calorimetry is the most exact method and this permits monitorization of the evolution, which is very variable in time, it gives the metabolic response to the thermal aggression, at the same time as permitting the analysis of the use of the administrated substrates. Its use has meant a dramatic decrease in the supply of calories administered to burn patients, with the present recommendation being 35-40 kcal/kg/d. The supply of non-proteineic calories has also been modified: It is recommended that at least 60-70% of the calories administered, be in the form of carbohydrates, without surpassing 1600 kcal/kg/d. The optimal relation of non-proteineic kcal:nitrogen, is 150:1. The administration route of the artificial nutrition support should be individualized in each patient, with the enteral route being the route of choice, as this is the most physiologic, the cheapest, and the safest; its use prevents the appearance of certain complications (Curling ulcer, cholecystitis, bacterial translocation); however, if his does not cover nutritional requirements of the burn patient, parenteral nutrition should be associated to this.
Peláez
J
J
Servicio de Medicina Intensiva de la Fundación Jiménez Díaz, Hospital La Paz, Madrid, España.
García de Lorenzo
A
A
Denia
R
R
Martínez Ratero
S
S
López Martínez
J
J
Caparrós
T
T
D002056:Burns / Q000628:therapy*; D006801:Humans; D018529:Nutritional Support
Soporte nutricional del paciente gran quemado.