Effects of early excision and aggressive enteral feeding on hypermetabolism, catabolism, and sepsis after severe burn.
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.


CONCLUSIONS
Early excision and concurrent aggressive feeding attenuate muscle catabolism and improve infectious outcomes after burn.
Hart
David W
DW
Department of Surgery, The University of Texas Medical Branch, Galveston, USA.
Wolf
Steven E
SE
Chinkes
David L
DL
Beauford
Robert B
RB
Mlcak
Ronald P
RP
Heggers
John P
JP
Wolfe
Robert R
RR
Herndon
David N
DN
D000704:Analysis of Variance; D015992:Body Mass Index; D001830:Body Surface Area; D001835:Body Weight; D002056:Burns / Q000378:metabolism* / Q000601:surgery; D002153:Calorimetry, Indirect; D002648:Child; D004734:Energy Metabolism; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D008297:Male; D009124:Muscle Proteins / Q000378:metabolism*; D018482:Muscle, Skeletal / Q000378:metabolism*; D010649:Phenylalanine / Q000378:metabolism; D016896:Treatment Outcome; D014946:Wound Infection / Q000378:metabolism
D009124:Muscle Proteins; D010649:Phenylalanine