title: Effects of early excision and aggressive enteral feeding on hypermetabolism, catabolism, and sepsis after severe burn.
abstract: 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.
authors.affiliation: Department of Surgery, The University of Texas Medical Branch, Galveston, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Hart
authors.forename: Steven E
authors.initials: SE
authors.lastname: Wolf
authors.forename: David L
authors.initials: DL
authors.lastname: Chinkes
authors.forename: Robert B
authors.initials: RB
authors.lastname: Beauford
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Mlcak
authors.forename: John P
authors.initials: JP
authors.lastname: Heggers
authors.forename: Robert R
authors.initials: RR
authors.lastname: Wolfe
authors.forename: David N
authors.initials: DN
authors.lastname: Herndon
mesh_terms: 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
chemical_list: D009124:Muscle Proteins; D010649:Phenylalanine