Nutrition and anabolic agents in burned patients.
OBJECTIVE
Much of the morbidity and mortality of severely burned patients is connected with hypermetabolism and catabolism with its accompanying impairment of wound healing and increased infection risks. In order to prevent the erosion of body mass, nutritional support and other strategies to prevent catabolism have become a major focus in the care of severely burned patients.


RESULTS
Major themes discussed in recent literature are dealing with enteral versus parenteral nutrition and gastric versus duodenal feeding. The possibility of overfeeding is another important aspect of high calorie nutrition as commonly used in burned patients. Specific formulas for enteral nutrition for specific metabolic abnormalities are under evaluation as well as the role of anabolic and anticatabolic agents.


CONCLUSIONS
From the clinical literature, total enteral nutrition starting as early as possible without any supplemental parenteral nutrition is the preferred feeding method for burned patients. Using a duodenal approach, especially in the early postburn phase, seems to be superior to gastric feeding. Administration of high calorie total enteral nutrition in any later septic phase should be critically reviewed due to possible impairment of splanchnic oxygen balance. Therefore, measurement of CO(2)-gap should be considered as a monitoring method during small bowel nutrition. The impact on the course of disease of supplements such as arginine, glutamine and vitamins as well as the impact of the use of anabolic and anticatabolic agents is not yet evident. Furthermore, the effect of insulin administration and low blood sugar regimes on wound healing and outcome in burned patients should be evaluated in future studies.
Andel
Harald
H
Department of Anesthesia and Intensive Care, Medical School, University of Vienna 1090, Waehringer Guertel 18-20, Vienna, Austria. harald.andel@univie.ac.at
Kamolz
Lars Peter
LP
Hörauf
Klaus
K
Zimpfer
Michael
M
D045930:Anabolic Agents / Q000378:metabolism; D002056:Burns / Q000378:metabolism* / Q000628:therapy; D004032:Diet; D019587:Dietary Supplements; D004386:Duodenum; D004750:Enteral Nutrition / Q000379:methods; D005248:Feeding Methods; D006801:Humans; D010288:Parenteral Nutrition / Q000379:methods; D013270:Stomach
D045930:Anabolic Agents