[Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): critically-burned patient].
The response to severe burns is characterized by hypermetabolism (the most hypermetabolic existing model of aggression) and hypercatabolism, with a high degree of destruction of the skeletal musculature. Metabolic disorders are most evident in the first two weeks after the burn, although they can be prolonged in direct relation to the complications that these patients develop. Nutritional-metabolic support is an essential part of the treatment of these patients and should be started early, preferentially through the enteral route, with parenteral nutrition as complementary support. Exact calculation of calorie-protein requirements in these patients is difficult, even when indirect calorimetry is used, due to the high loss of proteins and CO(2) through the skin. Specific pharmaconutrients are indicated, with a high dose of micronutrients. The use of drugs or medications with anabolic effects is also sometimes indicated.
Hospital Universitario La Paz, Madrid, España. agdl@telefonica.net
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A
García de Lorenzo y Mateos
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Ortiz Leyba
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Sánchez Sánchez
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D045930:Anabolic Agents / Q000627:therapeutic use; D002056:Burns / Q000378:metabolism / Q000628:therapy*; D002153:Calorimetry, Indirect; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000628:therapy; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004041:Dietary Fats / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D004750:Enteral Nutrition / Q000379:methods / Q000592:standards*; D005440:Fluid Therapy; D006801:Humans; D007249:Inflammation / Q000517:prevention & control; D008660:Metabolism; D018977:Micronutrients / Q000008:administration & dosage / Q000627:therapeutic use; D009124:Muscle Proteins / Q000378:metabolism; D009751:Nutritional Requirements; D010288:Parenteral Nutrition / Q000379:methods / Q000592:standards*; D012769:Shock / Q000517:prevention & control; D012955:Societies, Medical / Q000592:standards*; D012958:Societies, Scientific / Q000592:standards*; D013030:Spain; D014815:Vitamins / Q000008:administration & dosage
D000319:Adrenergic beta-Antagonists; D045930:Anabolic Agents; D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004044:Dietary Proteins; D018977:Micronutrients; D009124:Muscle Proteins; D014815:Vitamins