title: ESPEN endorsed recommendations: nutritional therapy in major burns.
abstract: OBJECTIVE
  Nutrition therapy is a cornerstone of burn care from the early resuscitation phase until the end of rehabilitation. While several aspects of nutrition therapy are similar in major burns and other critical care conditions, the patho-physiology of burn injury with its major endocrine, inflammatory, metabolic and immune alterations requires some specific nutritional interventions. The present text developed by the French speaking societies, is updated to provide evidenced-based recommendations for clinical practice.
  
  
  METHODS
  A group of burn specialists used the GRADE methodology (Grade of Recommendation, Assessment, Development and Evaluation) to evaluate human burn clinical trials between 1979 and 2011. The resulting recommendations, strong suggestions or suggestions were then rated by the non-burn specialized experts according to their agreement (strong, moderate or weak).
  
  
  RESULTS
  Eight major recommendations were made. Strong recommendations were made regarding, 1) early enteral feeding, 2) the elevated protein requirements (1.5-2 g/kg in adults, 3 g/kg in children), 3) the limitation of glucose delivery to a maximum of 55% of energy and 5 mg/kg/h associated with moderate blood glucose (target ≤ 8 mmol/l) control by means of continuous infusion, 4) to associated trace element and vitamin substitution early on, and 5) to use non-nutritional strategies to attenuate hypermetabolism by pharmacological (propranolol, oxandrolone) and physical tools (early surgery and thermo-neutral room) during the first weeks after injury. Suggestion were made in absence of indirect calorimetry, to use of the Toronto equation (Schoffield in children) for energy requirement determination (risk of overfeeding), and to maintain fat administration ≤ 30% of total energy delivery.
  
  
  CONCLUSIONS
  The nutritional therapy in major burns has evidence-based specificities that contribute to improve clinical outcome.
authors.affiliation: Burn Centre and General Intensive Care Department, University Hospital, Liège, Belgium.
authors.forename: Anne-Françoise
authors.initials: AF
authors.lastname: Rousseau
authors.forename: Marie-Reine
authors.initials: MR
authors.lastname: Losser
authors.forename: Carole
authors.initials: C
authors.lastname: Ichai
authors.forename: Mette M
authors.initials: MM
authors.lastname: Berger
mesh_terms: D000328:Adult; D000596:Amino Acids / Q000008:administration & dosage; D001786:Blood Glucose / Q000032:analysis; D002056:Burns / Q000178:diet therapy*; D002153:Calorimetry, Indirect; D002648:Child; D003422:Critical Care / Q000592:standards; 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*; D019317:Evidence-Based Medicine; D017408:Guidelines as Topic; D006801:Humans; D007362:Intensive Care Units; D018977:Micronutrients / Q000008:administration & dosage; D009751:Nutritional Requirements; D017410:Practice Guidelines as Topic; D012151:Resuscitation / Q000379:methods
chemical_list: D000596:Amino Acids; D001786:Blood Glucose; D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004044:Dietary Proteins; D018977:Micronutrients