title: International observational study of nutritional support in mechanically ventilated patients following burn injury.
abstract: BACKGROUND
  It has been proposed that nutritional therapy in critically ill patients after major burn reduces mortality. However, the actual practice of nutrient delivery, and the effect on outcome, has not been described.
  
  
  OBJECTIVE
  To evaluate international practices related to nutritional support and outcomes in mechanically ventilated patients with burn injury.
  
  
  METHODS
  Data from the International Nutrition Surveys (2007-2011) for patients with a primary diagnosis of burn were extracted and analysed.
  
  
  RESULTS
  Eighty-eight of 90 patients (aged 16-84 years) received enteral nutrition. The median time for initiation of enteral feeding was 17 h [range 0-65]. Fifty patients (57%) had interruptions to nutrient delivery, most often these interruptions were fasting for operative procedures. There were substantive energy and protein deficits [943 (654) kcal/day and 49 (41) g/day, respectively; mean (SD)]. Nineteen (21%) patients died within 60 days of admission, and the energy and protein deficits were greater in those that died compared with survivors [died vs. survived, energy: 1251 (742) vs. 861 (607) kcal/d; p=0.02; and protein 67(42) vs. 44(39) g/d; p=0.03]. Energy and protein deficits were associated with increased mortality with the greater the deficit, the stronger the association with death (odds ratio for death: energy deficit/100 kcal 1.10 (1.01, 1.19); p=0.028 and protein/10 g 1.16 (1.01, 1.33); p=0.037). Results were similar and remained significant after adjusting for severity of illness.
  
  
  CONCLUSIONS
  Mechanically ventilated patients following burn develop substantial energy and protein deficits, with lesser deficits observed in survivors.
authors.affiliation: Intensive Care Unit, Level 4, Emergency Services Building, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia 5000, Australia. Electronic address: adamczapran@nhs.net.
authors.forename: Adam
authors.initials: A
authors.lastname: Czapran
authors.affiliation: Intensive Care Unit, Level 4, Emergency Services Building, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia 5000, Australia.
authors.forename: William
authors.initials: W
authors.lastname: Headdon
authors.affiliation: Intensive Care Unit, Level 4, Emergency Services Building, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia 5000, Australia; Discipline of Acute Care Medicine, University of Adelaide, North Terrace, Adelaide, South Australia 5000, Australia.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Deane
authors.affiliation: Discipline of Medicine, University of Adelaide, North Terrace, Adelaide, South Australia 5000, Australia.
authors.forename: Kylie
authors.initials: K
authors.lastname: Lange
authors.affiliation: Intensive Care Unit, Level 4, Emergency Services Building, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia 5000, Australia; Discipline of Acute Care Medicine, University of Adelaide, North Terrace, Adelaide, South Australia 5000, Australia.
authors.forename: Marianne J
authors.initials: MJ
authors.lastname: Chapman
authors.affiliation: Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada.
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002056:Burns / Q000401:mortality / Q000628:therapy*; D003422:Critical Care; D016638:Critical Illness; D004044:Dietary Proteins; D019587:Dietary Supplements; D002149:Energy Intake; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005973:Glutamine / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D018529:Nutritional Support / Q000379:methods; D010288:Parenteral Nutrition / Q000379:methods*; D011446:Prospective Studies; D012121:Respiration, Artificial; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D004044:Dietary Proteins; D005973:Glutamine
keywords: Burn; Critical illness; Deficit; Energy; ICU; Intensive care; International nutrition survey; Nutrition; Protein