title: Impact of decreasing energy intakes in major burn patients: A 15-year retrospective cohort study.
abstract: Nutritional therapy is particularly important after major burn injury and specific nutritional guidelines have been developed. The study aimed at evaluating the impact of the changes in our nutritional practice, general compliance with the guidelines and potential consequences.
  
  
  
  Retrospective analysis of prospectively collected data in burn patients requiring intensive care (ICU) between 1999 and 2014.
  
  
  
  admission on day 1, full treatment and length of ICU stay >7 days. Four periods (P) were defined by protocol changes (P1: 1999-2001, P2: 2002-2005, P3: 2006-2010, P4: 2011-2014). Collected data: demographic and nutritional data, infectious complications, weights, CRP and prealbumin concentrations during the first 21 days.
  
  
  
  240 patients were included (median age 43 years, burned area 25%). Measured energy expenditure (MEE) was stable through all periods but the prescribed caloric target decreased significantly, and below MEE (P1: 33 kcal/kg, IQR 7, P4: 28 kcal/kg, IQR 8, p < 0.001). Energy delivery ended decreasing below 30 kcal/kg/day (P1: 30 kcal/kg, IQR 23, P4: 25 kcal/kg, IQR 12, p < 0.001). Protein intakes increased due the use of high protein solutions and glutamine (P1: 1.04 g/kg, IQR 0.90, P4: 1.26, IQR 0.99, p < 0.001). Weight loss by day 21 increased significantly according to area under the curve (P1: 701, IQR 38, P2: 722, IQR 51, P4: 689 IQR 63, p = 0.02). Prealbumin levels decreased with energy decrease (P1: 150 mg/L, IQR 110, P4: 80 mg/L, IQR 70, p = 0.003).
  
  
  
  The observed reduction of the energy delivery <30 kcal/kg was associated with a supplemental weight loss and lower prealbumin concentrations.
authors.affiliation: Service of Adult Intensive Care Medicine and Burns, University Hospital, Lausanne, Switzerland. Electronic address: olivier.pantet@chuv.ch.
authors.forename: Olivier
authors.initials: O
authors.lastname: Pantet
authors.affiliation: Service of Adult Intensive Care Medicine and Burns, University Hospital, Lausanne, Switzerland.
authors.forename: Patricia
authors.initials: P
authors.lastname: Stoecklin
authors.affiliation: Department of Computer Sciences, University Hospital, Lausanne, Switzerland.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Vernay
authors.affiliation: Service of Adult Intensive Care Medicine and Burns, University Hospital, Lausanne, Switzerland.
authors.forename: Mette M
authors.initials: MM
authors.lastname: Berger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002056:Burns / Q000178:diet therapy*; D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D016638:Critical Illness / Q000628:therapy; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D004734:Energy Metabolism; D004750:Enteral Nutrition / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D018673:Nutrition Policy; D009751:Nutritional Requirements; D009752:Nutritional Status; D010349:Patient Compliance; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism; D015431:Weight Loss; D055815:Young Adult
chemical_list: D004044:Dietary Proteins; D012709:Serum Albumin; D002097:C-Reactive Protein
keywords: Critical care; Energy requirement; Guidelines; Indirect calorimetry