Use and efficacy of a nutrition protocol for patients with burns in intensive care.

The University of Michigan Burn Center uses a protocol to standardize the assessment, initiation, and monitoring of nutritional support for patients with burns of greater than 30% total body surface area (TBSA). Six patients with 20% to 80% TBSA burns were followed for 3 weeks to determine the effect of the protocol on the assessment, initiation, monitoring, and adequacy of nutritional support. The protocol calls for resting energy expenditure (REE) measurement within 24 hours of injury, to be repeated 3 times per week, for assessment of caloric requirements. Patients experienced an average delay before first REE measurement of 3 days after burn injury because measurements were unavailable on weekends and surgical days. REE measurements were used to determine caloric requirements and to tailor nutritional support to fluctuating metabolic needs. In four of the six patients a Dobhoff feeding tube (Biosearch Medical Products, Inc., Somerville, N.J.) was placed in the small bowel and enteral nutrition was initiated within 24 hours of admission, as outlined in the protocol. Two patients received concurrent parenteral nutrition because of difficulty in placing the Dobhoff feeding tube when fluoroscopy was not available. The three patients receiving nutrition solely through enteral feeding had achieved 100% of their caloric requirements by day 2, 4, and greater than 7 days after injury, respectively. Overall, the six patients received enterally an average of 75% of their caloric requirements. The major reason for inadequate enteral support was interruption of tube feedings because of tube dislodgment or multiple surgical procedures. The protocol used weekly measurements of total iron-binding capacity and prealbumin level s parameters of nutritional support.(ABSTRACT TRUNCATED AT 250 WORDS)