Nutrition guidelines for burned patients.

Among all hospitalized patients, burned patients have been shown to have the greatest increase in metabolic demand. However, the temptation to overfeed those patients must be recognized, as that practice may lead to increased morbidity. Care must be taken to provide an appropriate nutritional regimen in order to minimize protein catabolism and to promote wound healing. Several formulas for calculating energy and protein needs for burned patients have been reviewed for this article, along with guidelines for estimating other nutrients for such patients. Methods for providing nutrition therapy depend on many factors, such as extent and degree of injury and gastrointestinal function. The feeding methods most commonly used are parenteral (peripheral and central venous alimentation) and enteral (oral and naso-gastric tube feeding). Guidelines for using both parenteral and enteral feedings are discussed, as well as reliable methods for evaluating the nutrition assessment of the burned patient. It must be noted that standard assessment parameters are often unreliable, and their limitations are also addressed. In addition, several new parameters are introduced, including compliance with caloric goal, corrected weight change, and prediction of total urinary nitrogen to be used to calculate nitrogen balance.