Improving Nutritional Support of Burn Service Patients by Increasing the Number of Days When 100% of Prescribed Formula Is Given.

The authors sought to increase the number of days when burn service patients receive 100% of prescribed enteral nutrition. The authors first performed a retrospective review of 37 patients (group 1) receiving enteral nutrition. The authors then created and implemented a nurse-directed feeding algorithm, placing patients into three age groups addressing maximum hourly infusion rates, high residual limits, initiating feeding, refeeding residuals, and replacing formula. The authors then performed a prospective review of 37 patients (group 2) fed utilizing the new algorithm. The amount of prescribed, infused, discarded, and missed feeds were recorded, as well as admitting diagnosis, age, gender, length of stay, ventilator days, infections, and mortality. All patients in group 1 (n = 37) received 100% of feeds 59.9% of prescribed days vs 76.5% in group 2 (n = 37; P = .003). Burn patients in group 1 (n = 26) received 100% of feeds 61.6% of prescribed days vs 85.4% in group 2 (n = 21; P < .001). The mean amount of hours tube feeds were held for surgery, procedures, clogged or dislodged tubes, in both historical control and the group using the restorative algorithm were the same. While there was a significant difference in burn size between groups (6.24 vs 18.39%, P = .01), there were no statistically significant differences in length of stay, ventilator days, or mortality. Implementation of a nurse-directed feeding algorithm improved delivery of enteral nutrition for all burn service patients, increasing the number of days when 100% of prescribed enteral nutrition is given.

Nutrition in Toxic Epidermal Necrolysis: A Multicenter Review.

BACKGROUND: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe exfoliative diseases treated in burn centers due to large skin losses. Literature on SJS/TEN refers to parenteral nutrition (PN) as the preferred route of nutrition support. This study describes nutrition support interventions in SJS/TEN patients admitted to burn centers. MATERIALS AND METHODS: Seven burn centers participated in this Institutional Review Board-exempted retrospective chart review of adults with SJS/TEN admitted from 2000-2012. RESULTS: This analysis included 171 patients with SJS/TEN. Median total body surface area involvement was 35% (n = 145; interquartile range [IQR], 16%-62%). The majority required mechanical ventilation (n = 105). Based on indirect calorimetry, measured energy needs were 24.2 kcal/kg of admit weight (n = 58; IQR, 19.4-29.9). Thirty-one patients did not require enteral nutrition (EN) and started oral intake on hospital day 1 (IQR, 1-2), and 81% required EN support due to inadequate oral intake and remained on EN until day 16 (median hospital day, 16; IQR, 9-25). High-protein enteral formulas predominated. PN was rarely used (n = 12, 7%). Most patients were discharged home (57%), with 14% still requiring EN. CONCLUSIONS: Nutrition support should be considered in patients with SJS/TEN due to increased metabolic needs and an inability to meet these needs orally. Most SJS/TEN patients continued on EN and did not require escalation to PN.

The relationship of body mass index and functional outcomes in patients with acute burns.

Obesity may contribute to the functional decline in elderly adults. It can also increase the risk of mortality in burn patients. However, little data exist regarding the relationship between obesity and functional outcomes in patients with burns. Data were collected regarding admission body mass index (BMI), length of stay, TBSA burn, inhalation injury, age, sex, discharge disposition, and discharge functional independence measure (FIM) scores for 221 patients. We used the classification and regression trees (CART) method to determine the strongest predictors of discharge disposition and FIM scores. Patients older than 59, with 0 to 30.75% TBSA burn, and a BMI of less than 27 were more likely to return home when compared with matched patients with a greater BMI. Regardless of age and BMI, patients with greater than 30.75% TBSA burn were less likely to return home (27.6%) posthospitalization when compared with patients with less than 30.75% TBSA burn (82.8%). Patients aged 54 to 72 years with less than 22.50% TBSA burn and a higher BMI (>25.15) demonstrated lower FIM locomotion scores than corresponding patients with a lower BMI (<25.15). Older patients (>72.5 years) with burns less than 22.50% TBSA and a larger BMI (>31.25) had lower transfer FIM scores when compared with matched patients with a smaller BMI (< or =31.25). Among patients with greater than 22.50 TBSA burn, women demonstrated lower FIM transfer and locomotion scores when compared with men. BMI may contribute to lower functional scores and the likelihood of discharge to an inpatient setting in elderly patients with less severe burns.