Nutrition support in burns - Is there consistency in practice?

Nutrition support is an integral part of the multidisciplinary management of a burn. However, the large body of research has lead to some confusion regarding optimal feeding practices. This review examines nutrition support practices in six United States (U.S.) and seven Australian burns units and compares practice to common themes and options in the literature. The review focuses on the consistency of practice in: managing the hormonal and metabolic changes resulting from a burn injury and their relationship to nutrition; techniques of estimating energy requirements; changes in macronutrient requirements; the use of specialized immune enhancing nutrition; methods of optimizing nutrition support; and methods of monitoring nutritional status and progress. In general, dietitians had a good understanding of the hypermetabolic response and increased nutritional requirements of burns patients. There were several areas where consistency was not seen, such as the fat and carbohydrate content of enteral formulas, the indications for use of total parenteral nutrition, the use of immunonutrition in enteral nutrition, and the most appropriate strategies for perioperative feeding. This is a reflection of inconclusive research outcomes. There was more consistency in the techniques used for estimation of energy requirements, although more widespread use of indirect calorimetry would be beneficial. The need for high energy and high protein enteral feeds was also recognized across all units studied. The limitations of common nutritional markers was understood and managed by the use of multiple markers.