Burns injury - PACT - ESICM

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Jeschke M, Norbury WB, Finnerty CC, Mlcak RP, Kulp GA, Branski LK, et al. Age differences in inflammatory and hypermetabolic postburn responses. Pediatrics 2008; 121(3): 497–507. PMID 18310198 Nutritional support See the PACT module on Nutrition. Energy requirements Several predictive energy requirements equations have been developed for burn injury with the intention of preventing the acute loss of lean body mass. A typical example was the Curreri equation which has led to massive and deleterious overfeeding and these equations should be definitively abandoned. Setting an energy target in patients with major burns is challenging in the absence of indirect calorimetry. However, the Toronto equation (further detail within interactive version) based on the study of a large patient population represents a good alternative to indirect calorimetry, and includes several important factors such as the burn size (%TBSA), previous day’s feed (last 24hrs’ caloric intake = CI), Age, Sex, and Weight (derived from the predicted resting EE via the Harris & Benedict equation), fever (T o ), and time after injury. Total EE= -4.343 + (10.5 %TBSA) + (0.23 x CI) + 0.84 REE H-B) + (114 x T°C) – (4.5 days) Allard JP, Pichard C, Hoshino E, Stechison S, Fareholm L, Peters WJ, et al. Validation of a new formula for calculating the energy requirements of burn patients. JPEN J Parenter Enteral Nutr 1990; 14(2): 115–118. PMID 2112617 Nutrition route In burns, early enteral nutrition (EN) is particularly important as it contributes to improved splanchnic perfusion during the early phase of resuscitation, prevents ileus, and attenuates the metabolic response to injury. Gastric EN should be introduced within the first 12 hrs after injury. Postpyloric feeding may be required in patients with the largest burns. Parenteral nutrition should be limited to the cases of intestinal failure with contraindication to EN. Failure is defined as the incapacity to deliver more than 60% of requirements calculated by the Toronto equation for more than four consecutive days by the postpyloric route, which is extremely rare in burn patients, who tolerate feeding rates up to 150 mL/hr for ‘catch up’ feeding after interruptions such as after repeated daily surgical procedures. 30
Lam NN, Tien NG, Khoa CM. Early enteral feeding for burned patients--an effective method which should be encouraged in developing countries. Burns 2008; 34(2): 192–196. PMID 17804169 Macronutrients The nutritional requirements are particularly increased for glucose and proteins. There is a maximal oxidation rate for glucose of 5 mg/kg/min for adults and children that should not be exceeded to avoid the development of fatty liver. Protein requirements are increased to 1.5-2 g/kg/day. Lipid delivery should probably be tightly controlled to
Page 1 and 2: AN ESICM MULTIDISCIPLINARY DISTANCE
Page 3 and 4: Pathophysiology ...................
Page 5 and 6: INTRODUCTION Most emergency medical
Page 7 and 8: 1/ PRE-HOSPITAL/IMMEDIATE CARE Prio
Page 9 and 10: Intravenous cannulae/needles and fl
Page 11 and 12: Fluid resuscitation (0-24 hrs) Burn
Page 13 and 14: Fluid resuscitation in patients wit
Page 15 and 16: Electrical burn injury is addressed
Page 17 and 18: Haberal M. Guidelines for dealing w
Page 19 and 20: Early tangential excision was first
Page 21 and 22: performed for these individuals and
Page 23 and 24: 4/ MANAGING CONCURRENT INJURIES AND
Page 25 and 26: Clinical signs of CO poisoning rela
Page 27 and 28: Although diagnosing CN poisoning is
Page 29 and 30: Electrical injuries Electrical inju
Page 31 and 32: 5/ CRITICAL CARE CONSIDERATIONS SPE
Page 33: Pruitt BA Jr. The diagnosis and tre
Page 37 and 38: Sheridan RL, Yu YM, Prelack K, Youn
Page 39 and 40: hydromorphone) is preferred. In the
Page 41 and 42: 6/ PERIOPERATIVE MANAGEMENT OF INTE
Page 43 and 44: Know your hospital guidelines for t
Page 45 and 46: 7/ BURNS IN CHILDREN Epidemiology a
Page 47 and 48: One can also use a modified Parklan
Page 49 and 50: 8/ OUTCOME, ETHICS & RESEARCH In a
Page 51 and 52: CONCLUSION In patients with burns c
Page 53 and 54: Initial resuscitation specific to b
Page 55 and 56: With due preparation and skilled as
Page 57 and 58: After wound debridement and escharo
Page 59 and 60: Sepsis diagnosis Catheter-related i

Burns injury - PACT - ESICM

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