Feeding During Resuscitation After Burn Injury

Masch, Jessica L.; Bhutiani, Neal; Bozeman, Matthew C.

doi:10.1002/ncp.10400

Cited by 11 publications

(19 citation statements)

References 32 publications

(78 reference statements)

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“…Indeed, the presence of this syndrome in both pathological conditions was confirmed by the detection of characteristic laboratory shifts, including the intensification of free radical oxidation in the blood plasma, as well as suppression of its antioxidant reserves. These results confirm our previously published results [18][19][20][21][22][23][24][25] and those of other authors 19,20,23,26,27 . At the same time, the persistent nature of these disorders is emphasized by the detection of increased levels of diene conjugates which increase about equally in patients with burns and osteomyelitis.…”

Section: Discussionsupporting

confidence: 93%

“…This may indicate that the process is active. In addition, it should be emphasized that an acute thermal burn injury does not involve the inclusion of compensatory mechanisms, in particular, enzyme antioxidant systems 18,20,21,26,28 . This leads to a rapid depletion of their reserves during the conditions of intensification of free radical formation.…”

Section: Discussionmentioning

confidence: 99%

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Oxidative stress in osteomyelitis and burns: Specific features of its role in development of pathology

et al. 2021

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Introduction: The purpose of this study was to evaluate and compare the features of the initiation and development of oxidative stress in patients with osteomyelitis and burns. Methods: We studied the oxidative metabolism of blood of 20 healthy subjects (controls), 15 patients with burns, and 18 patients with chronic osteomyelitis. All patients included in the second group had thermal burns of the I-II-III degree in trunk and limbs on an area of 31-80% of the body surface without thermal inhalation trauma. After standard sample preparation, a wide range of parameters of oxidative metabolism was determined in the blood. The intensity of free radical processes in blood plasma and red blood cells, and the total antioxidant activity was evaluated by Fe-induced biochemiluminescence. The concentration of malonic dialdehyde in blood plasma and red blood cells was determined. The level of diene and triene conjugates and Schiff bases was determined spectrophotometrically using reagent kits. The catalase and superoxide dismutase activities in the red blood cells of patients from each of the groups was also determined. Results: We showed that in osteomyelitis, which is a long-lasting process, changes in the balance of free radical generation and activity of the antioxidant system were compensatory and mostly related to changes in blood plasma. On the contrary, in burn victims, oxidative stress signs had a maladaptive character. They were seen in blood plasma and red blood cells, and accompanied by a pronounced depletion of enzyme antioxidant system reserves. Conclusion: Our study demonstrate the role of oxidative stress in patients with burns and chronic osteomyelitis, and demonstrate some specific features leading to formation of disease pathology. Such features of oxidative stress may be useful in future design of new approaches to correct the pathology of diseases.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Oxidative stress in osteomyelitis and burns: Specific features of its role in development of pathology

et al. 2021

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“…This study showed that GI dysmotility and unsuccessful PPT insertions were highest in patients that were under–fluid resuscitated or over–fluid resuscitated. The literature reports associations between over–fluid resuscitated patients and gut edema resulting in paralytic ileus, 2,24 but there are no reports currently associating inadequate fluid resuscitation and gastric complications in burn patients. In a heterogeneous population of critically ill patients, negative fluid balance was shown to be a risk factor for GI dysfunction because of decreased gastric vessel perfusion and tissue hypoxia leading to stasis 24 .…”

Section: Discussionmentioning

confidence: 99%

“…Following fluid resuscitation, the metabolic rate is elevated proportional to burn size (to double that seen in healthy patients). [1][2][3] In this population, provision of energy and protein below prescribed targets has been associated with increased mortality and hospital length of stay, reduced healing of skin-graft donor sites, increased infection rate, and catabolism of lean muscle to support vital functions. 1,2,[4][5][6][7][8] Energy delivery at ≥30 kcal/kg of body weight per day has been shown to be associated with improved survival, reduced complications, and reduced treatment duration in these patients.…”

Section: Introductionmentioning

confidence: 99%

Nutrition and Gastrointestinal Dysmotility in Critically Ill Burn Patients: A Retrospective Observational Study

Sierp

Kurmis

Lange

et al. 2020

J Parenter Enteral Nutr

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Background Gastrointestinal (GI) dysmotility impedes nutrient delivery in critically ill patients with major burns. We aimed to quantify the incidence, timing, and factors associated with GI dysmotility and subsequent nutrition delivery. Methods A 10‐year retrospective observational study included mechanically ventilated, adult, critically ill patients with ≥15% total body surface area (TBSA) burns receiving nutrition support. Patients with a single gastric residual volume ≥250 mL were categorized as having GI dysmotility. Daily medical and nutrition data were extracted for ≤14 days in the intensive care unit (ICU). Data are mean (SD) or median (interquartile range). Factors associated with GI dysmotility and the effect on nutrition and clinical outcomes were assessed. Results Fifty‐nine patients were eligible; 51% (n = 30) with GI dysmotility and 49% (n = 29) without. Baseline characteristics (dysmotility vs no dysmotility) were age (48 [33–60] vs 34 [26–46] years); Acute Physiology and Chronic Health Evaluation II score (16 [12–17] vs 13 [10–16]); sex ([men] 80% vs 86%); and TBSA (49% [35%–59%] vs 38% [26%–55%]). Older age was associated with increased probability of dysmotility (P = .049). GI dysmotility occurred 32 (19–63) hours after ICU admission but was not associated with reduced nutrient delivery. Postpyloric tube insertions were attempted in 83% (n = 25) of patients, with 72% (n = 18) being successful. Postpyloric feeding achieved higher nutrition adequacy than gastric feeding (energy: 82% [95% CI, 70–94] vs 68% [95% CI, 63–74], P = .036; protein: 75% [95% CI, 65–86] vs 61% [95% CI, 56–65], P = .009). Conclusion GI dysmotility occurs early in critically ill burn patients, and postpyloric feeding improves nutrition delivery.

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“…89 Early enteral feeding has become the accepted standard of care, with preserved gut mucosal integrity and motility reducing the risk of ileus or intestinal ischaemia. 90 A recent meta-analysis of randomised controlled trials showed decreased mortality as well as reduced rates of gastrointestinal (GI) bleeds and sepsis favouring feeding before 24 h compared to later than 48 h following burn injury. 91 Early feeding has been defined as commencing within four to six hours after burn injury.…”

Section: Nutritionmentioning

confidence: 99%

Challenges in anaesthesia and pain management for burn injuries

Stapelberg

2020

Anaesth Intensive Care

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Burn-injured patients provide unique challenges to those providing anaesthesia and pain management. This review aims to update both the regular burn anaesthetist and the anaesthetist only occasionally involved with burn patients in emergency settings. It addresses some aspects of care that are perhaps contentious in terms of airway management, fluid resuscitation, transfusion practices and pharmacology. Recognition of pain management failures and the lack of mechanism-specific analgesics are discussed along with the opioid crisis as it relates to burns and nonpharmacological methods in the management of distressed patients.

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Feeding During Resuscitation After Burn Injury

Cited by 11 publications

References 32 publications

Oxidative stress in osteomyelitis and burns: Specific features of its role in development of pathology

Oxidative stress in osteomyelitis and burns: Specific features of its role in development of pathology

Nutrition and Gastrointestinal Dysmotility in Critically Ill Burn Patients: A Retrospective Observational Study

Challenges in anaesthesia and pain management for burn injuries

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