Nutrition support in major burn injury: case analysis of dietetic activity, resource use and cost implications

Abstract

Work is now required to assess current nutrition practices across different UK centres and for a range of burn severities, to establish a baseline from which resource and financial requirements can ultimately be developed.

Dietetic service provision for burn care in the United Kingdom: are nutrition support standards being met?

“…Internationally, there appears to be varying models of practice and a lack of dietetic standards for staffing in burns (Eldad et al. , 1993; Masters & Wood, 2008; Windle, 2008). US burn centre verification guidelines acknowledge the need for a dietetic service, but no staff ratio recommendations have been proposed (American Burn Association, 2006).…”

A Protocol of Early Aggressive Acceleration of Tube Feeding Increases Ileus Without Perceptible Benefit in Severely Burned Patients

“…3,4 The provision of adequate nutrition can help ameliorate these adverse effects; however, adequate nutrition in this setting requires much higher caloric and protein intakes than is usual in the intensive care unit (ICU) environment. [1][2][3][4][5][6][7] Early nutrition is typically defined as initiation of feeds within the first 24 hours of hospitalization. 3,5 Provision of early nutrition therapy can reduce disease severity, prevent complications, decrease length of stay, and improve outcomes.…”

“…For example, an adult patient burned more than 50% of their TBSA will require upward of 5000 calories per day. 1,[3][4][5][6][7] Patients with large burn sizes or requiring mechanical ventilation may require enteral nutrition alone or in combination with oral feeding to meet their high requirements. Enteral nutrition is preferred over parenteral nutrition whenever possible.…”

“…[1][2][3][4][5][6][7] Early nutrition is typically defined as initiation of feeds within the first 24 hours of hospitalization. 6,7 Longstanding practice for enteral nutrition has included the routine monitoring of gastric residual volumes (GRV) by nursing staff, using the residual volume as a surrogate measure of gastric emptying. 3,5 The goal of nutrition supplementation is to promote wound healing, prevent infection, and attenuate the loss of muscle mass during critical illness associated with increased mortality and poorer long-term outcomes among survivors.…”

A time of change

“…The expanded role of dietitians in research, its impact on clinical practice and the uniqueness of dietetic skills were discussed further by Delahanty (2010). Research and audit are the tools that dietitians must use to demonstrate this uniqueness as well as efficacy (Neal & Cross, 2010) and value for money (Windle, 2008). Dietitians working in the NHS must engage in this agenda and the national improvement programmes such as Quality, Innovation, Productivity and Prevention (QIPP) (Brotherton, 2010).…”