A Proper Enteral Nutrition Support Improves Sequential Organ Failure Score and Decreases Length of Stay in Hospital in Burned Patients

Iranian Red Crescent Medical Journal

Jan 2016

DOI: 10.5812/ircmj.21775

Citations:14

Influential Citations:2

Interventional (Human) Studies

Enhanced Details

Methods

Design: double-blind randomized controlled clinical trial, conducted at Sina Burn Center, Tabriz University of Medical Sciences, Iran. Participants: 30 adults aged 18–60 years with severe burns (>20% TBSA; mean ~32.3% TBSA), 22 male and 8 female. Exclusions: cardiogenic shock, serious inhalation injury, hepatic or renal failure, contraindication to enteral feeding, pregnancy. Randomization: 15 per group (intervention vs control). Follow-up through day 9 with serial SOFA scoring.

Intervention

Enteral nutrition with ENTERA Meal (1 kcal/mL; 54.6% carbohydrate, 14% protein, 31.6% fat); started within 1 hour of ICU admission; initial rate 25 mL/h, titrated to meet calculated energy requirements within 3 days; energy target based on Harris-Benedict formula × 1.5; protein target 1.5–2 g/kg/day for TBSA >30%.

Results

Early, adequate enteral nutrition with ENTERA Meal significantly improved organ-function scores by day 9 (SOFA3 lower than SOFA1 in the intervention group; between-group SOFA3 vs SOFA0 difference significant, P=0.039). Length of hospital stay tended to be shorter in the intervention group (17.6±8.2 vs 23.1±11.9 days) but this was not statistically significant (P=0.375). Adequate early nutrition reduced hypermetabolic stress and may decrease LOS and costs in burn care.

Limitations

Small, single-center trial (n=30); short follow-up (9 days); some dropouts; limited generalizability across burn severities and settings.

Abstract

Background: Severe burned patients developed metabolic imbalances and systemic inflammatory response syndrome (SIRS), which can lead to malnutrition, impaired immunologic response, multiple organ failure and death. Studies have shown that providing an early and adequate nutrition support can lower hypermetabolic response and improve the outcome. Unfortunately, little emphasis has been given to the role of nutritional support, especially for demonstrating the importance of a proper nutritional support in determining the outcome of critically burned patients. Objectives: This study was designed to determine the possible protective effect of early and adequate nutrition support on sequential organ failure assessment (SOFA) score and length of stay (LOS) in hospital, in thermal burn victims. Patients and Methods: Thirty patients with severe thermal burn (More than 20% of total body surface area [TBSA] burn), on the first day in the intensive care unit, joined this double-blinded randomized controlled clinical trial. Patients were randomly divided into two groups: control group (group C, 15 patients) received hospital routine diet (liquid and chow diet, ad libitum) while intervention group (group I, 15 patients) received commercially prepared solution, with oral or tube feeding. The caloric requirement for these patients was calculated, according to the Harris-Benedict formula. The SOFA score was also measured on admission (SOFA0), day 2 (SOFA1), day 5 (SOFA2) and day 9 (SOFA3), consequently. The difference between the last measurement (SOFA3) and day 2 (SOFA1) was calculated. Results: The results showed that there was a significant change between SOFA3 and SOFA1, {-1[(-1) – 0], P = 0.013 vs. -1 [(-2) - 0], P = 0.109}. Mean LOS in hospital, for patients consuming commercial standard food, also proved to be shorter than those consuming hospital routine foods (17.64 ± 8.2 vs. 23.07 ± 11.89). Conclusions: This study shows that an adequate nutritional support, in patients with severe burn injury, can improve SOFA score. It is also more cost-effective, resulting in a shorter LOS in hospital. show less