J Wasiak1, H Cleland, R Jeffery. 1. Victorian Adult Burns Service, The Alfred Hospital, Prahran, Melbourne, Australia. j.wasiak@alfred.org.au
Abstract
BACKGROUND: Burn injury increases the body's metabolic demands, and therefore nutritional requirements. Provision of an adequate supply of nutrients is believed to lower the incidence of metabolic abnormalities, thus reducing septic morbidity, and improving survival rates. Enteral nutrition support is the best feeding method in a patient who is unable to achieve an adequate oral intake, but optimal timing of its introduction after burn injury (i.e. early versus late) needs to be established. The purpose of this review is to examine evidence for the effectiveness and safety of early versus late enteral nutrition support in adults with burn injury. METHODS: An examination of randomized and controlled clinical trials using various medical databases such as The Cochrane Library (Issue 3, 2006), MEDLINE (from 1950), CINHAL (from 1982) and EMBASE (from 1980). RESULTS: The trial evidence about the benefit of early enteral nutritional support on standardized clinical outcomes such as length of hospital stay and mortality remained inconclusive. Similarly, the question of whether early enteral feeding influenced or decreased metabolic rate, reduced septic and other complications remained uncertain. CONCLUSIONS: Promising results suggest early enteral nutrition support may blunt the hypermetabolic response to thermal injury, but it is insufficient to provide clear guidelines for practice. Further research incorporating larger sample sizes and rigorous methodology that utilizes valid and reliable outcome measures is essential.
BACKGROUND:Burn injury increases the body's metabolic demands, and therefore nutritional requirements. Provision of an adequate supply of nutrients is believed to lower the incidence of metabolic abnormalities, thus reducing septic morbidity, and improving survival rates. Enteral nutrition support is the best feeding method in a patient who is unable to achieve an adequate oral intake, but optimal timing of its introduction after burn injury (i.e. early versus late) needs to be established. The purpose of this review is to examine evidence for the effectiveness and safety of early versus late enteral nutrition support in adults with burn injury. METHODS: An examination of randomized and controlled clinical trials using various medical databases such as The Cochrane Library (Issue 3, 2006), MEDLINE (from 1950), CINHAL (from 1982) and EMBASE (from 1980). RESULTS: The trial evidence about the benefit of early enteral nutritional support on standardized clinical outcomes such as length of hospital stay and mortality remained inconclusive. Similarly, the question of whether early enteral feeding influenced or decreased metabolic rate, reduced septic and other complications remained uncertain. CONCLUSIONS: Promising results suggest early enteral nutrition support may blunt the hypermetabolic response to thermal injury, but it is insufficient to provide clear guidelines for practice. Further research incorporating larger sample sizes and rigorous methodology that utilizes valid and reliable outcome measures is essential.