Assessing nutritional needs for the burned patient.

Assessment of nutritional needs following thermal injury remains an important adjunct to providing dietary therapy designed to minimize the detrimental effects of hypermetabolism and subsequent catabolism. Most anthropometric measurements, frequently utilized in nonburned patients, have relatively little usefulness in assessing burned individuals. Energy expenditure can be adequately estimated for most patients by direct calorimetry, indirect calorimetry, or formulae. Direct calorimetry is the most expensive and complicated method, while use of a formula is the most inexpensive and least complicated. All yield good results in the clinical setting. Differences in estimated energy expenditure by the multiple formulae may be statistically significant, but rarely are clinically significant. Therefore selection of a formula should be based on simplicity. Estimations by formula require readjustment at intervals of 1 to 2 weeks. In general, enteral feedings remain superior to parenteral delivery of nutrients. Finally, current animal research suggests significant differences in metabolic and immunologic effects of the diet depending on qualitative make-up of dietary fat sources.