General nutritional management of the major burn adult patient and its complications

Abstract

Burns occur when soft tissues encounter a source of heat or energy, they vary in their presentation and severity; morbidity and mortality increase according to the amount of body surface affected, while the location of the injuries, the energy, and the exposure time contribute to the severity. Large burn patients present highly significant metabolic alterations that have a negative impact on morbidity, mortality, and recovery time. Nutritional support provides the necessary nutrients and therapeutic agents to maintain nutritional status. The main objective of nutritional support is to provide the different bodily demands that are a consequence of hyper catabolism. The initiation of early nutritional support in burned patients, who have criteria for it, represent one of the most effective factors in the metabolic regulation given by thermal injuries, manifesting as a decrease in the catabolic response and currently considered as a cornerstone in the basic management of major burns. There are three different routes of nutritional support: oral, enteral or parenteral. The oral route is recommended, if the patient can consume 60% of the caloric requirements. If intake is inadequate, enteral or parenteral nutrition should be considered. The severe burn patient requires multidisciplinary management. Burns that affect more than 20% of the affected body surface require early enteral nutrition as it improves survival and decreases hospital stay, as well as both gastrointestinal and general complications.