Nutritional Support Quality Assessment in Burn Patients

BACKGROUND: Nutritional support (NS) is a key component of intensive care for burn patients. However, during the course of burn disease, a discrepancy often exists between nutritional demands and the adequacy of their replenishment.

AIM: To assess the quality of NS as part of intensive care in burn patients.

METHODS: A retrospective analysis of NS quality was conducted based on the medical records of burn patients with protein-energy malnutrition (PEM) who were admitted to the intensive care unit and had a length of stay exceeding 3 days. On days 2, 5, 10, 15, 20, and 30, the Frank Index (FI), energy requirements (calculated using the Harris–Benedict equation), serum total protein and albumin levels, absolute lymphocyte count, and the energy-protein value of NS were assessed. Based on FI values, mortality, number of infectious complications (IC), length of stay in the intensive care unit, and hospital stay were analyzed. Statistical data processing was carried out using SPSS software, version 20.0. The results are presented as Me [25%; 75%] (median, upper and lower quartiles).

RESULTS: Data from 130 patients (123 males) were analyzed. Median age was 41 years [35.25; 58.25]. Total body surface area burned was 22% [15; 47]. Baseline FI was 47.5 units [32.75; 89.75]. Serum total protein concentration on day 2 was 52.5 g/L [48.0; 59.75], with a significant increase observed on days 10 (54.0 g/L [52.0; 62.25]) and 15 (59.95 g/L [54.25; 65.38]), p < 0.05. During the first 10 days, energy intake was 59.5% [46.7; 53.9] of the target values and reached 95.4% [55.4; 101.8] by day 30. Protein intake on day 10 was 1.15 [0.57; 1.53] g/kg body weight(BW)/day, not meeting target levels during the observation period. In the FI ≥60 group, energy intake on day 10 was 44.1% of the target, and protein intake was 0.88 [0.50; 1.08] g/kg BW/day; in the FI ≤60 group, energy intake was 63.2% of the target, and protein intake was 1.15 [0.57; 1.35] g/kg BW/day (p < 0.05). IC incidence and mortality were higher in the FI ≥60 group (p < 0.05). No significant difference was observed in IC rate or mortality based on baseline PEM severity.

CONCLUSION: During the acute phase of burn disease, energy and protein intake remain significantly below recommended targets. Adequate energy intake is achieved only by day 30, whereas protein intake remains insufficient, especially in patients with FI ≥60 units. Baseline PEM did not affect IC rates or survival.