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Burns

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Surgical Metabolism

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Abstract

Severe burn injury continues to represent a significant public health problem worldwide. More than one million burn injuries occur annually in the USA. Major burn injury is characterized by oxidative stress, a prolonged hypermetabolic and catabolic state, and immunosuppression. The systemic response to major burn injury is driven by a cascade of cytokines, catecholamines, and corticosteroids that are central to the hypermetabolic response. Resultantly, burn patients have increased cardiac work, increased myocardial oxygen consumption, tachycardia, lipolysis, liver dysfunction, severe muscle catabolism, increased protein degradation, and insulin resistance, and growth retardation has been seen in children. The innate response to significant burn injury increases metabolism to such a profound degree that severely burn-injured patients would succumb to the effects of protein calorie malnutrition without nutritional supplementation. This postburn hypermetabolism is associated with profound proteolysis resulting in lean body mass loss and muscle wasting.

Thus, providing the right balance of macro- and micronutrients and antioxidants is essential to mitigate the hypermetabolic and hypercatabolic state that results. International nutrition support guidelines advocate that enteral feedings should begin early in critically ill patients who have a functioning gastrointestinal tract. Providing severely burned patients with a high-carbohydrate, high-protein, low-fat enteral diet can lower the incidence of catabolism and pneumonia, compared to a high-fat, high-protein, low-carbohydrate product. While providing adequate calories and protein is the foundation of nutritional support, it is also important to provide vitamins and minerals, also known as micronutrients. Depressed levels of vitamin C, vitamin D, selenium, vitamin E, zinc, and copper have been reported in burn patients, and these losses occur mainly through the skin and urine.

Some nutritional or metabolically active supplements have demonstrated promise in promoting anabolism in burn patients, including insulin, the anabolic steroid oxandrolone, and propranolol; however, ongoing and future research is necessary to better understand modulation of the hypermetabolic response to severe burn injury and continue to improve burn outcomes.

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Author information

Authors and Affiliations

  1. The Oregon Burn Center, Legacy Emanuel Medical Center, Portland, OR, USA

    Danielle M. Toepfer

  2. Loyola Burn Center, Loyola University Chicago, and Stritch School of Medicine, Maywood, IL, USA

    Richard L. Gamelli

  3. The Oregon Burn Center and The Oregon Clinic, Portland, OR, USA

    Michael J. Mosier

Authors
  1. Danielle M. Toepfer
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  2. Richard L. Gamelli
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  3. Michael J. Mosier
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Correspondence to Michael J. Mosier .

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Editors and Affiliations

  1. Department of Surgery, Yale University School of Medicine, New Haven, CT, USA

    Kimberly A. Davis

  2. Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA

    Stanley H. Rosenbaum

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Toepfer, D.M., Gamelli, R.L., Mosier, M.J. (2020). Burns. In: Davis, K., Rosenbaum, S. (eds) Surgical Metabolism. Springer, Cham. https://doi.org/10.1007/978-3-030-39781-4_7

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