.jpg "Ada Jutba, BCCCP, PharmD photo")
Ada Jutba, BCCCP, PharmD
University of Florida Health Shands Hospital
Gainesville, Florida
Disclosure information not submitted.
Amir Kamel, PharmD, BCNSP
Clinical Pharmacy Specialist, Nutrition Support / Critical Care
n/a
Gainesville, Florida
Disclosure information not submitted.
Julie Cash, BCCCP, PharmD
ICU Clinical Pharmacy Specialist
n/a, United States
Disclosure information not submitted.
Janet Popp, MSN, RN, CCRN
Burn ICU Registered Nurse
University of Florida Health Shands Hospital, United States
Disclosure information not submitted.
Ashlee Allen, RN, BSN, CCRN
Burn ICU Registered Nurse
University of Florida Health Shands Hospital, United States
Disclosure information not submitted.
Laura Roberson, RN, BSN, CCRN
Burn ICU Registered Nurse
University of Florida Health Shands Hospital, United States
Disclosure information not submitted.
Quennie Omalay, RN, BSN, CCRN
Burn ICU Registered Nurse
University of Floirda Health Shands Hospital, United States
Disclosure information not submitted.
David Mozingo, MD, FACS
General Surgeon
University of Florida Health Shands Hospital, United States
Disclosure information not submitted.
Joshua Carson, MD, FACS
General Surgeon, Assistant Professor
University of Florida Health Shands Hospital, United States
Disclosure information not submitted.
Title: Impact of an Enteral Nutrition Protocol in Critically Ill Patients with Burn Injuries
Introduction: Nutrition support is crucial to the management of the critically ill burn patients to improve wound healing and reduce infection risk. The American Society of Enteral and Parenteral Nutrition (ASPEN) guidelines recommend 1.5 to 2 grams per kilogram per day of protein for burn patients; however, the optimal protein intake for burn patients remains controversial. In 2012, UF Health Shands implemented an enteral nutrition protocol which provides recommendations on protein requirements based on total body surface area (TBSA) burned. The purpose of this study is to characterize the institution's current practice as it relates to total protein intake and clinical outcomes.
Methods: This retrospective chart review study included adult patients admitted to the burn intensive care unit from January 2012 through August 2016 with burns of twenty percent or greater TBSA and received enteral nutrition. Patients less than 18 years old, without documented enteral nutrition, or unable to provide consent were excluded. The primary outcome was the mean daily amount of protein received. Secondary outcomes included skin graft loss, diarrhea, length of stay, and survival to hospital discharge.
Results: One hundred seventy-eight patients were screened; 104 were included for analysis. Mean age was 48±17 years. Sixty-four percent were male. Thirty-five patients had 20-29% TBSA burned, 27 had 30-39% TBSA burned, 20 had 40-49% TBSA burned, and 11 had 50-59% TBSA burned. The predominant mechanism of burn injury was thermal (82.2%). Mean protein intake was 2±0.6 grams per kilogram per day. Fifty-six percent experienced graft loss. Sixty-nine percent had at least one day with severe diarrhea. The median (IQR) length of stay was 33 (22-715) days. Eighty-two percent survived to hospital discharge.
Conclusions: Patients with >29% TBSA burned received significantly more total daily protein. Our institution's enteral nutrition protocol is consistent with recommendations from the ASPEN guidelines. There was no significant association between total protein intake and incidence of severe diarrhea. Further studies are needed to assess whether a higher protein target will lead to improved clinical outcomes for critically ill burn patients