[Enteral feeding in burn patients]. 1979

S Baux, and R Saizy, and P Aubert

The deleterious effects of denutrition, both generally and locally, in the development of extensive burns are widely known. These can be corrected either by reducing the nutritional loss or by increasing the intake. As far as the loss is concerned, the burned area may lead to a veritable "calorific haemorrhage", arising in cases where more than 30 to 40% of the body surface is affected. Nitrogen loss occurs in the urine, from the digestive tract, or from the burn itself, and in a 70 kg subject with a 40% burn, it can reach 40 g of nitrogen. This loss can be compensated in four ways: -- though this presents difficulties the oral route; -- the parenteral route; but intravenous feeding is often insufficient or dangerous; -- discontinuous enteral feeding; but this is poorly supported by the patient, badly assimilated, and dangerous; -- low-rate continuous enteral feeding (LRCEF) which is the preferred method. Use is made of continuous flow-rate pumps, which can be regulated and refrigerated (fig. 1). The solutions (fig. 2) are prepared as required and 2 to 3 litres are administered continuously throughout the 24 hour periods. Regular observations are made: -- daily for weight, urine output, blood and urine electrolytes, blood nitrogen and sugar; -- weekly, for protein and lipid electrophoresis. The results obtained during 3 periods (1973, 1975 and 1977) are reviewed. -- 1973 (19 patients, fig. 3). A cautious attitude prevailed and only one case of a positive cumulative result was noted. The total quantity ingested was never greater than 4 000 calories or 224 g of protein. There were quite a few incidents (fig. 4), and 45 "accident days" were reported. -- 1975 (13 patients). The nitrogen balance was occasionally positive. Cumulative results were obtained in 8 cases. There were 26 "accident days". Improvement was due to: . prompter recourse to LRCEF, . a more rapid progression in the amount given, . an increase in the maximum quantity, . increased water intake. These results led to the development of the present-day procedure which includes: . a preliminary tolerance-testing period of 8 days, during which intake is increased to 4 000 calories and 25 g of nitrogen, . a second period during which intake is adjusted to losses, with supplementary feeding by the parenteral or oral routes. -- 1977 (36 patients including 18 on water-beds). Better tolerance to the increase in the amounts ingested was recorded in the patients treated on a water-bed. This led to an increase in calories and nitrogen being given to these patients, who also seemed to have a greater ability to make use of the supplementary nitrogen. The use of LRCEF and water-beds, combined, needless to say, with the earliest possible covering of the burned skin area, make a substantial contribution to the reduction of losses in burn patients.

UI MeSH Term Description Entries
D009584 Nitrogen An element with the atomic symbol N, atomic number 7, and atomic weight [14.00643; 14.00728]. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells.
D011506 Proteins Linear POLYPEPTIDES that are synthesized on RIBOSOMES and may be further modified, crosslinked, cleaved, or assembled into complex proteins with several subunits. The specific sequence of AMINO ACIDS determines the shape the polypeptide will take, during PROTEIN FOLDING, and the function of the protein. Gene Products, Protein,Gene Proteins,Protein,Protein Gene Products,Proteins, Gene
D002056 Burns Injuries to tissues caused by contact with heat, steam, chemicals (BURNS, CHEMICAL), electricity (BURNS, ELECTRIC), or the like. Burn
D002149 Energy Intake Total number of calories taken in daily whether ingested or by parenteral routes. Caloric Intake,Calorie Intake,Intake, Calorie,Intake, Energy
D003967 Diarrhea An increased liquidity or decreased consistency of FECES, such as running stool. Fecal consistency is related to the ratio of water-holding capacity of insoluble solids to total water, rather than the amount of water present. Diarrhea is not hyperdefecation or increased fecal weight. Diarrheas
D004750 Enteral Nutrition Nutritional support given via the alimentary canal or any route connected to the gastrointestinal system (i.e., the enteral route). This includes oral feeding, sip feeding, and tube feeding using nasogastric, gastrostomy, and jejunostomy tubes. Enteral Feeding,Force Feeding,Nutrition, Enteral,Tube Feeding,Gastric Feeding Tubes,Feeding Tube, Gastric,Feeding Tubes, Gastric,Feeding, Enteral,Feeding, Force,Feeding, Tube,Feedings, Force,Force Feedings,Gastric Feeding Tube,Tube, Gastric Feeding,Tubes, Gastric Feeding
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D001513 Beds Equipment on which one may lie and sleep, especially as used to care for the hospital patient. Mattresses,Bed
D014508 Urea A compound formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. Basodexan,Carbamide,Carmol

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