Actual Burn Nutrition Care Practices: An Update

Abstract

In 1989, Williamson published a survey of nutrition care practices in burn centers. Nutrition practices have evolved since then; we conducted a study to determine the current scope of nutrition care in burn centers. With IRB approval, a 64 question survey was emailed to 103 burn centers listed in the Burn Care Resources in North America. Follow-up emails were sent to those who did not respond within 2 weeks. Sixty-five centers (63%) responded and included 66% of currently verified burn centers. Due to incomplete surveys, most questions had 45 to 50 responses. The centers averaged 246 annual admissions and all admitted non-burn patients. Eighty percent of dietitians had >5 years burn experience (vs 17% in 1989) and 90% also worked in other intensive care settings. Most dietitians reported advanced training or education (83%). Nutrition assessment, support and monitoring methods have changed though most centers continue to use serum proteins for assessment. Indirect calorimetry use has increased with most centers (78%) adding a 'stress factor' of 10 to 30% above measured energy needs. More centers provided specialized formulas including high-protein (82 vs 8.8%) and immune-enhancing (53 vs 12.3%) than in 1989. All gave a variety of vitamin and mineral supplements. Anabolic steroid and glutamine use was common (92 and 69%). Eighty percent of centers used glucose protocols with 54% having a goal of <or=120 mg/dl; another 42% used 121 to 150 mg/dl as a target. Burn dietitians reported more experience than previously documented but continued to work in other intensive care unit areas. The use of calorimetry and glucose control protocols increased in the past 20 years as did the use of anabolic steroids and supplements. Variability continued in assessment (particularly calorie estimates) and monitoring methods.