Effects of early excision and aggressive enteral feeding on hypermetabolism, catabolism, and sepsis after severe burn

David W. Hart, Steven Wolf, David L. Chinkes, Robert B. Beauford, Ronald P. Mlcak, John P. Heggers, Robert R. Wolfe, David Herndon, David Hoyt, Basil Pruitt, Tetsuo Yukioka

Research output: Contribution to journalArticle

123 Citations (Scopus)

Abstract

Background: Severe burn induces a systemic hypermetabolic response, which includes increased energy expenditure, protein catabolism, and diminished immunity. We hypothesized that early burn excision and aggressive enteral feeding diminish hypermetabolism. Methods: Forty-six burned children were enrolled into a cohort analytic study. Cohorts were segregated according to time from burn to transfer to our institution for excision, grafting, and nutritional support. No subject had undergone wound excision or continuous nutritional support before transfer. Resting energy expenditure, skeletal muscle protein kinetics, the degree of bacterial colonization from quantitative cultures, and the incidence of burn sepsis were measured as outcome variables. Results: Early, aggressive treatment did not decrease energy expenditure; however, it did markedly attenuate muscle protein catabolism when compared with delay in aggressive treatment. Wound colonization and sepsis were diminished in the early treatment group as well. Conclusion: Early excision and concurrent aggressive feeding attenuate muscle catabolism and improve infectious outcomes after burn.

Original languageEnglish (US)
Pages (from-to)755-764
Number of pages10
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume54
Issue number4
DOIs
StatePublished - Apr 1 2003

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Enteral Nutrition
Energy Metabolism
Sepsis
Nutritional Support
Muscle Proteins
Wounds and Injuries
Immunity
Skeletal Muscle
Cohort Studies
Therapeutics
Muscles
Incidence
Proteins

Keywords

  • Enteral feeding
  • Hypermetabolism
  • Severe burns

ASJC Scopus subject areas

  • Surgery

Cite this

Effects of early excision and aggressive enteral feeding on hypermetabolism, catabolism, and sepsis after severe burn. / Hart, David W.; Wolf, Steven; Chinkes, David L.; Beauford, Robert B.; Mlcak, Ronald P.; Heggers, John P.; Wolfe, Robert R.; Herndon, David; Hoyt, David; Pruitt, Basil; Yukioka, Tetsuo.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 54, No. 4, 01.04.2003, p. 755-764.

Research output: Contribution to journalArticle

Hart, DW, Wolf, S, Chinkes, DL, Beauford, RB, Mlcak, RP, Heggers, JP, Wolfe, RR, Herndon, D, Hoyt, D, Pruitt, B & Yukioka, T 2003, 'Effects of early excision and aggressive enteral feeding on hypermetabolism, catabolism, and sepsis after severe burn', Journal of Trauma - Injury, Infection and Critical Care, vol. 54, no. 4, pp. 755-764. https://doi.org/10.1097/01.TA.0000060260.61478.A7
Hart, David W. ; Wolf, Steven ; Chinkes, David L. ; Beauford, Robert B. ; Mlcak, Ronald P. ; Heggers, John P. ; Wolfe, Robert R. ; Herndon, David ; Hoyt, David ; Pruitt, Basil ; Yukioka, Tetsuo. / Effects of early excision and aggressive enteral feeding on hypermetabolism, catabolism, and sepsis after severe burn. In: Journal of Trauma - Injury, Infection and Critical Care. 2003 ; Vol. 54, No. 4. pp. 755-764.
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AU - Wolf, Steven

AU - Chinkes, David L.

AU - Beauford, Robert B.

AU - Mlcak, Ronald P.

AU - Heggers, John P.

AU - Wolfe, Robert R.

AU - Herndon, David

AU - Hoyt, David

AU - Pruitt, Basil

AU - Yukioka, Tetsuo

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AB - Background: Severe burn induces a systemic hypermetabolic response, which includes increased energy expenditure, protein catabolism, and diminished immunity. We hypothesized that early burn excision and aggressive enteral feeding diminish hypermetabolism. Methods: Forty-six burned children were enrolled into a cohort analytic study. Cohorts were segregated according to time from burn to transfer to our institution for excision, grafting, and nutritional support. No subject had undergone wound excision or continuous nutritional support before transfer. Resting energy expenditure, skeletal muscle protein kinetics, the degree of bacterial colonization from quantitative cultures, and the incidence of burn sepsis were measured as outcome variables. Results: Early, aggressive treatment did not decrease energy expenditure; however, it did markedly attenuate muscle protein catabolism when compared with delay in aggressive treatment. Wound colonization and sepsis were diminished in the early treatment group as well. Conclusion: Early excision and concurrent aggressive feeding attenuate muscle catabolism and improve infectious outcomes after burn.

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