Nutrition in Trauma and Burns

Nutritional support is a key, though often neglected, component of the intensive management of the patient who is a victim of severe trauma or burn injury. Indeed, the intense stress reaction and hypermetabolic response present in other types of critically ill patients is even more pronounced in the case of burn or trauma patients, leading to significant changes in body composition and resting energy expenditure. Knowledge about the pathophysiologic changes associated with these conditions has radically increased over the past 20–30 years, and along with this has come an increased awareness of the importance of defining caloric-protein requirements, route of administration, timing, and rate of progression of nutritional support. As much as the body of knowledge is rapidly increasing and many of the recommendations of scientific societies are derived from high-quality evidence, many recommendations still are extrapolated from studies conducted on critically ill patient populations that are not trauma or burn patients For this reason, the recommendations provided in this chapter are based, when at all possible, on studies performed on trauma or burn patients. Nevertheless, a brief discussion of some of the basic science principles of nutritional support is provided as a backdrop for the clinical studies presented in the later part of the chapter.