Major burns lead to a hypermetabolic response that is more dramatic than that identified in any other disease or injury. In addition, major burns increase the metabolic demands of the body, which can lead to severe weight body loss and an increased risk of mortality. The hyper-metabolic response is accompanied by severe catabolism and a loss of lean body mass as well as by a progressive decline of host defenses that impairs the immunological response. The protective functions of an intact skin are lost, leading to an increased risk of infection and protein loss. Therefore, adequate and timely provision of nutritional support is a vital component of the care of critically ill burn patients. In addition, nutrition therapy is important in burn care from the early resuscitation phase until the end of rehabilitation. A careful assessment of the nutritional state of burn patients is also important for reducing infection, recovery time, and long-term results. The nutritional therapy in severe burns has evidence-based specificities that help improve the clinical outcomes. The thumb 25 equation (25 kcal/kg of actual body weight) can be used as an alternative method to estimate the energy requirements of patients with major burns in cases where indirect calorimetry is unavailable or not applicable.
To predict the energy expenditure using the stress factor representing the ratio of the metabolic variation between pre-operation and post-operation in a pancreaticoduodenectomy (PD).
This was a prospective study conducted on 17 patients (11 males and 6 females) who underwent PD at Chonbuk National University Hospital between March 2010 and October 2011. The rest energy expenditure was measured by indirect calorimetry 1 day before and 3 days after surgery. The height, weight, and fat free mass were also measured 1 day before surgery.
The mean measured rest energy expenditure 1 day before PD (mREEpre) and 3 days after PD (mREEpost) were significantly different (16.8±2.6 vs. 18.8±3.5 kcal/kg/d, P=0.0076). The stress factor, representing the ratio of the metabolic changes between pre- and post-PD, was 1.12±0.17. The recommended energy requirement for PD patients is estimated to be 23∼24 kcal/ideal body weight/d [determined from the measured preoperative rest energy expenditure (16.8±2.6 kcal/kg/d)×activity factor (1.2∼1.3)×stress factor (1.12)].
PD patients maintained a hypermetabolic status and the applicable stress factor was 1.12.