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.
Selenium is an important trace element for antioxidative function. Low selenium plasma level in sepsis is associated with high oxidative damage and increasing consumption of selenium, which is thought to affect severity of burns. This study was conducted to investigate a relationship between selenium plasma levels and prognosis of burn patients.
In a retrospective review of 45 burn patients with more than 20% TBSA from January 2011 to May 2015, selenium plasma levels on days 2 to 7 after burn injury, abbreviated burn severity index (ABSI), mortality, length of stay in intensive care unit, and duration of intravenous antibiotics use were measured.
Selenium plasma levels on days 2 to 7 after burn injury were fairly correlated with ABSI (r=-0.640, P<0.001), TBSA (r=-0.640, P<0.001), duration of intravenous antibiotics use (r=-0.555, P<0.001), and length of stay in intensive care unit (r=-0.445, P=0.004). In comparison between survivor and non-survivor, statistical difference was observed between two selenium plasma levels (66.2±13.6 mcg/L versus 49.4±14.5 mcg/L, P=0.002).
In this study, selenium plasma levels on days 2 to 7 after burn injury was related to prognosis of major burn patients.