Energy deficits in major burn patients: When should a nasojejunal tube be considered?

Victoria Lo1, Vicki Young2, Richard Wong She3

1 Middlemore Hospital, 100 Hospital Road, Auckland 2025, Victoria.Lo@middlemore.co.nz
2 Middlemore Hospital, 100 Hospital Road, Auckland 2025
3 Middlemore Hospital, 100 Hospital Road, Auckland 2025, Richard.WongShe@cmdhb.org.nz

Introduction

Patients with major burns have a higher nutritional requirement due to the hypermetabolic response and the need for multiple operations. Perioperative fasting decreases available feeding time, leading to development of an energy deficit.

Nasojejunal (NJ) tube insertion allows for perioperative feeding but is an invasive procedure. There are no guidelines for when an NJ tube should be considered for a burn patient.

This study aims to determine the threshold of burn size and weight where NJ tube insertion should be considered to avoid developing significant energy deficits.

Methods

A database search identified all burn patients admitted to Middlemore Hospital between 2005 and 2011. Average perioperative fasting times were calculated based on operating times. Patients less than 15 years old were excluded as were patients who died during admission. Energy requirements were calculated based on the formula 35kcal/kg and deficits then calculated for each total burn surface area (TBSA) and weight group.

Results

Across all TBSA groups, the longest average operating times occurred in Week 1.

With nasogastric feeding at 140ml/hr, an energy deficit would develop in a 90kg patient with a TBSA 30-39%. However, lighter patients are generally fed at 80ml/h due to intolerance. At 80ml/hr, deficits will develop in all patients with burns greater than 50% TBSA and all patients heavier than 50kg with a burn greater than 30% TBSA.

Conclusion

NJ tube insertion should be considered in the first week for all patients with a burn greater than 50% TBSA and all patients heavier than 50kg with a 30% TBSA.

Key Words

Nasogastric feeding

About ANZBA

ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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