Ms Caroline Nicholls1,2, Ms Cheryl Brownlow1,2, Dr Nicola Clayton2,3,4,5, Ms Christine Parker2,6, Prof Peter Maitz2,7
1Department of Nutrition and Dietetics, Concord Hospital, Concord, Australia, 2Burns Unit, Concord Hospital, Concord, Australia, 3Speech Pathology Department, Concord Hospital, Concord, Australia, 4School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Australia, 5Faculty of Health Sciences, University of Sydney, Camperdown, Australia, 6Department of Nursing, Concord Hospital, Concord, Australia, 7Faculty of Medicine, University of Sydney, Camperdown, Australia
Optimal nutrition is paramount for timely wound healing in the patient with severe burn injury. Traditional existing predictive equations are limited and literature suggests that indirect calorimetry (IC) is the gold standard for assessing energy requirements in this population.
(1) investigate the effectiveness and patient acceptability of handheld calorimetry in the Burns Unit (BU) and, (2) compare results with predictive equations currently used.
All patients admitted to the BU over a 12 month period, ≥18years with burn injuries ≥10%TBSA or ≥75years with any burn size were recruited to participate. Resting energy requirements (REE) were measured using the FitMate® handheld calorimeter. Patients were surveyed regarding acceptability of the test, specifically time taken, comfort during IC and willingness to repeat the test. FitMate® results were compared with the Modified Schofield (MS) predictive equation and Toronto Formula (TF) results where appropriate.
32 participants were enrolled in the study. 78% reported IC was comfortable or very comfortable, 81% reported time taken was acceptable and agreed they would repeat the test. Median dietitian time spent was 40 minutes (IQR 30-50minutes) and nutritional management was adjusted in 31% of occasions. The difference between measured REE and estimated REE was >20% in 43% for the MS and 50% for the TF predictive equation.
Greater variability was seen when REE was estimated via predictive equations versus measurement via the FitMate®. Given the FitMate® was also well accepted by patients and was not time laborious, it is a feasible tool for routine REE measurement in the BU.
Caroline Nicholls is the Senior Burns Dietitian at Concord Hospital in Sydney. She is well recognised for her expertise in the field of nutrition support and clinical research, especially in severe burn injury.