كل شي يخص Burn Unit
- MARAM FADHEL
- May 21, 2015
- 3 min read
طبعا كل الكلام دا من uptodate واخر الدراسات اللي حصلت على البيرن
دي كل المعادلات اللي ممكن نستخدمها بس اكتر شي بتكون هاريس و كيوريري فورمولا
بالنسبة للفاكتور حق البروتين دا احدث شي
ودا رفرنس قوي ومعتمد لو مشيتي عليه محد راح يفتح فمو عليكي
pediatric ENERGY
Adult ENERGY
Harris-Benedict equation — the BEE is multiplied by an stress factor of 1.2 to 2.0. For all but the most extensive burn injuries, the acceptable stress factor is between 1.2 and 1.5
The equation used for men is: BEE (kcal per day) = 66.5 + (13.8) Weight in Kg + (5) Height in cm - (6.76) Age in years.
The equation used for women is: BEE (kcal per day) = 655 + (9.6) Weight in Kg + (1.85) Height in cm - (4.68) Age in years.
Curreri formula — It does not take into account gender, age, activity or ventilator status.
The Curreri formula for adults age 16 to 59 years is: Caloric requirement (kcal per day) = 25 kcal/kg/day + 40 kcal/percent TBSA burned/day
The Curreri formula for adults over age 60 years is: Caloric requirement (kcal per day) = 25 kcal/kg/day + 65 kcal/percent TBSA burned/day
Cunningham prediction equation — The Cunningham prediction equation uses fat free body mass (FFM) in calculating resting energy expenditure (REE).
REE (kcal/day) = 370 + 21.6(FFM).
Toronto formula — ventilated burn patient
The factors included in the equation are: a factor of activity, total body surface area (TBSA); caloric intake (CI); estimated basal energy expenditure calculated by the Harris-Benedict formula (EEBE), and number of post-burn days (PBD).
MEE ( kcal/day) = -4343 + (10.5 x percent TBSA) + (0.23 x CI) + (0.84 x EBEE) + (114 x Temp (degree C)) - (4.5 x PBD)
Protein
Administration of nutrition support with protein of 1.5 to 2.0grams/kg/day, approximately 20 to 25 percent of calories per day, will provide a balanced between synthesis and breakdown.
Estimated protein requirements for injured children of various age groups are as follows:
0 to 2 years – 2 to 3 g/kg/day;
2 to 13 years – 1.5 to 2 g/kg/day
13-18 years – 1.5 g/kg/day.
Glucose
approximately 50 percent of total calories.
Lipids
no more than 15 percent of total calories. oxidation of free fatty acids occurs at a rate more than double that of healthy people. Nutritional support with more than 15 percent of calories from lipid has been demonstrated to impair immunologic function
Vitamins A, C, and D
Vitamin A plays an important role in immune function, wound epithelialization, and prevention of free radical damage. Vitamin A toxicity can occur with high doses; vitamin C does not appear to have any known toxicities in high doses.
Vitamin C, an antioxidant, is an essential component of collagen cross-linking and therefore also influences wound healing. Levels of vitamins A and C are decreased in patients following burn injury, but can be replenished with supplementation
Trace minerals
Copper, zinc and selenium serve as antioxidants. Zinc also plays a role in collagen cross-linking, wound healing, and immune function. The depletion of copper and zinc in burn patients is attributed to a combination of urinary losses and exudative losses from wounds. The mechanism for the selenium deficiency is unclear and appears to be multifactorial
ESPEN (European Society for Clinical Nutrition and Metabolism) recommends Doses of 40.4 mmol copper, 2.9 mmol selenium and 406 mmol zinc are recommended for at least 30 days postburn
Immunonutrition
ESPEN (European Society for Clinical Nutrition and Metabolism) has made no recommendation regarding supplementation with alpha-3 fatty acids, arginine, or nucleotides for burned patients due to insufficient data, but recommends that glutamine be added to standard formulas. The Society of Critical Care Medicine (SCCM) and the American Society for Parental and Enteral Nutrition (ASPEN) guidelines include consideration of the addition of enteral glutamine to an enteral feeding regimen in burn patients while manage in the intensive care unit.
Branched-chain amino acids
The branched-chain amino acids (BCAAs) have anabolic, or at a minimum, anticatabolic properties. Leucine, in particular, has received a lot of attention because plasma leucine levels are typically depleted following a severe burn injury However, clinical studies have failed to show any benefit to the administration of supplemental leucine as a component of nutritional support for burn patients. At this time, supplementation of BCAAs in burn patients is not recommended.
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