Nutrition in Burn Patients: Towards A New Caloric Ratio

Abstract: Introduction: Nutrition in severely burned patients is an essential therapeutic pillar to combat hypercatabolism and prevent malnutrition. The objective of this study is to evaluate the clinical and biological efficacy of a systematic increase in calculated caloric needs by a factor of 1.5 in severely burned patients hospitalized at Mohammed VI University Hospital in Marrakech. Materials and Methods: Prospective analytical study in two phases (Phase 1: June 2018–December 2020; Phase 2: December 2020–2022), including 102 patients with total body surface area (TBSA) burned > 20%, admitted within 48 hours post-burn. Caloric needs were calculated according to Curreri (adults) and Schofield (children) formulas, multiplied by 1.5 during phase 2. A local enteral nutritional solution of 1,500 kcal/L was developed and introduced in phase 2. The primary endpoint is variation in body weight. Secondary endpoints are albumin level evolution and length of hospital stay. Results: Weight loss decreased from 8% (phase 1) to 3.5% (phase 2) (p = 0.003). Albumin level at discharge increased by 4 g/L compared to phase 1. Mean length of hospital stay decreased from 15 to 10 days (p = 0.01). A persistent intake deficit of 35 to 40% of calculated needs was observed, mainly related to digestive intolerances (45% of patients) and organizational constraints. Conclusion: Multiplication of calculated caloric needs by 1.5, combined with an adapted enteral nutritional solution, significantly improves clinical and biological parameters in severely burned patients. A multicenter randomized controlled trial is necessary to confirm these results.