Traitement nutritionnel du grand brûlé

Major burns (>20% BSA) cause an intense oxidative stress, metabolic alterations and an inflammatory response which are characterized by their intensity and duration, which exceeds those observe in all other pathologies. Modulation of these responses has become a therapeutic target. Burned patients required large amounts of energy (35-50 kcal/kg/day), glucose and proteins (1.5-2.5 g/kg/day) but limited amounts of fat (ideally less than 20% of total energy intake). Glutamine supplementations contribute to the normalization of the immune response and to improved wound healing. The enteral route (gastric or postpyloric) is to be preferred, and feeding should be initiated within hours of the injury. Acute and early deficits of micronutrients are caused by large exudative losses through the burn wounds. Substitution has significant biological and clinical benefits: the doses correspond to 5-10 times those used in parenteral nutrition and must be delivered for 7 to 30 days depending on burn size. Insulin which favors anabolism, and propranolol which attenuates catabolism belong to the standard therapeutic tools. Nutritional follow up is mandatory and is based on daily body weight, and weekly determination of prealbumin.