Management of severe burns injuries—a metabolic perspective

The current approach to severe burns injuries includes an early and aggressive surgical approach along with the application of supportive critical care principles. A major burn constitutes a major stress and burns patients undergo a prolonged increase in energy expenditure as a consequence of the stress response in terms of hormone release and inflammatory mediator activation. Mobilization of fat and protein stores leads to tissue wasting; wound healing is delayed and immune function is compromised. Many of the mechanisms underlying the obligatory catabolic changes have been revealed, and a variety of therapeutic responses have been suggested. Clinical application of these interventions has shown promise, but selection of the optimal strategy and timing for the individual patient remains unclear. Standardizing early burns management protocols with particular regard to resuscitation end-points and feeding regimes would be a valuable step towards assessing novel treatments. The potential benefit of a range of nutritional supplements and anabolic agents merits further investigation, but translating reports from the general intensive care population to specific cohorts of burned patients is not without risk. More accurate means to predict those burns patients likely to respond to intensive metabolic support strategies are necessary.