ABSTRACT

In 1949, a 49% TBSA burn caused 30% mortality in patients aged 0-l4years.2 Modern techniques of immediate total burn excision, rapid wound closure, and adequate early enteral feeding have made a great impact on mortality. Today, a 98% TBSA burn has a 30% mortality in the same age group.4 The hypermetabolic re­ sponse to the burn injury is driven by a series o f interconnecting physiologic and biochemical changes that are themselves promoted by the presence o f the wound. This chapter will describe the hypermetabolic response and then the hormonal and metabolic responses that drive hypermetabolism. An approach to the estimation of the nutritional requirements of burn patients and some of the practical issues in­ volved in delivery o f nutritional support will be outlined. Recent advances in phar­ macological support will also be summarized.