Early enhanced enteral nutrition in burned patients is associated with fewer infective complications and shorter hospital stay

Background: Major burn injury causes a catabolic state associated with depressed immunocompetence and a high incidence of morbidity and mortality. Previous studies have shown that provision of patients’ energy and nitrogen requirements early in the postburn period reduces net catabolism and supports the immune response. Methods: This observational study determined the effect of providing at least 50% of a patient's estimated requirement of energy and nitrogen (‘enhanced enteral nutrition, EN’) in 106 burned patients requiring intravenous fluid resuscitation. Multiple regression was used to determine associations between the delay to enhanced EN and the incidence of death, infection and total complications, and hospital stay. Results: Delay to enhanced EN was associated with infective complications (P=0.01) when adjusted for potential confounding factors. The risk of infection increases from 29% at 24 h to 66% at 48 h (number needed to treat, NNT: 3, and 1.5, respectively). In addition, the delay to enhanced EN was associated with hospital stay (P=0.001, 95% CI 1.5–5.5). A delay of 24 h was associated with an increase in hospital stay of 3.5 days. The associations held in survivors as well as the total group and therefore were not the result of early death causing a reduction in infections and hospital stay. No associations were found with death or total complications. Conclusion: Earlier commencement of EN which meets 50% of estimated energy and nitrogen requirements may reduce the incidence of infection and hospital stay. The potential clinical benefits and cost savings must be confirmed in prospective randomized controlled trials.