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Shriners Burns Institute, Cincinnati, OH 45219.
A series of laboratory experiments in thermally injured guinea pigs has shown that feeding by the enteral route immediately after injury results in a decreased metabolic response by preventing loss of the GI barrier to the entrance of intestinal endotoxin and bacteria. Feeding by the iv route or giving crystalline amino acids instead of intact protein does not prevent atrophy of the intestine, nor does it prevent the hypermetabolic response. Optimal diets for nutritional support of burn patients contain 20% of energy from whey protein, 2% from arginine, 0.5% from cysteine, and 0.5% from histidine. Lipids comprise 15% of nonprotein calories with 50% fish oil (high in omega-3 fatty acids) and 50% safflower oil (high in linoleic acid). In a prospective clinical study, administration of this new diet was found to reduce wound infection (p less than .03), shorten hospital stay (p less than .02), and reduce death (p less than .06) when compared to other standard enteral formulations.
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