Determination of energy requirements following application of a biodegradable dermal matrix after severe burn injury: a pilot study

Background: Major burn injuries cause a hypermetabolic state that is proportionate to the severity of the injury. Nutrition management guidelines for major burn injuries recommend using Indirect calorimetry (IC) as the ‘gold standard’ for measuring energy expenditure in major burn injuries. Biodegradable temporising matrix (BTM) is a synthetic dermal substitute used to temporise wounds prior to subsequent definitive split thickness skin grafting (STSG) in full thickness burns. This study aimed to examine the effect BTM has on energy expenditure via IC in major burns.

Methods: A prospective pilot study was conducted, measuring energy expenditure in nine major burns with >20% TBSA that received BTM as a part of their surgical burns management over a one year period (July 2020-July 2021). IC was conducted within 24 hours pre- and post- BTM application, pre- and post- definitive STSG and weekly throughout their hospital admission. Measured energy expenditure (MEE) was compared to three commonly used predictive equations – the Toronto, modified Schofield and ratio method (30-40kcal/kg/day).

Results: Mean age and burn injury size were 48(±22) years and 41(±20)% total body area.

Conclusions: Preliminary data indicates that BTM may attenuate the hypermetabolic response for energy expenditure following major burn injury. Equations were not accurate in predicting energy expenditure, grossly overestimating energy requirements in the acute recovery phase. This highlights the necessity for routine IC in clinical practice. A larger prospective comparative study is warranted to determine the effect of BTM on energy requirements and the metabolic response in major burn injuries.

Rochelle Kurmis

Rochelle commenced as Allied Health Project Manager for the Adult Burns Service at the Royal Adelaide Hospital (RAH), in 2010. This position oversees allied health research and development activities as well as quality assurance and improvement activities for the overall Adult Burns Service. Rochelle is current co-chair of the Joanna Briggs Institute (JBI) Burns Node, steering committee and reference committee member for the Burns Registry for Australia and New Zealand (BRANZ) and Burns Quality Improvement Program (BQIP) sub-committee member. Rochelle completed a Master’s in Clinical Science through the University of Adelaide in 2015.

Prior to her current position, Rochelle was a Clinical Dietitian at the RAH from 2004 covering various services and positions. Throughout her career, she has contributed to numerous quality assurance activities, including participation in local, state, and national evidence based guideline development projects, published numerous peer reviewed articles, and co-editor of the ANZBA Burns Trauma Rehabilitation Guidelines.

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