Factors influencing early using enteral nutrition in severe burn patients

doi:10.16139/j.1007-9610.2023.05.09

Abstract

Abstract:

Objective To analyze the main factors affecting early using enteral nutrition and the effect of enteral nutrition within 72 h after burning on outcomes by presenting a retrospective cohort study of 11 years of hospitalization data, to provide evidence for enteral nutrition regimens for severe burn patients. Methods A retrospective study analyzed adult extensive burn patients between January 2009 and December 2020. Patients enrolled in this study who admitted to the burn department within 24 h after burning and with a burned area of more than 30%. Univariate and multiple regression were used to analyze the main factors affecting early using enteral nutrition in patients with severe burn. Non parametric Mann-Whitney U test was used to compare the main influencing factors of enteral nutrition implementation within or after 72 h, as well as the impact on the treatment outcomes such as 28-day survival rate and in hospital survival rate. Results The univariate analysis found that total burn area, full-thickness burn area, burn type, and inhalation injury were the main factors of the time to initation of enteral nutrition in patients with severe burn (P<0.05). Incorporating the above single factors into multiple regression analysis, we found that the main factors affecting enteral nutrition using in patients with severe burn were full-thickness burn area (P=0.017) and inhalation injury (P=0.001). To analysis whether enteral nutrition was started within 72 h after burning, we found that inhalation injury and larger area of full-thickness burn area in patients was the main factors for initiating enteral nutrition. After matching injury situation with pre-injury situation, we found that using enteral nutrition within or after 72 h after injury were no significant differences in the survival rate, 28-day survival rate, and positive blood culture rate （P>0.05），but was associated with the lower incidence of bacteria positive in intravenous catheters (P=0.001) and the lower rate of parenteral nutrition treatment used within 7 d after burning (P=0.001). Conclusions The main factor for influencing early implement enteral nutrition in patients with severe burn were large area of full-thickness burn and inhalation injury. Enteral nutrition using within 72 h after burning reduces the incidence of catheter infection and the use of parenteral nutrition, thereby reducing the risk of treatment in patients with severe burn.

Key words: Extensive burn, Enternal nutrition, Parenteral nutrition, Catheter infection

CLC Number:

R459.3
R644

ZHANG Yin, DOU Yi, ZHANG Qin, WANG Wenliang, SHEN Xiaoxian, MA Zhenzhu, WU Beiwen. Factors influencing early using enteral nutrition in severe burn patients[J]. Journal of Surgery Concepts & Practice, 2023, 28(05): 441-447.

Figures/Tables 7

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Variables	Assignment method
Age	≤60=1，>60=0
Gender	male=1，female=0
Burn type	flame=1， other type=0
Total body surface area	30%-50% =1, >50%=0
Full-thickness burned area	≤20%=1， >20%=0
Inhalation injury	with inhalation injury=1, without inhalation injury=0

Item	Group	n	Start time of EN（d）	Z/χ² value	P value
Age(years)	≤60	438	4（3,5）	Z=-1.730	0.084
Age(years)	>60	84	3（3,5）	Z=-1.730	0.084
Gender	Male	405	4（3,5）	Z=-0.045	0.964
Gender	Female	117	4（3,5）	Z=-0.045	0.964
Burn type	Flame	403	4（3,5）	Z=-3.579	<0.001
Burn type	Other type	119	3（2,5）	Z=-3.579	<0.001
Total body surface area	30%-50%	243	3（3,4）	Z=-6.399	0.000
Total body surface area	>50%	279	4（3，6）	Z=-6.399	0.000
Full-thickness burn area	≤20%	260	3（3,4）	Z=-6.428	<0.001
Full-thickness burn area	>20%	262	4（3，6）	Z=-6.428	<0.001
Inhalation injury	Yes	192	5（4，6）	χ²=49.320	0.000
Inhalation injury	No	330	3（3,4）	χ²=49.320	0.000

Variable	B	Std Error	Beta	t value	P value
Constant	2.968	0.521		5.696	0.000
Inhalation injury	0.853	0.258	0.161	3.306	0.001
Full-thickness burn area	0.563	0.234	0.110	2.404	0.017

Item Gruop		Start EN within 72 h (n=215)	Start EN after 72 h (n=307)	Z/χ²value	P value
Age (year)		47(33,57)	46（36,55）	Z=-0.477	0.633
Gender [n(%)]	Male	168（78.1）	237（77.2）	χ²=0.064	0.800
Gender [n(%)]	Female	47（21.9）	70（22.8）	χ²=0.064	0.800
Burn type [n(%)]	Flame	154（71.6）	249（81.1）	χ²=6.456	0.011
Burn type [n(%)]	Other type	61（28.4）	58（18.9）	χ²=6.456	0.011
Total body surface area （%）		43 (35,60)	60（42,78）	Z=-6.578	0.000
Full-thickness burn area （%）		12（0,30）	30（10,50）	Z=-6.578	0.000
Inhalation [n(%)]	Yes	41（19.1）	151（49.2）	χ²=49.320	0.000
Inhalation [n(%)]	No	174（80.9）	156（50.8）	χ²=49.320	0.000

Item	Gruop	Start EN within 72 h(n=215)	Start EN after 72 h(n=307)	Z/χ²value	P value
Length of hospital stay（d）		31（23,42）	38（27,57）	Z=-4.206	0.000
28 d survival [n(%)]	survival	211（98.1）	288（93.8）	χ²=4.644	0.031
	death	4（1.9）	19（6.2）	χ²=4.644	0.031
Overall survival [n(%)]	survival	209（97.2）	275（89.6）	χ²=10.914	0.001
	death	6（2.8）	32（10.4）	χ²=10.914	0.001
blood culture [n(%)]	positive	13（6.1）	47（15.3）	χ²=10.665	0.001
blood culture [n(%)]	negative	202（93.9）	260（84.7）	χ²=10.665	0.001
21 d blood culture [n(%)]	positive	7（3.3）	31（10.1）	χ²=9.769	0.003
21 d blood culture [n(%)]	negative	208（96.7）	276（89.9）	χ²=9.769	0.003
Time to first positive blood culture（d）		17（11,29）	14（9,27）	Z=-0.727	0.467
Sputum culture [n(%)]	positive	21（9.8）	56（18.2）	χ²=7.220	0.007
	negative	194（90.2）	251（81.8）	χ²=7.220	0.007
14 d sputum culture [n(%)]	positive	13（6.1）	42（13.7）	χ²=7.818	0.005
14 d sputum culture [n(%)]	negative	202（93.9）	265（86.3）	χ²=7.818	0.005
Time to first positive sputum culture（d）		12（9,16）	9（5,15）	Z=-1.238	0.216
Intravenous catheter [n(%)]	positive	9（4.2）	45（14.7）	χ²=14.951	0.000
Intravenous catheter [n(%)]	negative	206（95.8）	262（85.3）	χ²=14.951	0.000
Time to first positive intravenous catheter culture（d）		15（8,24）	12（10,21）	Z=-0.105	0.917
EN tolerance [n(%)]	intolerance	16（7.4）	33（10.8）	χ²=1.626	0.202
EN tolerance [n(%)]	tolerance	199（92.6）	274（89.3）	χ²=1.626	0.202
PN usage [n(%)]	use	59（27.4）	175（57.0）	χ²=44.678	0.001
PN usage [n(%)]	unused	156（72.6）	132（43.0）	χ²=44.678	0.001
Start time for PN（d）		5（3,9）	5（4,8）	Z=-0.858	0.391