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Changes are demonstrated in resting energy expenditure (REE), stress hormones (epinephrine), cardiac function (cardiac output), gender hormones (testosterone), cytokines (interleukin-6), and body composition (lean body mass).
FIGURE 19-8 Effect of sepsis on resting energy expenditure, muscle protein breakdown, and fractional synthetic rate of muscle protein syn- thesis compared with like-sized burns.
Our group conducted a randomized clinical trial using Integra in the management of severe full-thickness burns of 50% TBSA or more in a population of pediatric patients, comparing it with standard autograft-allograft technique, and found Integra to be associated with attenuated hepatic dysfunction, improved resting energy expenditure, and improved aesthetic outcome.31 Allo- Derm, an acellular human dermal allograft, has been advocated for the management of acute burns.
To meet the minimal needs of all the patients in this study, 1.55 times the predicted basal energy expenditure would be required; however, giving calorie loads in excess of this probably leads to fat accumu- lation without affecting lean mass accretion. ftis correlated to 1.4 times the measured resting energy expenditure by indirect calo- rimetry. ftese studies indicate that the calculation of 2 times the predicted basal energy expenditure might be too high.
Raising the ambient temperature from 25° C to 33° C can diminish the magnitude of this obligatory response from 2.0 to 1.4 resting energy expenditure in patients exceeding 40% TBSA (Fig. 19-11).12 ftis simple environmental modulation is an important primary treatment goal that frequently is not realized.
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