Burns : journal of the International Society for Burn Injuries · 2026
Clinical value of enteral nutrition combined with supplemental parenteral nutrition in patients with major burns: A retrospective cohort study.
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Chang Jiang, Chen Fangyan, Lv Guozhong, Zhu Yugang, Zou Fang, Sun Dan
Аннотация
BACKGROUND: The hypermetabolic state following major burns frequently leads to severe negative energy balance, posing significant challenges to clinical nutritional management. This study aimed to retrospectively evaluate clinical outcomes associated with enteral nutrition (EN) combined with supplemental parenteral nutrition (SPN) compared with an EN strategy in real-world clinical settings.
METHODS: A retrospective cohort study was conducted using data from patients with major burns admitted to the burn unit of a tertiary hospital between January 2018 and December 2023. Group allocation was performed retrospectively according to actual parenteral nutrition (PN) contribution to total delivered calories during Days 1-14: patients with < 10% PN contribution were classified into the EN group and those with ≥ 10% were classified into the EN + SPN group. The primary outcome was time to complete wound healing (defined as ≥95% re-epithelialization). Key secondary outcomes included caloric achievement, prealbumin, nitrogen balance, ICU length of stay, catheter-related bloodstream infection (CRBSI), hyperglycemia, and 28-day and 60-day mortality.
RESULTS: A total of 186 patients were included (EN+SPN, n = 94; EN, n = 92). The primary outcome, time to complete wound healing, was significantly shorter in the EN + SPN group (32.4 ± 8.7 vs. 41.2 ± 11.3 days, P < 0.001). The EN + SPN group achieved a higher proportion of target calories (87.3% vs. 62.8%, P < 0.001) and showed higher day-14 prealbumin concentrations (196.8 ± 38.4 vs. 158.2 ± 34.1 mg/L, P < 0.001) and improved day-7 nitrogen balance (-1.2 ± 2.8 vs. -6.8 ± 3.4 g/day, P < 0.001). ICU length of stay was shorter (21.4 ± 8.6 vs. 28.2 ± 10.4 days, P < 0.001). Rates of CRBSI (6.4% vs. 4.3%, P = 0.529) and hyperglycemia (33.0% vs. 28.3%, P = 0.485) did not differ significantly. Neither 28-day nor 60-day mortality differed significantly between groups.
CONCLUSIONS: In patients with major burns, when EN failed to meet target caloric requirements, EN combined with SPN was associated with improved energy delivery, favorable biochemical trajectories, and shorter wound healing time, without an increased association with infection risk. An EN-first burn care pathway with SPN added when EN remains inadequate warrants prospective evaluation.
METHODS: A retrospective cohort study was conducted using data from patients with major burns admitted to the burn unit of a tertiary hospital between January 2018 and December 2023. Group allocation was performed retrospectively according to actual parenteral nutrition (PN) contribution to total delivered calories during Days 1-14: patients with < 10% PN contribution were classified into the EN group and those with ≥ 10% were classified into the EN + SPN group. The primary outcome was time to complete wound healing (defined as ≥95% re-epithelialization). Key secondary outcomes included caloric achievement, prealbumin, nitrogen balance, ICU length of stay, catheter-related bloodstream infection (CRBSI), hyperglycemia, and 28-day and 60-day mortality.
RESULTS: A total of 186 patients were included (EN+SPN, n = 94; EN, n = 92). The primary outcome, time to complete wound healing, was significantly shorter in the EN + SPN group (32.4 ± 8.7 vs. 41.2 ± 11.3 days, P < 0.001). The EN + SPN group achieved a higher proportion of target calories (87.3% vs. 62.8%, P < 0.001) and showed higher day-14 prealbumin concentrations (196.8 ± 38.4 vs. 158.2 ± 34.1 mg/L, P < 0.001) and improved day-7 nitrogen balance (-1.2 ± 2.8 vs. -6.8 ± 3.4 g/day, P < 0.001). ICU length of stay was shorter (21.4 ± 8.6 vs. 28.2 ± 10.4 days, P < 0.001). Rates of CRBSI (6.4% vs. 4.3%, P = 0.529) and hyperglycemia (33.0% vs. 28.3%, P = 0.485) did not differ significantly. Neither 28-day nor 60-day mortality differed significantly between groups.
CONCLUSIONS: In patients with major burns, when EN failed to meet target caloric requirements, EN combined with SPN was associated with improved energy delivery, favorable biochemical trajectories, and shorter wound healing time, without an increased association with infection risk. An EN-first burn care pathway with SPN added when EN remains inadequate warrants prospective evaluation.