The ancient Greek physician Hippocrates said, “Let food by thy medicine.” Nowhere is this idea more important than in the burn ward.
According to Dr. Larry Jones, director of the burn unit at Ohio State’s Wexner Medical Center, nutrition is a crucial part of healing serious burns. For example, without sufficient protein, muscles deteriorate and immunity plummets.
“The body needs protein to heal the wound and it’s going to take it from where ever it can get it,” he said.
Making new skin requires lots of extra calories, especially protein. If nutritional needs aren’t met, the body consumes its own tissue.
“Muscle is a likely target,” said Jones. “One of the muscles in the critically ill burn patient that the body likes to steal from is the diaphragm—the muscle that we use to breathe. Often times these burn patients are on ventilators, so the machine is doing the breathing for them. The body takes the protein from there because the machine is doing the work.”
Patients under Jones care have severe burns covering more than 20 percent of their body. Many start on a high protein diet long before they can actually eat. Patients are given a special formula through a feeding tube within six hours after entering the hospital.
Skip this nutritional step, and doctors will have problems administering other treatments later on. Jones said that in many instances, aggressive nutritional intervention “spells the difference between surviving and not surviving.”
“For a patient who has a large burn who is in the intensive care unit, nutrition is just as important as local wound care; just as important as skin grafting. As a matter of fact, if the patient is not nutritionally supported, the skin grafts will fail.”
With so much damaged tissue, severe burn patients typically need as much as two-and-a-half times the calories and four times the protein of a normal adult diet to heal properly. Even after patients can eat normally, the feeding tube continues to run day and night.
“A bad burn wound needs about 4,000 to 5,000 calories a day,” Jones said. “It’s impossible for any patient to eat this much, but especially a critically ill patient who is on a ventilator and is heavily sedated to take the necessary amount of calories in.”
Individual Needs
Doctors have known for decades that nutrition is essential to burn recovery, but recent research has refined their understanding. While protein is the primary nutrient for burn patients, other nutrients necessary for tissue repair include Vitamins A, C, and D, omega-3 fatty acids, and minerals such as selenium and zinc.
Burn patients who are also suffering from liver or kidney failure must have their feeding formulas tailored to fit their specific nutritional needs. Because patient needs can change throughout the course of treatment, Jones said that dietitians play a key role in crafting an appropriate treatment strategy.
“The dietitian makes rounds with us and on their own. They do the calculations on the nutritional needs of the patient, and share this with the rest of the team to make sure the patient’s needs are met,” he said.
Research is underway at Wexner Medical Center, to see if nutritional support is still necessary after the wound is closed and the bandages come off. Since it can take as much as a year and a half for a major burn to heal at the microscopic level, Jones suggests that patients should continue their high protein regimen even after they return home.
So if protein is especially important for major burns, what about minor ones? Jones says that if you scorch your finger on a hot stove, you don’t necessarily need a steak dinner. Just make sure you eat a well-balanced diet.
“Certainly it’s going to heal a lot faster if you’re getting protein, but also make sure you get proper servings of fruits and vegetables,” he said. “A nice piece of salmon and some asparagus is going to heal your small burn wound much better than a bag of potato chips and a soda. It’s just common sense. “
