662 Clinical Outcomes from Prospective Randomized Trials on the Proportion of Carbohydrates versus Fat in Enteral Nutrition for Burn Patients

Abstract Introduction Multiple organizations have developed guidelines for nutritional support following burn trauma. These guidelines are based on low levels of evidence and largely on expert opinion. We sought to compile randomized controlled trials (RCTs) evaluating clinical outcomes from carbohydrate versus fat in enteral nutrition (EN) for burn patients and then analyze outcomes via meta-analysis and compare these outcomes to current available guidelines. Methods We performed a literature search to identify RCTs evaluating outcomes of burn patients with different proportions of carbohydrate versus fat interventions. Meta-analyses were conducted on outcomes reported by more than one RCT with the DerSimonian and Laird random effects model. Statistical significance was established at α less than 0.05. Meta-analysis results were then evaluated alongside the available guidelines from American Society for Parenteral and Enteral Nutrition (ASPEN) and Society of Critical Care Medicine (SCCM), the European Society for Parenteral and Enteral Nutrition (ESPEN), and the International Society for Burn Injury (ISBI). Results We identified 3 studies meeting our inclusion criteria for RCTs. Meta-analysis showed lower fat, higher carbohydrate EN to be associated with lower incidence of pneumonia (p=0.0005) as well as a reduction in mortality (p=0.04). The ASPEN/SCCM and ISBI guidelines do not specifically address this topic. ESPEN recommends less than 60% carbohydrates and less than 35% fat. However, this is not in accordance with the 46–65% carbohydrate and 12–27% fat with favorable outcomes studied in the 3 identified RCTs. Conclusions As current guidelines are often not based on high levels of evidence, it was important to collect and evaluate all of the available RCTs. Our meta-analysis results of these RCTs demonstrated mortality benefits with lower fat, higher carbohydrate EN in burn patients. Additionally, we found lower rates of pneumonia with lower fat, higher carbohydrate EN. Applicability of Research to Practice Consideration should be made for 12–27% fat, 46–65% carbohydrate EN in burn patients; however, multicentered trials are required before strong recommendations can be made.