532 Intravenous Supplementation of Micronutrients in Patients with Severe Burns

Abstract Introduction Pneumonia is a prominent cause of morbidity and mortality in burn patients. The European Society for Clinical Nutrition and Metabolism (ESPEN) recommends supplementing with intravenous copper, selenium, and zinc, as a randomized controlled trials on burn patients in Switzerland showed decreased pneumonia rates. The purpose of this performance improvement project was to determine whether the intravenous supplementation of copper, selenium, and zinc had an association with the incidence of pneumonia in patients with total body surface area (TBSA) burns over 20% in order to determine if this practice should be re-initiated. Methods Based on available randomized controlled trial evidence, we began the clinical practice of providing intravenous trace elements to our patients with burns over 20% TBSA who were admitted to the burn intensive care unit and who had a central line. This clinical practice ended after 2 years when there was a national shortage of these intravenous trace elements. We performed a retrospective evaluation on patients admitted for initial burn care to our intensive care unit who received an intravenous solution containing 4 mg copper, 500 mcg selenium, and 40 mg zinc daily for a goal duration of 14 days in patients with 20–40% TBSA burns and 21 days in patients with over 40% TBSA burns. Patients who survived less than two days were excluded. In order to compare the incidence of pneumonia within the first 30 hospital days in patients who received intravenous trace element supplementation to those who did not, we matched patients based on age, burn size, and gender. Matched subjects were admitted either before or after the time period of intravenous trace element supplementation and these subjects received oral zinc supplementation. Descriptive statistics and Chi-Square were performed using JMP. Significance was set at p< 0.05. Results Pneumonia within the first 30 hospital days occurred in 63% of the 52 included patients with the following characteristics: 71% male, 52 ± 18 years old, 43 ± 15% TBSA burn, 29 ± 25 mechanical ventilator days, and 44% mortality. A significant difference in the incidence of pneumonia during the first 30 hospital days was not found between groups (intravenous trace element group: 70%; comparison group: 56%, p=0.28). Conclusions Supplementation of intravenous copper, selenium, and zinc was not significantly associated with incidence of pneumonia in our severely burned patients, contrary to previous research findings.