Carbohydrate and Wound Healing in Critically Ill Burn Patients: A Retrospective Cohort Study

Two randomized controlled trials conducted in acutely burned patients found clinical benefits with higher carbohydrate (60%-65% of total energy), lower fat (12%-15%) nutrition, including faster wound healing, fewer wound infections, decreased hospital stay, and less pneumonia. The primary purpose of this study was to assess whether our change in practice to a higher proportion of carbohydrates (60%) with 25% of energy from protein and 15% of energy from fat was associated with improved wound healing rates. Secondary outcomes evaluated included invasive fungal wound infections, ischemic bowel, sepsis, and mortality. Before February 2022, the use of a high-protein, relatively low-fat enteral formula (52% carbohydrate, 23% fat, and 25% protein) combined with a protein modular was the standard practice (PRE group) in our burn center. After, we implemented a higher carbohydrate feeding protocol (POST group). In this study, patients in the POST group were matched 2:1 by age, burn size, burn depth, inhalation injury, and gender to those in the PRE group. There were 66 patients evaluated: 18% female, 42 ± 13 years of age, burn size of 38% ± 21%TBSA. There was a statistically significant difference in wound healing rates (0.7% ± 0.5%TBSA/day PRE vs 1.1% ± 0.5%TBSA/day POST, P = .037). There was also significantly less sepsis (70%PRE vs 41%POST, P = .021). There were no statistically significant differences between groups in ischemic bowel (0%PRE vs 4%POST, P = .159), invasive fungal wound infection rates (14%PRE vs 5%POST, P = .245), or mortality (16%PRE, 9%POST; P = .447). We found a statistically significant increase in wound healing rates when administering a higher proportion of carbohydrate to our patients with severe burns.