The objective of this study was to evaluate resting energy expenditure (REE
) in spontaneously breathing and artificially ventilated burn patients duri
ng the entire intensive care period. In 27 patients with 51 +/- 20% body su
rface area burned (BSAB) the REE was determined via indirect calorimetry. T
hree groups were Formed according to the mortality prognosis index of Zawac
ki et al. In groups A, B, and C the predicted mortality rates were <20%, 20
% to 80%, and >80%, respectively. The frequency of acute respiratory distre
ss syndrome (ARDS), sepsis, renal failure, and mortality increased from gro
up A toward group C, The REE test revealed wide individual variation and wa
s usually overestimated by all tested formulas. The mean REE was comparable
in groups A, B, and C during the first 20 days (49 +/- 16% vs. 59 +/- 21%
vs. 57 +/- 18% above the REE calculated by the Harris-Benedict equation, or
HBEE). The REE of patients in groups A and B declined after this period, w
hereas the long-term ventilated patients in the prognostically unfavorable
group C showed a high REE up to the 45th day, usually accompanied by severe
organ dysfunction and major metabolic disorders. During this time a nutrit
ional regimen meeting the actual REE could not be achieved. In the clinical
situation when indirect calorimetry is not available, REE can be stated to
be 50% to 60% above HBEE in patients with >20% BSAB far at least 20 days.
Expecting a stable clinical course in patients with a predicted mortality o
f <20% (group A), oral nutrition usually seems sufficient after a short per
iod of artificial nutritional support (1 week). Patients with a predicted m
ortality of more than 20% have a complication-burdened clinical course and
a prolonged period of ventilation (groups B and C). These patients need par
enteral and enteral nutrition for at least 20 days after trauma to prevent
severe malnutrition.