late appearing. Circumferential, deep burns of the chest can lead to impaired
respiratory function regardless of the presence of inhalation injury. The
progressive edema that develops under the tightly affected skin impedes proper
respiratory function leading to poor compliance, poor ventilation and an
increase in peak inspiratory pressures. An chest wall escharotomy can be
useful in these circumstances.
VI. Nutrition
Patients affected by thermal injury exhibit a hypermetabolic,
hypercatabolic state that can result in severe loss of lean body mass. Children
are more vulnerable to protein-calorie malnutrition, given their proportionally
less body fat and smaller muscle mass. Patients affected by large burns
experience an increase in energy expenditure and protein metabolism just a
few days following the injury. This results in a negative nitrogen balance that
can last as long as 9 months after the insult. Significant weight loss, muscle
wasting, impaired immunity and delayed wound healing is evident. Prompt
initiation of nutrition (within the first 24-48 hours) to counteract this catabolic
state cannot be overemphasized. The enteral route is the preferred route when
possible. Most children can tolerate continuous feeds with subsequent
transition to bolus feeds. Patients who are intolerant of enteral feeds, will
require total parenteral nutrition (TPN). Tight control of serum glucose is
required given the predisposition of a hyperglycemic state after the injury. Most