Estimación del gasto energético en el paciente quemado mediante la utilización de ecuaciones predictivas; revisión bibliográfica

Introduction: The estimation of the caloric requirements of the burn patient is based on the measurement of his resting energy expenditure (REE) via indirect calorimetry, which is not available in all Burn Units, or its estimation by means of predictive equations. Goals: we analyze the history and state of art of the use of REE predictive equations in burn patients, and determine their validity. Methods: bibliographic review of the studies and reviews written in English and Spanish between 1989 and 2013. Results: More than 190 equations have been designed to estimate energy expenditure. These equations can be imprecise because they are based on measurements with a heterogeneous methodology and in heterogeneous groups. We describe the different parameters that are used in the different equations (stress and activity factors, total burn surface area, post-burn day, lean body mass), the influence of age in the calculation of the caloric requirements, and the most commonly used equations nowadays. We also describe the articles that evaluate the accuracy of the predictive equations when compared to REE indirect calorimetry measurements. Conclusions: Predictive equations are not precise in general in the burn patient. Until more accurate predictive equations are developed, we recommend calculation of the nutritional requirements in burn patients based on the energy expenditure measurement via indirect calorimetry.