Adjusting body weight for edema in severely burned patients

• Published in: Burns Vol. 49; no. 3; pp. 562 - 565
• Main Authors: Shields, Beth A., Fossati, Sandrine O., Cole, Renee E., Kieffer, Adam J., Vega, Saul J., Aden, James K., Williams, Alicia M., Cancio, Leopoldo C.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-05-2023
• Subjects: Body Weight; Burn; Burns - complications; Calorie; Edema; Energy; Hospitalization; Humans; Intensive Care Units; Nutrition; Retrospective Studies; Weight; Wound Healing; wt meas; Calorie; Edema; Nutrition; wt dry after healing; IQR; wt dry adm; Weight; Burn; REE; Energy; wt EDW; ICU; wt est av daily change; TBSA; wt
• ISSN: 0305-4179; 1879-1409
• DOI: 10.1016/j.burns.2023.01.008

Weight loss is difficult to quantify in critically ill burn patients, as the presence of edema can mask changes in dry body weight. We sought to estimate dry body weight using measured weights adjusted for reported extremity edema. We evaluated patients with at least 20% total body surface area (TBSA) burns admitted to our intensive care unit over a 3½-year period. Body weights were collected for this analysis from admission to the time of a recorded dry weight after wound healing. Extremity edema was collected at the time of each weight measurement and was categorized into three groups: (1) no edema, (2) 1 + pitting edema, (3) 2 + or 3 + pitting edema. Logistic regression yielded the following formula for estimating dry weight (in kg): 0.66 x measured body weight + 25 – (3 for 1 + pitting edema or 4 for 2 + or 3 + pitting edema of either upper extremity) – (4 for any pitting edema to either lower extremity) (p < 0.01, R2 = 0.81). These results may allow us to better estimate dry body weight changes in our edematous patients with severe burns. Nutrition goals can be adjusted earlier, when appropriate, based on these estimated dry body weight changes.
•Evaluation of weight loss during wound healing after severe burn was performed•Monitoring of nutritional status is difficult in the edematous burn patient•Novel methods to determine dry body weight loss is essential•Dry weight monitoring can allow for appropriate adjustments in nutrition support