The Role of Nurses in Nutritional Assessment of Burn Patients Using Indirect Calorimetry: Experience from Trauma Ward 4 (Burn Unit) Siriraj Hospital

Abstract

Burn injuries induce a severe and prolonged hypermetabolic response, resulting in energy requirements increased by 150 – 200% above normal levels. Accurate energy requirement assessment is, therefore, a critical component of nutritional
management. Although traditional predictive equations such as the Harris-Benedict equation and Curreri formula are widely used, they demonstrate only 75% and often overestimate energy requirements. This overestimation may lead to hyperglycemia, obesity, or infection, which can negatively impact the wound healing process. Indirect calorimetry has been recognized as the gold standard for assessing resting energy expenditure by measuring oxygen consumption and carbon dioxide production to calculate energy needs using the Weir equation. This article presents the nursing roles in the nutritional assessment of burn patients using indirect calorimetry, utilizing a two-year experience from Trauma Ward 4 (Burn Unit) at Siriraj Hospital as a case study. The nursing roles encompass three main phases: patient assessment and preparation, care during measurement procedures, and coordination of result reporting. Implementing this technology has transformed nurses from general caregivers to specialized experts in nutritional assessment with specific knowledge and skills. Results demonstrate improved accuracy in energy requirement assessment, reduced inappropriate feeding
practices, and maintenance of a high survival rate. The development of standardized practice guidelines, systematic personnel training, and the establishment of knowledge-sharing networks are essential factors for advancing nursing roles and enhancing the quality of burn patient care in the future. The experience from Siriraj Hospital's Burn Unit illustrates how modern technology integration can elevate nursing practice while maintaining excellence in patient outcomes. This transformation requires continuous professional development, interdisciplinary collaboration, and evidence-based practice implementation to optimize nutritional care delivery for burn patients.