Med Intensiva. 2018;42(5):306---316 www.elsevier.es/medintensiva REVIEW Update on metabolism and nutrition therapy in critically ill burned patients  E. Moreira a , G. Burghi b , W. Manzanares c,* a Centro de Tratamiento Intensivo del Hospital Maciel, ASSE, Montevideo, Uruguay b Centro Nacional de Quemados, Hospital de Clínicas, Facultad de Medicina, Universidad de la República (UdelaR), Montevideo, Uruguay c Cátedra de Medicina Intensiva, Hospital de Clínicas, Facultad de Medicina, Universidad de la República (UdelaR), Montevideo, Uruguay Received 22 May 2017; accepted 24 July 2017 Available online 21 May 2018 KEYWORDS Burn injury; Critical care; Hypermetabolism; Hypercatabolism; Micronutrients; Glutamine Abstract Major burn injury triggers severe oxidative stress, a systemic inflammatory response, and a persistent hypermetabolic and hypercatabolic state with secondary sarcopenia, multior- gan dysfunction, sepsis and an increased mortality risk. Calorie deficit, negative protein balance and antioxidant micronutrient deficiency after thermal injury have been associated to poor clin- ical outcomes. In this context, personalized nutrition therapy with early enteral feeding from the start of resuscitation are indicated. Over the last four decades, different nutritional and pharmacological interventions aimed at modulating the immune and metabolic responses have been evaluated. These strategies have been shown to be able to minimize acute malnutrition, as well as modulate the immunoinflammatory response, and improve relevant clinical outcomes in this patient population. The purpose of this updating review is to summarize the most current evidence on metabolic response and nutrition therapy in critically ill burn patients. © 2017 Elsevier Espa˜ na, S.L.U. and SEMICYUC. All rights reserved. Abbreviations: Co, cardiac output; EE, energy expenditure; GLUT4, glucose transporter type 4; Hr, heart rate; IL, interleukin; Vo2, oxygen consumption.  Please cite this article as: Moreira E, Burghi G, Manzanares W. Metabolismo y terapia nutricional en el paciente quemado crítico: una revisión actualizada. Med Intensiva. 2018;42:306---316. ∗ Corresponding author. E-mail address: wmanzanares@adinet.com.uy (W. Manzanares). 2173-5727/© 2017 Elsevier Espa˜ na, S.L.U. and SEMICYUC. All rights reserved.