Postinjury enteral tolerance is reliably achieved by a standardized protocol

被引:45
作者
Kozar, RA [1 ]
McQuiggan, MM
Moore, EE
Kudsk, KA
Jurkovich, GJ
Moore, FA
机构
[1] Univ Texas Houston, Dept Surg, Houston, TX USA
[2] Denver Hlth Med Ctr, Dept Surg, Denver, CO USA
[3] Univ Wisconsin, Dept Surg, Madison, WI USA
[4] Univ Washington, Harborview Med Ctr, Dept Surg, Seattle, WA 98104 USA
[5] Herman Hosp, Dept Surg, Houston, TX USA
关键词
enteral nutrition; enteral tolerance; trauma;
D O I
10.1006/jsre.2002.6409
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background. Postinjury enteral. nutrition (EN) is beneficial. Unfortunately, severely injured patients who should benefit most are frequently intolerant. To assist in maximizing enteral. tolerance in the critically injured, we first implemented a prospective analysis of the effectiveness of a standardized enteral protocol (EP) at a single institution followed by a prospective multi-institutional analysis of its implementation. Methods. Tolerance parameters were prospectively collected on severely injured patients at a single (Phase 1) and then multiple (Phase II) institutions. EN was begun at 15 cc/h and advanced every 12 h to a patient specific targeted goal. Intolerance symptoms (high nasogastric output/emesis, abdominal distention, and diarrhea) were assessed and graded every 12 h and managed using a standardized protocol. Tolerance was characterized as early (during initial advancement of feeds) or late (after standard goal) and classified as good (EN advanced per EP), moderate (rate decreased per EP), poor (EN held per EP), or EN discontinued (and TPN begun). Results. In Phase I patients (ISS = 25 +/- 3) early tolerance was good in 82% (14/17) while late good tolerance decreased to 65% (11/17). In Phase 11 patients (ISS = 30 +/- 2), early tolerance was good in 85% (41/49) and late tolerance was good in 80% (39/49). Moderate intolerance was primarily seen in Phase II patients and due to high gastric output in patients fed proximal to the ligament of Treitz (13/16). Overall 88% (15/17) of Phase I and 100% (49149) of Phase II patients were successfully maintained on EN. Conclusions. Severely injured patients exhibited good tolerance to EN when managed using a standardized protocol at four Level I trauma centers. Moderate intolerance was associated with high gastric output and may be lessened by feeding distal to the ligament of Treitz. (C) 2002 Elsevier Science (USA).
引用
收藏
页码:70 / 75
页数:6
相关论文
共 25 条
[1]   A study of problems associated with the delivery of enteral feed in critically ill patients in five ICUs in the UK [J].
Adam, S ;
Batson, S .
INTENSIVE CARE MEDICINE, 1997, 23 (03) :261-266
[2]   Maximizing tolerance of enteral nutrition in severely injured trauma patients: A comparison of enteral feedings by means of percutaneous endoscopic gastrostomy versus percutaneous endoscopic gastrojejunostomy [J].
Adams, GF ;
Guest, DP ;
Ciraulo, DL ;
Lewis, PL ;
Hill, RC ;
Barker, DE .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2000, 48 (03) :459-464
[3]  
BOLVIN MA, 2001, CRIT CARE MED, V29, P1916
[4]   GASTROINTESTINAL DYSFUNCTION AMONG INTENSIVE-CARE UNIT PATIENTS [J].
CHANG, RWS ;
JACOBS, S ;
LEE, B .
CRITICAL CARE MEDICINE, 1987, 15 (10) :909-914
[5]   ENTERAL NUTRITION IN THE CRITICALLY ILL PATIENT - A PROSPECTIVE SURVEY [J].
HEYLAND, D ;
COOK, DJ ;
WINDER, B ;
BRYLOWSKI, L ;
VANDEMARK, H ;
GUYATT, G .
CRITICAL CARE MEDICINE, 1995, 23 (06) :1055-1060
[6]   Effect of postpyloric feeding on gastroesophageal regurgitation and pulmonary microaspiration: Results of a randomized controlled trial [J].
Heyland, DK ;
Drover, JW ;
MacDonald, S ;
Novak, F ;
Lam, M .
CRITICAL CARE MEDICINE, 2001, 29 (08) :1495-1501
[7]   Complications of surgical feeding jejunostomy in trauma patients [J].
Holmes, JH ;
Brundage, SI ;
Yuen, P ;
Hall, RA ;
Maier, RV ;
Jurkovich, GJ .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1999, 47 (06) :1009-1012
[8]   The incidence of ventilator-associated pneumonia and success in nutrient delivery with gastric versus small intestinal feeding: A randomized clinical trial [J].
Kearns, PJ ;
Chin, D ;
Mueller, L ;
Wallace, K ;
Jensen, WA ;
Kirsch, CM .
CRITICAL CARE MEDICINE, 2000, 28 (06) :1742-1746
[9]   Routine intragastric feeding following traumatic brain injury is safe and well tolerated [J].
Klodell, CT ;
Carroll, M ;
Carrillo, EH ;
Spain, DA .
AMERICAN JOURNAL OF SURGERY, 2000, 179 (03) :168-171
[10]  
KOZAR RA, 2000, SHOCK S, V13, P86