ENTERAL VERSUS PARENTERAL-FEEDING - EFFECTS ON SEPTIC MORBIDITY AFTER BLUNT AND PENETRATING ABDOMINAL-TRAUMA

To investigate the importance of route of nutrient administration on septic complications after blunt and penetrating trauma, 98 patients with an abdominal trauma index of at least 15 were randomized to either enteral or parenteral feeding within 24 hours of injury. Septic morbidity was defined as pneumonia, intra-abdominal abscess, empyema, line sepsis, or fasciitis with wound dehiscence. Patients were fed formulas with almost identical amounts of fat, carbohydrate, and protein. Two patients died early in the study. The enteral group sustained significantly fewer pneumonias (11.8% versus total parenteral nutrition 31.%, p < 0.02), intra-abdominal abscess (1.9% versus total parenteral nutrition 13.3%, p < 0.04), and line sepsis (1.9% versus total parenteral nutrition 13.3%, p < 0.04), and sustained significantly fewer infections per patient (p < 0.03), as well as significantly fewer infections per infected patient (p < 0.05). Although there were no differences in infection rates in patients with injury severity score < 20 or abdominal trauma index less-than-or-equal-to 24, there were significantly fewer infections in patients with an injury severity score > 20 (p < 0.002) and abdominal trauma index > 24 (p < 0.005). Enteral feeding produced significantly fewer infections in the penetrating group (p < 0.05) and barely missed the statistical significance in the blunt-injured patients (p = 0.08). In the subpopulation of patients requiring more than 20 units of blood, sustaining an abdominal trauma index > 40 or requiring reoperation within 72 hours, there were significantly fewer infections per patient (p = 0.03) and significantly fewer infections per infected patient (p < 0.01). There is a significantly lower incidence of septic morbidity in patients fed enterally after blunt and penetrating trauma, with most of the significant changes occurring in the more severely injured patients. The authors recommend that the surgeon obtain enteral access at the time of initial celiotomy to assure an opportunity for enteral delivery of nutrients, particularly in the most severely injured patients.