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Mortality in Intensive Care and the Role of Enteral Nutrition in Trauma Patients

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Diet and Nutrition in Critical Care

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Abstract

This chapter provides a succinct review of the clinical evidence demonstrating the benefits of early enteral nutrition during recovery from major traumatic injury: reduced septic morbidity, reduced ventilator-associated pneumonia, reduced time to closure in patients managed with open abdomen, and a reduction in the severity of multiple organ dysfunction syndrome. Physiological mechanisms are reviewed to understand how these clinical benefits are translated into a reduction in mortality, as supported by a recent systematic review and meta-analysis of all available clinical trials.

Finally, a simple practice recommendation is made based on the accumulated evidence from clinical trials conducted in major trauma patients: enteral nutrition should be initiated after resuscitation is completed. Completion of resuscitation can be defined as (1) shock index ≤1 for at least 1 h (heart rate ÷ systolic blood pressure = shock index) or (2) systolic blood pressure >90 mmHg or mean blood pressure >70 mmHg without requirement for fluid boluses or increasing doses of vasoactive agents, for at least 1 h.

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Abbreviations

ASPEN:

American Society for Parenteral and Enteral Nutrition

h:

Hour

ICU:

Intensive care unit

mmHg:

Millimeters of mercury

MODS:

Multiple organ dysfunction syndrome

OR:

Odds ratio

p:

P value

SCCM:

Society of Critical Care Medicine

US:

United States of America

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Authors and Affiliations

  1. Northern Clinical School Intensive Care Research Unit, Royal North Shore Hospital, University of Sydney, Pacific Highway, St. Leonards, NSW, 2065, Australia

    Gordon S. Doig, Fiona Simpson & Philippa T. Heighes

Authors
  1. Gordon S. Doig
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  2. Fiona Simpson
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  3. Philippa T. Heighes
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Corresponding author

Correspondence to Gordon S. Doig .

Editor information

Editors and Affiliations

  1. Royal Free London Hospitals, Barnet General Hospital, London, UK

    Rajkumar Rajendram

  2. Division of Diabetes & Nutritional Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK

    Rajkumar Rajendram

  3. King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia

    Rajkumar Rajendram

  4. Department of Nutrition and Dietetics, Division of Diabetes & Nutritional Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK

    Victor R. Preedy

  5. Department of Biomedical Sciences, Faculty of Science & Technology, University of Westminster, London, UK

    Vinood B. Patel

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Doig, G.S., Simpson, F., Heighes, P.T. (2015). Mortality in Intensive Care and the Role of Enteral Nutrition in Trauma Patients. In: Rajendram, R., Preedy, V.R., Patel, V.B. (eds) Diet and Nutrition in Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7836-2_99

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  • DOI: https://doi.org/10.1007/978-1-4614-7836-2_99

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-7837-9

  • Online ISBN: 978-1-4614-7836-2

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