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

Living reference work entry
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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.

Keywords

Enteral Nutrition Multiple Organ Dysfunction Syndrome Paneth Cell Open Abdomen Bowel Sound 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

List of 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. 1.Northern Clinical School Intensive Care Research UnitRoyal North Shore Hospital, University of SydneySt. LeonardsAustralia

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