Mortality in Intensive Care and the Role of Enteral Nutrition in Trauma Patients
- 98 Downloads
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.
KeywordsEnteral Nutrition Multiple Organ Dysfunction Syndrome Paneth Cell Open Abdomen Bowel Sound
List of Abbreviations
American Society for Parenteral and Enteral Nutrition
Intensive care unit
Millimeters of mercury
Multiple organ dysfunction syndrome
Society of Critical Care Medicine
United States of America
- Burlew CC, Moore EE, Cuschieri J, Jurkovich GJ, Codner P, Nirula R, Millar D, Cohen MJ, Kutcher ME, Haan J, MacNew HG, Ochsner G, Rowell SE, Truitt MS, Moore FO, Pieracci FM, Kaups KL. Who should we feed? Western Trauma Association multi-institutional study of enteral nutrition in the open abdomen after injury. J Trauma Acute Care Surg. 2012;73(6):1380–7.PubMedCrossRefGoogle Scholar
- Doig GS, Heighes PT, Simpson F, Sweetman EA, Davies AR. Early enteral nutrition, provided within 24 hours of injury or intensive care unit admission, significantly reduces mortality in critically ill patients: a meta-analysis of randomised controlled trials. Intensive Care Med. 2009;35(12):2018–27.PubMedCrossRefGoogle Scholar
- Martindale RG, McClave SA, Vanek VW, McCarthy M, Roberts P, Taylor B, Ochoa JB, Napolitano L, Cresci G. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition: executive summary. Crit Care Med. 2009;37(5):1757–61.PubMedCrossRefGoogle Scholar
- Moore FA, Feliciano DV, Andrassy RJ, McArdle AH, Booth FV, Morgenstein-Wagner TB, Kellum Jr JM, Welling RE, Moore EE. Early enteral feeding, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis. Ann Surg. 1992;216(2):172–83.PubMedCentralPubMedCrossRefGoogle Scholar