The efficacy of an enteral access protocol for feeding trauma patients.
BACKGROUND
Proper enteral access to deliver specialized nutrition support in critically injured patients can be difficult, time consuming, and costly. We designed a protocol with interdisciplinary input to facilitate early enteral access in our trauma patients. Our primary objective was to determine if the protocol improved our ability to obtain small-bowel access in patients within 48 hours of their admission to the surgical intensive care unit (SICU). Secondary objectives were to examine the efficacy of the protocol by evaluating parenteral nutrition (PN) use, adequacy of enteral caloric delivery, and clinical outcomes including pneumonia and sepsis rates, SICU length of stay (LOS), hospital LOS, and mortality before and after its implementation.


METHODS
The medical records of 51 trauma patients admitted to the SICU, who met inclusion criteria, were reviewed retrospectively and divided into 2 groups. Patients in group 1 were admitted before protocol implementation (1997-1998, n = 17). Patients in group 2 were admitted after protocol implementation (1998-2000, n = 34).


RESULTS
Small-bowel access was achieved earlier in group 2 compared with group 1 [2.2 +/- 2 days vs 5.4 +/- 8 days, respectively (p = .04)]. PN was used less frequently in group 2 at 41.2% (14/34) as opposed to 64.7% (11/17) in group 1 (p = .05). There was a reduction in the number of days to reach caloric goal from 4.9 days in group 1 to 3.9 days in group 2 (n.s.). Clinical outcomes were similar in both groups.


CONCLUSIONS
The use of a protocol was effective in the achievement of prompt small bowel access. The number of days to reach caloric goal decreased after protocol implementation, but not to a statistically significant degree. However, we were able to detect a significant reduction in the use of PN.
Wooley
Jennifer
J
St. Joseph Mercy Hospital, Clinical Nutrition/Pharmacy, Ann Arbor, MI 48106, USA. wooleyj@trinity-health.org
Pomerantz
Richard
R
D000328:Adult; D016638:Critical Illness / Q000628:therapy*; D002149:Energy Intake; D004750:Enteral Nutrition / Q000379:methods*; D019317:Evidence-Based Medicine; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D010288:Parenteral Nutrition / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000628:therapy*