Effect of calorically dense enteral nutrition formulas on outcome in critically ill trauma and surgical patients.
BACKGROUND
Surgical and trauma patients are traditionally provided with calorically dense dietary formulas to deliver high amounts of nutrients. The benefits of these formulas remain unproven and may be associated with significant side effects and even increased mortality. We studied outcomes on surgical and trauma patients receiving either a calorically dense dietary formula or a normocaloric dietary formula.


METHODS
A retrospective analysis comparing outcomes in intensive care unit (ICU) surgical and trauma patients receiving either a calorically dense dietary formula or a normocaloric dietary formula was performed at the University of Pittsburgh Medical Center.


RESULTS
One hundred seventeen patients met study criteria. Surgical and trauma patients were analyzed separately. Despite receiving different calorically dense diets, caloric intake was not significantly different in surgical patients receiving either diet. However, surgical patients receiving a normocaloric formula exhibited decreased length of stay (14.7 +/- 10.1 vs 25.0 +/- 11.3 days; p = .01), ventilator days (14.3 +/- 12.9 vs 21.3 +/- 10.5 days; p = .04), and average daily glucose levels (129.8 +/- 4.1 vs 157.9 +/- 13.6 mg/dL; p =.01), and were more likely to be directly discharged home compared with those receiving a calorically dense dietary formula. Trauma patients receiving a calorically dense dietary formula were on average 17 years younger (p = .01). However, trauma patients receiving a normocaloric formula exhibited decreased length of stay (15.3 +/- 1.6 vs 18.7 +/- 1.6 days; p = .02) and a greater likelihood of direct discharge home.


CONCLUSIONS
The data generated suggest that what a patient is fed affects both short- and long-term outcomes. A prospective study should be designed to determine the ideal calories needed in surgical and trauma patients.
Bryk
Jodie
J
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
Zenati
Mazen
M
Forsythe
Raquel
R
Peitzman
Andrew
A
Ochoa
Juan B
JB
D018806:APACHE; D001786:Blood Glucose / Q000378:metabolism; D016638:Critical Illness / Q000628:therapy*; D002149:Energy Intake / Q000502:physiology*; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005526:Food, Formulated / Q000009:adverse effects / Q000032:analysis; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009751:Nutritional Requirements; D009753:Nutritive Value; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
D001786:Blood Glucose