title: A pilot study to explore the safety of perioperative postpyloric enteral nutrition.
abstract: BACKGROUND
  The practice of holding enteral nutrition (EN) 8 hours prior to surgery is common. We hypothesized that it was safe to continue postpyloric EN, and we developed an institutional practice pattern to investigate our hypothesis.
  
  
  METHODS
  Our pilot study included intubated patients in the surgical intensive care unit at Froedtert Memorial Lutheran Hospital who received EN via a nasojejunal (NJ) feeding tube and underwent 1 or more surgical procedures. Demographic, illness, and injury information were collected as well as length of time to NJ placement, time to initiation of EN, EN interruptions, and complications. Additional hours of EN were calculated by totaling the number of hours a patient received EN past midnight on the day of surgery.
  
  
  RESULTS
  A total of 14 patients with mean (SD) age 44.3 (19.9) were included. Patients had a mean (SD) Injury Severity Score (ISS) of 26.1 (9.2) on admission and underwent a total of 38 operations following placement of a feeding tube. The most frequent operation performed was an orthopedic procedure (n = 17; 46.1%). The mean (SD) length of EN interruptions for a single procedure was 222.4 (206.9) minutes. Patients received an additional 11.9 (4.7) hours of EN over the course of their hospitalization and an additional 1064.9 (490) kcal/d per operation. There were no adverse events.
  
  
  CONCLUSIONS
  Perioperative continuation of postpyloric EN is feasible in some critically ill surgical patients and can result in additional calories provided. A multidisciplinary approach and an institutional policy can increase the likelihood of meeting nutrition goals in these patients.
authors.affiliation: Medical College of Wisconsin and Affiliated Hospitals, 9200 West Wisconsin Ave, Milwaukee, WI 53226, USA. lmcelroy@mcw.edu
authors.forename: Lisa M
authors.initials: LM
authors.lastname: McElroy
authors.forename: Panna A
authors.initials: PA
authors.lastname: Codner
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Brasel
mesh_terms: D000328:Adult; D016638:Critical Illness / Q000628:therapy; D002149:Energy Intake; D004750:Enteral Nutrition / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007441:Intubation, Gastrointestinal / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D010865:Pilot Projects; D016896:Treatment Outcome; D055815:Young Adult