title: Feasibility of jejunal enteral nutrition for patients with severe duodenal injuries.
abstract: OBJECTIVE
  The aim of this study was to evaluate the feasibility of enteral nutrition (EN) for critically ill trauma patients with severe traumatic duodenal injuries who received placement of concurrent decompressing and feeding jejunostomies.
  
  
  METHODS
  Adult patients admitted to the trauma intensive care unit from January 2010 to December 2013, given concurrent afferent decompressing and efferent feeding jejunostomies for severe duodenal injury and provided EN or parenteral nutrition (PN), were retrospectively evaluated. Enteral feeding intolerance was defined as an increase in the decompressing jejunostomy drainage volume output, worsening abdominal distension, or cramping/pain unrelated to surgical incisions. Patients who failed initial EN were transitioned to PN.
  
  
  RESULTS
  Twenty-six patients were enrolled. Of the 24 patients given EN within the first 2 wk posthospitalization, 18 (75%) failed EN within 2 ± 2 d of initiating EN. EN was discontinued when increases were seen in decompressing jejunostomy drainage volume output (n = 11) and output with abdominal pain and/or distension (n = 6), or abdominal pain/distension was seen without an increase in output (n = 1). Jejunostomy drainage volume output increased from 474 ± 425 mL/d to 1168 ± 725 mL/d (P < 0.001) during EN intolerance. More patients with blunt intestinal injury than those with penetrating injuries (75% versus 15%, respectively; P = 0.035) tolerated EN. Patients initially given PN (n = 13) received more calories (P < 0.005) and protein (P < 0.001) than those given initial EN (n = 13).
  
  
  CONCLUSIONS
  The majority of patients with severe duodenal injuries and concurrent decompressing/feeding tube jejunostomies failed initial EN therapy.
authors.affiliation: Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, TN. Electronic address: rdickerson@uthsc.edu.
authors.forename: Roland N
authors.initials: RN
authors.lastname: Dickerson
authors.affiliation: Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Johnathan R
authors.initials: JR
authors.lastname: Voss
authors.affiliation: Department of Surgery, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Schroeppel
authors.affiliation: Department of Surgery, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: George O
authors.initials: GO
authors.lastname: Maish
authors.affiliation: Department of Surgery, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Magnotti
authors.affiliation: Department of Surgery, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Gayle
authors.initials: G
authors.lastname: Minard
authors.affiliation: Department of Surgery, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Croce
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D016638:Critical Illness / Q000628:therapy; D004386:Duodenum / Q000293:injuries*; D002149:Energy Intake; D004750:Enteral Nutrition / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D007582:Jejunostomy; D008297:Male; D010288:Parenteral Nutrition / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000628:therapy; D055815:Young Adult
keywords: Critical illness; Duodenal injury; Enteral nutrition; Parenteral nutrition; Trauma