title: Intraoperative Feeding Improves Calorie and Protein Delivery in Acute Burn Patients.
abstract: Enteral nutrition support is a critical component of modern burn care for severely burned patients. However, tube feeds are frequently withheld during the perioperative period because of aspiration concerns. As a result, patients requiring multiple operative procedures risk accumulating significant protein-calorie deficits. The objective of this study was to describe our American Burn Association-certified burn center's experience implementing an intraoperative feeding protocol in severely burned patients defined as a cutaneous burn ≥20% TBSA. A retrospective review of patients with major thermal injuries (2008-2013). Thirty-three patients with an average of seven operating room trips (range, 2-21 trips) were evaluated. Seventeen patients received intraoperative enteral feeds (protocol group) and 16 patients did not (standard group). Feeding was performed using an enteral feeding tube placed postpylorically and was continued intraoperatively, regardless of operative positioning. There was no statistically significant difference in mortality between the groups (P = .62). No intraoperative aspiration or regurgitation events were recorded. The protocol group received significantly more calculated protein and caloric requirements, 98.06 and 98.4%, respectively, compared with 70.6 and 73.2% in the standard group (P < .001). Time to goal tube feed infusion rate was achieved on average 3 days sooner in the protocol group compared with the standard group (3.35 vs 6.18 days, P = .008). Early initiation and continuation of enteral feeds in severely burned patients led to higher percentages received of prescribed goal protein and caloric needs without increased rates of aspiration, regurgitation, or mortality.
authors.affiliation: From the *Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Massachusetts; †Department of Surgery, University of Massachusetts Medical School, Worcester; ‡Department of Surgery, Columbia University Medical Center, Milstein Hospital, New York, New York; §Department of Physician Assistant Studies, George Washington University, Washington; ‖Division of Plastic and Reconstructive Surgery, University of California, San Francisco; ¶Department of Nutrition, Brigham and Women's Hospital, Boston, Massachusetts; #Department of Anesthesia, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and **Department of Surgery, Long Island Jewish Medical Center, New Hyde Park, New York.
authors.forename: David E
authors.initials: DE
authors.lastname: Varon
authors.forename: Gil
authors.initials: G
authors.lastname: Freitas
authors.forename: Neha
authors.initials: N
authors.lastname: Goel
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wall
authors.forename: Deepak
authors.initials: D
authors.lastname: Bharadia
authors.forename: Erin
authors.initials: E
authors.lastname: Sisk
authors.forename: Joshua C
authors.initials: JC
authors.lastname: Vacanti
authors.forename: Bohdan
authors.initials: B
authors.lastname: Pomahac
authors.forename: Indranil
authors.initials: I
authors.lastname: Sinha
authors.forename: Vihas M
authors.initials: VM
authors.lastname: Patel
mesh_terms: D002053:Burn Units; D002056:Burns / Q000601:surgery*; D003422:Critical Care / Q000379:methods; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009751:Nutritional Requirements; D019990:Perioperative Care / Q000379:methods*; D012189:Retrospective Studies