D. D. Yeh1, C. Cropano1, S. Quraishi1, E. Fuentes1, H. Kaafarani1, J. Lee1, Y. Chang1, G. D. Velmahos1 1Massachusetts General Hospital,Trauma, Emergency Surgery, Surgical Critical Care,Boston, MA, USA
Introduction: Enteral nutrition (EN) is an important component of surgical critical care, yet delivery of prescribed nutrition is often suboptimal. In surgical patients, EN is commonly interrupted for procedures. We hypothesized that continuing perioperative nutrition or providing compensatory nutrition would improve caloric delivery without increasing morbidity.
Methods: We enrolled 10 adult (age >18) surgical ICU patients receiving EN who were scheduled for elective tracheostomy and/or percutaneous endoscopic gastrostomy (PEG) between 07/2012-05/2014. In these patients, either perioperative EN was maintained or compensatory nutrition was used (particularly in the case of PEG tube placement). Perioperative EN was defined as continuing tube feeds up to (and sometimes during) operative procedures, whereas compensatory nutrition was defined as a temporary postoperative increase in the hourly EN rate to compensate for interrupted EN. We matched these patients to 40 other patients during the same time period who had tracheostomy and/or PEG placement while adhering to the traditional American Society of Anesthesiology NPO guidelines. Outcomes in patients receiving perioperative and/or compensatory feedings (FED) were compared to those not receiving them (UNFED) using Pearson’s chi-squared and Mann-Whitney Test for proportions and medians, respectively. All tests were two-sided and p<0.05 was considered significant.
Results:A total of 50 eligible subjects were enrolled. There was no difference in age, sex, BMI, APACHE II score, and prescribed calories (TABLE 1). However, patients in the UNFED group did have higher rates of PEG placement when compared to the FED group (40% vs. 0%, p=0.02) On the day of procedure, the FED group received more actual calories (median 1706 vs. 527 kcal, p<0.001) and a higher percentage of prescribed calories (92% vs 25%, p<0.001). Median caloric deficit on the day of the procedure was also significantly lower in the FED group (175 vs. 1213 kcal, p<0.001). There were no differences in total complications or GI complications between groups.
Conclusion:In our pilot study of surgical ICU patients undergoing tracheostomy and/or PEG tube placement, perioperative and compensatory nutrition resulted in higher caloric delivery and was not associated with increased morbidity. Larger studies are needed to validate our findings and to determine whether aggressive ICU nutrition improves outcomes in critically ill surgical patients.
