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Postinjury enteral tolerance is reliably achieved by a standardized protocol
Rosemary A Kozar1, Margaret M McQuiggan, Ernest E Moore
1Department of Surgery, University of Texas-Houston, Houston, Texas, USA.
The Journal of Surgical Research
|April 25, 2002
Summary
A standardized enteral nutrition protocol improved tolerance in critically injured patients. Feeding distal to the ligament of Treitz may reduce moderate intolerance due to high gastric output.
Area of Science:
- Critical Care Medicine
- Surgical Nutrition
- Trauma Management
Background:
- Enteral nutrition (EN) is crucial for postinjury recovery.
- Severely injured patients often experience intolerance to EN.
- Optimizing EN tolerance is vital for this patient population.
Purpose of the Study:
- To evaluate the effectiveness of a standardized enteral protocol (EP) for improving EN tolerance in severely injured patients.
- To assess the implementation of this EP across multiple trauma centers.
Main Methods:
- A prospective, multi-institutional study involving severely injured patients.
- Implementation of a standardized EP for initiating and advancing EN.
- Monitoring tolerance parameters and intolerance symptoms (gastric output, emesis, distention, diarrhea).
Main Results:
- High rates of early and late EN tolerance were observed across both single (Phase I) and multi-institutional (Phase II) settings (82-85% early, 65-80% late).
- Overall successful EN maintenance was high (88% Phase I, 100% Phase II).
- Moderate intolerance, primarily due to high gastric output, was noted in patients fed proximal to the ligament of Treitz.
Conclusions:
- A standardized enteral nutrition protocol effectively promotes tolerance in severely injured patients.
- Feeding distal to the ligament of Treitz may mitigate moderate intolerance related to high gastric output.