Timely enteral nutrition of ventilated polytrauma patients: current standards and room for improvements

Polytrauma patients in intensive care units (ICUs) face significant risks of morbidity and mortality, with nutrition playing a crucial role in mitigating energy deficits and complications such as multi-organ failure (MOF). This study aimed to evaluate adherence to enteral nutrition (EN) guidelines in ventilated polytrauma patients and explored correlations between EN timing and clinical outcomes.

A four-year retrospective (2019-2022) analysis of ventilated polytrauma patients (abbreviated injury scale > 2 in ≥ 2 body regions) admitted to a level 1 trauma centre. Collected data included demographics, injury characteristics and EN patterns. Early EN was defined as started withing 24 h. Statistical analysis assessed associations between EN, injury severity, and outcomes such as ICU length of stay (LOS), mortality, and MOF.

Of 182 patients (median age 41, male 77%, median ISS 34), 41 did not receive EN and were excluded. Of the remaining 141, 64% received early EN, with a median time to EN of 17.8 h. Early EN was associated with reduced ICU LOS (p = 0.016). Delaying EN initiation correlated with higher injury severity (p = 0.008). Each one-hour delay to EN increased MOF odds by 1.47% (OR: 1.0147, p = 0.07). EN interruptions (> 6 h) occurred 354 times.

Investigations into current EN standards in polytrauma patients demonstrated an average of 2.5 interruptions in EN exceeding 6 h per patient, with 40% not fed within 24 h. Combined with inconsistent dietician input, this offers room for improvement as early EN is associated with better outcomes, with a reduced ICU LOS established through this study.