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Early enteral feeding does not attenuate metabolic response after blunt trauma
S D Eyer1, L T Micon, F N Konstantinides
1Department of Surgery, University of Minnesota, Minneapolis.
Insights
Early enteral feeding after blunt trauma did not reduce the stress response or improve patient outcomes. This study found no significant differences in metabolic markers or clinical results between early and late feeding groups.
Area of Science:
- Trauma critical care
- Nutritional support
- Clinical research
Background:
- Early enteral feeding post-trauma is theorized to mitigate stress response and enhance recovery.
- The efficacy of early nutritional intervention in blunt trauma patients remains under investigation.
Purpose of the Study:
- To evaluate the impact of early enteral feeding on stress response and patient outcomes in blunt trauma survivors.
- To compare metabolic and clinical outcomes between early (<24 hours) and late (72 hours) enteral feeding regimens.
Main Methods:
- A prospective, randomized clinical trial involving 52 blunt trauma patients.
- Patients were assigned to early or late enteral feeding groups via nasoduodenal tubes, with a rapid advancement protocol.
- Outcomes assessed included metabolic markers (lactate, nitrogen, hormones), ICU/ventilator days, organ failure, infections, and mortality.
Main Results:
- No significant differences were observed in metabolic responses (plasma lactate, urinary nitrogen, catecholamines, cortisol) between groups.
- Both early and late feeding groups achieved nitrogen retention.
- There were no significant differences in ICU days, ventilator days, organ system failure, or mortality, though the early group had more total infections.
Conclusions:
- Early enteral feeding initiated within 24 hours after blunt trauma did not attenuate the physiological stress response.
- The timing of enteral feeding initiation did not significantly alter patient outcomes, including clinical recovery and survival rates.
Abstract:
Enteral feeding very early after trauma has been hypothesized to attenuate the stress response and to improve patient outcome. We tested this hypothesis in a prospective, randomized clinical trial in patients with blunt trauma. Following resuscitation and control of bleeding, 52 patients were randomized to receive early feedings (target, < 24 hours) or late feedings (target, 72 hours). Feeding was given via nasoduodenal feeding tubes. A rapid advance technique was used to achieve full volume and strength within 24 hours (goal, 1.5 g protein/kg.day). Patients who underwent at least 5 days of therapy were considered to have completed the study: 38 in all, 19 in each feeding group. Patients were similar in age, gender, Injury Severity Score, and mean PaO2/FiO2 ratio. The early group, however, had more patients with a PaO2/FiO2 < 150. After feeding began, the amount fed per day was the same in both groups. We found no significant differences in metabolic responses as measured by plasma lactate and urinary total nitrogen, catecholamines, and cortisol. Both groups achieved nitrogen retention. In addition, we found no significant differences in intensive care unit (ICU) days, ventilator days, organ system failure, specific types of infections, or mortality, although the early group had a greater number of total infections. In this study, early enteral feeding after blunt trauma neither attenuated the stress response nor altered patient outcome.