Nutritional Support of the Trauma Patient

Posted by e-Medical PPT Tuesday, February 7, 2012
Nutritional support is an integral component of the care of the critically injured patient.  The understanding of the metabolic changes associated with starvation, stress and sepsis has deepened over the past 20-30 years and along with this has come a greater appreciation for the importance of the timing, composition and route of nutritional support of the trauma patient.

Metabolic changes
“ebb phase”: lasts 12-24 hours, characterized by fever, ↑ O2 consumption, ↓ body temp, vasoconstriction
“flow phase”: lasts for the remainder of the acute illness, hypercatabolism, utilization of fat as the major fuel source
“anabolic phase”: begins with onset of recovery, characterized by normalization of vital signs, improved appetite and diuresis.
GOAL OF NUTRITIONAL SUPPORT: maintain vital organ structure and function

Route
TEN
Advantages:
Physiologic
Maintains mucosal integrity, minimizing risk of bacterial colonization
Fewer septic complications
Disadvantages:
Requires adequate gastric emptying
Risk of aspiration
Frequent interruptions in feeding necessitated by multiple trips to the OR

TPN
Advantages:
Does not require adequate gastric motility
No risk of aspiration
Disadvantages:
Intestinal mucosal atrophy
Catheter related sepsis
Expensive in relation to TEN

Recomendations:
FEED AS SOON AS POSSIBLE!!!
Early intragastric feedings (within 12 hours of burns) in burn patients to avoid gastroparesis
Post-pyloric feedings (beyond the Ligament of Treitz) in patients with severe head injury who do not tolerate gastric feeding
Direct small bowel feedings via nasojejunal feeding tubes, gastrojejunal tube, or feeding jejunostomy within 12-24 hours of injury in patients with blunt and penetrating abdominal injuries...

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