How long are burn patients really NPO in the perioperative period and can we effectively correct the caloric deficit using an enteral feeding "Catch-up" protocol?. Issue 8 (December 2018)

• Record Type: Journal Article
• Authors: Pham, C.H.; Collier, Z.J.; Webb, A.B.; Garner, W.L.; Gillenwater, T.J.
• Is Part Of: Burns. Volume 44:Issue 8(2018)
• Page Start: 2006
• Page End: 2010
• Publication Date: 2018-12
• Subjects: NPO nil per os -- ICU intensive care unit -- SS surgical start -- FR feeding restart; Burns -- Thermal injuries -- Critical care -- Enteral nutrition -- Tube feeding; Burns and scalds -- Periodicals; 617.11
• DOI: 10.1016/j.burns.2018.07.005
• Languages: English
• ISSNs: 0305-4179

Abstract

Highlights: Burn patients made NPO for surgery fast up to 14 h before restarting feeding. NPO for surgery results in a deficit of up to 50% the daily prescribed calories. A unique volume-based catch-up protocol can attenuate caloric losses. Abstract: Objective: "NPO at midnight" is a standard preoperative practice intended to reduce aspiration risk but can result in prolonged feeding interruptions in critically ill burn patients. Postoperative hyperalimentation in the form of a "catch-up" tube feeding protocol is routine. A retrospective review of our perioperative fasting practices and "catch-up" enteral feeding protocols was performed. Methods: Patients admitted to the Burn ICU from July 1st, 2015 to August 31st, 2016 were reviewed. Patients who had a protected airway in place, prescribed enteral nutrition, and underwent surgery were included. The time from NPO to surgical start (NPO-SS), NPO to feeding restart (NPO-FR), and calories received/prescribed were quantified. The efficacy of a postoperative catch-up feeding protocol was analyzed. Results: There were 41 patients that fit inclusion criteria with some undergoing multiple surgeries, yielding 109 surgeries/discrete perioperative events. The average total body surface area burn (38.1 ± 23.6%), age (38.8 ± 20.1 years), ICU days (45.0 ± 37.3 days), and ventilator days (35.1 ± 33.8 days) were calculated. Average fasting durations of NPO-SS and NPO-FR were 9.3 ± 3.1 and 14.2 ± 4.1 h, respectively. The average caloric deficit to prescribed calories ratio during the NPO-SS and NPO-FR periods were 1154 ± 629/3534 ± 851 kcal and 1765 ± 928/3534 ± 851 kcal, respectively. A post-operative catch-up protocol completely compensated for perioperative caloric deficits 68.8% (22/32) of the time. Conclusions: In critically ill burn patients, a preoperative fast resulted in an average loss of greater than 50% of prescribed calories on the day of surgery. Clinicians should re-evaluate the standard practice of making preoperative patients "NPO at midnight". An effective catch-up protocol can adequately reduce caloric deficits.