Nutrition and Gastrointestinal Dysmotility in Critically Ill Burn Patients: A Retrospective Observational Study. Issue 5 (25th August 2020)

• Record Type: Journal Article
• Authors: Sierp, Emma Louise; Kurmis, Rochelle; Lange, Kylie; Yandell, Rosalie; Chapman, Marianne; Greenwood, John; Chapple, Lee‐anne S
• Is Part Of: JPEN, Journal of parenteral and enteral nutrition. Volume 45:Issue 5(2021)
• Page Start: 1052
• Page End: 1060
• Publication Date: 2020-08-25
• Subjects: burns -- critical illness -- enteral nutrition -- feed intolerance -- gastrointestinal dysmotility -- postpyloric feeding; Parenteral feeding -- Periodicals; Enteral feeding -- Periodicals; 615.85484
• DOI: 10.1002/jpen.1979
• Languages: English
• ISSNs: 0148-6071

Abstract

Abstract: Background: Gastrointestinal (GI) dysmotility impedes nutrient delivery in critically ill patients with major burns. We aimed to quantify the incidence, timing, and factors associated with GI dysmotility and subsequent nutrition delivery. Methods: A 10‐year retrospective observational study included mechanically ventilated, adult, critically ill patients with ≥15% total body surface area (TBSA) burns receiving nutrition support. Patients with a single gastric residual volume ≥250 mL were categorized as having GI dysmotility. Daily medical and nutrition data were extracted for ≤14 days in the intensive care unit (ICU). Data are mean (SD) or median (interquartile range). Factors associated with GI dysmotility and the effect on nutrition and clinical outcomes were assessed. Results: Fifty‐nine patients were eligible; 51% (n = 30) with GI dysmotility and 49% (n = 29) without. Baseline characteristics (dysmotility vs no dysmotility) were age (48 [33–60] vs 34 [26–46] years); Acute Physiology and Chronic Health Evaluation II score (16 [12–17] vs 13 [10–16]); sex ([men] 80% vs 86%); and TBSA (49% [35%–59%] vs 38% [26%–55%]). Older age was associated with increased probability of dysmotility ( P = .049). GI dysmotility occurred 32 (19–63) hours after ICU admission but was not associated with reduced nutrient delivery. Postpyloric tube insertions were attempted in 83% (n = 25) of patients, with 72% (n = 18) being successful. Postpyloric feeding achieved higher nutrition adequacy than gastric feeding (energy: 82% [95% CI, 70–94] vs 68% [95% CI, 63–74], P = .036; protein: 75% [95% CI, 65–86] vs 61% [95% CI, 56–65], P = .009). Conclusion: GI dysmotility occurs early in critically ill burn patients, and postpyloric feeding improves nutrition delivery.