Document Detail


Early enteral nutrition in burns: compliance with guidelines and associated outcomes in a multicenter study.
MedLine Citation:
PMID:  21116188     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Early nutritional support is an essential component of burn care to prevent ileus, stress ulceration, and the effects of hypermetabolism. The American Burn Association practice guidelines state that enteral feedings should be initiated as soon as practical. The authors sought to evaluate compliance with early enteral nutrition (EN) guidelines, associated complications, and hospitalization outcomes in a prospective multicenter observational study. They conducted a retrospective review of mechanically ventilated burn patients enrolled in the prospective observational multicenter study "Inflammation and the Host Response to Injury." Timing of initiation of tube feedings was recorded, with early EN defined as being started within 24 hours of admission. Univariate and multivariate analyses were performed to distinguish barriers to initiation of EN and the impact of early feeding on development of multiple organ dysfunction syndrome, infectious complications, days on mechanical ventilation, intensive care unit (ICU) length of stay, and survival. A total of 153 patients met study inclusion criteria. The cohort comprised 73% men, with a mean age of 41 ± 15 years and a mean %TBSA burn of 46 ± 18%. One hundred twenty-three patients (80%) began EN in the first 24 hours and 145 (95%) by 48 hours. Age, sex, inhalation injury, and full-thickness burn size were similar between those fed by 24 hours vs after 24 hours, except for higher mean Acute Physiology and Chronic Health Evaluation II scores (26 vs 23, P = .03) and smaller total burn size (44 vs 54% TBSA burn, P = .01) in those fed early. There was no significant difference in rates of hyperglycemia, abdominal compartment syndrome, or gastrointestinal bleeding between groups. Patients fed early had shorter ICU length of stay (adjusted hazard ratio 0.57, P = 0.03, 95% confidence interval 0.35-0.94) and reduced wound infection risk (adjusted odds ratio 0.28, P = 0.01, 95% confidence interval 0.10-0.76). The investigators have found early EN to be safe, with no increase in complications and a lower rate of wound infections and shorter ICU length of stay. Across institutions, there has been high compliance with early EN as part of the standard operating procedure in this prospective multicenter observational trial. The investigators advocate that initiation of EN by 24 hours be used as a formal recommendation in nutrition guidelines for severe burns, and that nutrition guidelines be actively disseminated to individual burn centers to permit a change in practice.
Authors:
Michael J Mosier; Tam N Pham; Matthew B Klein; Nicole S Gibran; Brett D Arnoldo; Richard L Gamelli; Ronald G Tompkins; David N Herndon
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of burn care & research : official publication of the American Burn Association     Volume:  32     ISSN:  1559-0488     ISO Abbreviation:  J Burn Care Res     Publication Date:    2011 Jan-Feb
Date Detail:
Created Date:  2011-01-10     Completed Date:  2011-06-02     Revised Date:  2013-12-18    
Medline Journal Info:
Nlm Unique ID:  101262774     Medline TA:  J Burn Care Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  104-9     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
APACHE
Adult
Burns / complications*,  therapy*
Chi-Square Distribution
Enteral Nutrition / methods*
Female
Guideline Adherence*
Humans
Infection / epidemiology
Length of Stay / statistics & numerical data
Logistic Models
Male
Multiple Organ Failure / epidemiology
Practice Guidelines as Topic*
Prospective Studies
Respiration, Artificial
Statistics, Nonparametric
Survival Rate
Treatment Outcome
Grant Support
ID/Acronym/Agency:
1KL2RR025015-01/RR/NCRR NIH HHS; 2-U54-GM062119/GM/NIGMS NIH HHS; KL2 RR025015/RR/NCRR NIH HHS; U54 GM062119/GM/NIGMS NIH HHS
Comments/Corrections

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