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The Efficacy of an Enteral Access Protocol for Feeding Trauma Patients

Jennifer Wooley, MS, RD, CNSD^*
Richard Pomerantz, MD

^* Clinical Nutrition/Pharmacy and the Trauma Program and Department of Surgery, St. Joseph Mercy Health System, Ann Arbor, Michigan

Correspondence: Correspondence: J. Wooley, MS, RD, CNSD, St. Joseph Mercy Hospital, Clinical Nutrition/Pharmacy, 5301 East Huron River Dr, PO Box 995, Ann Arbor, MI 48106. Electronic mail may be sent to wooleyj{at}trinity-health.org.

Background: Proper enteral access to deliver specialized nutrition support in critically injured patients can be difficult, time consuming, and costly. We designed a protocol with interdisciplinary input to facilitate early enteral access in our trauma patients. Our primary objective was to determine if the protocol improved our ability to obtain small-bowel access in patients within 48 hours of their admission to the surgical intensive care unit (SICU). Secondary objectives were to examine the efficacy of the protocol by evaluating parenteral nutrition (PN) use, adequacy of enteral caloric delivery, and clinical outcomes including pneumonia and sepsis rates, SICU length of stay (LOS), hospital LOS, and mortality before and after its implementation. Methods: The medical records of 51 trauma patients admitted to the SICU, who met inclusion criteria, were reviewed retrospectively and divided into 2 groups. Patients in group 1 were admitted before protocol implementation (1997–1998, n = 17). Patients in group 2 were admitted after protocol implementation (1998–2000, n = 34). Results: Small-bowel access was achieved earlier in group 2 compared with group 1 [2.2 ± 2 days vs 5.4 ± 8 days, respectively (p = .04)]. PN was used less frequently in group 2 at 41.2% (14/34) as opposed to 64.7% (11/17) in group 1 (p = .05). There was a reduction in the number of days to reach caloric goal from 4.9 days in group 1 to 3.9 days in group 2 (n.s.). Clinical outcomes were similar in both groups. Conclusions: The use of a protocol was effective in the achievement of prompt small bowel access. The number of days to reach caloric goal decreased after protocol implementation, but not to a statistically significant degree. However, we were able to detect a significant reduction in the use of PN.

Nutrition in Clinical Practice, Vol. 20, No. 3, 348-353 (2005)
DOI: 10.1177/0115426505020003348


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