Enteral Nutrition

Abstract

Enteral nutrition (EN) is commonly interrupted in burn patients for many reasons, which leads to discrepancies between prescribed and actual EN delivery. The magnitude and origin of these discrepancies have never been well documented among burn patients. The purpose of this study was to examine differences between prescribed and actual EN delivery and to identify the specific causes of EN interruption and to quantify these. Retrospective review of patients treated between June 6, 2009 and June 6, 2012 at an adult regional American Burn Association-verified burn center who had ≥10% TBSA burns and who were prescribed EN for at least 24 hours. On postburn days (PBD) 0 to 14 the daily volume of EN prescribed by the dietitian was compared with the actual volume received by the patient. The cause and duration of interruptions to EN delivery were recorded. A total of 90 subjects, [mean (± SD) age 47 ± 18 years, 32% female, median %TBSA burn size 28, median %TBSA full-thickness burn size 11, and a 54% incidence of inhalation injury], were studied. EN was initiated at a median of 9.5 hours after burn center admission. Received calories were significantly less than prescribed calories on every study day. The median daily caloric deficit ranged between 172 and 930 kcal. The median percent of prescribed calories received each day ranged from 19% on PBD 0 to 91% on PBD 14. The mean (± SD) total duration of EN interruption was 8.9 ± 3.0 hours per day. Gradually increasing the feed rate to reach the prescribed EN goal rate ("ramping-in") was the most common cause of a discrepancy between prescribed and actual EN delivery, accounting for 35% of total discrepancy time. Interruptions for surgery accounted for 24% of total discrepancy time. Other causes of discrepancies were physician- or nurse-directed interruptions (16% of time), planned extubation (7%), feed intolerance (11%), tube malfunction (2%), bedside procedures (2%), and dressing changes (3%).Enterally fed burn patients received significantly less nutrition than prescribed. Some of the causes for discrepancies between prescribed and received EN are unavoidable, but many are not, suggesting the need for careful review and possible alteration of existing EN practices.

Interrupted Nutrition Support in Patients With Burn Injuries: A Single-Centre Observational Study

“…Our investigation supports similar findings by Czapan et al 5 and Sudenis et al 13 who documented deficits in feeding burn patients. Czapan et al examined caloric intake and mortality in critically ill burn patients in an international sample, while Sudenis et al 13 examined deficits in a single Canadian burn centre. They documented similar episodes of stopping and starting feeds, with fasting for procedures and surgery accounting for approximately 47% of interruptions.…”

“…Meeting the patients required nutritional needs while balancing other interventions can be challenging. Discrepancies in prescribed and administered formula volumes have been documented by Sudenis et al 13 who showed that feeding during the first 14 days post burn was interrupted, on average close to 9 hours a day. Enteral nutrition is often suspended for care needs such as surgery, sedation requirements, and major dressing changes.…”

Weight changes and patterns of weight measurements in hospitalized burn patients: a contemporary analysis

“…Suboptimal nutritional support has also been implicated in the weight loss of burn patients. Sudenis et al found that burn patients in a large adult burn center received fewer calories than the calories prescribed by a dietitian on every day of hospitalization studied [ 20 ]. The percentage of prescribed calories that patients actually received ranged from 19 to 91% as LOS increased [ 20 ].…”

“…Sudenis et al found that burn patients in a large adult burn center received fewer calories than the calories prescribed by a dietitian on every day of hospitalization studied [ 20 ]. The percentage of prescribed calories that patients actually received ranged from 19 to 91% as LOS increased [ 20 ]. The major causes for the discrepancies between prescribed and received calories included the interruption of feedings for surgery and gradual increases in the feed rate before reaching the prescribed goal [ 20 ].…”

“…The percentage of prescribed calories that patients actually received ranged from 19 to 91% as LOS increased [ 20 ]. The major causes for the discrepancies between prescribed and received calories included the interruption of feedings for surgery and gradual increases in the feed rate before reaching the prescribed goal [ 20 ]. Prescribing more calories than the patient needs may be one way to combat this caloric deficit.…”