Nutrition and Gastrointestinal Dysmotility in Critically Ill Burn Patients: A Retrospective Observational Study

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.

Gastrointestinal dysfunction is associated with mortality in severe burn patients: a 10-year retrospective observational study from South China

“…Early EN stimulates intestinal contraction through direct contact between the nutrients and intestinal mucosal cells and is of great importance in weakening hypermetabolism, reducing circulating stress hormones, and protecting the integrity and function of the intestinal mucosa. A large number of studies have provided evidence that early EN reduces the risk of GI bleeding, sepsis and organ injury, shortening the LOHS [ 51 ]. Raff et al [ 52 ] reported that the risk of GI haemorrhage in severe burn patients treated with early EN was reduced by 40%.…”

A Study of Early Parenteral Nutritional Support and Factors Associated with Clinical Outcomes in Major Pediatric Burn Patients

“…Major burns standard nutrition recommendation of very early enteral nutrition initiation and caloric goal achievement in a week [16][17][18] might not success in every case. 19 PN is one of the options to supply calories to reach daily goal in enteral intolerance and offer some specific nutrients support. For energy providing purpose, it can be used as partial caloric supplement or main supply source of daily energy requirement.…”

Clinical practice guidelines for nutritional assessment and monitoring of adult ICU patients in China

“…The studies included 10 prospective studies [ [114] , [115] , [116] , [117] , [118] , [119] , [120] , [121] , [122] , [123] ] and 16 retrospective studies. [ [124] , [125] , [126] , [127] , [128] , [129] , [130] , [131] , [132] , [133] , [134] , [135] , [136] , [137] , [138] , [139] ] The overall incidence rate of feeding intolerance in critically ill patients was found to be 0.40 (95% CI: 0.34 to 0.46), indicating a substantial association with adverse patient-centered outcomes. Particularly noteworthy is the OR for all-cause ICU mortality risk, which was 1.99 (95% CI: 1.69 to 2.35).…”