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Effect of Calorically Dense Enteral Nutrition Formulas on Outcome in Critically Ill Trauma and Surgical Patients

Jodie Bryk, BS^*,, Mazen Zenati, MD, MPH, PhD, Raquel Forsythe, MD, Andrew Peitzman, MD and Juan B. Ochoa, MD, FACS

From the ^* University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Correspondence: Juan B. Ochoa, MD, FACS, Department of Surgery, University of Pittsburgh, F1264 PUH-UPMC, 200 Lothrop Street, Pittsburgh, PA 15213. Electronic mail may be sent to ochoajb{at}upmc.edu.

Background: Surgical and trauma patients are traditionally provided with calorically dense dietary formulas to deliver high amounts of nutrients. The benefits of these formulas remain unproven and may be associated with significant side effects and even increased mortality. We studied outcomes on surgical and trauma patients receiving either a calorically dense dietary formula or a normocaloric dietary formula. Methods: A retrospective analysis comparing outcomes in intensive care unit (ICU) surgical and trauma patients receiving either a calorically dense dietary formula or a normocaloric dietary formula was performed at the University of Pittsburgh Medical Center. Results: One hundred seventeen patients met study criteria. Surgical and trauma patients were analyzed separately. Despite receiving different calorically dense diets, caloric intake was not significantly different in surgical patients receiving either diet. However, surgical patients receiving a normocaloric formula exhibited decreased length of stay (14.7 ± 10.1 vs 25.0 ± 11.3 days; p = .01), ventilator days (14.3 ± 12.9 vs 21.3 ± 10.5 days; p = .04), and average daily glucose levels (129.8 ± 4.1 vs 157.9 ± 13.6 mg/dL; p =.01), and were more likely to be directly discharged home compared with those receiving a calorically dense dietary formula. Trauma patients receiving a calorically dense dietary formula were on average 17 years younger (p = .01). However, trauma patients receiving a normocaloric formula exhibited decreased length of stay (15.3 ± 1.6 vs 18.7 ± 1.6 days; p = .02) and a greater likelihood of direct discharge home. Conclusions: The data generated suggest that what a patient is fed affects both short- and long-term outcomes. A prospective study should be designed to determine the ideal calories needed in surgical and trauma patients.

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