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Journal of Parenteral and Enteral Nutrition
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Techniques, Materials, Devices

Feasibility of Implementing a Reduced Fasting Protocol for Critically Ill Trauma Patients Undergoing Operative and Nonoperative Procedures

Robert M. Pousman, DO1, Colleen Pepper, BS2, Pratik Pandharipande, MD, MSCI2, Gregory D. Ayers, MS4, Beth Mills, MS, RD, CNSD5, Jose Diaz, MD3, Brian Collier, DO3, Rick Miller, MD3,4 and Gordon Jensen, MD, PhD6

From the 1 Department of Anesthesiology, David Geffen School of Medicine at UCLA, West Los Angeles VA, Los Angeles, California; 2 Departments of Anesthesia/Critical Care,3 Department of Surgery/Division of Trauma,4 Department of Biostatistics, and5 Center for Human Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee; and 6 Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania.

Address correspondence to: Robert M. Pousman, DO, 757 Westwood Plaza, Suite 3325. Los Angeles, CA 99095-7403; e-mail: frostitude{at}yahoo.com.

Background: This prospective, observational cohort study was designed to determine the feasibility of implementing a reduced enteral fasting protocol in mechanically ventilated trauma patients undergoing selected operative and nonoperative procedures. Methods: Critically ill, mechanically ventilated trauma patients undergoing selected operative and nonoperative procedures received enteral nutrition up until the time of the procedure, if receiving small bowel feeds, or received enteral nutrition that was discontinued 45 minutes before the procedure, if receiving gastric feeds. Results: Measures of delivery of nutrition such as total enteral nutrition delivered and days required to reach nutrition goal were collected. Complications measured were death, incidence of ventilator-associated pneumonia, urinary tract infection, catheter-related bloodstream infection, wound infection, hypoglycemia, and emesis during procedures. No significant demographic differences were observed between the 2 groups. Patients in the intervention group showed trends toward greater total enteral nutrition delivered and faster attainment of target nutrition goals, although these measures were not statistically significant. Patients in the intervention group had rates of infective complications similar to those in the standard group. The median (interquartile range) for intensive care unit length of stay in the intervention group vs standard group was 7 (5, 15) vs 7 (5, 12) (P = 0.94), and the ventilator days were 8 (4.2, 14) vs 7 (3, 11) (P = 0.37). Conclusions: A reduced fasting protocol was feasible for selected operative procedures, with trends toward improving nutrition delivery and no increase in adverse outcomes. A larger randomized study of this approach is warranted before adoption of this practice can be advocated.

Key Words: enteral nutrition • critically ill trauma patients • mechanical ventilation • complications • reduced fasting • procedures

Journal of Parenteral and Enteral Nutrition, Vol. 33, No. 2, 176-180 (2009)
DOI: 10.1177/0148607108327527
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