Effective delivery of enteral nutrition after hemorrhagic shock by a standardized protocol

Nathan P. Long, Robert G. Marvin, Margaret M. McQuiggan, Jacquelline LaWalker, Bruce A. McKinley, Christine S Cocanour, Frederick A. Moore

Research output: Contribution to journalArticle

Abstract

Introduction: Early EN is believed to benefit critically injured patients. However, it is a common perception that EN is poorly tolerated after resuscitation from hemorrhagic shock. Purpose: Report the efficacy of delivering EN using a standardized protocol in patients who survived shock resuscitation. Also, to analyze the reasons for deviation from the protocol (i.e. intolerance) in these patients. Methods: Prospective data collection of feeding tolerance, as part of an EN protocol designed and implemented by a multidisciplinary ICU team, in patients resuscitated from hemorrhagic shock. After obtaining jejunal access an immune-enhancing EN formula was started at 15 cc/hr and advanced by 15 cc/hr every 12 hrs to a goal based upon anthropometric and stress assessment. Clinical symptoms were simultaneously monitored and EN was not advanced, decreased or held based upon their severity. Results:Over a 4 month period ending July 1999, all 17 patients (age 40±4yrs, 88% blunt injury, ISS 39±4) who underwent large volume resuscitation received EN. Actual delivery of EN versus the protocol ideal is shown(table). Eight (47%) were advanced to goal without interruption. Among the remaining 9 patients there were 18 instances where EN was not advanced, decreased or stopped. The factors responsible were distention( 14/18), diarrhea (8), NGT ouput > 1000 ces (7), vomiting (1) and abdominal tenderness (1). However, despite some degree of intolerance, 88% received full dose EN by PID 7. Only 2 patients failed to reach goal and required supplemental TPN. Conclusion: EN can be successfully delivered by a standard protocol after shock resuscitation. Although symptoms of feeding intolerance are common, they are of limited duration and do not preclude effective enteral feeding. Protocol Patient Enteral access (hr after ICU admit) 48 70±10 60 mL/hr goal (hr after start) 60 65±10 Volume Infused over 10 dy(L) 12.1±1.3 10.7±1.3.

Original languageEnglish (US)
JournalCritical Care Medicine
Volume27
Issue number12 SUPPL.
StatePublished - 1999
Externally publishedYes

Fingerprint

Hemorrhagic Shock
Enteral Nutrition
Resuscitation
Shock
Nonpenetrating Wounds
Small Intestine
Vomiting
Diarrhea

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Long, N. P., Marvin, R. G., McQuiggan, M. M., LaWalker, J., McKinley, B. A., Cocanour, C. S., & Moore, F. A. (1999). Effective delivery of enteral nutrition after hemorrhagic shock by a standardized protocol. Critical Care Medicine, 27(12 SUPPL.).

Effective delivery of enteral nutrition after hemorrhagic shock by a standardized protocol. / Long, Nathan P.; Marvin, Robert G.; McQuiggan, Margaret M.; LaWalker, Jacquelline; McKinley, Bruce A.; Cocanour, Christine S; Moore, Frederick A.

In: Critical Care Medicine, Vol. 27, No. 12 SUPPL., 1999.

Research output: Contribution to journalArticle

Long, NP, Marvin, RG, McQuiggan, MM, LaWalker, J, McKinley, BA, Cocanour, CS & Moore, FA 1999, 'Effective delivery of enteral nutrition after hemorrhagic shock by a standardized protocol', Critical Care Medicine, vol. 27, no. 12 SUPPL..
Long NP, Marvin RG, McQuiggan MM, LaWalker J, McKinley BA, Cocanour CS et al. Effective delivery of enteral nutrition after hemorrhagic shock by a standardized protocol. Critical Care Medicine. 1999;27(12 SUPPL.).
Long, Nathan P. ; Marvin, Robert G. ; McQuiggan, Margaret M. ; LaWalker, Jacquelline ; McKinley, Bruce A. ; Cocanour, Christine S ; Moore, Frederick A. / Effective delivery of enteral nutrition after hemorrhagic shock by a standardized protocol. In: Critical Care Medicine. 1999 ; Vol. 27, No. 12 SUPPL.
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abstract = "Introduction: Early EN is believed to benefit critically injured patients. However, it is a common perception that EN is poorly tolerated after resuscitation from hemorrhagic shock. Purpose: Report the efficacy of delivering EN using a standardized protocol in patients who survived shock resuscitation. Also, to analyze the reasons for deviation from the protocol (i.e. intolerance) in these patients. Methods: Prospective data collection of feeding tolerance, as part of an EN protocol designed and implemented by a multidisciplinary ICU team, in patients resuscitated from hemorrhagic shock. After obtaining jejunal access an immune-enhancing EN formula was started at 15 cc/hr and advanced by 15 cc/hr every 12 hrs to a goal based upon anthropometric and stress assessment. Clinical symptoms were simultaneously monitored and EN was not advanced, decreased or held based upon their severity. Results:Over a 4 month period ending July 1999, all 17 patients (age 40±4yrs, 88{\%} blunt injury, ISS 39±4) who underwent large volume resuscitation received EN. Actual delivery of EN versus the protocol ideal is shown(table). Eight (47{\%}) were advanced to goal without interruption. Among the remaining 9 patients there were 18 instances where EN was not advanced, decreased or stopped. The factors responsible were distention( 14/18), diarrhea (8), NGT ouput > 1000 ces (7), vomiting (1) and abdominal tenderness (1). However, despite some degree of intolerance, 88{\%} received full dose EN by PID 7. Only 2 patients failed to reach goal and required supplemental TPN. Conclusion: EN can be successfully delivered by a standard protocol after shock resuscitation. Although symptoms of feeding intolerance are common, they are of limited duration and do not preclude effective enteral feeding. Protocol Patient Enteral access (hr after ICU admit) 48 70±10 60 mL/hr goal (hr after start) 60 65±10 Volume Infused over 10 dy(L) 12.1±1.3 10.7±1.3.",
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AU - McKinley, Bruce A.

AU - Cocanour, Christine S

AU - Moore, Frederick A.

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N2 - Introduction: Early EN is believed to benefit critically injured patients. However, it is a common perception that EN is poorly tolerated after resuscitation from hemorrhagic shock. Purpose: Report the efficacy of delivering EN using a standardized protocol in patients who survived shock resuscitation. Also, to analyze the reasons for deviation from the protocol (i.e. intolerance) in these patients. Methods: Prospective data collection of feeding tolerance, as part of an EN protocol designed and implemented by a multidisciplinary ICU team, in patients resuscitated from hemorrhagic shock. After obtaining jejunal access an immune-enhancing EN formula was started at 15 cc/hr and advanced by 15 cc/hr every 12 hrs to a goal based upon anthropometric and stress assessment. Clinical symptoms were simultaneously monitored and EN was not advanced, decreased or held based upon their severity. Results:Over a 4 month period ending July 1999, all 17 patients (age 40±4yrs, 88% blunt injury, ISS 39±4) who underwent large volume resuscitation received EN. Actual delivery of EN versus the protocol ideal is shown(table). Eight (47%) were advanced to goal without interruption. Among the remaining 9 patients there were 18 instances where EN was not advanced, decreased or stopped. The factors responsible were distention( 14/18), diarrhea (8), NGT ouput > 1000 ces (7), vomiting (1) and abdominal tenderness (1). However, despite some degree of intolerance, 88% received full dose EN by PID 7. Only 2 patients failed to reach goal and required supplemental TPN. Conclusion: EN can be successfully delivered by a standard protocol after shock resuscitation. Although symptoms of feeding intolerance are common, they are of limited duration and do not preclude effective enteral feeding. Protocol Patient Enteral access (hr after ICU admit) 48 70±10 60 mL/hr goal (hr after start) 60 65±10 Volume Infused over 10 dy(L) 12.1±1.3 10.7±1.3.

AB - Introduction: Early EN is believed to benefit critically injured patients. However, it is a common perception that EN is poorly tolerated after resuscitation from hemorrhagic shock. Purpose: Report the efficacy of delivering EN using a standardized protocol in patients who survived shock resuscitation. Also, to analyze the reasons for deviation from the protocol (i.e. intolerance) in these patients. Methods: Prospective data collection of feeding tolerance, as part of an EN protocol designed and implemented by a multidisciplinary ICU team, in patients resuscitated from hemorrhagic shock. After obtaining jejunal access an immune-enhancing EN formula was started at 15 cc/hr and advanced by 15 cc/hr every 12 hrs to a goal based upon anthropometric and stress assessment. Clinical symptoms were simultaneously monitored and EN was not advanced, decreased or held based upon their severity. Results:Over a 4 month period ending July 1999, all 17 patients (age 40±4yrs, 88% blunt injury, ISS 39±4) who underwent large volume resuscitation received EN. Actual delivery of EN versus the protocol ideal is shown(table). Eight (47%) were advanced to goal without interruption. Among the remaining 9 patients there were 18 instances where EN was not advanced, decreased or stopped. The factors responsible were distention( 14/18), diarrhea (8), NGT ouput > 1000 ces (7), vomiting (1) and abdominal tenderness (1). However, despite some degree of intolerance, 88% received full dose EN by PID 7. Only 2 patients failed to reach goal and required supplemental TPN. Conclusion: EN can be successfully delivered by a standard protocol after shock resuscitation. Although symptoms of feeding intolerance are common, they are of limited duration and do not preclude effective enteral feeding. Protocol Patient Enteral access (hr after ICU admit) 48 70±10 60 mL/hr goal (hr after start) 60 65±10 Volume Infused over 10 dy(L) 12.1±1.3 10.7±1.3.

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