Weekly multidisciplinary review of patients receiving PN was associated with reductions in the number of patients started on PN, total days that patients received PN, and number of patients who had short-duration (<5 days) PN use.
Supplementation of micronutrients after burn injury is common practice in order to fight oxidative stress, support the immune system, and optimize wound healing. Assessing micronutrient status after burn injury is difficult because of hemodilution in the resuscitation phase, redistribution of nutrients from the serum to other organs, and decreases in carrier proteins such as albumin. Although there are many preclinical data, there are limited studies in burn patients. Promising research is being conducted on combinations of micronutrients, especially via the intravenous route.
Adequate nutrition support is a key component in achieving favorable outcomes for the critically ill patient. Significant evidence supports starting enteral nutrition rather than parenteral nutrition as early as possible after injury to promote positive outcomes. Evidence shows that enteral nutrition improves patient outcomes and decreases intensive care unit length of stay by improving splanchnic blood flow, moderating the metabolic response, sustaining gut integrity, and preventing bacterial translocation from the gut to the bloodstream. Implementing early enteral nutrition can be challenging. This article describes the rationale for early enteral nutrition, the evidence that favors enteral nutrition over parenteral nutrition, barriers to delivery of full enteral nutrition, and an evidence-based protocol developed at Harborview Medical Center to promote appropriate support. The role of the registered dietitian on the health care team in facilitating appropriate feeding is discussed. In addition, we will describe emerging nutrition therapies including the use of antioxidants, addition of the amino acid glutamine, use of immune-enhancing enteral formulas, and the potential role of probiotics that show promise in improving patient outcome.
Introduction Kefir is an easy to administer per feeding tube probiotic yogurt that does not contain the risk of powdered probiotics, which may contaminate patient wounds or intravenous lines. Previous studies show patients taking probiotics may decrease hospital-acquired infections (HAI) although kefir has not been well studied. We hypothesized that kefir would be well tolerated and prevent infections among critically injured patients including patients with burn injury on enteral nutrition (EN). Methods We performed a retrospective review of adult critically injured patients at a level 1 trauma and burn center from January 2018 to March 2021 who received EN. Patients with a history of clostridium difficile (C. diff) were excluded. Patients who received kefir were given 120ml twice daily. The kefir protocol was improved with input from clinical stakeholders. The rate of C. diff, catheter-associated urinary tract infection (CAUTI), and central line-associated blood stream infection (CLABSI) were compared between patients who received kefir and those who did not. Incidence rate ratios (IRR) and corresponding 95% confidence intervals were calculated to assess differences in these rates. Results 3,814 patients met criteria, 545 of whom received kefir (14%). Suggested improvements to the kefir protocol by stakeholders were changing flavored to plain kefir to decrease the amount of carbohydrate, change to lactose-free kefir to improve usage in lactose intolerant patients, and educate nurses on flushing feeding tubes to avoid clogs. None of the incidence rates of HAI were significantly different between patients who received kefir and those who did not (Table 1). Crude IRRs suggest that C. diff infections may have occurred less frequently among patients who received kefir while the reverse occurred for CLABSI infections, though these results are not significant. Conclusions The kefir implementation was refined by stakeholder feedback. Although no clear benefit of kefir was observed with HAI reduction, future research should investigate the potential association between kefir use and C. diff.
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