A pilot review of gradual versus goal re-initiation of enteral nutrition after burn surgery in the hemodynamically stable patient

Safety and Tolerance of Intraoperative Enteral Nutrition Support in Pediatric Burn Patients

“…Shields et al found in their study of enterally fed adult burn patients who were grouped in either a goal rate reinitiation group or a slow reinitiation group after their first surgical procedure that there was no difference in feeding intolerances such as emesis, aspiration, or ischemic bowel. The group whose EN rate was resumed at goal rate postoperatively met a significantly higher amount of caloric goals vs the slow reinitiation group during the 36 hours postsurgery, indicating that a more aggressive approach to feeding preoperatively enhances nutrition intake and is well tolerated …”

“…The group whose EN rate was resumed at goal rate postoperatively met a significantly higher amount of caloric goals vs the slow reinitiation group during the 36 hours postsurgery, indicating that a more aggressive approach to feeding preoperatively enhances nutrition intake and is well tolerated. 9 In our sample, EN was provided for >80% of the patients' MLOS (59.4 ± 45 days). EN was continuously infused during surgical and bedside procedures, through dressing and line changes, therapy, and airway management modifications.…”

“…Although the reported incidence is variably low among certain populations, it is considered a serious complication of EN and is the leading cause of pneumonia, contributing to increased morbidity and mortality in critically ill patients . Additionally, EN is often not resumed immediately postoperatively or is conservatively titrated to calculated goal rates because of concern for gastric motility dysfunction, further extending the period of time without adequate nutrition …”

“…[5][6][7] Additionally, EN is often not resumed immediately postoperatively or is conservatively titrated to calculated goal rates because of concern for gastric motility dysfunction, further extending the period of time without adequate nutrition. 8,9 Burn patients require multiple surgical procedures for wound debridement, coverage, and reconstruction throughout their clinical course. EN support can be held for 8-14 hours throughout each perioperative period, ultimately resulting in significant caloric and protein deficits.…”

Cutting-Edge Forward Burn Nutrition: from the Battlefield to the Burn Center

“…The risk of perioperative aspiration is low using these guidelines, and some are advocating continuing post-pyloric feeding without interruption during extra-abdominal surgical procedures. EN can be resumed post-operatively at the hourly rate tolerated prior to surgery, provided the patient is otherwise hemodynamically stable [41]. EN is routinely held when epinephrine or norepinephrine is initiated; however, there appears to be no contraindication to m a i n t a i n i n g E N w h e n t h e p a t i e n t i s o t h e r w i s e hemodynamically stable receiving either low-dose vasopressin or dobutamine.…”