BACKGROUND: Assuring adequate enteral nutritional support in critically ill patients is challenging. By describing our experience, we sought to characterize the challenges, benefits, and complications of an approach that stresses enteral nutrition. STUDY DESIGN: We examined nutritional support received by victims of blunt trauma from 8 trauma centers. We grouped patients according to mean daily enteral caloric intake during the first 7 days. Group 1 received the fewest (0 kcal/kg/d) and group 5 the greatest (16 to 30 kcal/kg/d) number of calories in the first week. We focused our analyses on the patients remaining in the ICU for 8 days or longer and compared clinical outcomes among the groups. RESULTS: There were 1,100 patients in the ICU for 8 days or longer. Patients receiving the greatest number of enteral calories during the first week (group 5) had the highest incidence of ventilator-associated pneumonia (49%) and the lowest incidence of bacteremia (14%). Use of parenteral nutrition was associated with bacteremia (adjusted odds ratio = 2.5; 95% CI, 1.8-3.5), ventilator-associated pneumonia (adjusted odds ratio = 2.4; 95% CI, 1.7-3.3), and death (adjusted odds ratio = 1.9; 95% CI, 1.1-3.1). CONCLUSIONS: Enteral caloric intake during the first week was related to the pattern and severity of injury and was associated with important infectious outcomes. Our observations support moderating enteral intake during the first week after injury and avoiding parenteral nutrition.
BACKGROUND: Assuring adequate enteral nutritional support in critically illpatients is challenging. By describing our experience, we sought to characterize the challenges, benefits, and complications of an approach that stresses enteral nutrition. STUDY DESIGN: We examined nutritional support received by victims of blunt trauma from 8 trauma centers. We grouped patients according to mean daily enteral caloric intake during the first 7 days. Group 1 received the fewest (0 kcal/kg/d) and group 5 the greatest (16 to 30 kcal/kg/d) number of calories in the first week. We focused our analyses on the patients remaining in the ICU for 8 days or longer and compared clinical outcomes among the groups. RESULTS: There were 1,100 patients in the ICU for 8 days or longer. Patients receiving the greatest number of enteral calories during the first week (group 5) had the highest incidence of ventilator-associated pneumonia (49%) and the lowest incidence of bacteremia (14%). Use of parenteral nutrition was associated with bacteremia (adjusted odds ratio = 2.5; 95% CI, 1.8-3.5), ventilator-associated pneumonia (adjusted odds ratio = 2.4; 95% CI, 1.7-3.3), and death (adjusted odds ratio = 1.9; 95% CI, 1.1-3.1). CONCLUSIONS: Enteral caloric intake during the first week was related to the pattern and severity of injury and was associated with important infectious outcomes. Our observations support moderating enteral intake during the first week after injury and avoiding parenteral nutrition.
Authors: Joseph P Minei; Avery B Nathens; Michael West; Brian G Harbrecht; Ernest E Moore; Michael B Shapiro; Paul E Bankey; Jeffrey L Johnson; Bradley Freeman; Bruce A McKinley; Fredrick A Moore; Ronald V Maier Journal: J Trauma Date: 2006-05
Authors: Frederick A Moore; Bruce A McKinley; Ernest E Moore; Avery B Nathens; Michael West; Michael B Shapiro; Paul Bankey; Bradley Freeman; Brian G Harbrecht; Jeffrey L Johnson; Joseph P Minei; Ronald V Maier Journal: J Trauma Date: 2006-07
Authors: Brian G Harbrecht; Joseph P Minei; Michael B Shapiro; Avery B Nathens; Ernest E Moore; Michael A West; Paul E Bankey; Joseph Cuschieri; Jeffrey L Johnson; Ronald V Maier Journal: J Trauma Date: 2007-09
Authors: Avery B Nathens; Jeffrey L Johnson; Joseph P Minei; Ernest E Moore; Michael Shapiro; Paul Bankey; Brad Freeman; Brian G Harbrecht; Stephen F Lowry; Bruce McKinley; Fredrick Moore; Michael West; Ronald V Maier Journal: J Trauma Date: 2005-09
Authors: Michael A West; Michael B Shapiro; Avery B Nathens; Jeffrey L Johnson; Ernest E Moore; Joseph P Minei; Paul E Bankey; Brad Freeman; Brian G Harbrecht; Bruce A McKinley; Fredrick A Moore; Ronald V Maier Journal: J Trauma Date: 2006-08
Authors: F A Moore; D V Feliciano; R J Andrassy; A H McArdle; F V Booth; T B Morgenstein-Wagner; J M Kellum; R E Welling; E E Moore Journal: Ann Surg Date: 1992-08 Impact factor: 12.969
Authors: V M Peterson; E E Moore; T N Jones; C Rundus; M Emmett; F A Moore; B L McCroskey; T Haddix; P E Parsons Journal: Surgery Date: 1988-08 Impact factor: 3.982
Authors: Brodie A Parent; Max Seaton; Danijel Djukovic; Haiwei Gu; Brittany Wheelock; Sandi L Navarro; Daniel Raftery; Grant E O'Keefe Journal: J Trauma Acute Care Surg Date: 2017-04 Impact factor: 3.313
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Authors: Federico Coccolini; Derek Roberts; Luca Ansaloni; Rao Ivatury; Emiliano Gamberini; Yoram Kluger; Ernest E Moore; Raul Coimbra; Andrew W Kirkpatrick; Bruno M Pereira; Giulia Montori; Marco Ceresoli; Fikri M Abu-Zidan; Massimo Sartelli; George Velmahos; Gustavo Pereira Fraga; Ari Leppaniemi; Matti Tolonen; Joseph Galante; Tarek Razek; Ron Maier; Miklosh Bala; Boris Sakakushev; Vladimir Khokha; Manu Malbrain; Vanni Agnoletti; Andrew Peitzman; Zaza Demetrashvili; Michael Sugrue; Salomone Di Saverio; Ingo Martzi; Kjetil Soreide; Walter Biffl; Paula Ferrada; Neil Parry; Philippe Montravers; Rita Maria Melotti; Francesco Salvetti; Tino M Valetti; Thomas Scalea; Osvaldo Chiara; Stefania Cimbanassi; Jeffry L Kashuk; Martha Larrea; Juan Alberto Martinez Hernandez; Heng-Fu Lin; Mircea Chirica; Catherine Arvieux; Camilla Bing; Tal Horer; Belinda De Simone; Peter Masiakos; Viktor Reva; Nicola DeAngelis; Kaoru Kike; Zsolt J Balogh; Paola Fugazzola; Matteo Tomasoni; Rifat Latifi; Noel Naidoo; Dieter Weber; Lauri Handolin; Kenji Inaba; Andreas Hecker; Yuan Kuo-Ching; Carlos A Ordoñez; Sandro Rizoli; Carlos Augusto Gomes; Marc De Moya; Imtiaz Wani; Alain Chichom Mefire; Ken Boffard; Lena Napolitano; Fausto Catena Journal: World J Emerg Surg Date: 2018-02-02 Impact factor: 5.469