Daniel Dante Yeh1, Catrina Cropano2, Sadeq A Quraishi2, Eva Fuentes2, Haytham Kaafarani2, Jarone Lee2, George Velmahos2. 1. Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: dyeh2@partners.org. 2. Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts.
Abstract
BACKGROUND: Enteral nutrition (EN) delivery in the surgical intensive care unit (ICU) is often suboptimal as it is commonly interrupted for procedures. We hypothesized that continuing perioperative nutrition or providing compensatory nutrition would improve caloric delivery without increasing morbidity. MATERIALS AND METHODS: We enrolled 10 adult surgical ICU patients receiving EN who were scheduled for elective bedside percutaneous tracheostomy. In these patients (fed group), either perioperative EN was maintained or compensatory nutrition was provided. We compared the amount of calories delivered, caloric deficits, and the rate of complications of these patients with those of 22 contemporary controls undergoing tracheostomy while adhering to the traditional American Society of Anesthesiology nil per os guidelines (unfed group). We defined caloric deficit as the difference between prescribed calories and actual delivered calories. RESULTS: There was no difference in demographic characteristics between the two groups. On the day of procedure, the fed group had higher median delivered calories (1706 kcal; interquartile range [IQR], 1481-2009 versus 588 kcal; IQR, 353-943; P < 0.0001) and received a higher percentage of prescribed calories (92%; IQR, 82%-97% versus 34%; IQR, 24%-51%; P < 0.0001). Median caloric deficit on the day of the procedure was significantly lower in the fed group (175 kcal; IQR, 49-340 versus 1133 kcal; IQR, 660-1365; P < 0.0001). There were no differences in total overall ICU complications per patient, gastrointestinal complications on the day of procedure, or total infectious complications per patient between the two groups. CONCLUSIONS: In our pilot study, perioperative and compensatory nutrition resulted in higher caloric delivery and was not associated with increased morbidity.
BACKGROUND: Enteral nutrition (EN) delivery in the surgical intensive care unit (ICU) is often suboptimal as it is commonly interrupted for procedures. We hypothesized that continuing perioperative nutrition or providing compensatory nutrition would improve caloric delivery without increasing morbidity. MATERIALS AND METHODS: We enrolled 10 adult surgical ICU patients receiving EN who were scheduled for elective bedside percutaneous tracheostomy. In these patients (fed group), either perioperative EN was maintained or compensatory nutrition was provided. We compared the amount of calories delivered, caloric deficits, and the rate of complications of these patients with those of 22 contemporary controls undergoing tracheostomy while adhering to the traditional American Society of Anesthesiology nil per os guidelines (unfed group). We defined caloric deficit as the difference between prescribed calories and actual delivered calories. RESULTS: There was no difference in demographic characteristics between the two groups. On the day of procedure, the fed group had higher median delivered calories (1706 kcal; interquartile range [IQR], 1481-2009 versus 588 kcal; IQR, 353-943; P < 0.0001) and received a higher percentage of prescribed calories (92%; IQR, 82%-97% versus 34%; IQR, 24%-51%; P < 0.0001). Median caloric deficit on the day of the procedure was significantly lower in the fed group (175 kcal; IQR, 49-340 versus 1133 kcal; IQR, 660-1365; P < 0.0001). There were no differences in total overall ICU complications per patient, gastrointestinal complications on the day of procedure, or total infectious complications per patient between the two groups. CONCLUSIONS: In our pilot study, perioperative and compensatory nutrition resulted in higher caloric delivery and was not associated with increased morbidity.