Safety and efficacy of intraoperative gastric feeding during burn surgery

• Published in: Burns Vol. 45; no. 5; pp. 1089 - 1093
• Main Authors: Carmichael, Heather, Joyce, Stephanie, Smith, Tyler, Patton, Lacey, Lambert Wagner, Anne, Wiktor, Arek J.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.08.2019
• Subjects: Adult; Burn injury; Burns - surgery; Debridement; Energy Intake; Enteral nutrition; Enteral Nutrition - methods; Feasibility Studies; Female; Humans; Intraoperative Care - methods; Intraoperative Complications - epidemiology; Intubation, Gastrointestinal; Intubation, Intratracheal; Male; Mechanical ventilation; Middle Aged; Respiratory Aspiration - epidemiology; Retrospective Studies; Skin Transplantation; Treatment Outcome; Young Adult; Enteral nutrition; Burn injury; Mechanical ventilation
• ISSN: 0305-4179; 1879-1409
• DOI: 10.1016/j.burns.2018.12.009

•Enteral nutrition (EN) was continued intraoperatively in patients with an established airway.•This study included patients receiving EN via a nasogastric feeding tube.•Examined a total of N=249 operative days, including n=79 with tube feeds continued intraoperatively.•No intra-operative aspiration events documented.•When EN was continued for more than 50% of operations, patients met nutrition goals more frequently (81% vs. 69%, p=0.002). Large burns are associated with a dramatic increase in metabolic demand, and adequate nutrition is vital to prevent poor wound healing and septic complications. However, enteral nutrition (EN) support is frequently withheld perioperatively, risking nutritional deficits. We retrospectively examined the safety and feasibility of continuing EN during surgery in patients with an established airway, and estimated the impact of perioperative fasting on overall caloric intake. Mechanically ventilated patients admitted to our urban, verified burn center between January 2012 and July 2017 with greater than 20% total body surface area (TBSA) burns were included in this retrospective analysis. The total volume of EN received by the patient during each 24-h period and goal EN volume as determined by a clinical dietitian were collected. A total of 45 patients met criteria with mean TBSA of 44% (range 20–84%). Most patients had a gastric feeding tube (86%). Each patient underwent a median of 4 operations (range 1–33) for a total of 249 operative days and 991 non-operative days. There were no aspiration events. On non-operative days, patients met 85% of estimated caloric needs. EN was held on 170 operative days (69%), and on these days, only 34% of total caloric needs were met. EN was continued on 77 operative days (31%), and on these days, 95% of total caloric needs were met (p<0.001). Patients who had EN held for at least 50% of operative procedures (n=30) met only 69% of caloric goals while intubated. By comparison, patients who had EN continued for a majority of procedures (n=15) met 81% of caloric goals (p=0.002). Continuing EN intraoperatively in patients with an established airway appears to be a safe and efficacious way to meet patients’ nutritional needs, including when feeding is delivered via a gastric route. This is particularly important given that placement of nasojejunal feeding tubes can be difficult, particularly in resource-poor settings where endoscopic or fluoroscopic-guided placement may not be practical.