Critical Care Medicine-Gastrointestinal, Nutrition and Genitourinary Disorders>>>>>Nutrition in Critical Illness
Question 1#

A 22-year-old female who has sustained a 50% total body surface area burn in a house fire is intubated in the ICU. She is scheduled for serial debridements in the OR. The best management for perioperative nutrition includes:

A. Begin TPN to ensure adequate nutrition despite intermittent NPO periods
B. Place a postpyloric feeding tube to allow continuation of tube feeds intraoperatively
C. Stop tube feeds 8 hours before the OR start time
D. Stop tube feeds at midnight before the OR

Correct Answer is B

Comment:

Correct Answer: B

A metaanalysis in 2003 did not find a decreased risk for aspiration with prolonged NPO. Protein-calorie malnutrition has been linked to worse outcomes with respect to ventilator-free days, ICU and hospital LOS, wound healing, and mortality. Continuing tube feeds despite trips to the OR is the best choice for nutrition management in this scenario. There is no indication to initiate TPN at this time.

References:

1. Peev MP, Yeh DD, Quraishi SA, et al. Causes and consequences of interrupted enteral nutrition: a prospective observational study in critically ill surgical patients. JPEN J Parenter Enteral Nutr. 2015;39(1):21-27.
2. Abunnaja S, Cuviello A, Sanchez JA. Enteral and parenteral nutrition in the perioperative period: state of the art. Nutrients. 2013;5(2):608-623.