Open AccessBenefits of Immediate Jejunostomy Feeding after Major Abdominal Trauma???A Prospective, Randomized Study
Author(s) -
Ernest E. Moore,
Teresa S. Jones
Publication year - 1986
Publication title -
the journal of trauma/the journal of trauma
Language(s) - English
Resource type - Journals
eISSN - 1529-8809
pISSN - 0022-5282
DOI - 10.1097/00005373-198610000-00003
Subject(s) - medicine , parenteral nutrition , jejunostomy , enteral administration , abdominal trauma , laparotomy , surgery , sepsis , elemental diet , prospective cohort study , gastroenterology , randomized controlled trial , blunt
Benefits of immediate postinjury nutritional support remain ill defined. Seventy-five consecutive patients undergoing emergent celiotomy with an abdominal trauma index (A.T.I.) greater than 15 were randomized prospectively to a control group (no supplemental nutrition during first 5 days) or enteral-fed group. The enteral patients had a needle catheter jejunostomy (N.C.J.) placed at laparotomy with the constant infusion of an elemental diet (Vivonex HN) begun at 18 hours and advanced to 3,000 ml/day (3,000 kcal, 20 gm N2) within 72 hours. Control and enteral-fed groups were comparable with respect to demographic features, trauma mechanism, shock, colon injury, splenectomy, A.T.I., and initial nutritional assessment. Twenty (63%) of the enteral patients were maintained on the elemental diet greater than 5 days; four (12%) needed total parenteral nutrition (T.P.N.). Nine (29%) of the control patients required T.P.N. Nitrogen balance was markedly improved (p less than 0.001) in the enteral-fed group. Although visceral protein markers and overall complication rate were not significantly different, septic morbidity was greater (p less than 0.025) in the control group (abdominal infection in seven and pneumonia in two) compared to the enteral-fed patients (abdominal abscess in three). Analysis of patients with A.T.I. 15-40 disclosed sepsis in seven (26%) of the control versus one (4%) of the enteral-fed group (p less than 0.01). Our clinical experience demonstrates the feasibility of immediate postoperative enteral feeding via N.C.J. after major abdominal trauma, and suggests this early nutrition reduces septic complications in critically injured patients.