Intraoperative enteral nutrition does not increase the incidence of aspiration pneumonia in adult burn patients

Author(s):
Julia Cartwright; Anna Krzak; Jill Cherry-Bukowiec

Background:

Estimated energy needs of thermal injury patients can increase by 200 -300% with protein needs of more than 2.0 gm/kg/d for large TBSA injuries. Enteral nutrition (EN) is usually necessary to provide adequate nutrition. EN is frequently interrupted for wound care and operative interventions due to concern for aspiration regardless of feeding tube location. Recent studies found that EN interruptions result in a 48% caloric deficit and that 66% of interruptions are avoidable. Underfeeding predisposes patients to poor wound healing, decubitus ulcers, and infection. Incidence of aspiration is decreased by changing the level of EN infusion from the stomach to the small bowel (SB). In an effort to limit interruptions in EN delivery, we investigated the incidence of aspiration in thermal injury patients receiving SB feeding through the entire perioperative period.

Hypothesis:

Intraoperative SB EN does not increase the incidence of aspiration pneumonia in burn patients.

Methods:

A retrospective chart review was performed for patents (>18 years old) admitted to the burn unit in 2015 at a tertiary academic hospital/verified burn center. Patients admitted with a burn diagnosis who received SB EN and required operative intervention were included. Exclusion criteria were: contraindications to intraoperative feeding, including EN via gastric feeding, intraoperative prone positioning, or history of aspiration. Each operative case was reviewed for evidence of perioperative or intraoperative aspiration event(s).

Results:

Conclusions:

When applied appropriately, continuation of SB EN during the entire perioperative period does not increase incidence of aspiration pneumonia in thermal injury patients.