Nutritional Support in Critically Ill Trauma Patients

In critically ill trauma patients, EN should be initiated within 24 to 48 hours of injury, starting at a trophic rate and increasing to goal rate after hemodynamic stability is achieved. The modified NUTRIC score can help identify patients who will benefit most from aggressive and early nutritional intervention. In the first week of critical illness, the patient should receive only 70% to 80% of estimated calories and protein should be targeted to 1.5 to 2 g/kg. PN can be provided safely without increased adverse events and can be provided either exclusively or as an adjunct to inadequate EN. Many patients can tolerate gastric feeding, though post -pyloric feeding has been shown to decrease pneumonia rates. Gastric residual volume monitoring has not been shown to decrease the rate of aspiration pneumonia. Peri-operative (and intraoperative) feeding has been shown to be safe in selected patients and volumebased feeding strategies may help reduce iatrogenic macronutrient deficits.