(1304) Development of a Protocol to Minimize NPO Time in Mechanically Ventilated Trauma Patients

Introduction: Early enteral nutrition has been shown to be of great benefit to critically ill patients. However tube feeds are commonly held at midnight for planned procedures. This practice results in a notable decrease in nutrition delivery for patients who undergo multiple planned procedures. Our surgical ICU has previously developed a protocol for continuing tube feeds until the time of surgery for major burn and necrotizing soft tissue infection (NSTI) patients if they have a protected airway. Years of experience have demonstrated the safety of this protocol. Trauma patients frequently require multiple planned surgical interventions and could benefit from this workflow. We modified our existing workflow and expanded it to trauma patients.

Methods: Our team modified the existing protocol for major burn and NSTI patients with a protected airway to include trauma patients who are not scheduled to undergo intra-abdominal, intra-thoracic, or airway surgery. This applies to both gastric and post-pyloric tube feeds. Post-pyloric position is required for patients at high risk of gastric dysmotility. Tube feeds are continued until the time of surgery and then placed to suction for 5-10 minutes. Data compared quantity of enteral nutrition provided as percentage of tube feed volume compared to goal from 3-month periods pre- and post-intervention.

Results: For trauma patients who received at least 5 days of tube feeds and had > 1 trip to the operating room, the percentage of the goal tube feeding achieved during the first 5 days increased from 56.8% pre-intervention (n = 18) to 73.9% post-intervention (n = 27). The large increase this cohort led to a small increase in the overall percentage of goal tube feeding achieved among all patients from 67.3% (n = 158) to 68% (n = 69). This change was driven by the increased delivery during the first 3 days. Goal tube feeding achieved increased from 60.8% to 65.9%.

Conclusions: We took an existing protocol and expanded it with the aim to minimize the amount of time trauma patients were not receiving nutrition. This intervention had a large impact on nutrition delivery to trauma patients, and the impact on this sub-population was so large that it resulted in a change in overall nutrition metrics for the entire ICU.