Early enteral nutrition with advanced protein-calorie support in the intensive care of patients with multiple trauma as a mean for preventing multiple organ failure

Authors

DOI:

https://doi.org/10.22141/2224-0586.7.102.2019.180353

Keywords:

multiple trauma, nutritional therapy, protein-energy balance, complications

Abstract

Background. Insufficient attention to the problem of compensation of sharply increasing energy needs in polytrauma patients leads to a rapid decompensation of adaptive capacity of the body and development of complications, which are difficult to correct. Proper choice of time and method of nutritional therapy as well as composition and energy value of food mixtures helps reduce the metabolic response to stress and improves survival rates. The purpose of the study was to evaluate the effectiveness of early enteral nutrition with enhanced protein-calorie provision according to the PEP uP (Enhanced Protein-Energy Provision via the Enteral Route in Critical ill Patients) protocol in the intensive care of multiple trauma patients. Materials and methods. Forty patients with severe multiple trauma delivered to intensive care unit were examined on average 0.5 hours after injury. Their average age was 41.9 ± 2.4 years. Basic group (A) — 15 persons undergoing nutritional therapy according to the PEP uP protocol. Comparison group (B) consisted of 25 patients whose nutritional support was performed according to European guidelines on clinical nutrition of patients in the intensive care unit using standard polymeric formula. In order to assess the risk of multiple organ failure, the sequential organ failure assessment (SOFA) score was used on days 2, 3, and 5 of treatment. Serum levels of total protein and albumin were also determined in dynamics. Results. The severity of organ dysfunction on the SOFA score in both groups at admission was homogeneous. In group B from day 2, the development of persistent hypoproteinemia was detected that was not observed in group A. On the 5th treatment day, the level of albumin in group A was significantly higher than in group B. On day 3 in group B, the proportion of patients with manifestations of kidney damage increased: 31.8 % — 0 points, 54.5 % — 1 point, 13.7 % — 2 points on the SOFA score. In group A, none of the patients had 2 points on the SOFA score, 84.6 % had 1 point, 15.4 % had 0 points. During the first 3 days, there was a decrease in the manifestations of lung damage in both groups. The impact of early nutritional support on the dynamics of the oxygenation index, in our view, remains uncertain. Conclusions. The length of stay of patients with severe multiple trauma in the intensive care unit was reduced by an average of 3 days (in group A — 16.9 ± 1.4 days, in group B — 19.9 ± 1.2 days). Intensive care using the PEP uP protocol in the first 3–5 days reduced the risk of multiple organ failure resulting from a lower total SOFA score at this time in group A (1–4 points) compared to group B (4–7 points). Nutritional therapy using the method of early enteral nutrition with advanced protein-calorie support improves the adequacy of covering protein-energy needs in patients in the acute period of multiple trauma that may have a positive effect on reducing the incidence of complications and the length of stay of patients in the intensive care unit.

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Published

2019-11-25

How to Cite

Matolinets, N. (2019). Early enteral nutrition with advanced protein-calorie support in the intensive care of patients with multiple trauma as a mean for preventing multiple organ failure. EMERGENCY MEDICINE, (7.102), 11–17. https://doi.org/10.22141/2224-0586.7.102.2019.180353

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Original Researches

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