Gut failure-predictor of or contributor to mortality in mechanically ventilated blunt trauma patients?

C. M. Dunham, David Frankenfield, H. Belzberg, C. Wiles, B. Cushing, Z. Grant

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Abstract

Thirty-seven ventilator-dependent blunt trauma patients (ISS 36 ± 15) were randomized at 24 hours after injury to receive parenteral (TPN) (n = 15), enteral (TEN) (n = 12), or parenteral plus enteral (PN/EN) (n = 10) nutrition. The TEN and PN/EN patients had endoscopically placed transpyloric feeding tubes. Patients who had nutritional complications were two TPN (13%), three TEN (25%), and five PN/EN (50%). Enteral complications were tube occlusion (two), failed duodenal intubation (one), patient extubation of feeding tube (one), gastric reflux (two), and abdominal distention (two). Mortality rates were not different between the groups, but were significantly related to the nutrition-associated complications (p = 0.01): four deaths in ten (40%) with complications and one death in 27 (3.7%) without complications. All four deaths associated with complications occurred in the four with gastric reflux or abdominal distention. No deaths occurred in the other 18 TEN or PN/EN patients (p = 0.0001). Of the four deaths, three were associated with ARDS and respiratory infection (75%). Conclusions: In mechanically ventilated blunt trauma patients, endoscopic transpyloric tube placement and feeding has a substantial failure rate (36%). Intolerance to duodenal feeding has a remarkably high mortality (100%) in patients in whom gut dysfunction may be a manifestation of injury severity or directly affect survival.

Original languageEnglish (US)
Pages (from-to)30-34
Number of pages5
JournalJournal of Trauma
Volume37
Issue number1
DOIs
StatePublished - Jan 1 1994

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Small Intestine
Mortality
Wounds and Injuries
Enteral Nutrition
Mechanical Ventilators
Intubation
Respiratory Tract Infections
Stomach
Survival

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Dunham, C. M. ; Frankenfield, David ; Belzberg, H. ; Wiles, C. ; Cushing, B. ; Grant, Z. / Gut failure-predictor of or contributor to mortality in mechanically ventilated blunt trauma patients?. In: Journal of Trauma. 1994 ; Vol. 37, No. 1. pp. 30-34.
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abstract = "Thirty-seven ventilator-dependent blunt trauma patients (ISS 36 ± 15) were randomized at 24 hours after injury to receive parenteral (TPN) (n = 15), enteral (TEN) (n = 12), or parenteral plus enteral (PN/EN) (n = 10) nutrition. The TEN and PN/EN patients had endoscopically placed transpyloric feeding tubes. Patients who had nutritional complications were two TPN (13{\%}), three TEN (25{\%}), and five PN/EN (50{\%}). Enteral complications were tube occlusion (two), failed duodenal intubation (one), patient extubation of feeding tube (one), gastric reflux (two), and abdominal distention (two). Mortality rates were not different between the groups, but were significantly related to the nutrition-associated complications (p = 0.01): four deaths in ten (40{\%}) with complications and one death in 27 (3.7{\%}) without complications. All four deaths associated with complications occurred in the four with gastric reflux or abdominal distention. No deaths occurred in the other 18 TEN or PN/EN patients (p = 0.0001). Of the four deaths, three were associated with ARDS and respiratory infection (75{\%}). Conclusions: In mechanically ventilated blunt trauma patients, endoscopic transpyloric tube placement and feeding has a substantial failure rate (36{\%}). Intolerance to duodenal feeding has a remarkably high mortality (100{\%}) in patients in whom gut dysfunction may be a manifestation of injury severity or directly affect survival.",
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Gut failure-predictor of or contributor to mortality in mechanically ventilated blunt trauma patients? / Dunham, C. M.; Frankenfield, David; Belzberg, H.; Wiles, C.; Cushing, B.; Grant, Z.

In: Journal of Trauma, Vol. 37, No. 1, 01.01.1994, p. 30-34.

Research output: Contribution to journalArticle

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AU - Dunham, C. M.

AU - Frankenfield, David

AU - Belzberg, H.

AU - Wiles, C.

AU - Cushing, B.

AU - Grant, Z.

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