Nutrition and Gastrointestinal Dysmotility in Critically Ill Burn Patients: A Retrospective Observational Study.

BACKGROUND Gastrointestinal (GI) dysmotility impedes nutrient delivery in critically ill patients with major burns. We aimed to quantify the incidence, timing, and factors associated with GI dysmotility and subsequent nutrition delivery. METHODS A 10-year retrospective observational study included mechanically ventilated adult critically ill patients with ≥15% Total Body Surface Area (TBSA) burns receiving nutrition support. Patients were categorized as having GI dysmotility if they had any gastric residual volume (GRV) ≥250ml. Daily medical and nutritional data were extracted for up to 14 days in ICU. Data are mean (standard deviation (SD)) or median [interquartile range (IQR)]. Factors associated with GI dysmotility and the effect on nutritional and clinical outcomes were assessed. RESULTS Fifty-nine patients were eligible; 51% (n = 30) with GI dysmotility and 49% (n = 29) without. Baseline characteristics (dysmotility vs no dysmotility) were age: 48 [33-60] vs 34 [26-46] years; APACHE II: 16 [12-17] vs 13 [10-16]; sex (%Male): 80 vs 86%; and %TBSA: 49 [35-59] vs 38 [26-55]%. Older age was associated with increased probability of dysmotility (p = 0.049). GI dysmotility occurred 32 [19-63] hours after ICU admission but was not associated with reduced nutrient delivery. Post-pyloric tube (PPT) insertions were attempted in 83% (n = 25) of patients, with 72% (n = 18) being successful. Post-pyloric feeding achieved higher nutritional adequacy than gastric feeding (energy: 82 (95% CI 70-94) vs 68 (95% CI 63-74) %; p = 0.036) (protein: 75 (95% CI 65-86) vs 61 (95% CI 56-65) %; p = 0.009). CONCLUSION GI dysmotility occurs early in critically ill burned patients and post-pyloric feeding improves nutrition delivery. This article is protected by copyright. All rights reserved.