EARLY ENTERAL FEEDING DOES NOT ATTENUATE METABOLIC RESPONSE AFTER BLUNT TRAUMA

Enteral feeding very early after trauma has been hypothesized to atten uate the stress response and to improve patient outcome. We tested thi s hypothesis in a prospective, randomized clinical trial in patients w ith blunt trauma. Following resuscitation and control of bleeding, 52 patients were randomized to receive early feedings (target, <24 hours) or late feedings (target, 72 hours). Feeding was given via nasoduoden al feeding tubes. A rapid advance technique was used to achieve full v olume and strength within 24 hours (goal, 1.5 g protein/kg . day). Pat ients who underwent at least 5 days of therapy were considered to have completed the study: 38 in all, 19 in each feeding group. Patients we re similar in age, gender, Injury Severity Score, and mean PaO2/FiO2 r atio. The early group, however, had more patients with a PaO2/FiO2 <15 0. After feeding began, the amount fed per day was the same in both gr oups. We found no significant differences in metabolic responses as me asured by plasma lactate and urinary total nitrogen, catecholamines, a nd cortisol. Both groups achieved nitrogen retention. In addition, we found no significant differences in intensive care unit (ICU) days, ve ntilator days, organ system failure, specific types of infections, or mortality, although the early group had a greater number of total infe ctions. In this study, early enteral feeding after blunt trauma neithe r attenuated the stress response nor altered patient outcome.