Enteral feeding following major torso trauma: From theory to practice

Clinical studies have provided convincing evidence that early nutritional s upport benefits the metabolically stressed surgical patient, but the optima l route of substrate delivery, enteral or parenteral, continues to be debat ed. Optimal nutritional support following major torso trauma may best be pr ovided via early enteral feeding. This article defines optimal nutrition fo llowing major torso trauma based on recently reported basic and clinical in vestigation, and describes a systematic method to deliver nutritional care in the ICU based on ongoing investigation. Part I reviews clinical evidence to support the conclusions that early nutrition following major torso trau ma improves outcome, that the enteral route is preferred over the parentera l route, and that immune-enhancing enteral formulas should be used in selec ted patients. Part II describes an objective expert-evidence-consensus deri ved protocol strategy, including patient and formula selection, bedside sur gical procedures, and nutrition management, in a multidisciplinary ICU envi ronment. The specific mechanisms by which early enteral feeding benefits me tabolically stressed trauma patients are not known, but it appears that the beneficial effects of traditional nutritional support can be amplified usi ng specific nutrients that provide immune-enhancing effects. Additional inv estigation is needed and may provide insight to the role of the gastrointes tinal tract in critical illness.