412 Volume vs. Rate-Based Tube Feeding in Burn Patients: Improving Nutrition

Abstract

Proper nutrition is critical in healing from burns. Tube feeding is routinely employed to help meet nutritional goals, especially in intubated patients and large burns; however, the complexities of burn care frequently involve pausing tube feeding. Volume-based tube feeding is a strategy that provides goal volumes based on available hours per day compared to fixed hourly rates. This study aims to assess whether volume-based tube feeding is superior to traditional rate-based tube feeding at meeting nutritional goals. Starting in January 2016, a single burn center implemented a volume-based tube feeding protocol. All patients for calendar year 2016 requiring tube feeds for at least 5 continuous days were compared to all patients from the prior calendar year 2015. Demographics, burn characteristics, and tube feeding details were compared with univariate analysis. Daily tube feed goals and length of stay were primary outcomes; both were assessed with multivariate analysis using linear modeling. Thirty patients met study criteria. The cohort was 30.0% female and 93.3% flame burned, with a mean age of 44.2 years and mean TBSA of 30.6%. All patients suffered 3rd degree burns. Pausing tube feeds for perioperative care was the most common reason tube feeds were held at 33.7% of all held days. Volume-based tube feeding was the only independent predictor of increasing tube feed goals with an average goal met of 91.41% (SD 19.41) vs. 74.14% (SD 21.72), (linear coefficient 10.05, 95% CI 4.49–15.61, p-value 0.001). Tube feed hours held was the only independent predictor of lower tube feed goals (linear coefficient -5.52, 95% CI -7.73 - -3.31, p-value <0.001). Volume-based tube feeding was not associated with a significant difference in length of stay after controlling for covariates. Rate-based feeds showed an adjusted mean stay of 33.6 (SD 7.5) days vs. 36.3 (SD 11.1) days for volume-based feeds (linear coefficient 0.84, 95% CI -13.6 - 15.2, p=0.905). Perioperative care was the most common reason for holding tube feeding. Volume-based tube feeding was superior to rate-based tube feeding in maximizing daily nutritional goals. Additional studies are needed to assess whether volume-based feeding is associated with improved clinical outcomes. Volume-based tube feeds optimize nutritional goals and thus should be the preferred method of tube feeding in patients who require such nutritional support.