Enteral nutritional management in trauma patients blenderized feeds versus immunosupplemented feeds

Abstract

As patients with head injury and polytrauma have an increased basal metabolic rate and catabolism their nutritional requirements substantially increase. At the same time they have an obtunded sensorium and are unable to accept orally for a prolonged period of time. These patients should receive optimum nutritional support after 48 hours of injury to prevent multiple organ failure and sepsis. We studied the effect of blenderized versus immunosupplemented feeds. Patients in the age group of 20–35 years were selected and randomly divided into two groups of twenty five patients each. Energy requirements were calculated by the Harris-Benedict Equation. Protein requiret was calculated so as to have a C/N ration of 90:1. Control group received blenderized enteral feeds whereas study group received added immunonutrients for a period of two weeks. Enteral feeding was started within 48 hours of injury and the patient’s full nutritional requirements were reached by day four. Patients were assessed by maintaining daily nutrient intake record, serum albumin level and nitrogen balance on the admission and discharge, I.C.U. stay and length of stay. Patients were studied till discharge. Patients with diabetes, intraabdominal injury and absent bowel sound were excluded. P value was calculated by paired t test. Results showed that study group had significant increase In the nitrogen balance at discharge [<0.05] reduced ICU stay and Iength of stay as compared to control group but control group also showed a positive balance [<0.05], which was cost effective. We conclude that giving early enteral nutrition with a C:N ratio of 90:1 helps in better outcome. Immunonutrients supplementation certainly helps in increased nitrogen retention and reduces length of ICU stay.