Using current evidence-based guidelines, explain the decision-making process that would be applied in determining the route for nutrition support for the trauma patient

Question

What will be an ideal response?

Answer 1

Since feeding a critically ill surgical patient is a high priority for proper recovery and healing, there is a decision-making process that occurs to determine the route for nutrition support. For any patient, PO intake is the preferred choice in order to meet nutritional needs as naturally as possible. However, for critically ill patients such as Mr. Perez, this is not possible because he is mechanically ventilated and recent surgeries to the GI tract. According to the ASPEN guidelines, enteral nutrition would be appropriate for this patient if the GI tract is at least partially functional, there is no intestinal hemorrhage, no ileus or fistulas are present, no intractable vomiting is present, and no short bowel syndrome is present. Unfortunately, for this patient, some of these requirements for EN are not met, such as intestinal hemorrhage and the recent surgeries to the GI tract (removal of proximal jejunum resulting in discontinuity and followed by an anastomotic leak) that interrupts GI function. Due to these contraindications and the inability to meet at least 60% of his nutritional needs by EN, TPN was started for this patient. Additionally, since Mr. Perez is critically ill, nutritional support should be provided within the first 24-48 hours from admission.
This patient was S/P a traumatic event and in metabolic stress, meaning it was imperative to begin nutrition support as soon as feasibly possibly, optimally within 24-48 hours after admission into the ICU. Additionally, small amounts of EN (trophic feeds) were started along with PN in order to maintain gut integrity and intestinal mucosa; however, there is a potential for gut ischemia and necrosis if more than trophic EN was administered to meet all of this patient's nutritional needs. Due to the positive outcomes of open abdomen healing and EN (earlier closure rate, reduced fistula formation, and reduced mortality), it is important to wean this patient from TPN and have EN provide the majority of Mr. Perez's nutrition