Date of Degree

12-2014

Document Type

Thesis

Degree Name

Master of Science (MS)

Program

Nutrition

Advisor

Beth Senne-Duff

Advisor

Joseph Bonilla

Advisor

Beth Shields

Abstract

Enteral nutrition (EN) is frequently interrupted in the critically ill patient, which can lead to nutritional deficits and severe weight and lean body mass loss. Increased EN rates are being used more frequently to account for these interruptions. This study examined the maximum hourly EN rate (MAX rate) received by each subject and evaluated outcomes and tolerance in an effort to determine if there is a maximum threshold for the EN rate in this population. This retrospective observational study was conducted on an adult population admitted to a major burn center during a three year period who received EN and had ≥20% total body surface area (TBSA) burned requiring excision. Demographics, treatment, and outcomes data were collected during the MAX rate that each subject received and were analyzed with descriptive and comparative statistics. The gastrointestinal (GI) intolerance data examined included emesis, residuals ≥500 mL, aspiration, ≥1 L stool output in 24 hours, and necrotic bowel during or after MAX rate. IRB approval was obtained. Data were collected on 151 subjects with 48% ± 18% TBSA burn who were 33 ± 14 years old and met the inclusion criteria. The average MAX rate ordered and received was 154 ± 45 mL/hr. The factors that predicted mortality in this study were burn size (p =22=0.01). Pressor agents running during the MAX rate in 15% of the subjects (n=23). Subjects who were on pressors during the MAX rate had significantly higher residuals [445 (143, 525) mL vs. 140 (0,340) mL] than subjects who were not on pressors during the MAX rate. The total number of GI intolerance symptoms experienced per subject was a predictor of mortality, but the MAX rate was not associated with increased GI intolerance symptoms. Pressor use during MAX rate was associated with the total number of different types of GI intolerance symptoms experienced per subject and with mortality. There were no strong correlation between increase in MAX rate and incidence of negative outcomes, therefore a definitive MAX rate could not be established.

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