Gastric Emptying in Trauma Patients

Abstract

<i>Background/Aim:</i> The aim of this study was to obtain quantitative data on gastric emptying following trauma. <i>Methods:</i> In order to assess gastric emptying for early enteral feeding, we evaluated the absorption of an amino acid, <i>L</i>-[1-<sup>13</sup>C]phenylalanine, within 24 h of admission and 7 days later in 14 trauma patients (injury severity score 36 ± 2). Following nasogastric administration of 100 mg <i>L</i>-[1-<sup>13</sup>C]phenylalanine, the plasma <i>L</i>-[1-<sup>13</sup>C]phenylalanine enrichment at 30 and 60 min and the expired <sup>13</sup>CO<sub>2</sub> for 1 h in the breath were used to measure the degree of gastric emptying. <i>Results:</i> The plasma <i>L</i>-[1-<sup>13</sup>C]phenylalanine enrichment concentration at 30 min was 0.53 ± 0.23 mmol/l during the first study and 2.46 ± 0.62 mmol/l during the second study (p = 0.006, a fivefold increase). The <i>L</i>-[1-<sup>13</sup>C]phenylalanine plasma level in historic controls was 4.57 ± 1.48 mmol/l. The percent of the dose oxidized and expired as <sup>13</sup>CO<sub>2</sub> in 1 h was 0.51 ± 0.17 during the first 24-hour study compared to the second study of 3.37 ± 0.68 (p = 0.0008) 7 days later (an over sixfold increase). The percent of the dose oxidized in 1 h in 37 normal historic controls was 7.08 ± 0.33. <i>Conclusion:</i> These data indicate delayed gastric emptying with limited recovery in 1 week. We conclude that gastric feeding should not be employed, and the route for early nutritional intervention should be transpyloric for the trauma patient.