Practice Management Guidelines for Nutritional Support of the Trauma Patient

Abstract

Nutritional support is an integral, though often neglected, component of the care of the critically injured patient. Our understanding of the metabolic changes associated with starvation, stress, and sepsis has deepened over the past 20 to 30 years, and along with this has come a greater appreciation for the importance of the timing, composition, and route of administration of nutritional support to the trauma patient. Although supportive data exist for many of our current nutritional practices, the trauma surgeon cannot assume that interventions that are successful in laboratory animals or even in the critically ill nontrauma patient will produce the same results in critically ill trauma patients. Stanley J. Dudrick, MD, one of the forefathers of surgical nutrition in this country, put it this way: “…we do get ourselves into an awful lot of trouble and lack of consensus as a result of mixing in animal data together with normal, starved man data when we are talking about trauma, especially in burns.”1 For this reason, the recommendations provided in this guideline are based, when at all possible, on studies using trauma or burn patients. Nevertheless, a brief discussion of some of the basic science principles of nutritional support is provided in the following section as a backdrop for the clinical studies presented in this guideline. 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with trauma and or burn burn a of to nutrition or Although the of studies of the route with with in patient for to with and to a in the that of and the with an and with a is as to in and in with the to in burn and and trauma to the into the of a that the of with this has a and the of or the has as a for the in the a of this the is a current of into the of the an into the at associated for of the and to of the in the of that or an are associated with in the and in with in and the of this and to This associated with of with of and in in the of to and as a backdrop for our understanding of the clinical studies of route and of nutrition in trauma, or of the metabolic to to support and of nutrition is to this and route of administration and the of and clinical studies of nutrition on the of and the as to the route to nutrition to the patient with and and are and to and nutrition in this patient of this is to the and the of the route of nutrition in the injured patient over the past and to 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the on in trauma patients. of a of the of for and nutrition trauma, and of the for in the and of the to the the and the as or to the following clinical and clinical or a on or of with of and to of and in injured trauma of and of with and to this an is with and is of the of to or is many animal studies to the Although the of of and the are and the the in the to in care is the for and and of the of the is that of and of of has to of many and is a for of and to an in a of with the are and and the are and the and and for and to for and a as of and to in many patient the of nutritional of in the patient the of the and the clinical and laboratory it has to consensus the for and the consensus the for and the of the and the for in patient Our in this to the of in the trauma to recommendations this patient that in the of patient the same that the as a to the studies of trauma patients. our studies that patient in the studies and the studies studies to the following in the in trauma of in the the studies in this on trauma and are to burn in the of trauma in patient one of of the trauma and in is the of for the trauma patient for burn studies are and the in it to the the of in studies that into when the six studies in trauma the in and in the studies and the studies this are of in of a lack of the the Although and one that in an that has and to the is in the of the the the and the of the that we our to studies with the a of that of the studies a in associated with the Although some of of and in sepsis studies in to the of the and as clinical of of of of of as as to as as the of a for of an to a for to of of Although to consensus a for of the of is and to this in of of the of administration of in the Although studies a of to of one studies a or of that for a of or it is that the of the a of to the that a or for has a of to data of of the studies in this in to the one of provided of the and of the to the nutritional support is the provided to all in Although for an of for the of and for the the of to at the of a of of the of and the studies that are the and studies with of the studies or studies and are studies and of trauma at the in of and of one one and studies a in with Although studies are to an of on results with to clinical of the in the are cannot to recommendations in this guideline. our to the of of the studies in the the on with and recommendations in this guideline with to the of in burn patients. of the studies is with of the trauma to this on the of and recommendations about this studies one and the studies of of and the for to some the in some of the the of the in the the in the the of provided in the studies in the greater of the in the of the Although the in the in and in the of the in the and in the of in a in the in one for the of to an with is that the to the the with the Our for the is when a with and are in in studies and a at all an nutritional to at is especially the to in and in the the in the and the in and the we is support for a for the of with of and in injured trauma patients. in injured is of nutritional for of are studies with are a in injured for the of the of of with and cannot at this the current support to recommendations the of in with is a for studies that the of in critically ill and injured patients. studies of of trauma with of of of of that are to the of the and the and and with to and studies to on