Enteral nutrition delivery in patients admitted to a critical care unit following major trauma: Who’s at risk and what’s the impact?

Background: Hypermetabolism and enteral nutrition delivery challenges, result in trauma patients, becoming malnourished during their hospital, admission. This study aimed to explore enteral nutrition delivery, predictors of suboptimal delivery and the relationship with clinical outcomes in patients admitted to a critical care unit following major trauma. Methods: An exploration of nutrition related data collected as part of a multicentre prospective major trauma study was conducted. Nutrition related data included anthropometry, nutrition risk screening, feeding route, nutrition products, target volume, nutrition delivery and causes of enteral feeding interruptions. Multivariate logistic regression analysis was used to evaluate the strongest associations with suboptimal nutrition delivery. Results: Of 1036 participants, 71% ( n = 732) required enteral nutrition for a mean of 15.7 (7.9) days. Suboptimal nutrition delivery was prevalent throughout the admission. Mean energy target was 23.8 (6.37) versus 15.81 (3.43) kcal/kg/day delivered ( p < 0.001). Mean protein target was 1.27 (0.34) versus 0.89 (0.48) g/kg/day delivered ( p < 0.001). Factors associated with suboptimal nutrition delivery included male sex (OR, 1.82, 95% CI 1.27–2.60; p < 0.001), traumatic brain injury (OR, 1.67, 95% CI 1.16–2.40; p = 0.006) or high NUTRIC score (OR, 1.17, 95% CI 1.08–1.27; p < 0.001); early enteral nutrition reduced the risk of underfeeding (OR, 0.49, 95% CI 0.30–0.81; p = 0.006). Lower energy and protein delivery were associated with increased days of mechanical ventilation ( p < 0.001) and longer length of stay in both the critical care unit and overall hospital stay ( p < 0.001). Conclusion: Trauma patients experience inadequate enteral nutrition delivery which potentially negatively impacts clinical outcomes. Additional investigation is required to further understand the barriers and facilitators to adequate nutrition provision in critically ill trauma patients.