Skip to main content
  • Poster presentation
  • Open access
  • Published:

Enteral nutrition in mechanically ventilated patients with cervical spinal cord injury

Introduction

The aim of this study was to assess the adequacy of nutrition provision to mechanically ventilated patients in the acute phase after cervical cord injury. High spinal cord injury is associated with reduced gastric emptying due to excessive sympathetic activity from the isolated thoracolumbar cord [1], which is believed to compromise nasogastric delivery of nutrition and worsen clinical outcomes. However, the success of feeding early after high spinal cord injury has not been formally evaluated.

Methods

A retrospective cohort study. Success of enteral feeding and associated factors were reviewed for 28 days (or until ICU discharge) in all patients mechanically ventilated for at least 48 hours with cervical cord injury in a mixed, level 3 ICU, over a 2-year period. Adequacy of nutrition was defined as net calories delivered (including propofol) as a percentage of goal calories prescribed. Energy requirements were determined using the Schofield equation or a weight-based method (25 kcal/actual body weight). Data are presented as median and range.

Results

Seventeen patients were recruited (14 male, aged 37 years (18 to 78), BMI 27 (23 to 35), APACHE II 14 (8 to 26), ASIA score A - 13, B - 4, ICU length of stay (LOS) 40 days (14 to 78), hospital LOS 82 days (34 to 219), of which two died. Six patients were discharged prior to day 28. Goal calories were 2,140/day (1,867 to 3,400). Patients commenced enteral feeding 44 hours (1 to 107) after ICU admission and received a mean 73% (SD = 19%) of nutritional goals over the 28-day study period. Energy delivery by day 4 reached 88% of goals. There was a significant relationship (r = 0.564; P = 0.029) between feed volume and hospital LOS. Feeding did not influence any other clinical outcomes including ICU LOS and mortality. Eleven (65%) patients received prokinetics for 7 days (2 to 20). No patients received TPN or post-pyloric feeding.

Conclusions

Despite a high proportion of patients requiring prokinetics, most received adequate nasogastric nutrition during their stay in the ICU. Anecdotal evidence of weight loss and wasting after cervical spinal cord injury suggests that there are complex nutritional requirements in this group of patients and will form the basis for further studies.

References

  1. Lin VW, editors, et al.: Spinal Cord Medicine: Principles and Practice. New York: Demos Medical Publishing; 2003.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article

OConnor, S., Yau, Y., Yandell, R. et al. Enteral nutrition in mechanically ventilated patients with cervical spinal cord injury. Crit Care 15 (Suppl 1), P378 (2011). https://doi.org/10.1186/cc9798

Download citation

  • Published:

  • DOI: https://doi.org/10.1186/cc9798

Keywords