Effect of early enteral nutrition on outcomes of trauma patients requiring intensive care

Purpose: To investigate the effect of early enteral nutrition on outcomes of trauma patients in the intensive care unit (ICU).Methods: Clinical data of trauma patients in the ICU of Daping Hospital, China from January 2012 to December 2017 was retrospectively analyzed, including patient age, gender, injury mechanism, injury severity score (ISS), nutritional treatment, postoperative complications (wound infection, abdominal abscess, anastomotic rupture, pneumonia), mortality, and adverse events (nausea, vomiting, abdominal distention). Only adult trauma patients who developed bloodstream infection after surgery for damage control were included. Patients were divided into early enteral nutrition group (<48 h) and delayed enteral nutrition group (control group, >48 h). Data of all trauma patients were collected by the same investigator. Data were expressed as frequency (percentage), mean ± standard deviation (normal distribution), or median (Q1, Q3) (non-normal distribution) and analyzed by Chi-square test, Student’st-test, or rank-sum test accordingly. Multiple logistic regression analysis was further adopted to investigate the significant variables with enteral nutrition.Results: Altogether 876 patients were assessed and 110 were eligible for this study, including 93 males and 17 females, with the mean age of (50.0 ± 15.4) years. Traffic accidents (46 cases, 41.8%) and fall from height (31 cases, 28.2%) were the dominant injury mechanism. There were 68 cases in the early enteral nutrition group and 42 cases in the control group. Comparison of general variables between early enteral nutrition group and control group revealed significant difference regarding surgeries of enterectomy (1.5% vs. 19.0%,p = 0.01), ileum/transverse colon/sigmoid colostomy (4.4% vs. 16.3%,p = 0.01) and operation time (h) (3.2 (1.9, 6.1) vs. 4.2 (1.8, 8.8),p = 0.02). Other variables like ISS (p = 0.31), acute physiology and chronic health evaluation≥20 (p = 0.79), etc. had no obvious difference. Chi-square test showed a much better result in early enteral nutrition group than in control group regarding morality (0 vs. 11.9%,p = 0.03), length of hospital stay (days) (76.8 ± 41.4vs. 81.4 ± 44.7,p = 0.01) and wound infection (10.3% vs. 26.2%,p = 0.03). Logistic regression analysis showed that the incidence of wound infection was related to the duration required to achieve the enteral nutrition standard (OR = 1.095,p = 0.002). Seventy-six patients (69.1%) achieved the nutritional goal within a week and 105 patients (95.5%) in the end. Trauma patients unable to reach the enteral nutrition target within one week were often combined with abdominal infection, peritonitis, bowel resection, intestinal necrosis, intestinal fistula, or septic shock.Conclusion: Early enteral nutrition for trauma patients in the ICU is correlated with less wound infection, lower mortality, and shorter hospital stay.

Evaluation of Teaching and Learning： A Basis for Improvement in Medical Education

To the Editor： Individualized medical education is crucial for the quality improvement of physicians in hospitals. However, the capacity to acquire medical theory and clinical skills differs among different medical students, international medical students, residents, and training physiciansTheir skills are at very different levels. Differences in learners＇ characteristics can contribute to a mismatch with historical teaching strategies.

Three-Center Experience on Patients with Influenza-Associated Acute Respiratory Distress Syndrome in Chongqing, China

To the Editor：Influenza-associated acute respiratory distress syndrome （ARDS） remains a devastating clinical picture. From December 2017 to January 2018,ten patients with influenza-associated ARDS were admitted to three different hospital＇s Intensive Care Units （ICUs） in Chongqing,with all cases resulting in demise.The main documented reasons for their admission to the ICU were due to progressive dyspnea and worsening hypoxemia which lead to endotracheal intubation and mechanical ventilation in these patients.Identification of influenza viruses was achieved using nucleic-acid testing from venous blood.This study was approved by the Institutional Review Board of Daping Hospital,Army Medical University.