Nutrition management of industrial burns

SSO

EUROPEAN

over 60 yews (76f67 of REE vs. 52f59 of protein requirements) and surgical patients (Slf52 vs. 58f57% of REE; 44f27 vs. 33f29% of protein requirements). Conclusions: Calorie and protein deliveries increased significantly within five days of enteral nutrition initiation. Increasing the levels of EN prescriptions improved calorie and protein deliveries.

296-P. EARLY ENTERAL NUTRITION AFTER ABDOMINAL LABOUR

OF PARTURIENTS

E.M. Shifman Dep. of Anaesthesiology, Republican Perinatal Center, Petrozavodsk, Russian Federation Rationale: Inadequate feeding in postoperative period is one of the factors that leads to worse clinical outcome and increases complication rates. An attempt to provide the infusion therapy in order to compensate physical disorders in this situation doesn’t improve the patient’s status, moreover, it may be dangerous because the fluid balance id changed during pregnancy and postnatal period. The objective of this research is to evaluate the efficiency of early enteral nutrition therapy as a part of postoperative exe of patients with abdominal delivery. Method: A prospective, controlled, single blind trial. Two groups of partmients. The enteral nutrition of the patients in the first group was started six hours after the operation (“Berlamin modular” mixture, (n=178)). The second group (n=171) received traditional infusion therapy for the first two days after the operation. The assessing of partmients’ nutritional status before the operation in both groups gave similar results. The patmients were anaesthetised by spinal anaesthesia. The complication rates and rehabilitation periods after the surgery were analyzed and compared in both groups. Correlation and vxiance analysis has been chosen for data statistical processing. Results: No difference in length of hospital stay was revealed during group data comparison. The nutritional support stimulated the earlier patients’ activity and improved milk transfer. A valid decrease of pmulent-septic complications as compxed with the control group (piO.05) was revealed. Conclusions: E~ly enteral nutrition is not only a real alternative to infusion therapy, but it also improves the progress of the post-operative period of pxturients after cesarean section.

297-P. AN INVESTIGATION INTO THE USE OF TOTAL PARENTERAL NUTRITION WITHIN A DISTRICT GENERAL HOSPITAL OVER A TWO YEAR PERIOD (2000-2002) P.M. Murphy Dietetics, Royal Gwent Hospital, Newport, United Kingdom Rationale: There has been an increased appreciation of the complications of Total Pxenteral Nutrition (TPN) and an increased availability of enteral support options. In the absence of a Nutrition Support Team in our District General Hospital to facilitate consistent decision making and practice, an audit of TPN practice was conducted. Method: All consecutive patients refelled to the dietetic dep&ment for the commencement of parenteral nutrition were included. The clinical indication for TPN, route of access, occurrence of complications and duration of TPN was recorded. Appropriateness of parentera nutrition was considered based on the BAPEN guidelines. TPN indications,

administration

and complications

%(No.) Post operative

nutrition

Vomiting

Peripheral

52( 113) 16(35)

Small bowel Central

support

obstruction

line

6W) 70(152)

line

30(69)

Line complications

59(42)

Infectious

41(29)

complications

SOCIETY

OF PARENTERAL

AND

ENTERAL

NUTRlTION

Results: A total of 217 patients received parentera nutrition. In 56% of cases it was considered inappropriate and enteral nutrition support would have been feasible. Fifty-one per cent of TPN was initiated in the critical care setting. Mean duration of TPN was 8.5 days. In hospital mortality was 36% (n=79). Conclusions: Despite a wealth of evidence for the safety and efficacy of enteral nutrition support, parentera nutrition continues to be used. Complications associated with pxenteral nutrition xe potentially life threatening and its use therefore should be carefully controlled and administered. A dedicated team may be of benefit in ensuing decision making is consistent and evidence based.

298-P. NUTRITION

MANAGEMENT

OF INDUSTRIAL

BURNS

M. Sikroria’, U. Kumx’, N. Rajput’, H. Kuhni’ ‘Burns, JLN Hospital and Research Centre, Bhilai, 2Pharmacology, Surya Hospital, Pune, India Rationale: Buns with involvement of >40% body surface area (BSA) has a high mortality in India. We report a case series of industrial bums cases that were nutritionally managed in our unit. Method: Ten male glass factory workers (age36.2f12 years- range 2765) were admitted the same day in our unit following a blast in factory furnace. Nine of them had suffered extensive buns over BSA of median 83% (mean 57f41%) and 6 had also suffered inhalational injuries. After treatment of shock, nutritional support (NS) was instituted, along with other treatment. NS was calculated using Cul7-eri formula and consisted of a mixture of blendarized kitchen feeds + commercial enteral formula (Fresubin@) + intravenous glucose-amino acids (Aminomix@) + Intravenous lipid (Intralipid@). The hyperalimenting NS included daily 279f87.4 g/d proteins or amino acids and 4463f1400 Kcal energy provision. Patients wele fed in a combination of oral, enteral and parentaral nutrition. Results: NS was given to patients for a median 21 days (range 5-53 days) during their bums unit stay of median 22 days (range S-77d). Nine (90%) patients survived and wele discharged in a good condition. Five required skin grafting. One patient requtied ventilator support for 1 day and one patient suffered congestive heart failure that responded to treatment. The most frequent metabolic complication was hyperglycemia, which was rapidly controlled with intravenous insulin. Conclusions: It was possible to save lives of 9 out of 10 victims of an industrial blast who suffered severe and extensive buns by a combination of standard buns management, good nursing care and an aggressive nutrition support protocol.

299-P. ORAL INTAKE OF A SAMPLE OF IRRITABLE SYNDROME PATIENTS

BOWEL

R. Aller D. De Luis, T. Arranz, L. Del Olmo, L. Felnandez Salazar, -’ 0. Izaola, F. De la Calle Institute of Endocrinology and Nutrition, Hospital Clinic0 Universitatio, Valladolid, Spain Rationale: Many factors have been implied in irritable bowel syndrome (IBS). Diet has been related with symptoms of this entityThe aim of 0~1’ study was to analyze the diet of sample of patiens with IBS. Method: A total of 15 patients with IBS were evaluated (diagnosed by Rome criteria and without other colonic pathology). In all patients wele analyzed (age, sex, weight, height, body mass index (BMI). Total symptoms score test (TSS) was performed in all patients, witha nutritional questonnaire (three days). Results: Patients (11 females y 4 males) had a mean age of 48.3+14,4 yexs, weight 66.4+12.3 Kg and BMI 25X+4.6 points. Average in TSS test was 8.9+1.8 points. Average intake was 1620+430 Cal/day (24 Cal/kg/day, 76+30.7g de protein/day (17.7% TCV (total caloric value)), 66.2+22.3 g de fats/day (38.3% TCV) y 178.2+60.4 g de cxbohidrates/day (43.9%TCV). Macronmient intake showed a lower level of cxbohidrate and a higher level of fats compxed with RDA. Total fiber intake was 12.9+4.4 g/day (7.9 g/l000 Cal). Micronutrient intakes wele near to RDA. Univariant analyze