245 Enteral Nutrition and Aspiration Events in Patients Placed Prone for Burn Surgery: An Academic Institutional Review

Abstract

Introduction

The American Society of Anesthesiologists practice guidelines for preoperative fasting to reduce the risk of pulmonary aspiration do not include recommendations for holding post-pyloric enteral feeds. Our hospital protocol for critically ill, ventilated patients advises to continue enteral nutrition perioperatively as long as there is recent radiographic confirmation of a post-pyloric feeding tube position. This policy does not provide information regarding continuing vs. holding feeds in patients proned for surgery, and there is a lack of evidence regarding prone positioning and aspiration risk. Patients with posterior burns are often proned during surgery, and the decision to hold or continue post-pyloric feeds largely remains up to the anesthesiologist’s discretion. Without knowing the actual aspiration risk, we jeopardize burn patients when discontinuing feeds as their hypermetabolic state requires significant energy requirements. Our study aimed to review our institution’s current practice and determine if continuing post-pyloric enteral nutrition while placing patients in the prone position for burn surgery leads to an increase in aspiration events compared to holding feeds preoperatively.

Methods

A retrospective review of our burn registry was conducted from 2013–2016. All adult patients with posterior burns placed in the prone position during surgery were included. Preoperative X-ray reports were used to determine feeding tube position prior to surgery. The EMR was reviewed to determine NPO status. Postoperative X-ray reports, FiO2, SpO2, and ABG results were reviewed to evaluate for aspiration events up to 6 hours after surgery.

Results

Posterior burns were identified in 99 patients. In the 12 patients that met inclusion criteria, 21 procedures were performed. In one patient, a feeding tube had not been placed prior to the first 3 operations. In the remaining procedures, 10 feeding tubes were intra-gastric and 8 were post-pyloric. All patients were NPO for various amounts of time prior to OR.

Conclusions

Clinical practice varies depending on provider and feeding tube location before surgery. There were no aspiration events, although feeds were held prior to surgery.

Applicability of Research to Practice

Prospective studies are needed to determine preoperative gastric volume in patients with post-pyloric feeds to determine the safety of continuing enteral nutrition through surgery in any position.