Impact of duodenal feeding on the oxygen balance of the splanchnic region during different phases of severe burn injury

Enteral nutrition is recommended in burned patients. Depending on the amount administered, enteral feeding causes an increase of intestinal oxygen-demand. Since intestinal perfusion is decreased after major burns the aim of this study was to evaluate, whether duodenal feeding might be a cofactor for the development of a splanchnic O2-imbalance. In 15 severely burned patients during duodenal feeding starting within 6 h after injury the assessment of the CO2-gap between arterial and gastric CO2, as a parameter for the measurement of intestinal O2-balance was performed. Beginning prior to enteral nutrition CO2-gap measurements were carried out to show when the CO2-gap increased above 30 mmHg during the whole critical illness phase of the patients. When the CO2-gap increased above 30 mmHg enteral nutrition was reduced by 50% and the CO2-gap was measured 1 h later. In none of the patients the CO2-gap increased during increase of enteral nutrition. In seven patients, the CO2-gap increased between the 6th and 13th day above 30 mmHg and fell significantly 1 h after reduction of enteral nutrition. Contrary to the early postburn phase, enteral feeding might have adverse effects on the oxygen balance of the intestine in the later stages of the critical illness phase.