Trauma Nutrition — Calculating Nutrition — Clinical Pathway: ICU

Trauma Nutrition Clinical Pathway — ICU

Calculating Nutrition Needs for Trauma Patients, Enteral
Formula Recommendations

Basic Guidance

Lab Monitoring
  • Traditional lab-based measures of nutrition such as pre-albumin, albumin and total protein are negative acute phase reactants and, therefore, not indicative of nutrition status during the acute phase of traumatic injury.
  • Receiving PN:
    • PN panel: Twice weekly
    • BMP, Mg, Phos: Daily until goal calories reached
  • Additional nutrition-specific labs as clinically indicated
Calorie and
Fluid Needs
  • Allometric Calorie Equation (AE) Kcals/kg/day = 200 x M-0.4
  • Allometric Fluid Equation (AE) mL/kg/day = 300 x M-0.5
  • M = mass (or weight) in kilograms
Protein Needs
  • 15-20% of total calories:
    • < 2 yrs 2-3 g/kg
      2-13 yrs 1.5-2 g/kg
      ≥ 13 yrs 1.5 g/kg
Trophic Feeds
< 5 kg 3 mL/hr
5-20 kg 5 mL/hr
≥ 20 kg 10 mL/hr

Reference

Energy Needs Based on Clinical Status

Equation Description AE = Allometric Equation for Kcals calculated by formula above
AE X 0.8 - 0.9 Intubated, sedated, neuromuscular blockade
AE X 1.0
  • Intubated, sedated
  • Extensive soft tissue injuries, wounds
  • Single operative intervention
AE X 1.1+
  • No respiratory support
  • Intubated, sedated with pulmonary injury
  • Open abdomen
  • Fistulae
  • Multiple operative interventions
  • Significant burns
  • Malnutrition
  • Autonomic storming

Reference

Enteral Formula Recommendations

Review allergies

< 12 mos of age Good Start GentlePro, Good Start SoothePro, Similac Total Comfort
< 40 kg 1:1 mixture of Peptamen Junior Unflavored and Peptamen AF
≥ 40 kg Peptamen AF