Patient Encounter Part 1

A 25-year-old man was involved in a motor-vehicle accident in which he suffered several long bone fractures, a ruptured spleen, and a severe closed-head injury. This 5', 10"-man was well nourished and weighed 75 kg before the accident. During the first surgery to repair his abdominal injuries, the surgeon placed a feeding jejunostomy tube. Following surgery, the patient was taken to the intensive care unit (ICU), where he was mechanically ventilated and had an intracranial pressure monitor. He initially required significant amounts of vasopressor agents to maintain his blood pressure. The decision was made to delay dealing with the long bone fractures until he was more stable.

What would this patient's estimated caloric and protein requirements be?

What is the potential advantage of using EN rather than PN in this patient?

Why is a jejunostomy tube a good access route for feeding this patient?

Would it be prudent to start jejunal feedings immediately after the patient is admitted to the ICU following his abdominal surgery?

Surgically placed jejunostomy tubes are an option; similar to surgically placed gastrostomy tubes, they are placed through an incision in the abdominal wall, precluding the need for a tube down the nose or mouth. These tubes frequently are placed during laparotomy following abdominal trauma. Alternatively, jejunal access can be obtained by placing a jejunal extension through a PEG tube; the resulting tube is sometimes referred to as a PEGJ tube or G-J tube. Another option is to place a PEJ tube directly; this is more technically difficult than PEG placement and may not be available in some settings.

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