Burns 28 (2002) 60–64 Impact of duodenal feeding on the oxygen balance of the splanchnic region during different phases of severe burn injury Harald Andel a,∗ , Matthias Rab b , Dorothea Andel a , Klaus Hörauf a , Dagmar Felfernig a , Wolfgang Schramm a , Michael Zimpfer a,c a Department of Anesthesiology and Intensive Care, Vienna Medical School, University of Vienna, 18–20 Waehringer Guertel, A-1090 Vienna, Austria b Department of Plastic and Reconstructive Surgery, Vienna Medical School, University of Vienna, 18–20 Waehringer Guertel, A-1090 Vienna, Austria c Ludwig Boltzmann Institute of Clinical Anesthesiology and Intensive Care, Vienna Medical School, University of Vienna, 18–20 Waehringer Guertel, A-1090 Vienna, Austria Accepted 28 March 2001 Abstract 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 O 2 -imbalance. In 15 severely burned patients during duodenal feeding starting within 6 h after injury the assessment of the CO 2 -gap between arterial and gastric CO 2 , as a parameter for the measurement of intestinal O 2 -balance was performed. Beginning prior to enteral nutrition CO 2 -gap measurements were carried out to show when the CO 2 -gap increased above 30 mmHg during the whole critical illness phase of the patients. When the CO 2 -gap increased above 30 mmHg enteral nutrition was reduced by 50% and the CO 2 -gap was measured 1 h later. In none of the patients the CO 2 -gap increased during increase of enteral nutrition. In seven patients, the CO 2 -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. © 2002 Elsevier Science Ltd and ISBI. All rights reserved. Keywords: Enteral nutrition; Gastric tonometry; Burned patients; CO 2 -gap; Oxygen balance; Intestinal perfusion 1. Introduction Enteral nutrition after severe burn injury has been suggested to have a beneficial effect on gastrointestinal perfusion [1] and gut mucosal integrity [2]. High en- ergy nutrition is essential in the treatment of severely burned patients. However, animal data suggest adverse ef- fects of enteral overfeeding [3]. This might be due to a dose-dependent increase of intestinal oxygen consumption during enteral nutrition [4,5] whereas overall organ per- fusion is diminished in the early phase after burn injury [6]. Enteral feeding, therefore, might lead to a mismatch between oxygen delivery and oxygen consumption of the intestine. Following a previous study, where the impact of early duodenal feeding on the oxygen balance of the splanchnic region after severe burn injury was investigated [7] this study ∗ Corresponding author. Tel.: +431-40-400-6860; fax: +431-40-400-6862. E-mail address: harald.andel@univie.ac.at (H. Andel). investigates the impact of enteral nutrition during the later phase of critical illness in severely burned patients. The measurement of the ‘CO 2 -gap’, i.e. the difference between the arterial and the gastric CO 2 has been shown to be a valid parameter for intestinal oxygen balance [8,9]. Human data dealing with the influence of enteral nutri- tion on the oxygen balance of the intestine are presented rarely. The aim of this study was to evaluate whether adverse effects of enteral nutrition on intestinal oxygen balance might be obtained in the critical illness phase of severely burned patients. This study shows, that in the later stages of the critical illness phase, enteral feeding may be of negative influence on the oxygen balance of the intestine. 2. Subjects and methods The study design and study entry criteria were similar to the previous investigation [7] in order to obtain comparable results. 0305-4179/02/$22.00 © 2002 Elsevier Science Ltd and ISBI. All rights reserved. PII:S0305-4179(01)00059-6