Personalized Targeted Nutrition via StructurEd Nutrition Delivery Pathway to Improve Recovery of Physical Function in Trauma - SeND Home
Abstract
Due to improvements in trauma, surgical, and intensive care unit (ICU) practices and procedures, the majority of military and civilian patients who experience severe abdominal trauma are surviving their injuries, whether from gunshot wounds, explosive blasts, or blunt force trauma. However, studies have shown that after treatment these patients go on to experience significant post-hospital impairments in multiple areas, including physical function, muscle wasting/weakness, and poor quality of life (QoL), with less than half of these patients returning to work 1 year post-hospital stay. The two main drivers of this are: (1) trauma itself causes the body to go into a catabolic state that begins immediately after injury and can last throughout the patient’s hospital stay; and (2) the majority of abdominal trauma patients are significantly malnourished both during and after their treatment. Indeed, the majority of these patients fail to meet their prescribed nutritional goals while in hospital. The nature of their injuries, particularly in the case of military personnel, requires multiple operations to the abdomen, which not only prevents feeding these patients through their mouths (nothing-by-mouth status, or NPO) but also prevents feeding though the intestinal tract. The specific demands of these patients require a precision nutrition care program that incorporates the use of intravenous feeding (parenteral nutrition, or TPN). Previous studies, including work from our group, have shown that early nutritional intervention programs in the ICU that incorporate early TPN are not only feasible, but also show promising trends toward improved physical function, enhanced QoL, and increased muscle mass and strength. However, to date there are no personalized nutrition programs that incorporate the use of TPN throughout hospital stay for patients who experience trauma. To address this critical need in the field of trauma care, we propose the first prospective, randomized, phase 2 clinical trial evaluating our recently developed, personalized, structured nutrition program: the SeND Home Pathway. This proposal addresses the Topic Area of Nutrition Optimization, along with the corresponding Areas of Encouragement: (1) research into nutrition-based strategies to prevent or reduce the impact of disease, and (2) development of prolonged nutrition care strategies using oral and/or intravenous approaches, including precision nutrition care following injury or illness. The SeND Home Pathway is the first precision nutrition care program specifically designed for patients with severe abdominal trauma. The structure of SeND Home is based on diagnostic and treatment interventions developed in our Longitudinal Energy Expenditure and Metabolic Phenotype of COVID-19 Study (LEEP-COVID trial NCT04350073) 20 to optimize nutrition delivery in critically ill COVID-19 patients as well as international ICU nutrition guidelines to determine caloric needs. The SeND Home program will improve nutritional support for abdominal trauma patients by: (1) defining personalized longitudinal caloric requirements using new and innovative indirect calorimetry technology; (2) identifying protein-calorie malnutrition and effects of personalized nutrition delivery pathway via standardized methods, including measures of: (a) muscle strength, (b) muscle mass, intramuscular adipose tissue and muscle glycogen stores, and body composition (BIA); and (3) accelerating optimized nutrition delivery to major trauma patients by initiating early, personalized, goal-targeted nutrition. After discharge, SeND Home includes regular follow-up with each patient by registered dietitians over 3 months to discuss post-hospital nutrition management, promote optimal recovery, and provide resources such as educational handouts and personalized nutrition goals. This phase 2 randomized clinical trial will evaluate the effects of the SeND Home Pathway on (1) recovery of physical function and m
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 28, 2022
- Source ID
- W81XWH2211020
Entities
People
- Paul E Wischmeyer
Organizations
- Duke University
- United States Army