Gastric emptying in trauma patients

Background/Aim: The aim of this study was to obtain quantitative data on gastric emptying following trauma. Methods: In order to assess gastric emptying for early enteral feeding, we evaluated the absorption of an amino acid, L-[1-C-13]phenylalanine, within 24 h of admission and 7 days later in 14 trauma patients (injury severity score 36 +/- 2). Following nasogastric administration of 100 mg L-[1-C-13]phenylalanine, the plasma L-[1-C-13]phenylalanine enrichment at 30 and 60 min and the expired (CO2)-C-13 for 1 h in the breath were used to measure the degree of gastric emptying. Results: The plas ma L-[ 1-C-13]phenylalanine enrichment concentration at 30 min was 0.53 +/- 0.23 mmol/l during the first study and 2.46 +/- 0.62 mmol/l during the second study (p = 0.006, a fivefold increase). The L-[ 1-C-13]phenylalanine plasma level in historic controls was 4.57 +/- 1.48 mmol/l. The percent of the dose oxidized and expired as (CO2)-C-13 in 1 h was 0.51 +/- 0.17 during the first 24-hour study compared to the second study of 3.37 +/- 0.68 (p = 0.0008) 7 days later tan over sixfold increase). The percent of the dose oxidized in 1 h in 37 normal historic controls was 7.08 +/- 0.33. Conclusion: These data indicate delayed gastric emptying with limited recovery in 1 week. We conclude that gastric feeding should not be employed, and the route for early nutritional intervention should be transpyloric for the trauma patient.