scholarly journals Mechanical Ventilation Strategies in the Critically Ill Burn Patient: A Practical Review for Clinicians

2021 ◽  
Vol 2 (3) ◽  
pp. 140-151
Author(s):  
Jared S Folwell ◽  
Anthony P Basel ◽  
Garrett W Britton ◽  
Thomas A Mitchell ◽  
Michael R Rowland ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Burn Injury ◽  
Ventilatory Support ◽  
Inhalation Injury ◽  
Burn Patients ◽  
Bedside Clinician ◽  
Ventilation Strategies ◽  
Surgical Operations ◽  
Burn Patient

Burn patients are a unique population when considering strategies for ventilatory support. Frequent surgical operations, inhalation injury, pneumonia, and long durations of mechanical ventilation add to the challenging physiology of severe burn injury. We aim to provide a practical and evidence-based review of mechanical ventilation strategies for the critically ill burn patient that is tailored to the bedside clinician.

Mechanical ventilation in critically ill burn patient with inhalation injury: Can we avoid it?

2020 ◽  
Vol 44 (1) ◽  
pp. 54-56
Author(s):  
L. Cachafeiro Fuciños ◽  
M. Sánchez Sánchez ◽  
A. García de Lorenzo y Mateos
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Inhalation Injury ◽  
Burn Patient

631 Mobilization of Patient with Inhalation Burn Injury Requiring VV ECMO: A Case Study

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S159-S160
Author(s):  
Karina J Berenbaum ◽  
Lawrence Gottlieb ◽  
Annemarie O’Connor ◽  
Megan Teele ◽  
Cheryl Esbrook ◽  
...  
Keyword(s):  
Mechanical Circulatory Support ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Ventilatory Support ◽  
Early Mobilization ◽  
Inhalation Injury ◽  
Circulatory Support ◽  
Burn Patients ◽  
Inhalation Burn ◽  
Vv Ecmo

Abstract Introduction As extracorporeal membrane oxygenation (ECMO) becomes more popular, there is increasing evidence supporting the safety and feasibility of early physical and occupational therapy (PT, OT) and mobility with patients on ECMO. However, there is limited evidence to support mobilizing burn ECMO patients. This case discusses safety and feasibility and explains how to successfully mobilize a burn patient on ECMO. Methods The patient is a 56-year old male admitted after sustaining 16% total body surface area partial and full thickness burns to his face, neck, forearms, and hands following an explosion at work. He sustained an inhalational injury and was intubated upon admission. Progression of his inhalation injury led to respiratory failure despite maximal ventilatory support. To maintain appropriate oxygenation, he underwent placement of left femoral-left internal jugular veno-venous ECMO (VV-ECMO). The patient received PT and OT throughout his stay in the Burn ICU. After starting ECMO, the patient resumed therapy with a sitting restriction to < 45 degrees of left hip flexion. The critical care, burn, OT, PT, and cardiothoracic surgery teams discussed factors impacting his ability to participate in therapy, e.g., managing sedation to maximize wakefulness and titrating medications due to hypertension. Modifications to therapy treatments were made based on medical changes and the patient’s ability to participate. The patient was seen daily for mobilization by a PT, OT, nurse, and ECMO specialist team. Clinicians had extensive training and experience working with patients with acute mechanical circulatory support. Safety considerations were followed during all therapy sessions, including careful monitoring of ECMO flows, vitals signs, and securement of medical devices. Results While on ECMO for 11 days, the patient was engaged in daily therapy consisting of active exercise, bed mobility, transfers and standing balance activities. ECMO flows were maintained and no adverse events occurred during mobilization. From the first session on ECMO to day of discharge, the patient exhibited a 14-point increase in his Boston University Activity Measure for Post-Acute Care functional outcome score and progressed to ambulating 300 feet. Conclusions Burn patients on VV-ECMO with femoral cannulation can safely and effectively engage in therapy and early mobilization, which yield positive functional outcomes. A well-coordinated inter-disciplinary team and highly skilled staff is essential to provide safe and effective intervention. Applicability of Research to Practice Early mobilization of burn patients on ECMO is feasible and can ameliorate the effects of immobility. Burn therapists are an integral part of the inter-disciplinary team and should be trained to be skilled at providing care for patients on mechanical circulatory support.

111 Burn Sepsis Screening Tool to Facilitate Diagnosis of Burn Sepsis

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S74-S75
Author(s):  
Kaitlyn Libraro ◽  
Palmer Bessey ◽  
Jamie Heffernan ◽  
James Gallagher
Keyword(s):  
Critically Ill ◽  
Screening Tool ◽  
Burn Injury ◽  
Clinical Signs ◽  
Case Fatality ◽  
Inhalation Injury ◽  
Clinical Feature ◽  
Sepsis Diagnosis ◽  
Acute Decompensation ◽  
Sepsis Screening

Abstract Introduction Sepsis following critical burn injury is an ominous development that can lead to death. Most patients will manifest a systemic inflammatory response syndrome (SIRS), even without being septic. This may obscure the clinical recognition of developing sepsis and delay the initiation of effective treatment. We developed a burn sepsis screening tool (BSST) to facilitate the recognition of developing burn sepsis. The purpose of this study was to review the utility of that tool. Methods The BSST was based on several clinical signs, laboratory values, and changes in physiologic support modalities associated with sepsis. It consisted of nine parameters that could be scored as indicating or not indicating sepsis or not applicable. If three were positive, the patient was identified as septic, and a search for a septic source was undertaken and treatment initiated. The BSST was completed on patients judged to be critically ill during morning rounds over a period of nine months. The values were transcribed into a secure web database and analyzed using SAS 9.4. Results There were 593 individual encounters on 31 critically ill patients with burns and/or inhalation injury for which the BSST was completed. The mean age of the patients was 57 ± 4 years (Mean ± SEM), and the burn size was 24 ± 15 % TBSA. Eleven patients were women (36%) and 7 patients had inhalation injury (23%). The expected case fatality was 21 - 30% depending on the statistical model used. Six patients (19%) died. The length of stay was 64 ± 10 days and ranged from 3 to 267 days. A patient was judged to be septic in only 45 of the daily encounters (8.0 % ± 1.1). There were 21 instances of a new septic event made in 12 patients. Episode of sepsis separated by at least 5 days of no sepsis, were considered to be a new septic event. There was a substantial amount of data that was missing or not applicable. There were no significant differences in the septic parameters on days with new sepsis diagnosis when compared to the day prior, or compared to all encounters in patients that were never septic. Patients deteriorated acutely between BSST completions on only two occasions and both were stabilized. Conclusions The BSST was used consistently to help evaluate the daily status of critically ill burn injured patients. The expected case fatality of the group was moderately high, based on statistical models derived from the ABA Burn Registry. The observed outcome was as good as or better than predicted. Acute decompensation was rare. The BSST added daily administrative work to rounds, and the data recorded were often incomplete. Although the BSST did not demonstrate any single clinical feature that identified the transition from SIRS to sepsis, it did add structure and rigor to daily rounds. That contributed to the effectiveness of rounds, and it may have been responsible, in part, for the favorable outcomes.

11 Vitamin D Deficiency on Admission and the Association with Length of Stay in Patients with Thermal Injury: A Multi-center Analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S13-S14
Author(s):  
Sarah Zavala ◽  
Kate Pape ◽  
Todd A Walroth ◽  
Melissa A Reger ◽  
Katelyn Garner ◽  
...  
Keyword(s):  
Vitamin D ◽  
Length Of Stay ◽  
Vitamin D Deficiency ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Inhalation Injury ◽  
Hospital Length Of Stay ◽  
Burn Patients ◽  
Comfort Care ◽  
The Impact

Abstract Introduction In burn patients, vitamin D deficiency has been associated with increased incidence of sepsis. The objective of this study was to assess the impact of vitamin D deficiency in adult burn patients on hospital length of stay (LOS). Methods This was a multi-center retrospective study of adult patients at 7 burn centers admitted between January 1, 2016 and July 25, 2019 who had a 25-hydroxyvitamin D (25OHD) concentration drawn within the first 7 days of injury. Patients were excluded if admitted for a non-burn injury, total body surface area (TBSA) burn less than 5%, pregnant, incarcerated, or made comfort care or expired within 48 hours of admission. The primary endpoint was to compare hospital LOS between burn patients with vitamin D deficiency (defined as 25OHD < 20 ng/mL) and sufficiency (25OHD ≥ 20 ng/mL). Secondary endpoints include in-hospital mortality, ventilator-free days of the first 28, renal replacement therapy (RRT), length of ICU stay, and days requiring vasopressors. Additional data collected included demographics, Charlson Comorbidity Index, injury characteristics, form of vitamin D received (ergocalciferol or cholecalciferol) and dosing during admission, timing of vitamin D initiation, and form of nutrition provided. Dichotomous variables were compared via Chi-square test. Continuous data were compared via student t-test or Mann-Whitney U test. Univariable linear regression was utilized to identify variables associated with LOS (p < 0.05) to analyze further. Cox Proportional Hazard Model was utilized to analyze association with LOS, while censoring for death, and controlling for TBSA, age, presence of inhalation injury, and potential for a center effect. Results Of 1,147 patients screened, 412 were included. Fifty-seven percent were vitamin D deficient. Patients with vitamin D deficiency had longer LOS (18.0 vs 12.0 days, p < 0.001), acute kidney injury (AKI) requiring RRT (7.3 vs 1.7%, p = 0.009), more days requiring vasopressors (mean 1.24 vs 0.58 days, p = 0.008), and fewer ventilator free days of the first 28 days (mean 22.9 vs 25.1, p < 0.001). Univariable analysis identified burn center, AKI, TBSA, inhalation injury, admission concentration, days until concentration drawn, days until initiating supplementation, and dose as significantly associated with LOS. After controlling for center, TBSA, age, and inhalation injury, the best fit model included only deficiency and days until vitamin D initiation. Conclusions Patients with thermal injuries and vitamin D deficiency on admission have increased length of stay and worsened clinical outcomes as compared to patients with sufficient vitamin D concentrations.

87 Evaluating Endothelial Dysfunction in Thermally-injured Patients with syndecan-1, Tissue Factor Pathway Inhibitor, and Thrombomodulin as Predictors of Mortality

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S57-S58
Author(s):  
John W Keyloun ◽  
Saira Nisar ◽  
Kathleen Brummel-Ziedins ◽  
Maria Bravo ◽  
Matthew Gissell ◽  
...  
Keyword(s):  
Tissue Factor ◽  
Tissue Factor Pathway Inhibitor ◽  
Burn Injury ◽  
Endothelial Damage ◽  
Inhalation Injury ◽  
Burn Patients ◽  
Mixed Effect ◽  
Significant Difference ◽  
Tissue Factor Pathway ◽  
Injured Patients

Abstract Introduction Endotheliopathy in burn patients is largely uncharacterized. Syndecan-1 (SDC-1), thrombomodulin (TM), and tissue factor pathway inhibitor (TFPI) are components of the vascular endothelial glycocalyx. Proteolytic cleavage of these moieties may yield biomarkers for endothelial damage. The aim of this study is to evaluate endotheliopathy after burn injury by monitoring plasma levels of these biomarkers over time to investigate potential relationship to mortality. Methods Burn injured patients presenting to a regional burn center from 2012 to 2017 were prospectively enrolled. Blood samples were collected at 0, 2, 4, 8, 12, 24, 36, 48, 60, and 72 hours from admission. Plasma SDC-1, TM, and TFPI levels were quantified by ELISA. Demographic data and injury characteristics were obtained from the medical chart. Patients with concomitant inhalation injury, trauma, or < 10% total body surface area (TBSA) burns were excluded. Statistical analysis was performed using mixed-effect models with Sidak’s correction for multiple comparisons. Significance was set at p =0.05. Data are presented as mean ± standard deviation. Results A cohort of 22 patients was identified with an average age of 45±14 years, TBSA of 30±15%, with 6 patients who died from their injuries. The deceased group was older (59±13 vs. 40±10 years, p = 0.01), and there was no significant difference in burn size. Mean SDC-1 levels were higher in the deceased group at all time points (p=0.0004) and this difference was significant at hour 12 (106±11 vs. 41±31 ng/mL, p = 0.0002), hour 24 (160±39 vs. 35±20 ng/mL, p = 0.04) and hour 72 (100±3 vs. 35±38 ng/mL, p = 0.01). Mean soluble TM levels were higher in the deceased group after hour 12 (p = 0.04) and there was a trend towards higher TFPI levels after hour 12 in the deceased group. Conclusions Biomarkers are elevated in patients following burn injury who die, when inhalation injury and trauma are excluded. Given equivalent TBSA, older patients appear more sensitive to thermally induced glycocalyx degradation. SDC-1 shows the greatest promise as a prognostic indicator as levels tend to be higher among deceased patients on admission and are significantly higher as early as hour 12. Applicability of Research to Practice Reliable assessment of the patient’s endothelial damage may hold predictive value for clinicians and could assist in clinical decision making. Further research must investigate endotheliopathy in burn patients.

102 Wildfire Burns: Implications for Burn Care

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S67-S67
Author(s):  
Tina L Palmieri ◽  
Kathleen S Romanowski ◽  
Soman Sen ◽  
David G Greenhalgh
Keyword(s):  
Length Of Stay ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Ventilatory Support ◽  
Mass Casualty ◽  
Inhalation Injury ◽  
Burn Injuries ◽  
Injury Incidence ◽  
Burn Centers ◽  
Burn Care

Abstract Introduction Climate change, the encroachment of populations into wilderness, and carelessness have combined to increase the incidence of wildfire injuries. With the increased incidence has come an increase in the number of burn injuries. Prolonged extrication, delays in resuscitation, and the extreme fire and toxic air environment in a wildfire has the potential to cause more severe burn injury. The purpose of this study is to examine the demographics and outcomes of wildfire injuries and compare those outcomes to non-wildfire injuries. Methods Charts of patients admitted to a regional burn center during a massive wildfire in 2018 were reviewed for demographic, treatment, and outcome. We then obtained age, gender, and burn size matched controls from within 2 years of the incident, analyzed the same measures, and compared treatment and outcomes between the two groups. Results A total of 20 patients, 10 wildfire (WF) burns and 10 non-wildfire (NWF) burns, were included in the study. Age (59.6±7.8 WF vs. 59.4±7.4 years), total body surface area burn (TBSA) (14.9±4.7 WF vs. 17.2±0.9 NWF) and inhalation injury incidence (2 WF and 2 NWF) were similar between groups. Days on mechanical ventilation (24.3±19.4 WF vs. 9.4±9.8 NWF), length of stay (49.9±21.8 WF vs. 28.2±11.7 days) and ICU length of stay (43.0±25.6 WF vs 24.4±11.2 NWF) were higher in the WF group. WF patients required twice the number of operations. Mortality was similar in both groups (1 death/group). Conclusions Wildfire burn injuries, when compared to age, inhalation injury, and burn size matched controls, require more ventilatory support and have more operations. As a result, they have longer lengths of stay and have a prolonged ICU course. Burn centers should be prepared for the increased resource utilization that accompanies wildfire injuries. Applicability of Research to Practice All burn centers must be prepared for the possibility of wildfires and the increased resource utilzation that accompanies mass casualty events.

scholarly journals Stimulant Abuse in Burn Patients Is Associated With an Increased Use of Hospital Resources

2020 ◽  
Vol 41 (5) ◽  
pp. 921-925
Author(s):  
Ian F Hulsebos ◽  
Christopher H Pham ◽  
Zachary J Collier ◽  
Mike Fang ◽  
Sebastian Q Vrouwe ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Surgical Intervention ◽  
Inhalation Injury ◽  
Burn Injuries ◽  
Burn Patients ◽  
Peripheral Vasculature ◽  
Urine Toxicology ◽  
Hospital Resources ◽  
Hospital Days ◽  
Surgical Operations

Abstract Stimulant (cocaine, methamphetamine, and amphetamine) abuse compromises the peripheral vasculature through endothelial injury. In combination with the physiologic derangements seen in burn injuries, patients abusing stimulants may have additional impairments in wound healing. A retrospective review from July 1, 2015 to July 1, 2018 was performed at an American Burn Association-verified burn center. Patients with positive urine toxicology results for stimulants (ST(+)), and those without (ST(−)), who sustained burn injuries were identified and matched by age and TBSA. The primary outcome was mortality, and secondary outcomes included total length of stay (LOS), and need-for-surgery (grafting). In total, 130 patients ST(+) and 133 ST(−) patients were identified. There were no significant differences in age (40.9 ± 13.5 vs 39.2 ± 23.7 years, P = 0.46), Inhalation Injury (12.3 vs 9.0%, P = 0.39), or nutritional status (prealbumin: 17.3 ± 6.1 vs 17.1 ± 12.7 mg/dl, P = 0.66; albumin: 3.5 ± 0.6 vs 3.6 ± 0.7 g/dl, P = 0.45). There were no differences in mortality (6.1 vs 4.5%, P = 0.55), intensive care unit LOS (9.3 ± 16.5 vs 10.2 ± 20.9 days, P = 0.81), wound infections (15.4 vs 23.9%, P = 0.07), or wound conversion (6.9 vs 3.0%, P = 0.14). ST(+) patients had a significantly longer LOS (15.0 ± 16.9 vs 10.7 ± 17.3 days, P = 0.04), greater tobacco use (56.9 vs 18.0%, P = 0.00001), and greater need for grafting (54.6 vs 33.1%, P = 0.0004). ST(+) patients require more hospital resources—surgical operations and hospital days—than ST(−) patients. The increased need for surgical intervention may partially explain the increase in hospital days, in addition to the observation that ST(+) patients had more complex disposition issues than ST(−) patients.

Management of the Patient with Thermal Injuries

2016 ◽  
Author(s):  
Michael J. Mosier ◽  
Nicole S. Gibran
Keyword(s):  
Carbon Monoxide ◽  
Carbon Monoxide Poisoning ◽  
Fluid Management ◽  
Clinical Manifestations ◽  
Injured Patient ◽  
Inhalation Injury ◽  
Burn Patients ◽  
Burn Care ◽  
Burn Resuscitation ◽  
Burn Patient

Optimal care of the burn patient requires not only specialized equipment but also, more importantly, a team of dedicated surgeons, nurses, therapists, nutritionists, pharmacists, social workers, psychologists, and operating room staff. Burn care was one of the first specialties to adopt a multidisciplinary approach, and over the past 30 years, burn centers have decreased burn mortality by coordinating prehospital patient management, resuscitation methods, and surgical and critical care of patients with major burns. This review covers where to treat burn patients, fluid management, airway management, temperature regulation, airway control, nutrition, anemia, pain management, deep vein thrombosis prophylaxis, and putting it all together: an algorithmic approach to early care of the burn-injured patient. Figures show that the size of a burn can be estimated by means of the Rule of Nines, which assigns percentages of total body surface to the head, the extremities, and the front and back of the torso, the approach to the burn patient in the first 24 hours, and the approach to the burn patient during the second to fifth days after burn injury. Tables list American Burn Association criteria for burn injuries that warrant referral to a burn unit, criteria for outpatient management of burn patients, acute physiologic changes during burn resuscitation, acute biochemical and hematologic changes during burn resuscitation, measures of pulmonary function, mechanisms of pulmonary dysfunction and indications for mechanical ventilation, clinical manifestations of carbon monoxide poisoning, half-life of carbon monoxide–hemoglobin bonds with inhalation therapy, increased acute kidney injury in patients treated with hydroxocobalamin for suspected inhalation injury, clinical findings associated with specific inhaled products of combustion, bronchoscopic criteria used to grade inhalation injury, and formulas for estimating caloric needs in burn patients. This review contains 3 highly rendered figures, 12 tables, and 134 references

122 Prevalence and Associated Predictors for Patients Developing Chronic, Neuropathic Pain Following Burns

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S81-S82
Author(s):  
Kevin M Klifto ◽  
C Scott Hultman
Keyword(s):  
Mechanical Ventilation ◽  
Neuropathic Pain ◽  
Burn Injury ◽  
Hospital Length Of Stay ◽  
Direct Result ◽  
Medical Illness ◽  
Burn Patients ◽  
Chronic Neuropathic Pain ◽  
Burn Center ◽  
Burn Unit

Abstract Introduction Chronic pain, unrelated to the burn itself, can manifest as a long-term complication in patients sustaining burn injuries. The purpose of this study was to determine the prevalence and compare burn characteristics between burn patients who developed chronic neuropathic pain (CNP) and burn patients without CNP treated at a Burn Center. Methods A single-center, retrospective analysis of 1880 patients admitted to the adult Burn Center was performed from January 1, 2014 through January 1, 2019. Patients included were over the age of fifteen years, sustained a burn injury and were admitted to the Burn Unit. CNP was diagnosed clinically following burn injury. Patients were excluded from the definition of CNP if their pain was due to an underlying medical illness or medication. Comparisons between patients admitted to the Burn Unit with no pain and patients admitted to the Burn Unit who developed CNP were performed. Results One hundred thirteen (n=113) of the 1880 burn patients developed CNP as a direct result of burn injury over five years with a prevalence of 6%. Patients who developed CNP were a significantly older median age [54 vs. 46, p=0.002], abused alcohol [29% vs. 8.5%, p< 0.001], abused substances [31% vs. 9%, p< 0.001], were current everyday smokers [73% vs. 34%, p< 0.001], suffered more full-thickness burns [58% vs. 43%, p< 0.001], greater median %TBSA burns [6 vs. 3.5, p< 0.001], were more often intubated on mechanical ventilation [33% vs. 14%, p< 0.001], greater median number of surgeries [2 vs. 0, p< 0.001] and longer median hospital length of stay (LOS) [10 vs. 3 days, p< 0.001], compared to those who did not develop CNP, respectively. Median patient follow-up was 27 months. Conclusions The prevalence of CNP over five years was 6% in the Burn Center. Older ages, alcohol abuse, substance abuse, current everyday smoking, greater %TBSA burns, third degree burns, being intubated on mechanical ventilation, having more surgeries and longer hospital LOS were associated with developing CNP following burn injury. Applicability of Research to Practice The largest study to date assessing the prevalence of chronic nerve pain following burns. Identified new independent predictors for chronic neuropathic pain following burn injury, not previously assessed in the literature.

40 Implementation of a Nursing-driven Volume-based Enteral Feeding Protocol

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S27-S27
Author(s):  
Kristin Moore ◽  
Cheryl Cooper ◽  
Kayleigh Fagert ◽  
Amalia Cochran ◽  
Sheela S Thomas ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Enteral Nutrition ◽  
Clinical Outcomes ◽  
Burn Injury ◽  
Burn Patients ◽  
Improvement Project ◽  
Related Data ◽  
Catching Up ◽  
Time Period ◽  
Burn Patient

Abstract Introduction Nutrition in the burn patient is vital to proper wound healing and graft take, counteracting the hypermetabolic response, and improving patient outcomes. Studies support early, aggressive enteral nutrition for burn patients. Enteral nutrition is often interrupted during hospitalization, causing patients to fail to achieve their nutritional goals. To maximize nutritional support for burn patients, our institution implemented a nurse-driven, volume-based enteral infusion protocol (VBP). The goal of this quality improvement project was to compare clinical outcomes and volume of enteral nutrition received by the burn patient pre- and post-VBP. Methods A single-center retrospective analysis was conducted at one adult burn center comparing pre- and post-implementation of a VBP. Patients aged 18–89 years admitted to the SICU for initial management of burn injury between November 2014 – May 2015 (pre-VBP) and June 2015 – January 2016 (post-VBP) were included; for stepdown patients the time period ranged from June 2017 – December 2017 (pre-VBP) and February 2018 – September 2018 (post-VBP). Pertinent demographic and burn-related data were collected. Clinical outcomes included length of stay (LOS), complications as defined by National Burn Repository, duration of mechanical ventilation, percent weight gain or loss, and percent of enteral volume received. Results In the SICU, there were 10 patients pre-protocol and 12 patients post-protocol. When comparing pre-VBP to post-VBP demographics, mean TBSA was 19.6% (1–40.5) vs 24.83% (2–61.5%), with a mean age of 64.4 vs 60.7 years. For clinical outcomes, mean number of complications was 1.6 vs 2, with mean ventilator days of 16.2 vs 16.4, SICU mean length of stay/TBSA 1.99 vs 2.23 days, and hospital mean LOS/TBSA 3.83 vs 2.54 days. Overall prescribed amount of enteral nutrition received pre-VBP was 105% vs post-VBP amount received at 95% (p=0.09). For the step-down unit, there were 8 patients pre-protocol and 6 patients post-protocol. Overall prescribed amount of enteral nutrition received pre-VBP was 83% vs post-VBP amount received at 89% (p=0.3815). Conclusions While clinical outcomes remain unchanged during the evaluation period, our patients met their prescribed enteral nutrition volume requirements when a nurse-driven VBP was initiated. In addition, for non-ICU patients, a trend was seen towards increased tube feeds with VBP. Applicability of Research to Practice Nurse-driven VBPs allow for RNs to adjust the rate of enteral nutrition by “catching up” for interruptions in feeding to meet the patient’s nutritional goals for the day.

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