Clinical Pathway for Management of Nutrition in the Traumatically Injured Child Requiring ICU Care for ≥ 3 Days

  • Goal
    • Initiate nutrition within 72 hrs
    • Achieve calorie goal by post-injury day 7
    • Avoid prolonged recovery time and increased morbidity and mortality associated with inadequate nutrition
Multidisciplinary Team Assessment
  • Tertiary survey completed by Trauma team w/in 24 hrs of admission
  • Assess/identify pre-existing risk factors and malnutrition
  • Measure weight
    • Review patient growth chart
    • Update dosing weight
  • Plan nutrition with Trauma team, Trauma dietitian (RD)
    • Anticipate route — NJ, NG or CVC for parenteral nutrition (PN)
  • Frequent OR Considerations

Post-injury Day

Day 0

Day 1-2
Plan, Execute Access

Nutrition Considerations

Days 2-4
Begin Feeds

Enteral Nutrition

Parenteral Nutrition

Optimal route if not contraindicated

  • Arrange for appropriate access for PN
    • OR/PICU/IR for central access as indicated
  • Review with Trauma dietician
    • Patient-specific goals
    • Order PN
    • PN panel morning after starting
    • Advance rate to reach goal w/in 36 hrs

Day 5
Reassess

Nutrition Not Initiated

Days 6-7
Monitor

Nutrition at Patient-specific Goal

Monitor Nutrition During PICU Care
  • Biweekly weight checks (Monday/Thursday)
  • Weekly nutrition assessment completed by Trauma dietitian
  • Daily discussion between PICU and Trauma teams
    • % of estimated nutrition needs received
    • Address barriers if receiving < 90% of goal
  • Daily reassessment of ability to start/advance enteral feeds in children receiving PN
Posted: September 2021
Revised: June 2024, Revisions
Editors: Clinical Pathways Team