Scientific papers
Postinjury abdominal compartment syndrome does not preclude early enteral feeding after definitive closure

Presented at the 56th Annual Meeting of the Southwestern Surgical Congress, Monterey, California, April 18–21, 2004
https://doi.org/10.1016/j.amjsurg.2004.08.036Get rights and content

Abstract

Background

Critically injured patients are susceptible to the abdominal compartment syndrome (ACS), which requires decompressive laparotomy with delayed abdominal closure. Previous work by the University of Texas Houston group showed impaired gut function after resuscitation-associated gut edema. The purpose of this study was to determine if enteral nutrition was precluded by the intra-abdominal hypertension and bowel edema of the ACS.

Methods

Patients developing postinjury ACS from January 1996 to August 2003 at our level-I trauma center were reviewed. Patient demographics, time to definitive abdominal closure, and institution and tolerance of enteral nutrition were evaluated.

Results

Thirty-seven patients developed postinjury ACS during the study period; 26 men and 11 women with a mean age of 36 ± 4 and injury severity score of 33 ± 4. Mean intra-abdominal pressure before decompression was 32 ± 3 mm Hg, and concurrent mean peak airway pressure was 50 ± 4 cm oxygen. Enteral feeding was never started in 12 patients; 4 died within 48 hours of admission, 7 required vasoactive agents until their death, and 1 developed an enterocutaneous fistula requiring parenteral nutrition. Enteral feeding was initiated in the remaining 25 patients: 13 had feeds started within 24 hours of abdominal closure; 5 were fed with open abdomens; and 7 had a delay because of vasopressors (n = 2), multiple trips to the operating room (n = 2), paralytics (n = 2), and increased intra-abdominal pressures (n = 1). Once advanced, enteral feeding was tolerated in 23 (92%) of the 25 patients with attainment of goal feeds in a mean of 3.1 ± 1 days.

Conclusions

Despite the bowel edema and intra-abdominal hypertension related to the ACS, early enteral feeding is feasible after definitive abdominal closure.

Section snippets

Materials and methods

Denver Health Medical Center (DHMC) is a state-certified and American College of Surgeons–verified level-I regional trauma center and integral teaching facility of the University of Colorado Health Sciences Center. Patients undergoing decompressive laparotomy for ACS from January 1996 to August 2003 were identified using our trauma registry database and operative records, and subsequently reviewed. ACS was defined as intra-abdominal hypertension >25 mmHg as measured by urinary bladder pressure

Results

During the study period, 16,662 patients were admitted to the hospital after traumatic injury; 2,762 patients were admitted to the surgical intensive care unit with an injury severity score >15. Thirty-seven patients developed postinjury ACS requiring operative decompression during the 7.5 year study period; 26 men and 11 women had a mean age of 36 ± 4 and a mean injury severity score of 33 ± 4. Twenty-eight of these patients (76%) suffered blunt trauma. Mean intra-abdominal pressure (urinary

Comments

The physiologic benefits of enteral nutrition are widely recognized. Multiple studies have shown decreased septic complications, prevention of gut mucosal atrophy, preservation of normal flora, and attenuation of the hypermetabolic postinjury response with TEN [8], [9], [10], [11], [12], [13]. In our clinical studies, septic complications in postoperative patients, notably intra-abdominal abscess and pneumonia, were only 18% in patients given early TEN versus 35% in those administered total

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