The Midwest Surgical Association
Early enteral nutrition can be successfully implemented in trauma patients with an “open abdomen”

Presented at the Midwest Surgical Association Annual Meeting, Lake Geneva, WI, August 2–5, 2009.
https://doi.org/10.1016/j.amjsurg.2009.08.033Get rights and content

Abstract

Background

The presence of an “open abdomen” after a trauma laparotomy can complicate the nutritional management of injured patients.

Methods

The medical records of patients admitted to an American College of Surgeons–verified level 1 trauma center were evaluated. The timing of nutritional support was noted. The method to obtain abdominal closure was also noted.

Results

Twenty-three patients were included in the study. Enteral nutrition was successfully initiated in 52% of patients before fascial closure. Enteral nutrition was initiated 3.8 days after the initial laparotomy in these patients. All patients successfully achieved fascial and skin closure, obviating the need for delayed hernia repair or skin grafting.

Conclusions

Enteral nutrition can be successfully initiated in patients with “open abdomens.” In our series, early enteral nutrition did not alter our ability to ultimately obtain fascial and skin closure.

Section snippets

Methods

The medical records of patients admitted to an American College of Surgeons–verified level 1 trauma center were reviewed. The trauma database was queried to obtain a list of patients who underwent a laparotomy and were returned to the intensive care unit with open abdomens. For purposes of study enrollment, an “open abdomen” was defined as the lack of skin and fascial approximation upon completion of a laparotomy. Patients with admitting diagnoses involving injuries and patients aged ≥18 years

Results

Twenty-three patients met the inclusion criteria. The average patient age was 33.7 years. Three quarters of patients were male. Penetrating mechanisms of injury were more common than blunt mechanisms (61% vs 39%). The average hospital length of stay was 30.4 days, with 18 of those days spent in the intensive care unit. There were no deaths in the study. Patients in the study spent an average of 13 days on mechanical ventilation.

Most patients sustained multiple organ injuries. The average injury

Comments

Our results demonstrate that an unselected group of patients with heterogeneous injuries can successfully be given enteral nutrition before definitive fascial closure. These results are important in light of the increased use of damage-control procedures over the past 2 decades. Damage control laparotomy was developed to improve surgical and medical management of patients with life-threatening coagulopathy.2 It consists of an abbreviated laparotomy in which enterotomies are ligated without

References (17)

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    A similar trend was also noted by the other studies included in our study. Burlew et al. report the EN cohort taking 5 days longer to achieve primary closure [26], and our overall results show longer closure time and hospital stay for the EN cohort. Further, subgroup analysis by Burlew et al. excluding patients with bowel injury showed a shorter time to closure EN is associated with higher fascial closure rates, decreased complication rates and decreased mortality.

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