The Midwest Surgical AssociationEarly enteral nutrition can be successfully implemented in trauma patients with an “open abdomen”
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)
- et al.
Nutrition support of the trauma patient
Nutrition
(2002) - et al.
Effect of immediate enteral feeding on trauma patients with an open abdomen: protection from nosocomial infections
J Am Coll Surg
(2008) - et al.
Practical nutritional management in the trauma intensive care unit
Surg Clin North Am
(2000) - et al.
Postinjury abdominal compartment syndrome does not preclude early enteral feeding after definitive closure
Am J Surg
(2004) - et al.
Modern management of complex open abdominal wounds of war: a 5-year experience
J Am Coll Surg
(2008) - et al.
Damage-control laparotomy
Curr Opin Crit Care
(2006) - et al.
Management of the major coagulopathy with onset during laparotomy
Ann Surg
(1983) - et al.
Incidence and clinical pattern of the abdominal compartment syndrome after “damage-control” laparotomy in 311 patients with severe abdominal and/or pelvic trauma
Crit Care Med
(2000)
Cited by (54)
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2020, Journal of Pediatric Surgery Case ReportsA meta-analysis of the outcomes following enteral vs parenteral nutrition in the open abdomen in trauma patients
2020, Journal of Critical CareCitation Excerpt :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.
ESPEN guideline on clinical nutrition in acute and chronic pancreatitis
2020, Clinical Nutrition