Feeding the Open Abdomen

• Published in: JPEN. Journal of parenteral and enteral nutrition Vol. 31; no. 5; pp. 410 - 415
• Main Authors: Collier, Bryan, Guillamondegui, Oscar, Cotton, Bryan, Donahue, Rafe, Conrad, Andrew, Groh, Kate, Richman, Jill, Vogel, Todd, Miller, Richard, Diaz, Jose
• Format: Journal Article
• Language: English
• Published: Silver Spring, MD SAGE Publications 01-09-2007; ASPEN; American Society for Parenteral and Enteral Nutrition
• Subjects: Abdominal Injuries - complications; Abdominal Injuries - surgery; Abdominal Injuries - therapy; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Bacterial Infections - epidemiology; Biological and medical sciences; Cost-Benefit Analysis; Critical Care - economics; Critical Care - methods; Diseases of the digestive system; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition; Enteral Nutrition - economics; Enteral Nutrition - methods; Female; Fistula - epidemiology; Hospital Costs; Humans; Injury Severity Score; Intensive care medicine; Male; Medical sciences; Postoperative Complications - epidemiology; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Retrospective Studies; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival Rate; Time Factors; Treatment Outcome; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Nutrition; Enteral administration; Parenteral administration; Abdomen; Feeding
• ISSN: 0148-6071; 1941-2444
• DOI: 10.1177/0148607107031005410

Background: The purpose of this study was to determine if early
enteral nutrition improves outcome for trauma patients with an open abdomen
(OA). Methods: Retrospective review was used to identify 78 patients
who required an OA for ≥4 hospital days, survived, and had available
nutrition data. Demographic data and nutrition data comprising enteral
nutrition initiation day and daily % target goal were collected. Patients were
divided into 2 groups: early enteral feeding (EEN), initiated ≤4 days
within celiotomy; and late enteral feeding (LEN; >4 days). Outcomes
included infectious complications, early closure of the abdominal cavity
(<8 days from original celiotomy), and fistula formation. Results:
Fifty-three of 78 (68%) patients were men, with a mean age of 35 years; 74%
had blunt trauma. Forty-three of 78 (55%) patients had EEN, whereas 35 of 78
(45%) had LEN. There was no difference with respect to demographics, injury
severity, or infectious complication rates. Thirty-two of 43 (74%) patients
with EEN had early closure of the abdominal cavity, whereas 17 of 35 (49%)
patients with late feeding had early closure (p = .02). Four of 43
(9%) patients with EEN demonstrated fistula formation, whereas 9 of 35 (26%)
patients with late feeding formed fistulae (p = .05). The EEN group
had lower hospital charges (p = .04) by more than $50,000.
Conclusions: EEN in the OA was associated with (1) earlier primary
abdominal closure, (2) lower fistula rate, (3) lower hospital charges.
Seventy-eight patients undergoing at least 4 hospital days of open abdomen care were evaluated in terms of nutrition provision, infectious complications, and noninfectious complications. Patients who received early enteral feedings had less fistulae formation, earlier abdominal wall closure, and lower hospital charges.