Document Detail


Postinjury abdominal compartment syndrome does not preclude early enteral feeding after definitive closure.
MedLine Citation:
PMID:  15619479     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
C Clay Cothren; Ernest E Moore; David J Ciesla; Jeffrey L Johnson; John B Moore; James B Haenel; Jon M Burch
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  American journal of surgery     Volume:  188     ISSN:  0002-9610     ISO Abbreviation:  Am. J. Surg.     Publication Date:  2004 Dec 
Date Detail:
Created Date:  2004-12-27     Completed Date:  2005-02-10     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370473     Medline TA:  Am J Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  653-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, Denver Health Medical Center, and the University of Colorado Health Sciences Center, 777 Bannock St., MC 0206, Denver, CO 80204, USA. clay.cothren@dhhs.org
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MeSH Terms
Descriptor/Qualifier:
Abdomen / physiopathology,  surgery
Abdominal Injuries / complications*,  diagnosis,  surgery
Cohort Studies
Combined Modality Therapy
Compartment Syndromes / etiology,  physiopathology,  therapy*
Critical Care
Critical Illness
Edema / physiopathology
Enteral Nutrition / standards*,  trends
Female
Humans
Injury Severity Score
Laparotomy / methods
Male
Pressure
Prognosis
Retrospective Studies
Risk Assessment
Survival Rate
Trauma Centers
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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