Effect of Immediate Enteral Feeding on Trauma Patients with an Open Abdomen: Protection from Nosocomial Infections

Dissanaike, Sharmila; Pham, Tam N.; Shalhub, Sherene; Warner, Keir J.; Hennessy, Laura; Moore, Ernest E.; Maier, Ronald V.; O’Keefe, Grant E.; Cuschieri, Joseph

doi:10.1016/j.jamcollsurg.2008.06.332

Cited by 127 publications

(70 citation statements)

References 31 publications

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“…Early initiation of EN is associated with a reduced risk of infections, lower ICU mortality, No risk of aspiration and of gastrointestinal intolerance Delayed achievement of the energy target Immediate achievement of the energy target Frequently associated with negative protein-energy balance Improvement of the protein-energy balance lower hospital mortality and shorter length of ICU stay in mechanically ventilated ICU patients [56][57][58][59][60], and with a decreased rate of infectious complications, a shorter total length of hospital stay, and lower overall costs of management of postsurgical patients [61,62]. However, EN is frequently insufficient to cover the energy expenditure even in the hands of a well-trained and experienced nutrition team.…”

Section: Choice Of Nutritional Support In Patients With Csmentioning

confidence: 99%

Cardiogenic shock and nutrition: safe?

et al. 2010

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Cardiogenic shock is a common diagnosis in patients in the intensive care unit (ICU), and is characterized by a decreased cardiac output in the presence of adequate intravascular volume associated with an inadequate tissue perfusion including a physiological reduction in the splanchnic territory. It may occur in isolation as a reflection of cardiac pathology, or it may be part of a shock syndrome involving other pathogenic mechanisms. As the use of enteral nutrition (EN) is associated with an increase in mesenteric arterial output, EN could be deleterious by overwhelming the mechanisms of mesenteric adaptation. Accordingly, EN has been suspected to increase the risk of mesenteric ischaemia, bacterial translocation and sepsis in ICU patients with cardiogenic shock. International guidelines recommend a cautious use of EN within 72 h following cardiogenic shock. Recent evidence indicates that mesenteric arterial output may decrease during parenteral nutrition administration, suggesting that parenteral nutrition could have a protective effect on splanchnic organs in ICU patients with cardiogenic shock. Contrary to former beliefs, several meta-analyses have shown that parenteral nutrition is not associated with increased mortality. Exclusive EN is associated with negative energy balance and the combination of EN with supplemental parenteral nutrition during the first days following ICU admission has been proposed to prevent negative energy balance. Such a nutritional strategy could also be beneficial for the mesenteric circulation in cardiogenic shock, and consequently may improve the clinical outcome of patients with cardiogenic shock. Clinical trials are warranted to verify these hypotheses.

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Section: Choice Of Nutritional Support In Patients With Csmentioning

confidence: 99%

Cardiogenic shock and nutrition: safe?

et al. 2010

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“…In the study by Dissanaike et al, 41 the mortality rate was lower for the enteral feeding group (12.5%) than for the group not given enteral feedings (23.5%), but the difference was not statistically significant. The results of the study by Collier et al 39 also revealed no significant mortality benefit for enteral feeding.…”

Section: Nutritional and Metabolic Supportmentioning

confidence: 79%

“…35,[38][39][40] In a study by Dissanaike et al, 41 rates of ventilator-associated pneumonia were significantly lower in the enterally fed group (43.8%) than in the nonfed group (72.1%), but ICU length of stay, hospital length of stay, and wound or bloodstream infections did not differ significantly between the 2 groups. Collier et al 39 found no statistical significance in rates of bloodstream, wound, or urinary infections and length of ICU or hospital stays between patients who received early enteral feedings and patients who did not.…”

Section: Nutritional and Metabolic Supportmentioning

confidence: 99%

Open Abdomen in Trauma and Critical Care

Fitzpatrick

2017

Critical Care Nurse

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The open abdomen technique and temporary abdominal closure after damage control surgery is fast becoming the standard of care for managing intra-abdominal bleeding and infectious or ischemic processes in critically ill patients. Expansion of this technique has evolved from damage control surgery in severely injured trauma patients to use in patients with abdominal compartment syndrome due to acute pancreatitis and other disorders. Subsequent therapies after use of the open abdomen technique and temporary abdominal closure are resuscitation in the intensive care unit and planned reoperation to manage the underlying cause of bleeding, infection, or ischemia. Determining the need for this poten- T he open abdomen is a technique with recently expanded implementation in managing complex problems in critically ill patients. First used in trauma care in the 1990s, the technique is now a management strategy for many other illnesses and conditions in critically ill adults. The mainstay of treatment for intra-abdominal infections, intra-abdominal bleeding, and abdominal compartment syndrome (ACS), whatever the cause, is the intentional creation of an open abdomen, which is a laparotomy wound that allows a damaged or edematous viscera to expand, reducing intra-abdominal pressure (IAP) and related complications.1 The technique of the open abdomen is defi ned as intentionally leaving the fascial edges of the abdomen unapproximated (laparostomy) through a surgically created entrance into the cavity. As a result, the abdominal contents are exposed but are protected by a temporary 22

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“…This includes critically ill septic patients with peritonitis associated with nontraumatic intestinal perforation [13]. More recently, it has been reported that in trauma patients with open abdomens, immediate enteral nutrition is safe and associated with a decreased pneumonia rate [14]. Accordingly, during our study period, we admitted four patients after damage control surgery with open abdomens.…”

Section: Discussionmentioning

confidence: 99%