Nitrogen balance, protein loss, and the open abdomen*

Cheatham, Michael L.; Steindorf, Karen; Brzezinski, Stacy J.; Lube, Matthew W.

doi:10.1097/01.ccm.0000250390.49380.94

Cited by 161 publications

(101 citation statements)

References 15 publications

(26 reference statements)

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“…Due to this, the addition of nitrogen balances out the loss of 2g of nitrogen with each litre of intra-abdominal fluid released. 9 Skin regeneration includes at least 2 processes which requires protein as a substrate: cell proliferation (mainly fibroblasts) and the synthesis of protein -collagen. All the cell structures are made of protein, so its synthesis is essential to tissue damage repair and constitutes active metabolic factors that are indispensable for the survival of the organism, among others, in the situations of increased catabolism.…”

Section: Discussionmentioning

confidence: 99%

Role of nutritional intervention in negative pressure wound therapy (NPWT). Case report of patient treated by 'open abdomen' method.

Kuczyńska

2017

NPWTJ

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Abstract-Introduction: Wound healing process depends on many factors. As it has been proved many times before, nutrition is one of the key factors in wound healing therapy. When there is an insufficient supply of nutrients and malnutrition, wound healing processes slow down and the inflammatory phase is prolonged, which requires high energy expenditure and as a consequence, may lead to the loss of lean body mass and the development of sarcopenia and cachexia. This promotes the formation of non-healing chronic wounds.In this paper we would like to emphasize the role of nutrition, as an integral part of wound healing processes, which should encompass the current metabolic needs associated with patient's clinical condition.Case report: This case describes a young male patient with gastrointestinal tract insufficiency and an extensive postoperative wound treated by the open abdomen method. In the course of increased catabolism, water and electrolyte loss and disturbances as well as nutritional insufficiencies, body mass loss and progressive cachexia occurred in this patient and, as a consequence, the wound healing processes was significantly diminished.Conclusions: Inducing and maintaining the anabolic processes in the organism and control of the enhanced catabolism in response to metabolic stress or injury are essential actions in optimizing the treatment and healing process. These are possible to achieve by the early introduction of balanced and individualized nutritional treatment regimens, provision of the energy and appropriate nutrients, which enables the restoration of lean body mass and stimulation of the healing processes.

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Section: Discussionmentioning

confidence: 99%

Role of nutritional intervention in negative pressure wound therapy (NPWT). Case report of patient treated by 'open abdomen' method.

Kuczyńska

2017

NPWTJ

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“…Si bien lo anteriormente detallado es cierto y ha tenido injerencia plena en la indicación del AA, estamos totalmente convencidos de que el criterio, la sensatez y la experiencia del cirujano en la selección de los pacientes son los responsables de la mejor adecuación en la indicación de este procedimiento [62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79] . En la actualidad las indicaciones más aceptadas son: 1) Sepsis abdominal grave con SCA.…”

Section: Indicacionesunclassified

“…En los tratados con TPN la mortalidad fue menor, con mayores tasas de cierre parietal definitivo 74 , y, en los análisis de regresión logística, la probabilidad de sobrevida fue tres veces mayor.…”

Section: -2017unclassified

Manejo Del Abdomen Abierto: Desde La Operación Inicial Al Cierre Definitivo

Latif¹

2017

Rev Argent Cirug

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“…The presence of abdominal burns may pose specific challenges to the management of the open abdomen with regard to infectious complications. The presence of significant protein loss via an open abdomen needs to be considered [26]. Early enteral and/or parenteral nutrition is of the utmost importance in these hypercatabolic patients, although recent literature results may advocate the opposite in ICU patients [27].…”

Section: Management Of Iah and Acs In Burn Patientsmentioning

confidence: 99%

Intra-abdominal hypertension and abdominal compartment syndrome in burns, obesity, pregnancy, and general medicine

Malbrain¹,

Keulenaer²,

Oda³

et al. 2015

Anaesthesiol Intensive Ther

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Intra-abdominal hypertension (IAH) is an important contributor to early organ dysfunction in trauma and sepsis. However, relatively little is known about the impact of intra-abdominal pressure (IAP) in general internal medicine, pregnant patients, and those with obesity or burns. The aim of this paper is to review the pathophysiologic implications and treatment options for IAH in these specific situations. A MEDLINE and PubMed search was performed and the resulting body-of-evidence included in the current review on the basis of relevance and scientific merit. There is increasing awareness of the role of IAH in different clinical situations. Specifically, IAH will develop in most (if not all) severely burned patients, and may contribute to early mortality. One should avoid over-resuscitation of these patients with large volumes of fluids, especially crystalloids. Acute elevations in IAP have similar effects in obese patients compared to non-obese patients, but the threshold IAP associated with organ dysfunction may be higher. Chronic elevations in IAP may, in part, be responsible for the pathogenesis of obesity-related co-morbid conditions such as hypertension, pseudotumor cerebri, pulmonary dysfunction, gastroesophageal reflux disease, and abdominal wall hernias. At the bedside, measuring IAP and considering IAH in all critical maternal conditions is essential, especially in preeclampsia/eclampsia where some have hypothesized that IAH may have an additional role. IAH in pregnancy must take into account the precautions for aorto-caval compression and has been associated with ovarian hyperstimulation syndrome. Recently, IAP has been associated with the cardiorenal dilemma and hepatorenal syndrome, and this has led to the recognition of the polycompartment syndrome. In conclusion, IAH and ACS have been associated with several patient populations beyond the classical ICU, surgical, and trauma patients. In all at risk conditions the focus should be on the early recognition of IAH and prevention of ACS. Patients at risk for IAH should be identified early through measurements of IAP. Appropriate actions should be taken when IAP increases above 15 mm Hg, especially if pressures reach above 20 mm Hg with new onset organ failure. Although non-operative measures come first, surgical decompression must not be delayed if these fail. Percutaneous drainage of ascites is a simple and potentially effective tool to reduce IAP if organ dysfunction develops, especially in burn patients. Escharotomy may also dramatically reduce IAP in the case of abdominal burns.

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Nitrogen balance, protein loss, and the open abdomen*

Cited by 161 publications

References 15 publications

Role of nutritional intervention in negative pressure wound therapy (NPWT). Case report of patient treated by 'open abdomen' method.

Role of nutritional intervention in negative pressure wound therapy (NPWT). Case report of patient treated by 'open abdomen' method.

Manejo Del Abdomen Abierto: Desde La Operación Inicial Al Cierre Definitivo

Intra-abdominal hypertension and abdominal compartment syndrome in burns, obesity, pregnancy, and general medicine

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