Nutritional Management of Patients With Enterocutaneous Fistulas: Practice and Progression

Tang, Qin-qing; Hong, Zhiwu; Ren, Huajian; Wu, Lei; Wang, Gefei; Gu, Guosheng; Chen, Jun; Zheng, Tao; Wu, Xiuwen; Ren, Jianan; Li, Jieshou

doi:10.3389/fnut.2020.564379

Cited by 19 publications

(30 citation statements)

References 70 publications

(69 reference statements)

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“…In this study, the refeeding strategy was performed on the basis of sepsis. As one of the most common critical illnesses in the ICU, sepsis and sepsisassociated nutritional management remain a difficult problem to solve (25). The pathology of lung injury and elevated plasma TNF-α, IL-1β, IL-6, and MPO demonstrated that our sepsis model was well-constructed.…”

Section: Discussionmentioning

confidence: 99%

SIRT3-mediated mitochondrial autophagy in refeeding syndrome-related myocardial injury in sepsis rats

Li¹,

Lu²,

Zhang³

et al. 2022

Ann Transl Med

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Background: Myocardial injury induced by refeeding syndrome (RFS) is one of the important causes of deterioration in critically ill patients. Sirtuin-3 (SIRT3) has been shown to regulate mitochondrial autophagy in myocardial ischemia/reperfusion injury; however, the role of mitochondrial autophagy on RFS-related myocardial injury in patients in critical condition has not been reported on.Methods: Thirty Sprague-Dawley (SD) rats were divided into 3 groups (n=10 each group): the control group; the standard calorie refeeding (SCR) group; and the low calorie refeeding (LCR) group. The rats were weighed every third or four days from day 1 to day 14. On day 14, all rats were anesthetized and received an echocardiography test. Blood and bronchoalveolar lavage fluid (BALF) were collected and tested for arterial oxygen pressure (PaO 2 ), phosphorus (P), and calcium (Ca), creatine kinase-MB (CK-MB), lactate dehydrogenase (LDH), and cardiac troponin 1 (cTnI), myeloperoxidase (MPO), tumor necrosis factor α (TNF-α), interleukin-1β (IL-1β), and IL-6. The histopathological change of hearts and lungs were evaluated, and lung injury score was calculated. Mitochondrial autophagy related proteins (including Beclin1, LC3, mitofusin-2, Mfn2, PINK1, Parkin, and SIRT3) were analyzed using a Western blot. To evaluate the effect of SIRT3, 20 rats were divided into 2 groups (n=10 each group): The adeno-associated virus 9 (AAV9-Nc) group; and the AAV9-SIRT3 overexpression (AAV9-SIRT3) group. The protocols for rats were the same as the SCR group since day 22 after injection of AAV9. The protein expressions of PINK1, Parkin, and SIRT3 were compared between the AAV9-Nc group and AAV9-SIRT3 group.Results: SCR caused significant decline in cardiac contractility and increased inflammatory cell infiltration in myocardial tissue. Meanwhile, Beclin1, LC3, PINK1, Parkin, and SIRT3 levels decreased, while Mfn2 showed no significant change. Furthermore, significant positive correlations were also found between SIRT3 and P, PINK1, and Parkin, and significant negative correlations were found between SIRT3 and CK-MB, LDH, and cTnI. Overexpression of SIRT3 activated the PINK1/Parkin mediated mitochondrial autophagy.Conclusions: SIRT3 has an essential role in RFS-related myocardial injury during LPS induced chronic sepsis in rats, probably via regulating mitochondrial autophagy.

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Section: Discussionmentioning

confidence: 99%

SIRT3-mediated mitochondrial autophagy in refeeding syndrome-related myocardial injury in sepsis rats

Li¹,

Lu²,

Zhang³

et al. 2022

Ann Transl Med

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“…TPN or enteral nutrition is one among the corroborative cares to stop subsequent malnutrition and dyselectrolytemia. 21,22 Gastrointestinal secretions decrease by 30-50 percent in patients getting TPN thus helping in fistula closure.…”

Section: Enteral Versus Parenteral Feedingmentioning

confidence: 99%

“…TPN or enteral nutrition is one among the corroborative cares to stop subsequent malnutrition and dyselectrolytemia. 21 , 22 …”

Section: Enteral Versus Parenteral Feedingmentioning

confidence: 99%

Management of Enterocutaneous Fistula: A Review

Ghimire

2022

J Nepal Med Assoc

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Enterocutaneous fistula is any communication between bowel and skin or atmosphere outside the body. It can be classified by various means by etiology, organ of origin, etc. Enterocutaneous fistula can occur after any gastrointestinal surgery where there is some trauma during surgery or other associated causes such as malignancy, inflammatory bowel disease, foreign body, etc. Enterocutaneous fistula needs a multidisciplinary approach as its management is a very tedious and complex process. Sepsis, malnutrition, and dyselectrolytemia are three key factors during the management of enterocutaneous fistula, so these should be properly addressed for better and efficient outcomes. There is excess fistula effluent which should be replaced adequately in high output fistula. The nutrition of the patient plays a vital role in the success of enterocutaneous fistula management so if the patient can tolerate oral or enteral feeding should be commenced as soon as possible otherwise parenteral nutrition should be advised. Wound care should be done aggressively, proper skincare, timely drainage of any localised abscesses should be done. Patients should be properly resuscitated and stabilised before any definitive investigations and management. Surgical therapy can be staged and should not be rushed which results in failure of this complex disease process.

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“…An enterocutaneous fistula (ECF) is an abnormal connection between the gastrointestinal tract and the skin or atmosphere (enteroatmospheric fistula [1] [EAF]) .Estimated 75-85% are iatrogenic, occur after an abdominal surgery.…”

Section: Introductionmentioning

confidence: 99%

“…There are several ways in which ECF has been classified, including by output, etiology, and source [1,2,3]. Most often, a high-output ECF is characterized as one with >500 mL/24 hours, low output <200 mL/24 hours, and a moderate output fistula between 200 and 500 mL/24 hours [1]. Historical reported mortality rates as high as 10-30%.…”

Section: Introductionmentioning

confidence: 99%

Enterocutaneous fistula; Management Challenges,Areterospective Review of 11 Patients Treated in our Institute

Ishaq¹,

Khan²,

Khan³

et al. 2021

JCLR

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Enterocutaneous fistula is a local pathology and systemic disorder. OBJECTIVES: To analyze postoperative outcomes, morbidity, and mortality in patients treated for enterocutaneous fistula in our institute for past 18 months. DESIGN, SETINGS AND PATIENTS: Reterospective review of records of patients presented to Liaquat national university hospital Karachi, Pakistan between Jan 2010 to June 2011 with diagnosis of EC fistula. RESULTS: A total of eleven patients presented with diagnosis of enterocutaneous fistula in our institute in specified duration. Mean age at presentation was 33 years with amle to female ratio of 3:1.72.7 % had high output fistula and 27.2 % had low output fistula. Small bowel was involved in 72.7%, large bowel in 18.18% and 9.0% had both small and large bowel fistula.45.45% patients had single fistula while 54.55 had multiple fistula. Total length of stay varied between 22-150 days .6/11 (54.54%) had nosocomial infection, 3/11(27.27%) had bed sores.2/11(18.18%) had TPN related complications.Spontaneous closure occurred in 8/11(72.77) patients and definitive surgical closure was performed in one patient. Mortality rate was 18.8 %. CONCLUSION: Enterocutaneous fistula is a devastating outcome for both surgeons and patients, sytemetic timely multidisciplinary approach can save lives.

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Nutritional Management of Patients With Enterocutaneous Fistulas: Practice and Progression

Cited by 19 publications

References 70 publications

SIRT3-mediated mitochondrial autophagy in refeeding syndrome-related myocardial injury in sepsis rats

SIRT3-mediated mitochondrial autophagy in refeeding syndrome-related myocardial injury in sepsis rats

Management of Enterocutaneous Fistula: A Review

Enterocutaneous fistula; Management Challenges,Areterospective Review of 11 Patients Treated in our Institute

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