Early Enteral Nutrition Improves Outcomes of Open Abdomen in Gastrointestinal Fistula Patients Complicated With Severe Sepsis

Yuan, Yujie; Ren, Jianan; Gu, Guosheng; Chen, Jun; Li, Jieshou

doi:10.1177/0884533611426148

Cited by 42 publications

(30 citation statements)

References 26 publications

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“…The most serious complication associated with open abdomen therapy is gastrointestinal fistula [51]. Other complications, such as wound infection, intra-abdominal abscess, and recurrent hernia, are commonly reported.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Outcomes between Early Fascial Closure and Delayed Abdominal Closure in Patients with Open Abdomen: A Systematic Review and Meta-Analysis

Chen

et al. 2014

Gastroenterology Research and Practice

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Up to the present, the optimal time to close an open abdomen remains controversial. This study was designed to evaluate whether early fascial abdominal closure had advantages over delayed approach for open abdomen populations. Medline, Embase, and Cochrane Library were searched until April 2013. Search terms included “open abdomen,” “abdominal compartment syndrome,” “laparostomy,” “celiotomy,” “abdominal closure,” “primary,” “delayed,” “permanent,” “fascial closure,” and “definitive closure.” Open abdomen was defined as “fail to close abdominal fascia after a laparotomy.” Mortality, complications, and length of stay were compared between early and delayed fascial closure. In total, 3125 patients were included for final analysis, and 1942 (62%) patients successfully achieved early fascial closure. Vacuum assisted fascial closure had no impact on pooled fascial closure rate. Compared with delayed abdominal closure, early fascial closure significantly reduced mortality (12.3% versus 24.8%, RR, 0.53, P < 0.0001) and complication incidence (RR, 0.68, P < 0.0001). The mean interval from open abdomen to definitive closure ranged from 2.2 to 14.6 days in early fascial closure groups, but from 32.5 to 300 days in delayed closure groups. This study confirmed clinical advantages of early fascial closure over delayed approach in treatment of patients with open abdomen.

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Section: Discussionmentioning

confidence: 99%

Comparison of Outcomes between Early Fascial Closure and Delayed Abdominal Closure in Patients with Open Abdomen: A Systematic Review and Meta-Analysis

Chen

et al. 2014

Gastroenterology Research and Practice

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“…A recent multi-institutional study demonstrated that EN after an open abdomen was associated with increased fascial closure rates, reduced complications rates, and improved mortality [53]. Besides, early EN could now be delivered successfully via various approaches in patients with IAI, with reduced fistula formation and improved mortality rates [54, 55]. This early initiation of enteral feeding was reported to be an independent predictor of successful fascial closure in OA patients complicated with intestinal fistula [45].…”

Section: The Open Abdomen In Treatment Of Intra-abdominal Infectionmentioning

confidence: 99%

Current Status of the Open Abdomen Treatment for Intra-Abdominal Infection

Yuan

Ren

2013

Gastroenterology Research and Practice

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The open abdomen has become an important approach for critically ill patients who require emergent abdominal surgical interventions. This treatment, originating from the concept of damage control surgery, was first applied in severe traumatic patients. The ultimate goal is to achieve formal abdominal fascial closure by several attempts and adjuvant therapies (fluid management, nutritional support, skin grafting, etc.). Up to the present, open abdomen therapy becomes matured and is multistage-approached in the management of patients with severe trauma. However, its application in patients with intra-abdominal infection still presents great challenges due to critical complications and poor clinical outcomes. This review focuses on the specific use of the open abdomen in such populations and detailedly introduces current concerns and advanced progress about this therapy.

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“…Individualizing the nutritional management plan in terms of caloric and protein requirements and feeding route has been recommended in several studies 6,11,24…”

Section: Discussionmentioning

confidence: 99%

Nutritional management of enterocutaneous fistula: a retrospective study at a Malaysian university medical center

Badrasawi¹,

Shahar²,

Sagap³

2014

JMDH

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Enterocutaneous fistula is a challenging clinical condition with serious complications and considerable morbidity and mortality. Early nutritional support has been found to decrease these complications and to improve the clinical outcome. Location of the fistula and physiological status affect the nutrition management plan in terms of feeding route, calories, and protein requirements. This study investigated the nutritional management procedures at the Universiti Kebangsaan Malaysia Medical Center, and attempted to determine factors that affect the clinical outcome. Nutritional management was evaluated retrospectively in 22 patients with enterocutaneous fistula seen over a 5-year period. Medical records were reviewed to obtain data on nutritional status, biochemical indices, and route and tolerance of feeding. Calories and protein requirements are reported and categorized. The results show that surgery was the predominant etiology and low output fistula was the major physiological category; anatomically, the majority were ileocutaneous. The spontaneous healing rate was 14%, the total healing rate was 45%, and the mortality rate was 22%, with 14% due to fistula-associated complications. There was a significant relationship between body mass index/serum albumin levels and fistula healing; these parameters also had a significant relationship with mortality. Glutamine was used in 50% of cases; however, there was no significant relationship with fistula healing or mortality rate. The nutritional status of the patient has an important impact on the clinical outcome. Conservative management that includes nutrition support is very important in order to improve nutritional status before surgical repair of the fistula.

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Early Enteral Nutrition Improves Outcomes of Open Abdomen in Gastrointestinal Fistula Patients Complicated With Severe Sepsis

Abstract: Nutrition therapy plays an important role in the management of gastrointestinal fistula with severe sepsis. Early EN could be successfully delivered for that population, with improved mortality risk.

Cited by 42 publications

References 26 publications

Comparison of Outcomes between Early Fascial Closure and Delayed Abdominal Closure in Patients with Open Abdomen: A Systematic Review and Meta-Analysis

Comparison of Outcomes between Early Fascial Closure and Delayed Abdominal Closure in Patients with Open Abdomen: A Systematic Review and Meta-Analysis

Current Status of the Open Abdomen Treatment for Intra-Abdominal Infection

Nutritional management of enterocutaneous fistula: a retrospective study at a Malaysian university medical center

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