Redefining “bowel regimen”: Pharmacologic strategies and nutritional considerations in the management of small bowel fistulas

Parli, Sara E.; Pfeifer, Carolyn; Oyler, Douglas R.; Magnuson, Barbara; Procter, Levi

doi:10.1016/j.amjsurg.2018.01.040

Cited by 13 publications

(25 citation statements)

References 55 publications

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“…The effluent nature and output probability are highly correlated to the anatomic region. Low, moderate, and high output fistula are generally defined as <200 mL/day, 200–500 mL/day, and >500 mL/ day, respectively ( 14 ). Low-output fistula has a higher likelihood of spontaneous closure, and a portion of patients with ECF will heal spontaneously with appropriate nutritional support and wound care ( 15 ).…”

Section: Clinical Management Of Ecfmentioning

confidence: 99%

“…ECF patients often develop malnutrition during their medical treatment and nutritional support plays a vital role. Correcting and preventing further malnutrition is a clinical challenge for multidisciplinary medical teams and patients ( 14 ). In 1978, Prof. Jie-shou Li of Jingling Hospital put forward the principle of nutritional support for patients with ECF, which is giving enteral nutrition priority, supplemented by parenteral nutrition ( 19 ).…”

Section: Nutritional Management Of Ecfmentioning

confidence: 99%

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Nutritional Management of Patients With Enterocutaneous Fistulas: Practice and Progression

et al. 2020

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The management of enterocutaneous fistulas (ECF) can be challenging because of massive fluid loss, which can lead to electrolyte imbalance, severe dehydration, malnutrition and sepsis. Nutritional support plays a key role in the management and successful closure of ECF. The principle of nutritional support for patients with ECF should be giving enteral nutrition (EN) priority, supplemented by parenteral nutrition if necessary. Although total parenteral nutrition (TPN) may be indicated, use of enteral feeding should be advocated as early as possible if patients are tolerant to it, which can protect gut mucosal barrier and prevent bacterial translocation. A variety of methods of enteral nutrition have been developed such as fistuloclysis and relay perfusion. ECF can also be occluded by special devices and then EN can be implemented, including fibrin glue application, Over-The-Scope Clip placement and three-dimensional (3D)-printed patient-personalized fistula stent implantation. However, those above should not be conducted in acute fistulas, because tissues are edematous and perforation could easily occur.

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Section: Clinical Management Of Ecfmentioning

confidence: 99%

Section: Nutritional Management Of Ecfmentioning

confidence: 99%

Nutritional Management of Patients With Enterocutaneous Fistulas: Practice and Progression

et al. 2020

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“…26,30 To maintain a positive nitrogen balance, stimulate wound healing, and replenish protein stores in those with a high-output ECF, 1.5-2.5 grams of protein per kilogram daily is recommended. 32,33 This recommendation is a significant increase compared with the healthy adult requirements of 0.8 g/kg/day protein. Several studies have also examined the estimated protein losses from effluent output.…”

Section: Macronutrient Requirementsmentioning

confidence: 99%

“…If the anatomical assessment determines there is at least 60-100 cm of nonobstructed, healthy small bowel remaining with an intact ICV and colon, thereby allowing for adequate absorption, then an EN access route may be selected. 33 For patients with a distal fistula, a gastric or duodenal feeding tube is likely adequate. These patients may adapt and tolerate an oral diet and/or EN and never require PN initiation.…”

Section: Enteral Accessmentioning

confidence: 99%

“…Studies have failed to show benefit to fluid and electrolyte balance, and it is not recommended to implement SERS in practice. 33 The benefits of fistuloclysis include the prevention of bowel atrophy for future ECF repairs and the minimization or elimination of PN support. A UK IF unit implemented fistuloclysis in 12 patients with an average of >500 mL of jejunocutaneous and ileocutaneous fistula output.…”

Section: Enteral Accessmentioning

confidence: 99%

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Nutrition Management of the High‐Output Fistulae

et al. 2020

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Enterocutaneous fistulae (ECFs) are commonly encountered complications in medical and surgical practice. High-output fistulae are associated with significant morbidity and mortality, poor quality of life, and a substantial healthcare burden. An interdisciplinary team approach is crucial to prevent and mitigate the adverse clinical consequences of high-output ECFs including sepsis, metabolic derangements, and malnutrition. Patients with ECFs are at a significantly higher risk of developing malnutrition and close monitoring by nutrition support professionals and/or a nutrition support team is an essential component of their medical management. High-output ECFs often require the initiation of nutrition support through either enteral or parenteral routes. Historically, parenteral nutrition (PN) has been the primary method of nutrition support in these patients. However, oral and enteral nutrition (EN) should remain viable options if an evaluation of the location of the ECF, amount of remaining functional bowel, and volume of ECF output identifies favorable conditions. Additionally, in contrast to PN, oral nutrition and EN are the preferred method of feeding because of the maintenance of the structural and functional integrity of the gastrointestinal tract. The inclusion of pharmacological interventions can greatly assist with the reduction and stabilization of ECF output and thereby permit sustained enteral feeding. Initiation of supplemental or full PN will be required if oral nutrition and EN lead to metabolic derangements, fail to meet energy requirements, or do not maintain or improve the patient's nutrition status. The main focus of this review is to discuss the nutrition management of patients with high-output ECFs.

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Exploration of critical care nurses' challenges in caring for enterocutaneous fistula as a complication for an open abdomen: A qualitative study

Chipu,

Kearns,

Modula

2024

Health Science Reports

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Background and AimsEnterocutaneous fistula is a severe complication of an open abdomen, which poses devastating challenges for critical care nurses. The study aimed to explore and describe the challenges faced by critical care nurses caring for patients with enterocutaneous fistulas in a tertiary public hospital in Gauteng, South Africa.MethodsA qualitative, exploratory, descriptive, and contextual design was conducted to understand the challenges experienced by the critical care nurses caring for patients with enterocutaneous fistulas. The standards for reporting qualitative research checklists are utilized. The study conducted four semistructured focus group interviews with six members in each group.ResultsCritical care nurses revealed two overarching themes: the challenges regarding difficult nursing care and the lack of resources to provide quality patient care. Care of patients with ECF highlighted that nurses were not coping with the care of such patients.ConclusionCollaboration of a multidisciplinary team involving dieticians, surgeons, and enterostomal therapy nurses could improve the management of ECF without surgical intervention, increase the knowledge and skills of nurses, alleviate their challenges, and yield safe patient outcomes. Standardized and updated protocols will ensure the best practices toward quality patient care that facilitate healing, closure, and reducing mortality and morbidity rates. The key principles for caring for patients with open abdomen, presenting with enterocutaneous fistulas, are based on correcting fluids and electrolytes, nutritional optimization and support, control of abdominal sepsis, wound care management, pain control, and emotional support to critical care nurses and ward nurses.

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Redefining “bowel regimen”: Pharmacologic strategies and nutritional considerations in the management of small bowel fistulas

Cited by 13 publications

References 55 publications

Nutritional Management of Patients With Enterocutaneous Fistulas: Practice and Progression

Nutritional Management of Patients With Enterocutaneous Fistulas: Practice and Progression

Nutrition Management of the High‐Output Fistulae

Exploration of critical care nurses' challenges in caring for enterocutaneous fistula as a complication for an open abdomen: A qualitative study

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