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Open Abdomen pp 187-204 | Cite as

Nutritional Support in Patients with an Open Abdomen

  • Patricia Marie Byers
  • Andrew B. Peitzman
Chapter
Part of the Hot Topics in Acute Care Surgery and Trauma book series (HTACST)

Abstract

Nutritional support has evolved over the last 50 years with improvements in line care, enteral access, enteral formulas, and intestinal rehabilitation, which has occurred in conjunction with major advances in critical care and operative management of surgical emergencies. The utilization of the open abdomen in cases of damage control surgery and for treatment of abdominal compartment syndrome has been a paradigm shift. Although the open abdomen was initially popularized in trauma patients, it is now commonly applied in burn patients and patients with catastrophic operative emergencies. Nutritional support of these patients is extremely challenging, and a standardized approach remains elusive. Several retrospective and prospective studies have demonstrated that early enteral feedings benefit this population, but there is no consensus on how to proceed if this therapy fails (Burlew et al., J Trauma Acute Care Surg 73:1380–1387, 2012; Moore and Burlew, Nutr Clin Pract 31:9–13, 2016; Collier et al., J Parenter Enter Nutr 31:410–415, 2007; Dissanaike et al., J Am Coll Surg 31:410–415, 2008; Byrnes et al., Am J Surg 199:359–362, 2010). Recent publications on nutritional support in ICU patients have reported increased mortality and complications in patients treated with aggressive nutritional support, while others have reported these same adverse events in patients who developed progressive caloric and protein deficits (Weijs et al., J Parenter Enter Nutr 36:60–68, 2012; Singer et al., Intensive Care Med 37:601–609, 2011; Caesar et al., N Engl J Med 365:506–517, 2011; Heiddegger et al., Lancet 381:385–393, 2013).

To develop an effective clinical approach in this patient population, this conflicting literature must be placed in perspective. Older studies and those across mixed intensive care units, age groups, and disease processes must be interpreted carefully. This most challenging patient population requires a customized approach due to the variability that has been noted in these patients (Burlew et al., J Trauma Acute Care Surg 73:1380–1387, 2012). Nutrition support must be managed and titrated, similar to other critical interventions, such as pressor support and ventilator therapy.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Dewitt Daughtry Department of SurgeryUniversity of Miami Miller School of MedicineMiamiUSA
  2. 2.Department of SurgeryUniversity of Pittsburgh School of MedicinePittsburghUSA

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