Who should we feed? A Western Trauma Association multi-institutional study of enteral nutrition in the open abdomen after injury

Clay Cothren Burlew, Ernest E. Moore, Joseph Cuschieri, Gregory J. Jurkovich, Panna Codner, Ram Nirula, D. Millar, Mitchell J. Cohen, Matthew E. Kutcher, James Haan, Heather G. MacNew, M. Gage Ochsner, Susan Rowell, Michael S. Truitt, Forrest O. Moore, Fredric M. Pieracci, Krista L. Kaups

    Research output: Contribution to journalArticle

    50 Citations (Scopus)

    Abstract

    BACKGROUND: The open abdomen is a requisite component of a damage control operation and treatment of abdominal compartment syndrome. Enteral nutrition (EN) has proven beneficial for patients with critical injury, but its application in those with an open abdomen has not been defined. The purpose of this study was to analyze the use of EN for patients with an open abdomen after trauma and the effect of EN on fascial closure rates and nosocomial infections. METHODS: We reviewed patients with an open abdomen after injury from January 2002 to January 2009 from 11 trauma centers. RESULTS: During the 7-year study period, 597 patients required an open abdomen after trauma. Most were men (77%) sustaining blunt trauma (72%), with a mean (SD) age of 38 (0.7) years, an Injury Severity Score of 31 (0.6), an abdominal injury score of 3.8 (0.1), and an Abdominal Trauma Index score of 26.8 (0.6). Of the patients, 548 (92%) had an open abdomen after a damage control operation, whereas the remainder experienced an abdominal compartment syndrome. Of the 597 patients, 230 (39%) received EN initiated before the closure of the abdomen at mean (SD) day 3.6 (1.2) after injury. EN was started with an open abdomen in one quarter of the 290 patients with bowel injuries. For the 307 patients without a bowel injury, logistic regression indicated that EN is associated with higher fascial closure rates (odds ratio [OR], 5.3; p G 0.01), decreased complication rates (OR, 0.46; p = 0.02), and decreased mortality (OR, 0.30; p = 0.01). For the 290 patients who experienced a bowel injury, regression analysis showed no significant association between EN and fascial closure rate (OR, 0.6; p = 0.2), complication rate (OR, 1.7; p = 0.19), or mortality (OR, 0.79; p = 0.69). CONCLUSION: EN in the open abdomen after injury is feasible. For patients without a bowel injury, EN in the open abdomen is associated with increased fascial closure rates, decreased complication rates, and decreased mortality. EN should be initiated in these patients once resuscitation is completed. Although EN for patients with bowel injuries did not seem to affect the outcome in this study, prospective randomized controlled trials would further clarify the role of EN in this subgroup.

    Original languageEnglish (US)
    Pages (from-to)1380-1387
    Number of pages8
    JournalJournal of Trauma and Acute Care Surgery
    Volume73
    Issue number6
    DOIs
    StatePublished - Dec 2012

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    Enteral Nutrition
    Abdomen
    Wounds and Injuries
    Odds Ratio
    Intra-Abdominal Hypertension
    Mortality
    Abdominal Injuries
    Injury Severity Score
    Trauma Centers
    Cross Infection
    Resuscitation
    Randomized Controlled Trials
    Logistic Models
    Regression Analysis
    Outcome Assessment (Health Care)

    Keywords

    • abdominal compartment syndrome
    • damage control operation
    • enteral nutrition
    • Open abdomen

    ASJC Scopus subject areas

    • Critical Care and Intensive Care Medicine
    • Surgery

    Cite this

    Who should we feed? A Western Trauma Association multi-institutional study of enteral nutrition in the open abdomen after injury. / Burlew, Clay Cothren; Moore, Ernest E.; Cuschieri, Joseph; Jurkovich, Gregory J.; Codner, Panna; Nirula, Ram; Millar, D.; Cohen, Mitchell J.; Kutcher, Matthew E.; Haan, James; MacNew, Heather G.; Ochsner, M. Gage; Rowell, Susan; Truitt, Michael S.; Moore, Forrest O.; Pieracci, Fredric M.; Kaups, Krista L.

    In: Journal of Trauma and Acute Care Surgery, Vol. 73, No. 6, 12.2012, p. 1380-1387.

    Research output: Contribution to journalArticle

    Burlew, CC, Moore, EE, Cuschieri, J, Jurkovich, GJ, Codner, P, Nirula, R, Millar, D, Cohen, MJ, Kutcher, ME, Haan, J, MacNew, HG, Ochsner, MG, Rowell, S, Truitt, MS, Moore, FO, Pieracci, FM & Kaups, KL 2012, 'Who should we feed? A Western Trauma Association multi-institutional study of enteral nutrition in the open abdomen after injury', Journal of Trauma and Acute Care Surgery, vol. 73, no. 6, pp. 1380-1387. https://doi.org/10.1097/TA.0b013e318259924c
    Burlew, Clay Cothren ; Moore, Ernest E. ; Cuschieri, Joseph ; Jurkovich, Gregory J. ; Codner, Panna ; Nirula, Ram ; Millar, D. ; Cohen, Mitchell J. ; Kutcher, Matthew E. ; Haan, James ; MacNew, Heather G. ; Ochsner, M. Gage ; Rowell, Susan ; Truitt, Michael S. ; Moore, Forrest O. ; Pieracci, Fredric M. ; Kaups, Krista L. / Who should we feed? A Western Trauma Association multi-institutional study of enteral nutrition in the open abdomen after injury. In: Journal of Trauma and Acute Care Surgery. 2012 ; Vol. 73, No. 6. pp. 1380-1387.
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    abstract = "BACKGROUND: The open abdomen is a requisite component of a damage control operation and treatment of abdominal compartment syndrome. Enteral nutrition (EN) has proven beneficial for patients with critical injury, but its application in those with an open abdomen has not been defined. The purpose of this study was to analyze the use of EN for patients with an open abdomen after trauma and the effect of EN on fascial closure rates and nosocomial infections. METHODS: We reviewed patients with an open abdomen after injury from January 2002 to January 2009 from 11 trauma centers. RESULTS: During the 7-year study period, 597 patients required an open abdomen after trauma. Most were men (77{\%}) sustaining blunt trauma (72{\%}), with a mean (SD) age of 38 (0.7) years, an Injury Severity Score of 31 (0.6), an abdominal injury score of 3.8 (0.1), and an Abdominal Trauma Index score of 26.8 (0.6). Of the patients, 548 (92{\%}) had an open abdomen after a damage control operation, whereas the remainder experienced an abdominal compartment syndrome. Of the 597 patients, 230 (39{\%}) received EN initiated before the closure of the abdomen at mean (SD) day 3.6 (1.2) after injury. EN was started with an open abdomen in one quarter of the 290 patients with bowel injuries. For the 307 patients without a bowel injury, logistic regression indicated that EN is associated with higher fascial closure rates (odds ratio [OR], 5.3; p G 0.01), decreased complication rates (OR, 0.46; p = 0.02), and decreased mortality (OR, 0.30; p = 0.01). For the 290 patients who experienced a bowel injury, regression analysis showed no significant association between EN and fascial closure rate (OR, 0.6; p = 0.2), complication rate (OR, 1.7; p = 0.19), or mortality (OR, 0.79; p = 0.69). CONCLUSION: EN in the open abdomen after injury is feasible. For patients without a bowel injury, EN in the open abdomen is associated with increased fascial closure rates, decreased complication rates, and decreased mortality. EN should be initiated in these patients once resuscitation is completed. Although EN for patients with bowel injuries did not seem to affect the outcome in this study, prospective randomized controlled trials would further clarify the role of EN in this subgroup.",
    keywords = "abdominal compartment syndrome, damage control operation, enteral nutrition, Open abdomen",
    author = "Burlew, {Clay Cothren} and Moore, {Ernest E.} and Joseph Cuschieri and Jurkovich, {Gregory J.} and Panna Codner and Ram Nirula and D. Millar and Cohen, {Mitchell J.} and Kutcher, {Matthew E.} and James Haan and MacNew, {Heather G.} and Ochsner, {M. Gage} and Susan Rowell and Truitt, {Michael S.} and Moore, {Forrest O.} and Pieracci, {Fredric M.} and Kaups, {Krista L.}",
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    TY - JOUR

    T1 - Who should we feed? A Western Trauma Association multi-institutional study of enteral nutrition in the open abdomen after injury

    AU - Burlew, Clay Cothren

    AU - Moore, Ernest E.

    AU - Cuschieri, Joseph

    AU - Jurkovich, Gregory J.

    AU - Codner, Panna

    AU - Nirula, Ram

    AU - Millar, D.

    AU - Cohen, Mitchell J.

    AU - Kutcher, Matthew E.

    AU - Haan, James

    AU - MacNew, Heather G.

    AU - Ochsner, M. Gage

    AU - Rowell, Susan

    AU - Truitt, Michael S.

    AU - Moore, Forrest O.

    AU - Pieracci, Fredric M.

    AU - Kaups, Krista L.

    PY - 2012/12

    Y1 - 2012/12

    N2 - BACKGROUND: The open abdomen is a requisite component of a damage control operation and treatment of abdominal compartment syndrome. Enteral nutrition (EN) has proven beneficial for patients with critical injury, but its application in those with an open abdomen has not been defined. The purpose of this study was to analyze the use of EN for patients with an open abdomen after trauma and the effect of EN on fascial closure rates and nosocomial infections. METHODS: We reviewed patients with an open abdomen after injury from January 2002 to January 2009 from 11 trauma centers. RESULTS: During the 7-year study period, 597 patients required an open abdomen after trauma. Most were men (77%) sustaining blunt trauma (72%), with a mean (SD) age of 38 (0.7) years, an Injury Severity Score of 31 (0.6), an abdominal injury score of 3.8 (0.1), and an Abdominal Trauma Index score of 26.8 (0.6). Of the patients, 548 (92%) had an open abdomen after a damage control operation, whereas the remainder experienced an abdominal compartment syndrome. Of the 597 patients, 230 (39%) received EN initiated before the closure of the abdomen at mean (SD) day 3.6 (1.2) after injury. EN was started with an open abdomen in one quarter of the 290 patients with bowel injuries. For the 307 patients without a bowel injury, logistic regression indicated that EN is associated with higher fascial closure rates (odds ratio [OR], 5.3; p G 0.01), decreased complication rates (OR, 0.46; p = 0.02), and decreased mortality (OR, 0.30; p = 0.01). For the 290 patients who experienced a bowel injury, regression analysis showed no significant association between EN and fascial closure rate (OR, 0.6; p = 0.2), complication rate (OR, 1.7; p = 0.19), or mortality (OR, 0.79; p = 0.69). CONCLUSION: EN in the open abdomen after injury is feasible. For patients without a bowel injury, EN in the open abdomen is associated with increased fascial closure rates, decreased complication rates, and decreased mortality. EN should be initiated in these patients once resuscitation is completed. Although EN for patients with bowel injuries did not seem to affect the outcome in this study, prospective randomized controlled trials would further clarify the role of EN in this subgroup.

    AB - BACKGROUND: The open abdomen is a requisite component of a damage control operation and treatment of abdominal compartment syndrome. Enteral nutrition (EN) has proven beneficial for patients with critical injury, but its application in those with an open abdomen has not been defined. The purpose of this study was to analyze the use of EN for patients with an open abdomen after trauma and the effect of EN on fascial closure rates and nosocomial infections. METHODS: We reviewed patients with an open abdomen after injury from January 2002 to January 2009 from 11 trauma centers. RESULTS: During the 7-year study period, 597 patients required an open abdomen after trauma. Most were men (77%) sustaining blunt trauma (72%), with a mean (SD) age of 38 (0.7) years, an Injury Severity Score of 31 (0.6), an abdominal injury score of 3.8 (0.1), and an Abdominal Trauma Index score of 26.8 (0.6). Of the patients, 548 (92%) had an open abdomen after a damage control operation, whereas the remainder experienced an abdominal compartment syndrome. Of the 597 patients, 230 (39%) received EN initiated before the closure of the abdomen at mean (SD) day 3.6 (1.2) after injury. EN was started with an open abdomen in one quarter of the 290 patients with bowel injuries. For the 307 patients without a bowel injury, logistic regression indicated that EN is associated with higher fascial closure rates (odds ratio [OR], 5.3; p G 0.01), decreased complication rates (OR, 0.46; p = 0.02), and decreased mortality (OR, 0.30; p = 0.01). For the 290 patients who experienced a bowel injury, regression analysis showed no significant association between EN and fascial closure rate (OR, 0.6; p = 0.2), complication rate (OR, 1.7; p = 0.19), or mortality (OR, 0.79; p = 0.69). CONCLUSION: EN in the open abdomen after injury is feasible. For patients without a bowel injury, EN in the open abdomen is associated with increased fascial closure rates, decreased complication rates, and decreased mortality. EN should be initiated in these patients once resuscitation is completed. Although EN for patients with bowel injuries did not seem to affect the outcome in this study, prospective randomized controlled trials would further clarify the role of EN in this subgroup.

    KW - abdominal compartment syndrome

    KW - damage control operation

    KW - enteral nutrition

    KW - Open abdomen

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