Nonocclusive bowel necrosis occurring in critically ill trauma patients receiving enteral nutrition manifests no reliable clinical signs for early detection

Robert G. Marvin, Bruce A. McKinley, Margaret McQuiggan, Christine S Cocanour, Frederick A. Moore

Research output: Contribution to journalArticle

112 Citations (Scopus)

Abstract

Background: Nonocclusive bowel necrosis (NOBN) has been associated with early enteral nutrition (EN). The purpose of this study was to determine the incidence of this complication in our trauma intensive care unit population and to define a typical patient profile vulnerable to NOBN. Methods: Thirteen cases of NOBN were identified among 4,311 patients (0.3%) over a 64-month period ending October 1998. Their charts were analyzed for a variety of clinical data, including prospective EN tolerance data in 4. Results: Twelve (92%) patients were enterally fed prior to diagnosis for 10 ± 8 days (range 3 to 21). Tachycardia (n = 12, 92%); fever/hypothermia, (n = 12, 92%), and an abnormal white blood cell count (n = 11, 85%) were consistently present. Abdominal distention was common but tended to be a late sign (n = 12). Seven (56%) survived. In 4 patients with tolerance data, 3 reached the goal rate of feeds prior to diagnosis. Two became distended at >12 hours from diagnosis. Gastric tonometry demonstrated a decreased NgpHi (<7.30) after starting EN in all 3 in whom it was monitored. Conclusions: NOBN developed in 0.3% of our trauma patients. Onset occurs in the second week in high-acuity patients who have had a period of EN tolerance. Clinical findings resemble bacterial sepsis with tachycardia, fever, and leukocytosis. Gastrointestinal specific signs are not consistent or occur late. Thus, we could not identify an early, useful clinical indicator. Gastric carbon dioxide tonometry may detect a vulnerable subgroup of patients. (C) 2000 by Excerpta Medica, Inc.

Original languageEnglish (US)
Pages (from-to)7-12
Number of pages6
JournalAmerican Journal of Surgery
Volume179
Issue number1
DOIs
StatePublished - Jan 2000
Externally publishedYes

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Enteral Nutrition
Critical Illness
Necrosis
Wounds and Injuries
Manometry
Tachycardia
Stomach
Fever
Patient Acuity
Leukocytosis
Hypothermia
Leukocyte Count
Carbon Dioxide
Intensive Care Units
Sepsis
Incidence
Population

ASJC Scopus subject areas

  • Surgery

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Nonocclusive bowel necrosis occurring in critically ill trauma patients receiving enteral nutrition manifests no reliable clinical signs for early detection. / Marvin, Robert G.; McKinley, Bruce A.; McQuiggan, Margaret; Cocanour, Christine S; Moore, Frederick A.

In: American Journal of Surgery, Vol. 179, No. 1, 01.2000, p. 7-12.

Research output: Contribution to journalArticle

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abstract = "Background: Nonocclusive bowel necrosis (NOBN) has been associated with early enteral nutrition (EN). The purpose of this study was to determine the incidence of this complication in our trauma intensive care unit population and to define a typical patient profile vulnerable to NOBN. Methods: Thirteen cases of NOBN were identified among 4,311 patients (0.3{\%}) over a 64-month period ending October 1998. Their charts were analyzed for a variety of clinical data, including prospective EN tolerance data in 4. Results: Twelve (92{\%}) patients were enterally fed prior to diagnosis for 10 ± 8 days (range 3 to 21). Tachycardia (n = 12, 92{\%}); fever/hypothermia, (n = 12, 92{\%}), and an abnormal white blood cell count (n = 11, 85{\%}) were consistently present. Abdominal distention was common but tended to be a late sign (n = 12). Seven (56{\%}) survived. In 4 patients with tolerance data, 3 reached the goal rate of feeds prior to diagnosis. Two became distended at >12 hours from diagnosis. Gastric tonometry demonstrated a decreased NgpHi (<7.30) after starting EN in all 3 in whom it was monitored. Conclusions: NOBN developed in 0.3{\%} of our trauma patients. Onset occurs in the second week in high-acuity patients who have had a period of EN tolerance. Clinical findings resemble bacterial sepsis with tachycardia, fever, and leukocytosis. Gastrointestinal specific signs are not consistent or occur late. Thus, we could not identify an early, useful clinical indicator. Gastric carbon dioxide tonometry may detect a vulnerable subgroup of patients. (C) 2000 by Excerpta Medica, Inc.",
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