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

Research output: Contribution to journalArticle

53 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 1 2012
Externally publishedYes

Fingerprint

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

  • Surgery
  • Critical Care and Intensive Care Medicine

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; Codner, Panna; Nirula, Ram; Millar, D.; Cohen, Mitchell J.; Kutcher, Matthew E.; Haan, James; MacNew, Heather G.; Ochsner, M. Gage; Rowell, Susan E.; Truitt, Michael S.; Moore, Forrest O.; Pieracci, Fredric M.; Kaups, Krista L.

In: Journal of Trauma and Acute Care Surgery, Vol. 73, No. 6, 01.12.2012, p. 1380-1387.

Research output: Contribution to journalArticle

Burlew, CC, Moore, EE, Cuschieri, J, Jurkovich, G, Codner, P, Nirula, R, Millar, D, Cohen, MJ, Kutcher, ME, Haan, J, MacNew, HG, Ochsner, MG, Rowell, SE, 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 ; Codner, Panna ; Nirula, Ram ; Millar, D. ; Cohen, Mitchell J. ; Kutcher, Matthew E. ; Haan, James ; MacNew, Heather G. ; Ochsner, M. Gage ; Rowell, Susan E. ; 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.
@article{fc5ffb8f7c0c4ad29a5d8e03e25ab0a2,
title = "Who should we feed? A Western Trauma Association multi-institutional study of enteral nutrition in the open abdomen after injury",
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 Gregory Jurkovich 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 Rowell, {Susan E.} and Truitt, {Michael S.} and Moore, {Forrest O.} and Pieracci, {Fredric M.} and Kaups, {Krista L.}",
year = "2012",
month = "12",
day = "1",
doi = "10.1097/TA.0b013e318259924c",
language = "English (US)",
volume = "73",
pages = "1380--1387",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

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

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 E.

AU - Truitt, Michael S.

AU - Moore, Forrest O.

AU - Pieracci, Fredric M.

AU - Kaups, Krista L.

PY - 2012/12/1

Y1 - 2012/12/1

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

UR - http://www.scopus.com/inward/record.url?scp=84870644450&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84870644450&partnerID=8YFLogxK

U2 - 10.1097/TA.0b013e318259924c

DO - 10.1097/TA.0b013e318259924c

M3 - Article

C2 - 22835999

AN - SCOPUS:84870644450

VL - 73

SP - 1380

EP - 1387

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 6

ER -