Laparotomy for abdominal sepsis in the critically ill

Early enteral nutrition improves outcomes of open abdomen in gastrointestinal fistula patients complicated with severe sepsis

BACKGROUND

Although nutrition therapy is favorably considered as an assistant therapeutic measure in critical illness, little data evaluate its role in gastrointestinal fistula patients with severe sepsis after an open abdomen. The purpose of this study is to evaluate the role of early nutrition therapy in that population.

METHODS

This is a retrospective review of patients who underwent open abdomen management for gastrointestinal fistula and severe sepsis from January 2001 to June 2009. Nutrition therapy, fistula, abdominal closure, and demographics were noted. Succus entericus reinfusion (SER) was performed for high-output volume or multiple fistulae. Patients were divided into two groups based on whether enteral nutrition (EN) was initiated within 14 days after admission. Delivery route of nutrients, mortality, complications, and time to abdominal closure were compared among groups.

RESULTS

Eighty-two patients were included. Fifty-six (68.3%) patients survived to discharge. Forty-one (50%) patients received SER. EN was initiated within 14 days in 36 patients, with a mean initiation time at 8.3 ± 3.4 days; 46 patients did not start any EN within 14 days (29.9 ± 20.9 days). The mean age, BMI, APACHE II score, and fistula characteristics were similar between groups. The abdominal closure was accomplished more rapidly in patients fed within 14 days (142.8 vs 184.5 days, P = .017), with decreased mortality (11.1% vs 47.8%, P < .001).

CONCLUSIONS

Nutrition therapy plays an important role in the management of gastrointestinal fistula with severe sepsis. Early EN could be successfully delivered for that population, with improved mortality risk.