title: Nonocclusive bowel necrosis occurring in critically ill trauma patients receiving enteral nutrition manifests no reliable clinical signs for early detection.
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.
authors.affiliation: Department of Surgery, University of Texas at Houston, USA.
authors.forename: R G
authors.initials: RG
authors.lastname: Marvin
authors.forename: B A
authors.initials: BA
authors.lastname: McKinley
authors.forename: M
authors.initials: M
authors.lastname: McQuiggan
authors.forename: C S
authors.initials: CS
authors.lastname: Cocanour
authors.forename: F A
authors.initials: FA
authors.lastname: Moore
mesh_terms: D000328:Adult; D016638:Critical Illness; D004750:Enteral Nutrition / Q000009:adverse effects; D005260:Female; D006801:Humans; D015994:Incidence; D007422:Intestines / Q000098:blood supply / Q000473:pathology*; D007511:Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D008297:Male; D009336:Necrosis; D013997:Time Factors; D014947:Wounds and Injuries / Q000150:complications / Q000628:therapy