Nutrition support for the patient with an open abdomen after major abdominal trauma.
OBJECTIVE
Nutrition support in the severely injured trauma patient is crucial to minimize the hypermetabolic stress response. Even though enteral nutrition is the preferred method of feeding, it is not always feasible after multiple trauma. We present a complex nutritional case in a patient who sustained severe abdominal trauma with a severe liver injury, rib fractures, and pulmonary contusion.


METHODS
The patient required several repeat laparotomies, abdominal packing, and temporary abdominal closure. The clinical course was complicated by hypotension requiring multiple vasopressors; coagulopathy requiring more than 35 U of packed red cells, more than 50 U of fresh frozen plasma, and more than 80 U of platelets; acute renal failure requiring dialysis; and pneumonia and acute respiratory distress syndrome requiring intricate ventilator management. Nutrition intervention began on post-trauma day 4 with total parenteral nutrition due to hypotension, resuscitation, and massive bowel edema; by post-trauma day 8. the patient was receiving goal nutrients.


RESULTS
On post-trauma day 27, bowel edema was significantly less, and a nasoenteric feeding tube was placed and enteral feeding initiated. By post-trauma day 31, full enteral feeds were tolerated, and total parenteral nutrition was stopped. Nutrient provision was adjusted daily to account for organ and metabolic changes including hepatic, pulmonary, and renal dysfunction. The patient did well and was eventually extubated and eating a regular diet.


CONCLUSIONS
With careful monitoring and adjusting of the nutritional plan, a hypermetabolic complex trauma patient with an open abdomen can be fed optimally, safely, and successfully despite increased bowel edema and multiple organ dysfunction.
McKibbin
Blake
B
Department of Surgery, Medical College of Georgia, 1120 15th Street, Augusta, GA 30912, USA.
Cresci
Gail
G
Hawkins
Michael
M
D000007:Abdominal Injuries / Q000150:complications / Q000628:therapy*; D058186:Acute Kidney Injury / Q000628:therapy; D000328:Adult; D001778:Blood Coagulation Disorders / Q000150:complications / Q000628:therapy; D003422:Critical Care; D004750:Enteral Nutrition; D017707:Erythrocyte Transfusion; D006801:Humans; D007022:Hypotension / Q000150:complications / Q000188:drug therapy; D008297:Male; D018529:Nutritional Support; D010289:Parenteral Nutrition, Total; D010949:Plasma; D017713:Platelet Transfusion; D011014:Pneumonia / Q000150:complications / Q000628:therapy; D006435:Renal Dialysis; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000628:therapy; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D014662:Vasoconstrictor Agents