Postinjury abdominal compartment syndrome does not preclude early enteral feeding after definitive closure.
BACKGROUND
Critically injured patients are susceptible to the abdominal compartment syndrome (ACS), which requires decompressive laparotomy with delayed abdominal closure. Previous work by the University of Texas Houston group showed impaired gut function after resuscitation-associated gut edema. The purpose of this study was to determine if enteral nutrition was precluded by the intra-abdominal hypertension and bowel edema of the ACS.


METHODS
Patients developing postinjury ACS from January 1996 to August 2003 at our level-I trauma center were reviewed. Patient demographics, time to definitive abdominal closure, and institution and tolerance of enteral nutrition were evaluated.


RESULTS
Thirty-seven patients developed postinjury ACS during the study period; 26 men and 11 women with a mean age of 36 +/- 4 and injury severity score of 33 +/- 4. Mean intra-abdominal pressure before decompression was 32 +/- 3 mm Hg, and concurrent mean peak airway pressure was 50 +/- 4 cm oxygen. Enteral feeding was never started in 12 patients; 4 died within 48 hours of admission, 7 required vasoactive agents until their death, and 1 developed an enterocutaneous fistula requiring parenteral nutrition. Enteral feeding was initiated in the remaining 25 patients: 13 had feeds started within 24 hours of abdominal closure; 5 were fed with open abdomens; and 7 had a delay because of vasopressors (n = 2), multiple trips to the operating room (n = 2), paralytics (n = 2), and increased intra-abdominal pressures (n = 1). Once advanced, enteral feeding was tolerated in 23 (92%) of the 25 patients with attainment of goal feeds in a mean of 3.1 +/- 1 days.


CONCLUSIONS
Despite the bowel edema and intra-abdominal hypertension related to the ACS, early enteral feeding is feasible after definitive abdominal closure.
Cothren
C Clay
CC
Department of Surgery, Denver Health Medical Center, and the University of Colorado Health Sciences Center, 777 Bannock St., MC 0206, Denver, CO 80204, USA. clay.cothren@dhhs.org
Moore
Ernest E
EE
Ciesla
David J
DJ
Johnson
Jeffrey L
JL
Moore
John B
JB
Haenel
James B
JB
Burch
Jon M
JM
D000005:Abdomen / Q000503:physiopathology / Q000601:surgery; D000007:Abdominal Injuries / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003161:Compartment Syndromes / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D003422:Critical Care; D016638:Critical Illness; D004487:Edema / Q000503:physiopathology; D004750:Enteral Nutrition / Q000592:standards* / Q000639:trends; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007813:Laparotomy / Q000379:methods; D008297:Male; D011312:Pressure; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D014193:Trauma Centers; D016896:Treatment Outcome