Intra-abdominal pressure as a prognostic factor for tolerance of enteral nutrition in critical patients.
BACKGROUND
The purpose of this study is to establish a relationship between tolerance of enteral nutrition (EN) and intra-abdominal pressure (IAP) in critical patients, establish an objective measure for monitoring tolerance, and determine a threshold value for IAP.


METHODS
Prospective and observational study at the critical care unit. Seventy-two patients were recruited with an expected stay of more than 72 hours and scheduled to receive EN. We recorded IAP and clinical and laboratory variables to describe predictive ones for tolerance of EN at the start of nutrition.


RESULTS
The largest group was polytrauma patients (41.7%). Of the patients, 40.3% had undergone surgery prior to inclusion in the study. Most patients (87.5%) were fed via nasogastric tube. Physiological POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity) on admission was 26.4 ± 7.6, and surgical POSSUM was 22.4 ± 8.0. The mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 13.6 ± 6.0. Mortality was 31.9%. In all, 70.8% tolerated EN. The univariate analysis revealed a statistically significant relation between tolerance of EN and surgical POSSUM, APACHE II, and baseline IAP. The multivariate analysis showed a relationship between APACHE II score, baseline IAP, and the tolerance of EN. So, on the basis of these 2 variables, logistic regression analysis can predict whether a patient will tolerate the diet with an overall precision of 80.3%.


CONCLUSIONS
In critically ill patients, there is a relation between IAP values and the tolerance of EN. The baseline IAP with the APACHE II score can predict the tolerance of EN.
Department of Surgery, Hospital Universitario, Barcelona, Spain. nbejaranog@hotmail.com
Natalia
N
Bejarano
Salvador
S
Navarro
Pere
P
Rebasa
Oscar
O
García-Esquirol
Judit
J
Hermoso
D018806:APACHE; D000005:Abdomen / Q000503:physiopathology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness / Q000628:therapy; D004750:Enteral Nutrition / Q000009:adverse effects*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011312:Pressure; D011379:Prognosis; D011446:Prospective Studies; D055815:Young Adult