[Nutritional support in patients with open abdomen]

Area of Science:

• Surgical critical care
• Gastroenterology
• Clinical nutrition

Background:

• Open abdomen management presents significant challenges in post-surgical patients.
• Effective nutritional support is crucial for improving outcomes in this high-risk group.
• The hypermetabolic response in open abdomen patients necessitates tailored nutritional interventions.

Purpose of the Study:

• To design and evaluate a protocol for assessing tolerance, effectiveness, and nutritional support in post-surgical patients with an open abdomen.
• To compare outcomes between different nutritional support modalities: total parenteral nutrition (TPN), enteral nutrition (EN), and mixed support.
• To determine the impact of nutritional support on morbidity and mortality in open abdomen patients.

Main Methods:

• A prospective descriptive study was conducted on 24 post-surgical patients with an open abdomen managed with a Bogota bag.
• Patients received either TPN, EN via needle catheter jejunostomy (NCJ), or a mixed nutritional approach.
• Tolerance to EN was defined as at least 4 consecutive days without diarrhea or pain; patients with less than 4 days in the open abdomen were excluded.

Main Results:

• 75% of patients showed favorable outcomes, being discharged in good condition; 25% died due to multiple organ failure secondary to sepsis.
• 66% of patients experienced no nutritional support complications. Hyperglycemia occurred in 21% of TPN patients, and diarrhea in 13% of EN patients.
• 69% of patients receiving EN achieved 80% of their estimated caloric goal within 4-5 days of formula administration.

Conclusions:

• Integral care combined with individualized nutritional support can mitigate the hypermetabolic response in open abdomen patients.
• Tailored nutritional strategies are effective in reducing morbidity and mortality in this patient population.
• The study protocol provides a framework for optimizing nutritional support in complex surgical cases.