Enteral Nutrition in Patients With an Open Peritoneal Cavity

Abstract

Recent surgical advances have led to the increased survival of critically ill patients requiring postoperative nutritional supplementation. One technique, which has been increasingly used, is that of the open peritoneal cavity. In these cases, the peritoneum is left open, and the viscera are protected with a temporary dressing until the abdomen can be closed. The aim of this study was to evaluate the efficacy and tolerance of enteral nutrition in patients who need open peritoneal cavity management techniques. Patients at a tertiary referral center requiring the use of open peritoneal cavity management who received at least 4 days of enteral nutrition were included in the study. Retrospective data were collected on patients admitted between January 1999 and December 2000, and prospective data were collected on patients between January and May 2001. Energy expenditure and actual caloric and protein intake were determined in all patients. Prealbumin levels and nitrogen balance studies were analyzed when available. Intolerance, defined as diarrhea or gastric reflux, was also evaluated. Average daily total caloric intake was 77 ± 27%, and average daily protein intake was 68 ± 24% of estimated needs. Initial serum prealbumin levels were low and remained below normal but increased in some patients during the study. Average nitrogen balance studies from 3 patients was –15 ± 9.7 g/d. Diarrhea and gastric reflux occurred in 42% and 36% of patients, respectively, and were easily treated. Enteral nutrition can be effectively used in patients requiring open peritoneal cavity management after laparotomy. Overall, enteral nutrition is relatively well tolerated in this patient population.