Kuppinger, David; Hartl, Wolfgang H.
Feeding Patients with Severe Abdominal Infections: Special Aspects.
In: Viszeralmedizin, No. 1: pp. 41-45
Background: Feeding patients with severe abdominal infections isparticularly demanding. Method: The authors electronically searched theMEDLINE, EMBASE and Cochrane databases (using the keywords‘peritonitis’, ‘severe sepsis’, ‘nutrition’, ‘practice parameter’, and‘guideline’) and reviewed their personal databases for articles relevantto the issue which have been published between 2002 and 2012. Results:Patients suffering from abdominal sepsis are at a high risk for severehyperglycemia and insulin resistance. Due to an excessive proteincatabolism which cannot be overcome by standard nutritional therapy,these patients are malnourished and require a particularly carefulnutritional support. The latter is not guided by the actual energyexpenditure (which markedly increases during the acute phase) but by thecapacity of the organism to utilize exogenous substrates (this capacityusually decreases during the acute phase). It is of outmost importanceto supply sufficient amounts of protein or amino acids. Ideally, thepatients should be fed enterally. Even in patients with severe abdominalcomplications (anastomotic leakage), modern tube and jejunostomytechniques as well as surgical strategies allow an adequate enteralsupply of calories. However, patients suffering from a severe abdominalsepsis often exhibit a delayed gastrointestinal passage (delayed gastricemptying, small bowel paralysis, colonic pseudo-obstruction). Thesepathologies restrict enteral nutrition and should be recognized as earlyas possible by appropriate clinical surveillance. Besides a clinicalexamination of the abdomen, measurement of gastric residual volumerepresents the best control parameter when providing food into thestomach. Delayed gastrointestinal passage should be treated asaggressively as possible. Primary objective is the cure of the abdominalfocus. In addition, use of drugs with an antiperistaltic action shouldbe restricted as much as possible. Severe cases may profit frommedications with a properistaltic action combined with specific physicalmeasures. Conclusion: Feeding patients suffering from an abdominalinfection requires an individualized, patient-centered approach whichrequires a profound nutritional and special gastroenterologicalknowledge.