Petit Laurent, Faure Nicolas, Pereira Bruno, Dubuisson Vincent, Berard Xavier, Biais Matthieu, Carrié Cédric
Anesthesiology and Critical Care Department, Pellegrin University Hospital, Bordeaux, France.
Biostatistics Unit, Délégation Recherche Clinique and Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France.
J Abdom Wall Surg. 2024 Dec 18;3:13702. doi: 10.3389/jaws.2024.13702. eCollection 2024.
In critically ill surgical patients treated with open abdomen and negative pressure therapy (OA/NPT), the association between nutritional support and clinical outcome is still controversial. The main objective of this study was to assess the effect of enteral nutritional support during the acute phase (i.e., the first 7 days) on clinical outcome (abdominal wall closure rate or fistula formation) in critically ill surgical patients treated by OA/NPT.
Over a 5-year period, every critically ill patient who underwent nutritional support while treated by OA/NPT was retrospectively included. The main study outcome was a composite criterion, defined as delayed abdominal closure ≥8 days and/or secondary abdominal complications (secondary anastomotic leak, intra-abdominal abscess and fascial dehiscence). Inverse probability of treatment weight (IPTW) was derived from a propensity score model. Multivariable logistic regression was used to test the association between clinical outcome and different modalities of nutritional support (enteral nutrition vs. nil per os during the first week after OA/NPT, early vs. late enteral nutrition, normal vs. low caloric/protein intake).
Over the study period, 171 patients were included and 50% underwent delayed abdominal closure and/or secondary abdominal complications. The rate of delayed abdominal closure or secondary abdominal complications was significantly lower in patients who received enteral nutrition versus those who remained nil per os (40% vs. 61%, ), with an IPTW-adjusted OR of poor clinical outcome of 0.49 [95%CI: 0.25-0.98]. There was no other statistical association between modalities of nutritional support and the study outcome.
In critically ill patients with OA/NPT, the use of enteral feeding within 7 days after surgery was associated with better clinical outcome. Further studies are mandatory to better define the adequate timing for enteral feeding, the energy needs and the protein requirements during the acute phase after OA/NPT.
在接受开放腹腔和负压治疗（OA/NPT）的重症外科患者中，营养支持与临床结局之间的关联仍存在争议。本研究的主要目的是评估急性期（即前7天）肠内营养支持对接受OA/NPT治疗的重症外科患者临床结局（腹壁关闭率或瘘管形成）的影响。
在5年期间，回顾性纳入了每一位接受OA/NPT治疗并接受营养支持的重症患者。主要研究结局是一个复合标准，定义为腹壁延迟关闭≥8天和/或继发性腹部并发症（继发性吻合口漏、腹腔内脓肿和筋膜裂开）。治疗权重的逆概率（IPTW）来自倾向评分模型。多变量逻辑回归用于检验临床结局与不同营养支持方式（OA/NPT后第一周肠内营养与禁食、早期与晚期肠内营养、正常与低热量/蛋白质摄入）之间的关联。
在研究期间，纳入了171例患者，50%的患者出现了腹壁延迟关闭和/或继发性腹部并发症。接受肠内营养的患者腹壁延迟关闭或继发性腹部并发症的发生率显著低于禁食患者（40%对61%），IPTW调整后的不良临床结局OR为0.49[95%CI：0.25-0.98]。营养支持方式与研究结局之间没有其他统计学关联。
在接受OA/NPT的重症患者中，术后7天内使用肠内喂养与更好的临床结局相关。需要进一步研究以更好地确定肠内喂养的合适时机、OA/NPT后急性期的能量需求和蛋白质需求。
