Nutritional management of a patient with an open abdomen

Abstract

The use of the open abdomen as a technique in the management of complex surgery patients can be the result of a variety of contributing factors, including surgical or medical causes, as well as indications.¹ The early initiation of goal-directed enteral nutrition support improves wound healing, decreases intensive care unit (ICU) and hospital length of stay, and might improve survival following critical illness or injury.¹ The benefits of enteral nutrition in surgical and critical illness have been recognised since the early 1980s and are now well described.² Because of the nature of these patients, the establishment of sufficient enteral nutrition support can be challenging. Therefore, they might require parenteral nutrition (PN) support in the early postoperative phase until the physiological status has normalised.² The early use of PN is of particular importance in patients with pre-existing malnutrition.² Nutrition support in the patient discussed in this publication was complicated by haemodynamic instability, fluid restriction owing to renal failure and fistula formation in the open abdomen, which necessitated the long-term use of PN support.