Advertisement

World Journal of Surgery

, Volume 37, Issue 9, pp 2053–2060 | Cite as

Early Enteral Nutrition Prevents Intra-abdominal Hypertension and Reduces the Severity of Severe Acute Pancreatitis Compared with Delayed Enteral Nutrition: A Prospective Pilot Study

  • Jia-kui Sun
  • Wei-qin LiEmail author
  • Lu Ke
  • Zhi-hui Tong
  • Hai-bin Ni
  • Gang Li
  • Lu-yao Zhang
  • Yao Nie
  • Xin-ying Wang
  • Xiang-hong Ye
  • Ning Li
  • Jie-shou Li
Article

Abstract

Background

To investigate the effects of early enteral nutrition (EEN) on intra-abdominal pressure (IAP) and disease severity in patients with severe acute pancreatitis (SAP).

Methods

Enteral nutrition (EN) was started within 48 h after admission in the EEN group and from the 8th day in the delayed enteral nutrition (DEN) group. The IAP and intra-abdominal hypertension (IAH) incidence were recorded for 2 weeks. The caloric intake and feeding intolerance (FI) incidence were recorded daily after EN was started. The severity markers and clinical outcome variables were also recorded.

Results

Sixty patients were enrolled to this study. No difference about IAP was found. The IAH incidence of the EEN group was significantly lower than that of the DEN group from the 9th day (8/30 versus 18/30; P = 0.009) after admission. The FI incidence of the EEN group was higher than that of the DEN group during the initial 3 days of feeding (25/30 versus 12/30; P = 0.001; 22/30 versus 9/30; P = 0.001; 15/30 versus 4/30; P = 0.002). Patients with an IAP <15 mmHg had lower FI incidence than those with an IAP ≥15 mmHg on the 1st day (20/22 versus 17/38; P < 0.001), the 3rd day (11/13 versus 8/47; P < 0.001), and the 7th day (3/5 versus 3/55; P = 0.005) of feeding. The severity markers and clinical outcome variables of the EEN group were significantly improved.

Conclusions

Early enteral nutrition did not increase IAP. In contrast, it might prevent the development of IAH. In addition, EEN might be not appropriate during the initial 3–4 days of SAP onset. Moreover, EN might be of benefit to patients with an IAP <15 mmHg. Early enteral nutrition could improve disease severity and clinical outcome, but did not decrease mortality of SAP.

Keywords

Enteral Nutrition Sequential Organ Failure Assessment Severe Acute Pancreatitis Enteral Feeding Multiple Organ Dysfunction Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

This work was supported in part by Grants from the Key Project of the Eleventh Five-Year Plan Foundation of People’s Liberation Army (No. 06G041). No sponsors had interventions in the study design, data collection, and analysis.

Conflict of interest

The authors declare no conflict of interest

References

  1. 1.
    Oláh A, Romics L Jr (2008) Early enteral nutrition in acute pancreatitis: benefits and limitations. Langenbecks Arch Surg 393:261–269CrossRefPubMedGoogle Scholar
  2. 2.
    Bakker OJ, van Santvoort HC, van Brunschot S et al (2011) Pancreatitis, very early compared with normal start of enteral feeding (PYTHON trial): design and rationale of a randomised controlled multicenter trial. Trials 12:73CrossRefPubMedGoogle Scholar
  3. 3.
    Hegazi R, Raina A, Graham T et al (2011) Early jejunal feeding initiation and clinical outcomes in patients with severe acute pancreatitis. J Parenter Enteral Nutr 35:91–96CrossRefGoogle Scholar
  4. 4.
    Kumar A, Singh N, Prakash S et al (2006) Early enteral nutrition in severe acute pancreatitis: a prospective randomized controlled trial comparing nasojejunal and nasogastric routes. J Clin Gastroenterol 40:431–434CrossRefPubMedGoogle Scholar
  5. 5.
    Deenichin GP (2008) Abdominal compartment syndrome. Surg Today 38:5–19CrossRefPubMedGoogle Scholar
  6. 6.
    Gudmundsson FF, Gislason HG, Dicko A et al (2001) Effects of prolonged increased intra-abdominal pressure on gastrointestinal blood flow in pigs. Surg Endosc 15:854–860CrossRefPubMedGoogle Scholar
  7. 7.
    Diebel LN, Dulchavsky SA, Wilson RF (1992) Effect of increased intra-abdominal pressure on mesenteric arterial and intestinal mucosal blood flow. J Trauma 33:45–48CrossRefPubMedGoogle Scholar
  8. 8.
    De Waele JJ, Leppäniemi AK (2009) Intra-abdominal hypertension in acute pancreatitis. World J Surg 33:1128–1133. doi: 10.1007/s00268-009-9994-5 CrossRefPubMedGoogle Scholar
  9. 9.
    Chen H, Li F, Sun JB et al (2008) Abdominal compartment syndrome in patients with severe acute pancreatitis in early stage. World J Gastroenterol 14:3541–3548CrossRefPubMedGoogle Scholar
  10. 10.
    Cothren CC, Moore EE, Ciesla DJ et al (2004) Postinjury abdominal compartment syndrome does not preclude early enteral feeding after definitive closure. Am J Surg 188:653–658CrossRefPubMedGoogle Scholar
  11. 11.
    Bradley EL 3rd (1993) A clinically based classification system for acute pancreatitis. Summary of the international symposium on acute pancreatitis, Atlanta, Ga, September 11–13, 1992. Arch Surg 128:586–590CrossRefPubMedGoogle Scholar
  12. 12.
    Tao HQ, Zhang JX, Zou SC (2004) Clinical characteristics and management of patients with early acute severe pancreatitis: experience from a medical center in China. World J Gastroenterol 10:919–921PubMedGoogle Scholar
  13. 13.
    De Campos T, Braga CF, Kuryura L et al (2008) Changes in the management of patients with severe acute pancreatitis. Arq Gastroenterol 45:181–185CrossRefPubMedGoogle Scholar
  14. 14.
    Mao EQ, Tang YQ, Fei J et al (2009) Fluid therapy for severe acute pancreatitis in acute response stage. Chin Med J (Engl) 122:169–173Google Scholar
  15. 15.
    Brisinda G, Vanella S, Crocco A et al (2011) Severe acute pancreatitis: advances and insights in assessment of severity and management. Eur J Gastroenterol Hepatol 23:541–551CrossRefPubMedGoogle Scholar
  16. 16.
    Van Baal MC, van Santvoort HC, Bollen TL et al (2011) Systematic review of percutaneous catheter drainage as primary treatment for necrotizing pancreatitis. Br J Surg 98:18–27CrossRefPubMedGoogle Scholar
  17. 17.
    McClave SA, Martindale RG, Vanek VW et al (2009) Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: society of critical care medicine (SCCM) and American society for parenteral and enteral nutrition (A.S.P.E.N.). J Parenter Enteral Nutr 33:277–316CrossRefGoogle Scholar
  18. 18.
    Kreymann KG, Berger MM, Deutz NE et al (2006) ESPEN guidelines on enteral nutrition: intensive care. Clin Nutr 25:210–223CrossRefPubMedGoogle Scholar
  19. 19.
    Rice TW, Swope T, Bozeman S et al (2005) Variation in enteral nutrition delivery in mechanically ventilated patients. Nutrition 21:786–792CrossRefPubMedGoogle Scholar
  20. 20.
    Rice TW, Mogan S, Hays MA et al (2011) Randomized trial of initial trophic versus full-energy enteral nutrition in mechanically ventilated patients with acute respiratory failure. Crit Care Med 39:967–974CrossRefPubMedGoogle Scholar
  21. 21.
    Spanier BW, Bruno MJ, Mathus-Vliegen EM (2011) Enteral nutrition and acute pancreatitis: a review. Gastroenterol Res Pract. doi: 10.1155/2011/857949 PubMedGoogle Scholar
  22. 22.
    Reintam A, Parm P, Redlich U et al (2006) Gastrointestinal failure in intensive care: a retrospective clinical study in three different intensive care units in Germany and Estonia. BMC Gastroenterol 6:19CrossRefPubMedGoogle Scholar
  23. 23.
    Gianotti L, Meier R, Lobo DN et al (2009) ESPEN guidelines on parenteral nutrition: pancreas. Clin Nutr 28:428–435CrossRefPubMedGoogle Scholar
  24. 24.
    Cheatham ML, Malbrain ML, Kirkpatrick A et al (2007) Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndromeII. Recommendations. Intensive Care Med 33:951–962CrossRefPubMedGoogle Scholar
  25. 25.
    Malbrain ML, Cheatham ML, Kirkpatrick A et al (2006) Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. I. Definitions. Intensive Care Med 32:1722–1732CrossRefPubMedGoogle Scholar
  26. 26.
    De Waele JJ, Hoste E, Blot SI et al (2005) Intra-abdominal hypertension in patients with severe acute pancreatitis. Crit Care 9:R452–R457CrossRefPubMedGoogle Scholar
  27. 27.
    Dambrauskas Z, Parseliunas A, Gulbinas A et al (2009) Early recognition of abdominal compartment syndrome in patients with acute pancreatitis. World J Gastroenterol 15:717–721CrossRefPubMedGoogle Scholar
  28. 28.
    Oda S, Hirasawa H, Shiga H et al (2005) Management of intraabdominal hypertension in patients with severe acute pancreatitis with continuous hemodiafiltration using a polymethyl methacrylate membrane hemofilter. Ther Apher Dial 9:355–361CrossRefPubMedGoogle Scholar
  29. 29.
    De Waele JJ, Hoste EA, Malbrain ML (2006) Decompressive laparotomy for abdominal compartment syndrome: a critical analysis. Crit Care 10:R51CrossRefPubMedGoogle Scholar
  30. 30.
    Ke L, Ni HB, Sun JK et al (2012) Risk factors and outcome of intra-abdominal hypertension in patients with severe acute pancreatitis. World J Surg 36:171–178. doi: 10.1007/s00268-011-1295-0 CrossRefPubMedGoogle Scholar
  31. 31.
    Windsor AC, Kanwar S, Li AG et al (1998) Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis. Gut 42:431–435CrossRefPubMedGoogle Scholar
  32. 32.
    Meier R, Ockenga J, Pertkiewicz M et al (2006) ESPEN guidelines on enteral nutrition: pancreas. Clin Nutr 25:275–284CrossRefPubMedGoogle Scholar
  33. 33.
    Ammori BJ (2003) Role of the gut in the course of severe acute pancreatitis. Pancreas 26:122–129CrossRefPubMedGoogle Scholar
  34. 34.
    McClave SA, Dryden GW (2002) Issues of nutritional support for the patient with acute pancreatitis. Semin Gastrointest Dis 13:154–160PubMedGoogle Scholar
  35. 35.
    Grau T, Bonet A, Grupo de Trabajo de Metabolismo y Nutrición de la Sociedad Española et al (2005) Multicenter study on incidence of total parenteral nutrition complications in the critically-ill patient ICOMEP study. Part II. Nutr Hosp 20:278–285PubMedGoogle Scholar
  36. 36.
    Al-Bahrani AZ, Abid GH, Holt A et al (2008) Clinical relevance of intra-abdominal hypertension in patients with severe acute pancreatitis. Pancreas 36:39–43CrossRefPubMedGoogle Scholar
  37. 37.
    Ke L, Tong ZH, Ni HB et al (2012) The effect of intra-abdominal hypertension incorporating severe acute pancreatitis in a porcine model. PLoS One 7:e33125CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Jia-kui Sun
    • 1
  • Wei-qin Li
    • 1
  • Lu Ke
    • 1
  • Zhi-hui Tong
    • 1
  • Hai-bin Ni
    • 1
  • Gang Li
    • 1
  • Lu-yao Zhang
    • 1
  • Yao Nie
    • 1
  • Xin-ying Wang
    • 1
  • Xiang-hong Ye
    • 1
  • Ning Li
    • 1
  • Jie-shou Li
    • 1
  1. 1.Department of General Surgery, Jinling HospitalNanjing University School of MedicineNanjingChina

Personalised recommendations