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165. Postsurgical Infections are Reduced with Specialized Nutrition Support.

Author

Waitzberg, Dan L., Saito, Hideaki, Plank, Lindsay D., Jamieson, Glyn G., Jagannath, Palepu, Tsann-Long Hwang, Mijares, Juan M., and Bihari, David

Subjects
*SURGICAL complications, *INFECTION, *DISEASES, *ELECTIVE surgery, *CLINICAL trials, *META-analysis
Abstract

Objective: The objective was to examine the relationship between pre-, peri-, and postoperative specialized nutritional support with immune-modulating nutrients and postoperative morbidity in patients undergoing elective surgery. Methods: Studies were identified by searching MEDLINE, review article bibliographies, and abstracts and proceedings of scientific meetings. All randomized clinical trials in which patients were supplemented by the IMPACT formula before and/or after elective surgery and the clinical outcomes reported were included in the meta-analysis. Seventeen studies (n = 2,305), 14 published (n = 2,102), and 3 unpublished (n = 203), fulfilled the inclusion criteria. Ten studies (n = 1,392) examined the efficacy of pre- or perioperative IMPACT supplementation in patients undergoing elective surgery, whereas 7 (n = 913) assessed postoperative efficacy. Fourteen of the studies (n = 2,083) involved gastrointestinal (GI) surgical patients. Postoperative complications, mortality, and length of stay in hospital (LOS) were major outcomes of interest. Results: IMPACT supplementation, in general, was associated with significant (39%-61%) reductions in postoperative infectious complications and a significant decrease in LOS in hospital by an average of 2 days. The greatest improvement in postoperative outcomes was observed in patients receiving specialized nutrition support as part of their preoperative treatment. In GI surgical patients, anastomotic leaks were 46% less prevalent when IMPACT supplementation was part of the preoperative treatment. Conclusion: This study identifies a dosage (0.5-1 I/day) and duration (supplementation for 57 days before surgery) of IMPACT that contributes to improved outcomes of morbidity in elective surgery patients, particularly those undergoing GI surgical procedures. The cost effectiveness of such practice is supported by recent health economic analysis. Findings suggest preoperative IMPACT use for the prophylaxis of postoperative complications in elective surgical patients. [ABSTRACT FROM AUTHOR]

Published
2006
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166. Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study.

Author

Malbrain, Manu L. N. G., Chiumello, Davide, Pelosi, Paolo, Wilmer, Alexander, Brienza, Nicola, Malcangi, Vincenzo, Bihari, David, Innes, Richard, Cohen, Jonathan, Singer, Pierre, Japiassu, Andre, Kurtop, Elizabeth, De Keulenaer, Bart L., Daelemans, Ronny, Del Turco, Monica, Cosimini, P., Ranieri, Marco, Jacquet, Luc, Laterre, Pierre-François, and Gattinoni, Luciano

Subjects
*HYPERTENSION, *BLOOD circulation disorders, *ABDOMINAL diseases, *COMPARTMENT syndrome, *MUSCLE diseases, *CRITICAL care medicine, *INTENSIVE care units, *HYPERTENSION epidemiology, *ABDOMEN, *COMPARATIVE studies, *LONGITUDINAL method, *RESEARCH methodology, *MEDICAL cooperation, *RESEARCH, *EVALUATION research, *BODY mass index, *DISEASE prevalence
Abstract

Objective: Although intra-abdominal hypertension (IAH) can cause dysfunction of several organs and raise mortality, little information is available on the incidence and risk factors for IAH in critically ill patients. This study assessed the prevalence of IAH and its risk factors in a mixed population of intensive care patients.Design: A multicentre, prospective 1-day point-prevalence epidemiological study conducted in 13 ICUs of six countries.Interventions: None.Patients: Ninety-seven patients admitted for more than 24 h to one of the ICUs during the 1-day study period.Methods: Intra-abdominal pressure (IAP) was measured four times (every 6 h) by the bladder pressure method. Data included the demographics, medical or surgical type of admission, SOFA score, etiological factors such as abdominal surgery, haemoperitoneum, abdominal infection, massive fluid resuscitation, and ileus and predisposing conditions such as hypothermia, acidosis, polytransfusion, coagulopathy, sepsis, liver dysfunction, pneumonia and bacteraemia.Results: We enrolled 97 patients, mean age 64+/-15 years, 57 (59%) medical and 40 (41%) surgical admission, SOFA score of 6.5+/-4.0. Mean IAP was 9.8+/-4.7 mmHg. The prevalence of IAH (defined as IAP 12 mmHg or more) was 50.5 and 8.2% had abdominal compartment syndrome (defined as IAP 20 mmHg or more). The only risk factor significantly associated with IAH was the body mass index, while massive fluid resuscitation, renal and coagulation impairment were at limit of significance.Conclusion: Although we found a quite high prevalence of IAH, no risk factors were reliably associated with IAH; consequently, to get valid information about IAH, IAP needs to be measured. [ABSTRACT FROM AUTHOR]

Published
2004
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