Feeding Patients with Severe Abdominal Infections: Special Aspects

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.