Abstract | OBJECTIVE: DESIGN: Prospective, observational cohort study. SETTING: Adult surgical/ trauma intensive care unit of a level I trauma center. PATIENTS: INTERVENTIONS: Serial 24-hr collections of urine and abdominal fluid protein were performed to characterize abdominal fluid protein loss and evaluate the clinical effect of accounting for abdominal fluid nitrogen as part of nitrogen balance calculations. MEASUREMENTS AND MAIN RESULTS:
Nitrogen intake correlates with urinary nitrogen loss but not with abdominal fluid nitrogen loss. Abdominal fluid nitrogen loss is significant and remains relatively stable in the early postoperative period. Nutritional calculations that fail to account for abdominal fluid nitrogen loss significantly overestimate actual nitrogen balance by an average of 3.5 g/24 hrs. CONCLUSIONS: The open abdomen represents a significant source of protein/ nitrogen loss in the critically ill. Failure to account for this loss in nutritional calculations may lead to underfeeding and inadequate nutritional support with a direct effect on patient outcome. Although direct measurement of abdominal fluid protein loss may be optimal, an estimate of 2 g of nitrogen per liter of abdominal fluid output should be included in the nitrogen balance calculations of any patient with an open abdomen.
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Authors | Michael L Cheatham, Karen Safcsak, Stacy J Brzezinski, Matthew W Lube |
Journal | Critical care medicine
(Crit Care Med)
Vol. 35
Issue 1
Pg. 127-31
(Jan 2007)
ISSN: 0090-3493 [Print] United States |
PMID | 17095940
(Publication Type: Journal Article, Validation Study)
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Chemical References |
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Topics |
- Abdominal Cavity
- Adult
- Aged
- Bias
- Body Fluids
(chemistry, metabolism)
- Compartment Syndromes
(etiology, metabolism, surgery)
- Critical Care
(methods)
- Critical Illness
(therapy)
- Decompression, Surgical
(adverse effects, methods)
- Energy Intake
- Homeostasis
- Humans
- Middle Aged
- Monitoring, Physiologic
(methods)
- Nitrogen
(analysis, deficiency, metabolism)
- Nutrition Assessment
- Nutritional Requirements
- Nutritional Support
(methods)
- Prospective Studies
- Protein Deficiency
(etiology, prevention & control)
- Proteins
(analysis, metabolism)
- Risk Factors
- Suction
(adverse effects, methods)
- Water-Electrolyte Imbalance
(etiology, prevention & control)
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