Nutritional and metabolic correction in the intensive therapy of peritonitis

Introduction. The current concept of the metabolic and nutritional support of patients with peritonitis considers the early enteral administration of corrective solutions, special pharmaconutrients, and feeding formulas as a component of the pathogenetic treatment that contributes to recovery of the intestinal morphofunctional status, to resolution of intestinal failure (IF), to correction of metabolic disturbances, and to adequate provision of the body’s energy-plastic needs.

Objective: to improve treatment results in patients with peritonitis due to early enteral feeding of special formulas in order to resolve IF and to correction of nutritional and metabolic disorders.

Subjects and methods. A unicenter randomized study was conducted in 54 patients with generalized purulent peritonitis. In Group 1 (a comparison group; n = 25), enteral therapy for IF encompassed intestinal lavage, enterosorption, stepwise intraintestinal administration of glucose saline solution (3–4 days) and then the standard formula Nutrient Standard (1.0 kcal/ml) (5–6 days). In Group 2 (a study group; n = 29), the multi-elemental (oligopeptide) formula Nutrient Elemental was used in the first step and switched to the metabolic formula Nutrient Hepa in the second step, and then to the standard balanced nutrition formula Nutrient Standard. Hemodynamic parameters, oxygen budget, volemia, metabolism, immune system, gastrointestinal function, levels of enzymes, and hormonal status were studied.

Results. In Group 2 patients, the processes of absorption of glucose saline ingredients started to recover on days 2–3 and those of digestion of the semi-elemental formula Nutrient Elemental did on days 3–4. The early enteral feeding of the semi-elemental formula in combination with a formula with a high content of branched amino acids and the lowest level of aromatic amino acids, and the presence of serum proteins facilitated the resolution of IF within a shorter time period than in Group 1 patients and could also adequately meet the body’s energy and plastic needs.

Conclusion. Active small bowel decompression, intestinal lavage, enterosorption in combination with artificial therapeutic feeding that has been properly selected and performed in accordance with the given technology with the obligatory and early inclusion of a semi-elemental nutrition formula are shown to be powerful therapeutic factors that contribute to the resolution of IF and thus to the improvement of the results of peritonitis treatment. 

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