Enteral Nutrition Support for Abdominal Compartment Syndrome in Morbidly Obese Patient : A Case Report from a Medical Intensive Care Unit (ICU)

Main Article Content

Nurul Huda Razalli
Sa'ida Munira Johari
Nancy Park


Compartment syndrome occurs when pressure within a closed muscle or bone compartment builds to dangerous levels. This pressure can decrease blood flow to nerve and muscle cells, leading to ischemia and organ dysfunction. Challenges in providing enteral nutrition for abdominal compartment syndrome (ACS) patients include the increase risk for developing gastrointestinal symptoms such as diarrhea, constipation and distention. There are limited reports available on the nutritional management of ACS patients in the ICU especially those with morbid obesity condition to guide dietitians in providing nutritional support for these patients. Here, we report the enteral nutrition management of a mechanically ventilated, morbidly obese patient with ACS in a critical care setting by adopting postpyloric feeding, using prokinetic agents and implementing PO2/FiO2 ratio calculation for prescription of most suitable enteral formula.


Download data is not yet available.

Article Details

Author Biographies

Nurul Huda Razalli, Universiti Kebangsaan Malaysia

Senior Lecturer & DietitianDietetic Program

Sa'ida Munira Johari, Universiti Kebangsaan Malaysia

Graduate Student

Nancy Park, St. John Hospital and Medical Center,



Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, Waele, J. De , et al. Results from the international conference experts on intra-abdominal hypertension and abdominal compartment syndrome. I. Definitions. Intensive Care Med 2006;32:1722-32. [Google Scholar]

Daugherty EL, Liang H, Taichman D, Hansen-Flaschen J, Fuchs BD. Abdominal compartment syndrome is common in medical intensive care unit patients receiving large-volume resuscitation. J Intensive Care Med 2007;22:294-9. [Google Scholar]

Malbrain ML, Chiumello D, Pelosi P, Bihari D, Innes R, et al. Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiology study. Crit Care Med 2005;33:315-322. [Google Scholar]

Sugrue M. Abdominal compartment syndrome. Curr Opin Crit Care 2005;11:333-8. [Google Scholar]

Theodossis SP, Athanasios DM, Ioannis P, Isaak K, Nicki P. Abdominal compartment syndrome-Intraabdominal hypertension: Defining, diagnosing, and managing. J Emerg Trauma Shock 2011;4(2):279-91. [Google Scholar]

Cheatham ML, Malbrain ML, Kirkpatrick A, Surgue M, Parr M, Waele, J. De , et al. Results from the International Conference Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations. Intensive Care Med 2007;33:951-62. [Google Scholar]

Malbrain M. Different techniques to measure intra-abdominal pressure (IAP): Time for a critical appraisal. Intensive Care Med 2004;30:357-71. [Google Scholar]

Hill LT, Miller M. The effect of intra-abdominal hypertension on gastrointestinal function. Southern African Journal of Critical Care 2011;27(1):12-8. [Google Scholar]

Yip KF, Rai V, Wong KK. Evaluation of delivery of enteral nutrition in mechanically ventilated Malaysian ICU patients. BMC anesthesiology 2014;14(1):127. [Google Scholar]

Port AM, Apovian C. Metabolic support of the obese intensive care unit patient: a current perspective. Curr Opin Clin Nutr Metab Care 2010;13(2):184-191. [Google Scholar]

Secombe P, Harley S, Chapman M, Aromataris E. Feeding the critically ill obese patient: a systematic review protocol. JBI Database System Rev Implement Rep 2015;13(10):95-109. [Google Scholar]

Jeevanadam M, Young DH, Schiller WR. Obesity and the metabolic response to severe multiple trauma in man. J Clin Invest 1991;87(1):262-269. [Google Scholar]

Nguyen NQ, Chapman MJ, Frase RJ, Bryant LK, Burgstad C, Ching K, et al. The effects of sedation on gastric emptying and intra-gastric meal distribution in critical illness. Intensive Care Med 2008;34:454-460. [Google Scholar]

Reid C. Frequency of under- and overfeeding in mechanically ventilated ICU patients: causes and possible consequences. J Hum Nutr Dietet 2006;19:13-22. [Google Scholar]

Klein CJ, Stanek GS, 3rd WCE. Overfeeding macronutrients to critically ill adults: metabolic complications. J Am Diet Assoc 1998;98(7):795-806. [Google Scholar]

Frankenfield D, Smith JS, Cooney RN. Validation of 2 approaches to predicting resting metabolic rate in critically ill patients. JPEN 2004;28:259-264. [Google Scholar]

McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. 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. JPEN 2016;40(2):159-211. [Google Scholar]

McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B, et al. 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. JPEN J Parenteral Enteral Nutr 2009;33(3):277-316. [Google Scholar]

Malone AM. Permissive underfeeding: its appropriateness in patients with obesity, patients on parenteral nutrition, and non-obese patients receiving enteral nutrition. Curr Gastroenterol Rep 2007;9(4):317-322. [Google Scholar]

Frankenfield D, Roth-Yousey L, Compher C. Comparison of predictive equations for resting metablic rate in healthy nonobese and obese adults: a systematic review. J Am Diet Assoc 2005;105(5):775-789. [Google Scholar]

Hill LT, Hill B, Miller M, Michell WL. The effect of intra-abdominal hypertension on gastro-intestinal fucntion. Southern African J Crit Care 2011;27(1):12-19. [Google Scholar]