Complications Of Enteral Nutrition Research Articles

Complications of pediatric enteral nutrition at home: a systematic review of quantitative research

Objective: Identifying complications related to enteral nutrition at home in children is important in terms of establishing standard discharge education and training programs to support parents in managing complications. The study aimed to synthesize current evidence on the complications of pediatric enteral nutrition at home.
 Methods: The study was conducted according to PRISMA recommendations. Eight databases were reviewed between 2012 and 2022 in Turkish, German, and English languages. Articles were assessed in three stages: title, abstract, and full text. The review included 18 studies that met all the inclusion criteria. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instruments were used to assess the quality appraisal of the studies.
 Results: A total of 18 studies with 19,531 children were included from 14 countries. The outcome measures were major and minor complications with pediatric enteral nutrition at home. 11 of the 18 papers included were retrospective studies on complications of PEG. In studies reporting the overall rate of major complications ranged from 0% to 14.3%, and the most common complications were reoperation (2.64%-12.4%), and gastrocolic fistula/perforation (0.9%-3.8%). In studies reporting the overall rate of minor complications, the rate ranged from 16.4%-73.6% and the most common complications were infection (8.2%-31.9%), dislodgement (1.6%-21%), skin granulation (4%-50.4%), and vomiting (1%-49.89%).
 Conclusion: This systematic review reveals that the rate of complications in pediatric enteral nutrition at home cannot be underestimated. Healthcare providers should plan their practice considering these complications to support parents in managing complications of pediatric enteral nutrition at home.

Asuhan Keperawatan Kritis Pada Pasien Chronic Kidney Disease CKD Dengan Intervensi Inovasi Memberikan Nutrisi Enteral Menggunakan Metode Intermiten Feeding Untuk Mengurangi Produksi Residu Lambung di Ruang ICU RSU Kabupaten Tengerang

Background: Critical care developed starting from a need for patients experiencing life-threatening illnesses that could be better met if the patient was cared for in a different room. Chronic Kidney Disease (CKD) is defined as a decrease in kidney function characterized by a glomerular filtration rate (GFR) < 60 ml/min/1.73 m2 that occurs for more than 3 months (Mahesvara, 2020). Nutrition is an important part of the management of critical patients such as those suffering from advanced Chronic Kidney Disease (CKD). Providing nutrition to critical patients is to encourage the healing process. Inaccuracy in administering enteral nutrition can cause complications such as high gastric residual volume, gastric retention, diarrhea, nausea and vomiting. High gastric residues during enteral nutrition increase the risk of pulmonary aspiration which is the most severe complication of enteral nutrition. Intermittent feeding is one method of providing enteral nutrition to prevent these complications. The aim of this research is to provide comprehensive nursing care for patients with Chronic Kidney Disease (CKD). This writing method uses patient intervention and observation carried out for three days, to determine the patient's condition and provide appropriate nursing care which is then documented. Results: Based on the results of the intervention and monitoring carried out, it can be concluded that there are differences in the conditions of gastric residue production before and after the enteral feeding intervention using the intermittent feeding method. With the result criteria of maintaining nutritious food intake increases. Conclusion: In critical patients there is a slowdown in gastric emptying and intestinal motility so that if enteral nutrition is given quickly into the stomach there will be an increase in gastric residue. Nursing action as an evidence base that can be given is in the form of providing enteral nutrition using the intermittent feeding method so that the stomach can be better prepared to receive nutrition because it is given gradually, a stomach that is not completely filled will be able to digest food better and the stomach will empty more quickly, thereby reducing the risk of aspiration.

Diarrhoea and constipation during artificial nutrition in intensive care unit: A prospective observational study

To describe the occurrence of gastrointestinal (GI) complications, specifically diarrhoea and constipation, in artificially (enterally or parenterally) fed critically ill patients within their first seven-day stay in Intensive Care Unit (ICU). Observational prospective study conducted from September 1st to October 30th, 2019 and from August 1st to October 30th, 2021, in an ICU of a 1000-bed third-level hospital. General characteristics, nutritional variables, and medications administered were recorded and analysed. This study was registered on ClinicalTrials.gov (Identifier: NCT05473546). In total, 100 critically ill patients were included. Diarrhoea was present in 44 patients (44.0%), while constipation occurred in 22 (22.0%) patients. Patients with diarrhoea were generally those admitted for respiratory failure, whereas patients without diarrhoea were mostly affected by neurological disorders (22.7% vs 25%, respectively; p=0.002). Likewise, patients with constipation were primarily those admitted for trauma (36.4%). Trauma patients were almost 24 times more likely to be constipated than patients with respiratory failure (OR 23.99, CI 1.38-418.0) and patients receiving diuretics were over 16 times more likely to have diarrhoea than patients not receiving diuretics (OR 16.25, IC 1.89-139.86). GI complications of enteral nutrition represent still a very common issue in ICU. The main predictor of constipation was an admission for trauma whereas the main predictor of diarrhoea was the use of diuretics. Clinicians should consider and integrate these findings into more personalized nutritional and management protocols to avoid gastrointestinal complications.

Administration of enteral nutrition and gastrointestinal complications in Covid-19 critical patients in prone position

BackgroundThe prone position (PP) used in the treatment of critically ill patients infected with SARS-CoV-2, may be a barrier to enteral nutrition (EN). This study aimed to analyze the effectiveness and complications of EN in the PP, as well as clinical outcomes.MethodsProspective cohort study with patients in EN and coronavirus disease 2019 (COVID-19), on mechanical ventilation (MV), which whom needed or not PP. Gastrointestinal intolerances (GII) related to PP were evaluated, and correlated with possible confounding factors. EN, days on MV, Intensive Care Unit (ICU) length of stay, hospital length of stay, ventilator-associated pneumonia (VAP) and mortality were analyzed. The data were evaluated daily and compared prone group (PG=57) and supine group (SG=69).ResultsThe PP was associated with GII (P=0.000) and presented in 32 patients (26,44%) with no difference among groups. Association between epinephrine (P=0.003), vasopressin (P=0.018), and GII was observed. There was no difference between the total volume of enteral nutrition (TVEN) infused in the groups. However, the mean EN infused for the days when the patient was on PP was (70.0% ± 31.5) and for the days in supine position was (74.8% ± 27.3), P= 0.006. The PG had a longer time on MV (P=0.005) and ICU (P=0.003) and PP was associated with VAP (P=<0.001). The infused TVEN showed no association with VAP (P=0.09).ConclusionPP was a determining factor in GII and proved to be a risk factor for VAP, but the EN protocol seems to have ensured an adequate EN supply in PP and be a safe alternative.

Bedside gastrointestinal ultrasound combined with acute gastrointestinal injury score to guide enteral nutrition therapy in critically patients

BackgroundTo use gastric ultrasound to evaluate function and to determine the start time of enteral nutrition (EN) in patients with acute gastrointestinal injury (AGI).MethodsWe reviewed records from 105 patients who suffered AGI levels two (AGI II). We recorded several data points, including ultrasonographic transverse area of gastric antrum (CSA), left descending colonic or right ascending colonic diameter (Diam), peristatic frequency (Peri), EN start time, EN dose, prealbumin (PA), and EN complications. The recovery of intestinal function after EN treatment was judged as success. If there was EN treatment complication, this was judged as failure. We analyzed the changes in gastrointestinal function after EN treatment, to determine feeding time.ResultsThere were 69 patients in the successful group, and 36 in the failure group. There were no significant differences between the two groups in age, intra abdominal pressure (IAP), APACHE II, PA and disease composition (p > 0.05).There were significant differences in terms of EN startup time, CSA, Diam, Peri, and PA, between the EN success and failure groups. We found IAP does not reflect gastrointestinal function;CSA ≤ 9cm2, Diam ≤ 2.9 cm, Peri > 3 bpm, indicated that the three indexes could reflect the recovery of gastrointestinal function. Receiver operating curve analysis showed that combined CSA, Diam, Peri evaluation determined the best time to start EN.ConclusionsMonitoring gastric antrum transversal area, colonic diameter, colonic peristatic frequency using ultrasound can guide the timing of initiation of enteral nutrition treatment.

Nursing Practice Based on Evidence-Based Concepts to Prevent Enteral Nutrition Complications for Critically Ill Neurosurgical Patients.

PurposeTo explore the practical value of enteral nutrition care guided by evidence-based concepts in preventing enteral nutritional complications in critically ill neurosurgical patients.MethodsThree hundred critically ill patients from March 2020 to October 2021 from our neurosurgery department were included in the study. Patients were divided into a control group (March to December 2020, n = 150) and a study group (January to October 2021, n = 150) according to the order of their admission. The control group received conventional enteral nutrition care, and the study group received enteral nutrition care based on evidence-based concept guidance. The levels of serum nutritional indicators [hemoglobin (Hb), albumin (ALB), and total protein (TP)], feeding compliance rate, the incidence of complications (gastric retention, bloating, diarrhea, reflux, vomiting, aspiration, stress ulcers, etc.), and prognosis during the observation period were compared between the two groups. The scores of the questionnaire of knowledge, attitude, and practice on nutrition among neurosurgical nurses before and after the implementation of evidence-based care were compared among nursing staff in the study group.ResultsAt 1 and 2 weeks after enrollment, Hb, ALB, and TP levels were lower in both groups than before enrollment in the same group (P < 0.05). At 2 weeks after enrollment, Hb, ALB, and TP levels were higher in both groups than at 1 week after enrollment in the same group (P < 0.05). At 1 and 2 weeks after enrollment, Hb, ALB, and TP levels were higher in the study group than in the control group (P < 0.05). At 7 days after feeding, the feeding compliance rate was higher in the study group (94.67%) than in the control group (70.00%) (P < 0.05). The total complication rate was lower in the study group (8.00%) than in the control group (16.00%) (P < 0.05). The percentage of good prognosis was higher in the study group (34.00%) than in the control group (23.33%) (P < 0.05). After the implementation of evidence-based care, caregivers in the study group scored higher on nutrition knowledge, nutrition attitudes, and nutrition practices than those before the implementation (P < 0.05).ConclusionThe implementation of evidence-based nursing interventions in critically ill neurosurgical patients based on evidence-based concepts is of great clinical value in correcting their nutritional status, preventing enteral nutritional complications, improving prognosis, and enhancing the nutritional knowledge, attitudes, and practices of nursing staff.

Initiating enteral nutrition in patients with severe acute heart failure during mechanical circulatory support

<h2>Summary</h2><h3>Background</h3> While a number of observational studies of enteral nutrition (EN) during mechanical circulatory support (MCS) have been conducted, fewer have looked into severe acute heart failure (AHF), specifically. <h3>Methods</h3> This retrospective observational study investigated patients admitted to a single cardiac care unit from January 2014 to March 2020 for AHF and requiring invasive mechanical ventilation within 72 hours of admission. We investigated clinical outcomes and EN complications in the group of patients for whom EN was initiated during MCS (MCS group). The primary outcome was 30-day mortality. <h3>Results</h3> Forty-seven patients in the MCS group met the inclusion criteria. The 30-day mortality rate was 32% (15) in the MCS group. The number of patients with EN complications were 24 [51%] in the MCS group. Multivariate analysis revealed that no association found between EN initiation during MCS and the 30-day mortality rate and EN complications. (OR:0.94, 95% CI:0.27–3.23, P = 0.922, OR:1.29, 95% CI:0.31–5.29, P = 0.724, respectively). <h3>Conclusion</h3> EN can be selected as the feeding route during MCS, because the adverse events and intolerance associated with EN initiation is not increased when the patients with severe AHF were made hemodynamically stable using MCS.

Increased Rate of Serum Prealbumin Level after Preoperative Enteral Nutrition as an Indicator of Morbidity in Gastrectomy for Gastric Cancer with Outlet Obstruction.

Preoperative malnutrition is believed to contribute to increased postoperative complications. Preoperative serum prealbumin level was reported to be a predictor of nutritional status and postoperative complications after gastrointestinal surgery, including gastrectomy. Gastric outlet obstruction caused by gastric cancer leads to insufficient nutritional status. However, the impact of preoperative enteral nutrition using naso-jejunal feeding tubes for patients with gastric outlet obstruction is not fully understood. From July 2010 to June 2020, 50 patients with gastric cancer-induced outlet obstruction who underwent gastrectomy following preoperative enteral nutrition via feeding tube were included. We investigated the relationship between changes in nutritional status after preoperative enteral nutrition and postoperative complications. Postoperative complications were defined as grade ≥II based on the Clavien-Dindo classification. The median period of preoperative enteral nutrition was 10days. The median increase rate of the serum prealbumin level was 10.5% (interquartile range, 0.63-38.2%), and patients with an increase rate ≥ 10% were defined as the elevated group. Postoperative morbidity was significantly higher in the non-elevated group (P = 0.0031). Univariate and multivariate analyses showed that an increased rate of the serum prealbumin level was an independent risk factor of postoperative complications for patients with gastric outlet obstruction caused by gastric cancer (P = 0.0025 and P = 0.009, respectively). Preoperative enteral nutrition improved the serum prealbumin level of patients with gastric cancer-induced outlet obstruction, and an increased rate of prealbumin can be an indicator of sufficient preoperative enteral nutrition and decreased postoperative morbidity.

Nutritional status and its association with in-hospital major adverse cardiac events in patients with severe heart failure: a prospective study.

Objectives: this study aimed to evaluate the relationship of Nutritional Risk Screening 2002 (NRS2002) and in-hospital major adverse cardiac events (MACE) in patients with severe heart failure. Methods: an observational study was conducted at the emergency intensive care units (EICU) of Shandong University Qilu Hospital from January 2017 to December 2019. Nutritional screening and assessment were performed at the time of admission to hospital with the NRS2002. Results: of the 209 patients included, 16 cases (7.66 %) were not at nutritional risk, and 193 cases (92.34 %) were at risk. Among them, 12 cases (5.74 %) were malnourished, 38 cases (18.18 %) were at high nutritional risk, and 115 cases (55.02 %) were overweight and obese. The differences in prealbumin (PA) and N-terminal B-type natriuretic peptide precursor (NT-proBNP) between the 2 groups were statistically significant (p < 0.05). A total of 134 cases (64.12 %) received nutrition treatment support, of which 39 cases (29.10 %) received enteral nutrition (EN), 77 cases (57.46 %) parenteral nutrition, and 18 cases (13.43 %) enteral nutrition combined with parenteral nutrition (EN + SPN) support treatment. In all, 31 cases (54.39 %) reached 100 % of the target dose. Patients in the EN and EN + SPN groups had 37 MACE (64.91 %) and 31 enteral nutrition complications (54.39 %), with differences between the 3 groups being statistically significant (p < 0.05). Conclusion: the nutritional risk of patients with severe heart failure is high, and age and heart function are positively correlated with nutritional risk. The complications rate of patients with high nutritional risk is significantly higher than in those with low risk; the higher the nutritional risk, the higher the hospital mortality rate - that is, nutritional risk affects disease outcome.

Supporting patients to get home and stay home: a covid-19 case study on the impact of an enteral nutrition nursing service

Rationale: The COVID-19 pandemic has precipitated an increased focus on National Health Service (NHS) care and resources including the value of nutrition. Discharges home on enteral nutrition (EN) and feeding tube complications requiring emergency department (ED) attendance or admission increase pressure on resources1. This study evaluated the impact of an EN homecare company nursing service on patient care and NHS resources during the pandemic.

Lipid enemas for meconium evacuation in preterm infants \u2013 a retrospective cohort study

BackgroundEnemas are used in preterm infants to promote meconium evacuation, but frequent high-volume enemas might contribute to focal intestinal perforation (FIP). To replace a regime consisting of frequent enemas of varying volume and composition, we implemented a once-daily, low-volume lipid enema (LE) regimen. We investigated its impact on meconium evacuation, enteral nutrition, and gastrointestinal complications in preterm infants.MethodsWe performed a single-center retrospective study comparing cohorts of preterm infants < 28 weeks gestation or < 32 weeks, but with birth weight < 10th percentile, before and after implementing LE. Outcomes were rates of FIP, necrotizing enterocolitis (NEC), and sepsis. We assessed stooling patterns, early enteral and parenteral nutrition. We used descriptive statistics for group comparisons and logistic regression to identify associations between LE and gastrointestinal complications and to adjust for group imbalances and potential confounders. Exclusion criteria were gastrointestinal malformations or pre-determined palliative care.ResultsData from 399 infants were analyzed, 203 before vs. 190 after implementing LE; in the latter period, 55 protocol deviations occurred where infants received no enema, resulting in 3 groups with either variable enemas, LE or no enema use. Rates of FIP and sepsis were 11.9% vs. 6.4% vs. 0.0% and 18.4% vs. 13.5% vs. 14.0%, respectively. NEC rates were 3.0% vs. 7.8% vs. 3.5%. Adjusted for confounders, LE had no effect on FIP risk (aOR 1.1; 95%CI 0.5–2.8; p = 0.80), but was associated with an increased risk of NEC (aOR 2.9; 95%CI 1.0–8.6; p = 0.048). While fewer enemas were applied in the LE group resulting in a prolonged meconium passage, no changes in early enteral and parenteral nutrition were observed. We identified indomethacin administration and formula feeding as additional risk factors for FIP and NEC, respectively (aOR 3.5; 95%CI 1.5–8.3; p < 0.01 and aOR 3.4; 95%CI 1.2–9.3; p = 0.02).ConclusionImplementing LE had no clinically significant impact on meconium evacuation, early enteral or parenteral nutrition. FIP and sepsis rates remained unaffected. Other changes in clinical practice, like a reduced use of indomethacin, possibly affected FIP rates in our cohorts. The association between LE and NEC found here argues against further adoption of this practice.Trial registrationRegistered at the German Register of Clinical Trials (no. DRKS00024021; Feb 022021).

Early Enteral Nutrition and Gastrointestinal Complications in Pediatric Patients on Extracorporeal Membrane Oxygenation.

ABSTRACTObjectives:To assess the safety of enteral nutrition (EN) in children on extracorporeal membrane oxygenation (ECMO). To describe nutritional status and the characteristics of the nutritional support in this population.Methods:A retrospective single-center analysis (2006–2016) including children <18 years on ECMO. Demographic data, nutritional status, characteristics of nutritional support, and development of gastrointestinal (GI) complications were recorded.Results:One hundred children, with a median age of 9.7 months (interquartile range [IQR] 3.9–63.1) were enrolled. Undernutrition was prevalent among children on ECMO (33.3%) mainly in patients <2 years (P = 0.042). Most patients (64%) received EN at some point during ECMO therapy. EN was administered in the first 48 hours after ECMO initiation (48HEN) to 60.3% of the children.Mortality rate in the Pediatric Intensive Care Unit was lower in patients who received EN as the initial artificial nutrition support (ANS) (37.7 vs 51%, P = 0.005) and in children on 48HEN (34% vs 50%, P = 0.04). In the logistic regression analysis, duration of ECMO support and low cardiac output indication were the only factors associated with mortality.Although most patients on ECMO (45%) developed digestive complications, they were mostly mild, being constipation the most prevalent. In the logistic regression analysis, EN was not associated with an increase in GI complications (P = 0.09). Only three patients developed intestinal ischemia (one without EN and two on EN).Conclusions:Undernutrition is prevalent among children on ECMO, mainly in infants <2 years. EN is not associated with severe gastrointestinal complications or higher mortality in these children.

Effect of Bundle Management in the Reduction of EN Complications in Patients Receiving Enteral Nutrition (EN) in the ICU

To investigate the efficacy of bundle management in reducing EN complications in ICU enteral nutrition (EN) patients. Methods: In this study, 90 patients with enteral nutrition who were admitted to our hospital and ICU from January 2018 to January 2021 were randomly divided into two groups by random number method: control group (n = 45) treated with routine nursing management and study group (n = 45) treated with bundle management by random number method. The nursing outcomes of the two groups were compared. Results: The incidence rate of enteral nutrition complications in the study group was significantly lower than that in the control group (P&lt;0.05). The nutritional indexes after intervention in the study group were significantly better than those in the control group (P&lt;0.05). There was no significant difference in the relative ratio of nutritional indexes before intervention between the two groups (P&gt;0.05). The satisfaction degree of the patients’ family members in the study group was significantly better than that of the patients’ family members in the control group (P&lt;0.05). Conclusion: Bundle management measures for patients with enteral nutrition in ICU can effectively improve the nutritional index of patients and the satisfaction of their family members, and reduce the incidence of complications of enteral nutrition, which has obvious clinical value.

Effect of Bundle Management in the Reduction of EN Complications in Patients Receiving Enteral Nutrition (EN) in the ICU

To investigate the efficacy of bundle management in reducing EN complications in ICU enteral nutrition (EN) patients. Methods: In this study, 90 patients with enteral nutrition who were admitted to our hospital and ICU from January 2018 to January 2021 were randomly divided into two groups by random number method: control group (n = 45) treated with routine nursing management and study group (n = 45) treated with bundle management by random number method. The nursing outcomes of the two groups were compared. Results: The incidence rate of enteral nutrition complications in the study group was significantly lower than that in the control group (P&lt;0.05). The nutritional indexes after intervention in the study group were significantly better than those in the control group (P&lt;0.05). There was no significant difference in the relative ratio of nutritional indexes before intervention between the two groups (P&gt;0.05). The satisfaction degree of the patients' family members in the study group was significantly better than that of the patients' family members in the control group (P&lt;0.05). Conclusion: Bundle management measures for patients with enteral nutrition in ICU can effectively improve the nutritional index of patients and the satisfaction of their family members, and reduce the incidence of complications of enteral nutrition, which has obvious clinical value.

20 CAUSES OF READMISSIONS FOR PATIENTS DISCHARGED ON ENTERAL NUTRITION

Introduction Hospital readmissions adversely impact patients' quality of life and are costly. Interventions to avoid readmissions can reduce healthcare costs as well as improve patient outcomes. Patients discharged with enteral nutrition (EN) are noted to have increased hospital readmissions but data on the causes for readmissions are limited. We assessed the proportion of patients discharged with EN through an enteral access device (DCEN) readmitted for nutritional care and determined the contributing factors to readmissions. Methods Using electronic health record (EHR) data, we conducted a retrospective cohort study of all hospital encounters in a tertiary care, urban hospital from 7/2017 - 12/2019 with DCEN and unplanned readmission within 30-days. For each readmission, chart review was performed by a research assistant (AP) and physician (SP) to evaluate whether discharge documentation identified the primary cause of readmission to be complications of EN or gastrointestinal symptoms (nausea, vomiting, diarrhea, abdominal pain) attributed to EN. For these EN-related readmissions, we collected the details of readmission cause, hospital course addressing the cause, and EN-related plan adjustments upon discharge. A secondary outcome was the number of days from initiation of EN to readmission. For non-EN related admissions, we evaluated for EN-related plan adjustments upon discharge to assess for secondary nutrition-related benefit from the readmission. Results Over the 30-month period, there were 224 encounters with DCEN and unplanned 30-day readmissions. 46 of 224 (20.54%) were identified as EN-related readmissions. 18/46 (39.1%) were related to symptoms the team attributed to EN, 20/46 (43.5%) documented enteral access device (EAD) issues, and 8/46 (17.4%) were due to sodium imbalance attributed to dehydration (Figure 1). The median number of days since initiating EN was 53 (IQR 21-145) and 29/46 (63.0%) were within 90 days of initiating EN. Of the 178 readmissions with a primary indication not related to EN, 58 (32.6%) involved a change to EN plan. Conclusion A significant proportion of patients discharged with EN have readmissions related to EN, especially within 90 days of initiating EN. The three most common causes, accounting for more than 80% of readmissions, were GI symptoms of intolerance, issues with the EAD, and sodium imbalance attributed to dehydration. A significant proportion of those with readmissions unrelated to EN have secondary nutrition-related benefit during the readmission. Quality improvement interventions targeting post-discharge care to address these causes may decrease hospital readmissions in this high-risk and medically complex population. Download : Download high-res image (65KB) Download : Download full-size image Pareto chart of causes for readmission. EAD: enteric access device. The line represents the cumulative total.

Analysis of frequency and risk factors for complications of enteral nutrition in children in Poland after percutaneous endoscopic gastrostomy placement

ObjectivesThe aim of the study was to assess the complication rate and identify whether age, nutritional status, and history of respiratory aspiration prior to percutaneous endoscopic gastrostomy (PEG) are risk factors for post-PEG placement complications in Polish children. In addition, the safety of two enteral feeding methods (3 h vs. 8 h) after PEG insertion in children was compared. MethodsChildren with clinical indications for PEG placement were recruited from six medical centers in Poland to participate in the study. The patients were centrally randomized to receive the first bolus feed via a feeding tube at 3 h (group 1) or 8 h (group 2) after PEG placement. The preprocedural preparation, postoperative care, and resumption of feeding were performed on all of patients in accordance with the study protocol. Patients were followed for 12 mo. ResultsOf the 97 randomized patients, 49 were assigned to group 1 and 48 to group 2. Full feed after PEG placement was achieved within 24 to 48 h in most cases (74% vs. 82%). There were no differences between the groups regarding the number of early mild (31.3% vs. 31.3%) and serious (2.1% vs 8.3%) complications or the duration of hospitalization after PEG placement (P > 0.05). The most common serious complication after PEG placement was accidental displacement of PEG. Most reported late complications were mild. The results of the regression analysis indicate no statistically significant effect of age, body mass index standard deviation score, white blood cell count, serum albumin level, and respiratory aspiration in the medical history on the occurrence of mild and severe complications. ConclusionsThe early initiation of post-PEG feeding was not associated with an increase in the number of complications. Most complications after the PEG procedure were mild. Age, serum albumin level, white blood cells, body mass index standard deviation score, and a history of aspiration to the respiratory tract were not confirmed as a risk factor for post-PEG complications in children.

The complications of enteral nutrition in medical wards

The effects of Enteral Nutrition (EN) in patients unable to feed themselves have been widely explored although studies in low-/mean- intensity words are lacking. To measure the prevalence of EN side effects in medical wards and to explore their risk factors. Metodi. Observational, retrospective study on matched patients. All patients in the medical departments of the Azienda Ospedaliero-Universitaria Senese were enrolled (81 cases and 162 controls) from 1 August 2018 to 1 September 2019, aged over 50 years and hospitalized for longer than 4 days. The NE side effects such as diarrhea, vomiting, gastric stagnation and abdominal pain were collected from clinical records The presence of EN, age of patients, mobilization and use of antibiotics during hospitalization were considered risk factors. The prevalence of diarrhea, vomiting, gastric and abdominal pain ranged from 4.9% to 11.1%. The EN was not a significant risk factor for the onset of gastrointestinal disorders, and these complications were always lower than in the controls. Vomiting, diarrhea and abdominal pain were more frequently, though not significantly, associated to antibiotic treatments; the age of subjects significantly predicted the diarrhea, showing a protective effect with the age increase. The study shows a low prevalence of diarrhoea, vomiting and abdominal pain compared to the literature. These symptoms were not significantly associated to the EN, that cannot be considered a risk factor.

A prediction model of enteral nutrition complicated with severe diarrhea in ICU patients based on CD55.

Severe diarrhea is a common complication of enteral nutrition in intensive care unit (ICU) patients. CD55 not only plays a vital role in immune but also plays a crucial role in intestinal function. We intended to build a prediction model of enteral nutrition complicated with severe diarrhea in ICU patients based on CD55. This was a prospective, single-center, observational study. We collected 116 patients with enteral nutrition in the ICU. We collected blood samples from patients at the time of admission, tested blood biomarkers [CD55, interleukin-10 (IL-10), diamine oxidase, D-lactic acid and endotoxin], and recorded daily defecation and enteral nutrition. Finally, through multi-factor logistic regression model, a prediction model based on multiple prediction indicators was formed, and new joint predictive factors were calculated. The prediction model of enteral nutrition complicated with severe diarrhea in ICU patients was constructed through data processing analysis. A total of 116 adult patients with enteral nutrition were divided into two groups: 77 patients without severe diarrhea and 39 with severe diarrhea. Compared with patients without severe diarrhea, CD55 on granulocyte membrane surface(gCD55) of patients with severe diarrhea was significantly reduced (P<0.0001), and CD55 on erythrocyte membrane surface(eCD55) of patients with diarrhea was significantly reduced (P<0.0001), serum IL-10 in patients with diarrhea significantly decreased compared with those without diarrhea, P<0.0001.The area under the curve of receiver operating characteristic (AUCROC) was 0.919 in gCD55 predicting severe diarrhea, when cutoff value =99.95%, the optimal sensitivity was 96.2%, and specificity was 100%. The AUROC of eCD55 and IL-10 in predicting severe diarrhea was 0.658 and 0.558 respectively. Based on this, a prediction model was established. The prediction model was: In[P/(1- P)] =-24.68 gCD55 -2.26 eCD55 +0.0041 IL-10 +2,691, the goodness of fit test of the model was P=0.44, and the AUCROC of the model was 0.92. gCD55 and eCD55 had certain predictive value in enteral nutrition complicated with severe diarrhea.

The prevalence and possible causes of enteral tube feeding intolerance in critically ill patients: A cross-sectional study.

Background:Enteral tube feeding intolerance (ETFI) is one of the most common complications of enteral nutrition (EN), which may lead to increased mortality and length of intensive care unit (ICU) stay. This study aimed to determine the prevalence of ETFI and effects on feeding intolerance on nutrition and clinical outcomes in Iran.Materials and Methods:This cross-sectional study was conducted in 2019 at the three general ICUs of Imam Reza Hospital in Mashhad, Iran, during 7 days on 245 patients. The collected data included demographic characteristics, primary diagnosis, the Acute Physiology and Chronic Health Evaluation II (APACHE ІІ) score, Sequential Organ Failure Assessment (SOFA) score, duration of mechanical ventilation, and length of ICU stay. Feeding intolerance was assessed using daily questionnaires for 7 days. ETFI was determined as the interruption of EN based on gastrointestinal causes, including large gastric residuals, abdominal distension, vomiting, diarrhea, and subjective discomfort.Results:Overall, 245 critically ill patients (122 males and 123 females) were included in this study, with a mean age of 58.43 ± 19.2 years in three general ICUs. The highest prevalence rate of ETFI was 91.8%, which occurred on the 2nd day although the rate decreased in the following days. The minimum ETFI was observed on the last day (38.8%). Feeding intolerance was associated with the increased APACHE II scores (P = 0.04), SOFA scores (P < 0.001), and duration of mechanical ventilation (P < 0.001) compared with the tolerant patients. The most common causes of ETFI in the patients admitted to the ICU were gastric residual volume (GRV), large GRV, vomiting, and distension.Conclusion:ETFI was prevalent in almost two-third (66%) of the critically ill patients receiving EN based on the GRV. ETFI was associated with deteriorated nutritional status and clinical outcomes.

Effects of an Enteral Formula Containing Fermented Dairy Products on Epithelial Ion Transport in Rat Intestines.

Diarrhea is the most common complication of enteral nutrition (EN). Pro/prebiotics are typically used to prevent diarrhea during EN. This study aimed to demonstrate the effects of enteral formula containing fermented dairy products (FDPs) and galacto-oligosaccharides on intestinal mucosal functions in rats. After feeding rats with regular rodent chow (RRC), standard formula (STD-F), and FDP-containing formula (FDP-F) for 2 wk, the rats were sacrificed with their intestines removed. Then, the electrophysiological properties of intestinal epithelia were measured using the Ussing chamber. In addition, organic acids and microbiota in the cecal contents were analyzed. In FDP-F-fed rats, electrical nerve activation-evoked increase in short-circuit current (Isc) in the cecum and middle colon was reduced compared with STD-F-fed rats. Mucosal propionate-evoked changes in Isc in FDP-F-fed rats were also reduced in the terminal ileum. The total cecal organic acid concentration in STD-F-fed rats decreased compared with RRC-fed rats, and approximately half was recovered in FDP-F-fed rats, which contributed to the recovery of acetate and butyrate concentrations. In microbiota analysis, the density of total bacteria, particularly Bifidobacterium, in cecal contents increased in FDP-F-fed rats. In conclusion, the consumption of FDP-F changed the total amounts and components of gut microbiota and organic acids, and resulted in inhibitory changes in mucosal luminal stimulant- and nervous system-mediated fluid secretory function. These findings suggest that FDP-F might prevent the incidence of diarrhea during EN.