Early Enteral Feeding In Patients Research Articles

Breakage of an orogastric tube in a critically Ill patient: a case report.

This case report describes a 58-year-old patient with the diagnosis of stroke, in whom there was breakage of an orogastric tube during a prolonged ICU stay. Early enteral feeding in patients without any contraindications is associated with improved organ survival and recovery, and decreased incidence of infections, which decreases the ICU stay and improves the overall outcome. Nasogastric and orogastric tubes are the most commonly inserted feeding tubes. Breakage of an orogastric tube is a rare complication that can occur due to manufacturing defects, exposure to a harsh acidic environment, and forceful flushing of an obstructed tube. Timely identification of the broken feeding tube can help the treating clinicians retrieve it easily even with the help of a laryngoscope in selected patients.

S13 Early Feeding Rates in Acute Pancreatitis Is Associated With Decreased Length of Hospitalization

Introduction: Guidelines recommend that patients with acute pancreatitis (AP) receive early oral or enteral feeding within 24 hours of diagnosis rather than keeping patients nil per os. Early feeding reduces rates of multiorgan failure and necrotizing pancreatitis. We sought to understand whether early feeding affected length of hospitalization for AP, identify factors associated with early feeding, and determine whether an order set for acute pancreatitis would improve early feeding rates. Methods: We identified adult patients (age ≥18 years) hospitalized at Yale New Haven Hospital, a tertiary academic medical center with a diagnosis of AP by ICD-10 code and/or serum lipase ≥3 times the upper limit of normal from April 2019-January 2021 and reviewed their charts to confirm the diagnosis of AP and the timing of diet order entry. We created and implemented an electronic medical record order set for AP including guidelines and diet, imaging, and consult orders in October 2020 (Figure 1). E-mails were sent to notify hospitalists and medicine residents of the order set. Primary outcome was the proportion of patients who received a diet order within 24 hours following diagnosis of AP. Logistic regression was performed to evaluate the relationship between early feeds within 24 hours of AP diagnosis and patient factors. Results: A total of 707 patients were hospitalized with AP, and 496 patients (70.2%) had enteral feeds within 24 hours of AP diagnosis. Patients receiving early feeds had shorter hospitalizations compared to patients receiving delayed feeds (mean [SD] 8.4 days [12.8] versus 5.4 days [8.2]) (P < 0.01) and were less likely to be hospitalized in the intensive care unit (ICU) (odds ratio 0.45, 95% confidence interval 0.32–0.63) (Table 1). There was no difference in gender, race, ethnicity between patients who received feeds within 24 hours of AP diagnosis and those who received feeds >24 hours after AP diagnosis. Implementation of an order set containing guidelines and orders for diet, imaging, and consults did not significantly improve early feeding within 24 hours of AP diagnosis (70.5% versus 68.9%) likely due to limited usage by providers. Conclusion: Early enteral nutrition is associated with shorter hospitalizations among patients with AP. Patients receiving oral or enteral feeds within 24 hours of AP diagnosis were less likely to be in the ICU. Durable and effective quality improvement initiatives are needed to improve rates of early enteral feeding in patients with AP. Table 1. - Factors associated with early enteral feeding in acute pancreatitis Variable Odds Ratio 95% Confidence Interval p-value Intensive Care Unit Hospitalization 0.45 0.32-0.63 < 0.01 Age 1.00 0.99-1.01 0.99 Race White/Caucasian Black/African-American Other/Not Listed reference0.920.98 reference0.63-1.360.63-1.52 0.92 Ethnicity Non-Hispanic Hispanic Other/Not Listed Reference1.160.22 Reference0.75-1.790.02-2.40 0.33 Figure 1: Timeline of Interventions

Early enteral feeding in patients with gastrointestinal surgery time to send the patient home early

Background: There has been a trend among surgeons to delay enteral feeding following gastrointestinal surgery so that complications like anastomotic site leak and infection can be prevented and also to give time for operated site to heal. Newer studies suggest that early enteral feeding is useful in comparison to conventional method of feeding i.e. waiting for bowel function to return. This study was undertaken to evaluate the safety and tolerability of early enteral feeding after gastrointestinal surgeries in terms of postoperative complications and length of hospitalization.Methods: This study was prospective observational study with retrospective controls done over a period of 18 months at a tertiary care center in India. 35 patients were included in each group (case versus control). Early enteral feeding was defined as commencement of oral feed within 48 hours of surgery. The data was analyzed using statistical package of social science (SPSS Version 20; Chicago Inc., USA).Results: Both groups were found to be well matched in terms of age and sex distribution. The mean hospital stay for patients given early enteral feeding was significantly lower as compared to controls (10.26±3.09 versus 13.4±2.186). They had a complication rate of 11.4 % as compared to late enteral feeding group (25.7%).Conclusions: Early enteral feeding has been found beneficial in most of the studies worldwide. Hence, it is time to open our minds and embrace it to improve surgical outcome in gastrointestinal surgery practice.

Outcomes of early enteral feeding in patients after curative colorectal cancer surgery: A retrospective comparative study.

To compare the clinical outcomes of patients with and without early enteral nutrition after colorectal cancer surgery. This is a retrospective comparative study using propensity score-matched cases. The study subjects were patients who received colorectal cancer resection surgeries during 2013 and 2018 in a Taiwan medical center. Data of the following variables were retrieved from subjects' medical records: age, sex, diagnosis, pathological stage, surgical approach, comorbidity, risk of malnutrition, anesthesia duration, enteral nutrition, time to the first postoperative flatus, time to the first defecation, feeding associated symptoms, nutrition interruptions, time to achieve nutrition goals, postoperative complications, the length of hospital stay. Subjects who received enteral nutrition within 48h after the surgery were considered as the early enteral nutrition group. After propensity score matching, 227 subjects in each group were included in the final analysis. The early enteral nutrition group showed better results in the time to first postoperative flatus (mean difference: 0.96, 95% confidence interval: 1.16~-0.76), the time to achieve nutrition goals (mean difference: 1.26, 95% confidence interval: 0.65~-1.87), and the length of hospital stay (mean difference: 1.53, 95% confidence interval: 2.56~-0.42), compared with the delayed enteral nutrition group. There were no between-group differences in the incidences of vomiting, distension, ileus, anastomosis leak, infection, re-operation, and interruptions of enteral nutrition. Enteral feeding after colorectal cancer surgery can accelerate the recovery of gastrointestinal tract activities, promote nutrient intake, and shorten the length of hospital stay without increasing postoperative complications.

Early Enteral Feeding After Living Donor Liver Transplantation Prevents Infectious Complications: A Prospective Pilot Study.

Infectious complications, including bacteria, virus, and fungus, often occur after liver transplantation and are the most frequent causes of in-hospital mortality. The current study prospectively analyze the effect of early enteral feeding in patients after living donor liver transplantation (LDLT)Between January 2013 and August 2013, 36 patients underwent LDLT. These patients were randomly assigned to receive enteral formula via nasointestinal feeding tubes [enteral feeding (EN) group, n = 17] or maintenance on intravenous fluid until oral diets were initiated (control group, n = 19). All patients completed the study.The pretransplant and perioperative characteristics of patients did not differ between the 2 groups. The incidence of bacterial infection was significantly lower in the EN group (29.4%) than in the control group (63.2%) (P = 0.043). In addition, the incidence of bile duct complications in the EN group was lower than in the control group (5.9% versus 31.6%, P = 0.041). Multivariate analysis showed that early enteral feeding was closely associated with bacterial infections (odds ratio, 0.178; P = 0.041). There was no statistically significant difference in nutritional status between the 2 groups. There were no cases of in-hospital mortality.Early enteral feeding after LDLT prevents posttransplant bacterial infection, suggesting the possibility of a reduction of in-hospital mortality as a result of decreased infectious complications.

Early Initiation of Enteral Feeding in Cancer Patients after Outpatient Percutaneous Fluoroscopy-Guided Gastrostomy Catheter Placement

PurposeTo report the results of early enteral feeding in patients with cancer after outpatient placement of a percutaneous fluoroscopy-guided gastrostomy (PFG). Materials and MethodsFrom January 2008 through December 2008, 121 consecutive patients with cancer underwent outpatient placement of a PFG for nutrition. Of these patients, 118 patients met criteria for early feeding, and 113 were successfully fed early (after at least 3 hours). Of the patients fed early, 5 had insufficient follow-up for further analysis leaving 108 patients for outcomes analysis. After placement of the PFG, patients were put on low-wall suction via the PFG for 1 hour followed by feeding via the PFG at least 3 hours after placement. Follow-up evaluation was done the next business day. The medical records were reviewed for 30-day outcomes of early feeding, technical aspects of the procedures, and complications. ResultsAfter placement of the PFG, 98% (118 of 121) of patients met criteria for early feeding, and 93% (113 of 121) of patients were successfully fed early. The median time between the end of the procedure and initiation of feeding was 4 hours (interquartile range, 3.7–4.4 h). The 30-day minor complication rate was 14% (15 of 108), and the 30-day major complication rate was 1% (1 of 108). No complications were directly attributable to early feeding. ConclusionsEarly initiation of tube feedings after outpatient placement of a PFG was well tolerated in patients with cancer and carried comparable risks to previously reported results using traditional delayed feeding protocols. Early feeding provided patients with prompt enteral nutrition and eliminated the need for routine hospital admission after the procedure.

EComment. Enteral nutrition following oesophagectomy for oesophageal carcinoma 3 July 2012

The systemic effects of malignancy and obstruction caused by oesophageal strictures means patients with oesophageal carcinoma are frequently malnourished. Wheble and colleagues [1] point out there is a paucity of data to identify whether a routine early post-operative enteral feeding after oesophageal resection is beneficial. They correctly conclude none of the randomized studies show any mortality benefits. However none of trials quoted examined whether any preoperative predictors of nutrition status would affect the outcome (mortality). This information could be used to see if stratification of patients based on nutritional status resulted in any benefit of early enteral feeding. Larger sample sizes would be needed for such an analysis. A study not quoted by the authors compared the outcomes of 44 patients who underwent early enteral feeding in patients who underwent oesophageal resection to a historical cohort of patients who underwent parenteral feeding [2]. Although no difference in 30-day perioperative mortality was found, early enteral feeding compared to parenteral feeding reduced both the stay in the ICU and overall hospital stay. Therefore, until more robust data is available, routine early postoperative enteral feeding should not be abandoned. Conflict of Interest: None declared

The Safety of Early Enteral Feeding after Emergency Gastrointestinal Surgery

Postoperative early feeding has many advantages, and current guidelines recommend the early diet or enteral feeding after gastrointestinal surgery. However, there are controversies in emergency situation. The aim of this study was to assess the safety of early enteral feeding in patients underwent emergency gastrointestinal (GI) surgery. We reviewed the patients underwent emergency GI surgery by single surgeon from March 2008 to December 2010, retrospectively. The early feeding was defined when feeding was started within 72 hours after operation. Fifty-three patients were enrolled. Men were 31, with mean 60.6 (±18.5) years old age. Thirty-three patients were treated in the intensive-care unit after operation. The most common cause of operation was bowel perforation, and followed by intestinal obstruction. Segmental resection with primary anastomosis of small bowel is the most common operation. Thirty-two of them started the diet within 48 hours postoperatively. Twenty-nine patients had post-operative complications. Wound complications were the most common, and followed by the abdominal pain, and ileus. Wound complications were developed in 18 patients, and the post-feeding abdominal pain was in 7 patients. Anastomotic leakage and intraabdominal abscess were developed in 2 patients, and 1 patient required reoperation to treat the anastomotic disruption. One patient developed pneumonia and sepsis, and resolved under conservative treatment. There was no mortality in these patients. Early enteral feeding may be safe in cases of emergency GI surgery. However, it may require further studies to confirm the safety and feasibility of the early feeding in emergency situations.

The use of prophylactic percutaneous endoscopic gastrostomy and early enteral feeding in patients with advanced head and neck cancer-A prospective longitudinal study

Summary Background&aims This descriptive study aimed to explore the effect of early nutritional support and enteral feeding using percutaneous endoscopic gastrostomy (PEG) in preventing malnutrition in patients with locally advanced head-neck cancer. Method Sixty-four patients received a prophylactic PEG before treatment. Weight, body mass index (BMI), body composition, fat free mass index (FFMI), dysphagia and use of tube feeding were followed during two years. Results The patients started to use their PEGs on average 30 days after treatment start and used enteral feeding for 180 days. PEG was well tolerated with few side-effects. After one-year 89% had returned to almost normal diet. At the time of inclusion in the study, 42% had lost weight, on average 6% of their normal weight. Despite nutritional advice and early tube feeding the patients continued to lose weight. The largest weight loss was found after six months (average 11.2%). At that follow-up 62% of the patients were malnourished (loss of >10% of their weight at inclusion), however BMI, and more importantly, the fat free-mass remained normal, probably due to the rather slow weight loss progression. Conclusion Patients required nutritional support and enteral feeding for an extended time-period, however a normal body composition was maintained despite weight loss.

Before–after study of a standardized ICU protocol for early enteral feeding in patients turned in the prone position

To evaluate an intervention for improving the delivery of early enteral nutrition (EN) in patients receiving mechanical ventilation with prone positioning (PP). Eligible patients receiving EN and mechanical ventilation in PP were included within 48h after intubation in a before-after study. Patients were semi-recumbent when supine. Intolerance to EN was defined as residual gastric volume greater than 250ml/6h or vomiting. In the before group (n=34), the EN rate was increased by 500ml every 24h up to 2000ml/24h; patients were flat when prone and received erythromycin (250mgIV/6h) to treat intolerance. In the intervention group (n=38), the EN rate was increased by 25ml/h every 6h to 85ml/h, 25 degrees head elevation was used in PP, and prophylactic erythromycin was started at the first turn. Compared to the before group, larger feeding volumes were delivered in the intervention group (median volume per day with PP, 774ml [IQR 513-925] vs. 1170ml [IQR 736-1417]; P<0.001) without increases in residual gastric volume, vomiting, or ventilator-associated pneumonia. An intervention including PP with 25 degrees elevation, an increased acceleration to target rate of EN, and erythromycin improved EN delivery.

Parenteral and Early Enteral Feeding in Patients with Colonic Tumor

Objective: to provide evidence whether it is expedient to use an early enteral feeding protocol in patients with colonic malignancies in the postoperative period to prevent and to correct hemodynamic disorders, oxygen imbalance, and malnutrition. Subjects and methods. A hundred patients (61 males and 39 females) aged 66.2±5.0 years, who had Stages 2—3 colonic malignancies, were examined. Two algorithms of postoperative management were analyzed using the traditional diet and early enteral feeding. Results. The early enteral feeding protocol improves central hemodynamics and oxygen and nutritional status, prevents moderate protein-energy deficiency in the early postoperative period and reduces the number of complications and fatal outcomes in patients with colonic malignancies. Key words: malignancies, malnutrition, hemo-dynamics, oxygen status, enteral feeding.

Five-year experience of early enteral feeding in patients undergoing allogeneic stem cell transplantation following myeloablative conditioning for malignancy

7043 Background: The aim of this work was to investigate the evolution of our practices regarding nutritional support and its impact on early outcomes over the last 5 years. Methods: From Jan 01 to...

Five-Year Experience of Early Enteral Feeding in Patients Undergoing Allogeneic Stem Cell Transplantation Following Myeloablative Conditioning.

Since the early 2003 with the encouraging preliminary results of our pivotal study (Seguy, transplantation), all pts refereed to our unit for myeloablative Allogenic Stem Cell Transplantation (allo-CST) were offered right away enteral feeding via a naso-gastric tube (NGT). The aim of this work was to investigate the evolution of our practices regarding nutritional support and its impact on early outcomes over the last five years. During a systematic individual pre-transplantation interview, all pts were provided with comprehensive information regarding NGT feeding. They received advice on an ongoing basis from a multidisciplinary team. Between Jan 01 and Dec 05, 121 pts who underwent myeloablative allo-SCT were offered EN. Among them, 94 (78%) agreed to receive EN (EN group) and 27 (22%) refused the NGT (without EN group: WEN group) and received either parenteral nutrition (PN) (n=22) or oral feeding only (n=5). The NGT was inserted shortly after transplantation. Bacteriological high-controlled oral diet intake was encouraged for as long as the patient was able to sustain it. The daily oral intake was scheduled to provide 100% of estimated requirements for energy (30–35 kcal/kg/day). Overnight NGT feeding, was gradually increased depending on the patient's tolerance in order to reach 50–70% of energy requirement within 5 days. In case of intolerance toward EN, additional or total PN was given. In the WEN group, pts received PN when total oral intake was less than two-thirds of the average energy requirement over 5 days. Except for the pts' age (EN-group, 38y vs WEN 28y, p=.038), the two groups were comparable in terms of initial pts' characteristics and transplantation modalities. Median duration of EN was 14 days (1–59) and 61 pts received no additional PN while the median duration of the PN was 12 days (2–70). There was no significant difference between the two groups regarding duration of hospitalization, nutritional status at discharge and duration and grade of mucositis. Significant differences were observed, however: engraftment, 100% vs 93%, p=.05, duration of neutropenia, 20d (10–64) vs 25d (18–100), p=.0001 and thrombopenia 27d (6–100) vs 56d (50–100), p=.014; serum albumine level at discharge < 35g/L, 45% vs 76%, p=.005 for EN-group vs WEN-group, respectively. Pts with EN developed less often acute grade III/IV GVHD (9% vs 37%; p=0.001) and non-bacterial infections (9% vs 41%; p=.0002). In addition, pts with enteral feeding had better 100-day survival (92% vs. 67%, P=0.001) with less infection-related deaths. In multivariate analysis the absence of enteral nutrition was the only factor adversely influencing 100-day survival (CI 95%: 1.55–14.9 0.646; P=.007). In order to evaluate the practices over time regarding nutritional support in our unit, we compared the initial period (2001–02) when pts (n=41) had the choice between EN and PN with the second period (2003–05) when EN was offered systematically (n=80). In the second period, pts received less often PN (73% vs. 31%, p<.0001) and more often EN (49% vs. 93%, p<.0001) with longer duration (10d vs. 15d; p=.001). In addition, EN started earlier after transplantation (5d vs 2d, p=.004).CONCLUSION: EN has been well tolerated and dramatically reduced the proportion of pts requiring PN. This study confirms the positive impact of EN on early outcome of pts undergoing myeloablative allo-CST. When possible EN should be preferred to PN.

Early enteral feeding of patients with multiple trauma

The case study illustrates the recovery of a patient with multiple trauma who was fed a peptide-based formula via the enteral route soon after the trauma. Although the clinical course might have been worse if D.H. had not received this treatment, his generally excellent recovery might be partly attributable to this therapy. Although stress hypermetabolism occurs in most patients with multiple trauma within 48 hours after injury, no known treatment can arrest or reverse this problem. However, the lethal catabolic and septic effects of stress hypermetabolism can be at least partly thwarted through delivery of enteral nutrients within 72 hours after trauma.

Burns

Inhalation injuries still significantly increase the morbidity and mortality of burn patients. Advances in ventilatory support appear to decrease the frequency of pneumonia and improve the survival of patients. It is now well accepted that early enteral feeding of patients with burn injuries is very important. The addition of anabolic agents in burn care and nutrition may be of importance. Patients receiving pre-storage filtered blood components have fewer blood transfusion-induced side effects and the requirement for transfusion is reduced. Current research on the cellular response to burn injury holds promise for further improvement in burn care.

The benefit of early enteral feeding in patients undergoing liver transplantation

The benefit of early enteral feeding in patients undergoing liver transplantation

Re: McArdle et al: Early Enteral Feeding of Patients with Major Burns

Re: McArdle et al: Early Enteral Feeding of Patients with Major Burns