Early Enteral Nutrition Therapy Research Articles

Effects of early enteral nutrition in patients with severe burns: A systematic review.

Nutritional problems in the early stages of severe burns are prominent and seriously affect the clinical outcomes of patients. Our aim is to analyze the effects of early enteral nutrition (EEN) in patients with severe burns. In this study, relevant articles were searched in 8 English and Chinese data, with a time limit from the creation of the database to June 2023. Two researchers independently completed the search, screening and quality assessment of the articles. We conducted a systematic review and meta-analysis of randomized controlled trials that examined EEN therapy in people with severe burns. We compared the effects of EEN and non-EEN therapy in severely burned patients. The outcomes were mortality, gastrointestinal complications, nutritional indicators, gastrointestinal hormones, sepsis, length of hospital stay and wound healing time. Categorical variables were expressed as OR and 95% CI was calculated, and continuous variables were expressed as MD and 95% CI was calculated. The protocol for this systematic review was registered in PROSPERO on May 12, 2023 (identifier CRD42023422895). Nineteen studies with a total of 1066 participants met the inclusion criteria. When comparing EEN therapy with non-EEN therapy, the experiment group had significantly lower mortality [OR = 0.39, 95% CI (0.20, 0.74), P = .004], lower wound healing time [MD = -10.77, 95% CI (-13.66,-7.88), P < .00001], fewer gastrointestinal complications [OR = 0.18, 95% CI (0.09, 0.36), P < .00001], lower rates of gastrointestinal hemorrhage [OR = 0.12, 95% CI (0.04, 0.36), P = .0001], lower rates of sepsis [OR = 0.40, 95% CI (0.24, 0.66), P = .0005], shorter length of hospital stay [MD = -12.08, 95% CI (-13.61, 9.19-10.56), P < .00001], and higher prealbumin levels [MD = 29.04, 95% CI (21.98, 36.10), P < .00001], higher total albumin levels [MD = 6.74, 95% CI (4.29, 9.19), P < .00001], and gastrin levels [MD = 15.93, 95% CI (10.12, 21.73), P < .00001]. However, there was no significant difference in albumin between the 2 groups [MD = 2.62, 95% CI (-0.30, 5.55), P = .08] or motilin levels [MD = 12.48, 95% CI (-43.59, 68.56), P = .66]. EEN plays an important role in the rehabilitation of patients with severe burns. EEN is beneficial to reduce complications and the length of hospital stay, maintain organ function, optimize the nutritional status of patients, promote wound healing, and improve the survival rate of patients.

Effect of sequential vs. non-sequential early enteral nutrition therapy on nutritional status, recovery, and quality of life of patients with esophageal cancer.

To study the effects of early sequential enteral nutrition (ESEN) therapy and early non-sequential enteral nutrition (EN) therapy on the nutritional status, recovery, and quality of life of patients who undergo postoperative chemotherapy for esophageal cancer. The data of 90 patients who underwent postoperative chemotherapy for esophageal cancer in Gansu Provincial Cancer Hospital from January 2018 to June 2020 were analyzed retrospectively. Patients were divided the Test group and the Control group (n=45 each) based on the method of nutritional support. Patients in the Control group were treated with non-sequential early enteral nutrition and the Test group treated with sequential early enteral nutrition until the discharge. Nutritional status, recovery, and quality of life of the chemotherapy patients in the two groups were compared. After the intervention, the pre-protein, albumin and hemoglobin levels were higher in the Test group than in the control group (p<0.05). Postoperative exhaustion, incision healing and length of hospital stay were significantly lower in the Test group than in the Control group (p<0.05), while the scores on all dimensions of the short-form 36 health survey scale (SF-36) and the total score were higher than in the Control group (p<0.05). Sequential early enteral nutrition may be used for patients who undergo chemotherapy after esophageal cancer surgery to promote their early recovery and improve their quality of life and nutritional status.

Effects of Psychiatric Issues and Early Enteral Nutrition Therapy on Anxiety and Quality-of-Life of Patients with Gastric Cancer.

Objectives: In this study, we assessed the effects of psychiatric issues and early enteral nutrition therapy on anxiety and quality-of-life of patients with gastric cancer. Methods: We enrolled 60 patients with gastric cancer treated from January 2018 to November 2020 and divided them into 2 groups using a random number table (N=30 per group). All patients received early enteral nutrition therapy. The control group was given routine nursing; treatment of persons in the observation group was supplemented with additional psychiatric nursing. We then compared anxiety-depression scores, treatment compliance, nutritional status indices, and quality-of-life score. Results: The Self-rating Anxiety Scale (SAS) score and the Self-rating Depression Scale (SDS) score significantly declined in both groups after nursing compared with those before nursing (p<.05). After nursing, the SAS score and SDS score were lower in the observation group versus the control group (p<.05). The total rate of treatment compliance in the observation group (93.33%) was higher than that in the control group (73.33%) (p<.05). After nursing, the levels of hemoglobin, albumin, prealbumin, and transferrin were significantly higher in both groups than before nursing (p<.05), but higher in the observation group (p<.05). After nursing, the quality-of-life score was significantly higher in both groups than before nursing (p<.05), but higher in the observation group (p<.05). Conclusion: During enteral nutrition therapy for patients with gastric cancer, psychiatric treatment can effectively alleviate patient anxiety and depression, enhance treatment compliance, improve nutritional status, and enhance quality-of-life.

Fluid restriction management in the treatment of COVID-19: a single-center observational study

The relationship between fluid management and the severity of illness, duration of treatment, and outcome of coronavirus disease 2019 (COVID-19) is not fully understood. This study aimed to evaluate whether weight change during hospitalization was associated with COVID-19 severity, length of hospital stay, and route of admission. In this study, we assessed the effectiveness of fluid restriction management in patients with severe COVID-19. COVID-19 patients admitted to our hospital between July 2020 and October 2021 were analyzed. Patients were treated with standard drug therapy based on the Japanese guidelines and respiratory support according to the severity of the disease. Early enteral nutrition, defecation management, and anticoagulation therapy were also administered. Fluid restriction management was performed using furosemide and continuous renal replacement therapy as needed unless hemodynamic instability or hyperlactatemia was present. Patient background, route of admission (ambulance, A; transfer, T), weight at admission and discharge, the severity of illness (oxygen therapy, G1; mechanical ventilation, G2; extracorporeal membrane oxygenation, G3), in-hospital mortality, and length of hospital stay were analyzed. There were 116 subjects: G1 (n = 48), G2 (n = 43), and G3 (n = 25), with ages (median [IQR]) of 58 (47–70), 65 (53–71.5), 56 (51–62) years, 40 (83.3%), 31 (72.1%), and 19 (76.0%) males, respectively. Hospital stays were 4.5 (2–7), 10 (7–16), and 18 (15–26) days, and the in-hospital mortality rates were 0 (0%), 7 (16.3%), and 8 (32%), respectively. Body mass index on admission was 26 (23.1–30.2), 27.1 (22.7–31.1), and 31.5 (27.1–33.1) kg/m2, and weight loss during admission was 1.1 (0–2.9), 4.6 (2.3–5.7), 9.2 (5.6–10.5) kg (P < 0.001, Jonckheere–Terpstra test. Weight loss in the severe group (G2 + G3) was 3.4 (0.5–5.8) kg [A, n = 12] and 5.6 (4.4–9) kg [T, n = 43] [P = 0.026, Mann–Whitney U test]. The lengths of hospital stay were 5 (2–7), 9 (7–15), and 18 (12–26) days [P < 0.001, Jonckheere–Terpstra test]. In our fluid restriction management, patients with severe COVID-19 had significant longer hospital length of stay, weight loss, especially those who were transferred to the hospital.

Application Effect of Intra-Abdominal Pressure Monitoring System in Early Enteral Nutrition Nursing of ICU Patients.

In order to study and explore the application effect of intra-abdominal pressure monitoring in guiding ICU patients to implement early enteral nutrition therapy, we selected patients admitted to the emergency department of a hospital and classified them into groups A (n = 105) and B (n = 98). Among them, the A group gave early enteral nutrition treatment by monitoring the residual gastric mass, and the B group gave early enteral nutrition treatment by monitoring the stomach. It has been established that, compared to gastric residue monitoring, intra-abdominal pressure monitoring in ICU patients with early enteral nutrition therapy has an obvious advantage, it helps to improve the prognosis of patients, and intra-abdominal pressure combined with gastric residual monitoring scheme can effectively reduce the early enteral nutrition in the ICU patients, the incidence of abdominal distension, vomiting, and make it reach the goal as soon as possible. Early enteral nutrition in patients with increased tolerance is of great significance.

Research advances on early enteral nutritional therapy in severe burn patients

Severe burns can lead to persistent hypermetabolism. Studies have shown that early enteral nutrition therapy is related to improving the prognosis of severe burn patients, reducing the mortality rate, and reducing gastrointestinal complications and infectious complications. This article introduces the nutritional benefits and non-nutritive benefits of early enteral nutrition therapy for severe burn patients (maintaining the integrity of the intestinal mucosa function and structure and promoting wound healing), the timing and pathways of nutritional intervention, ways of energy evaluation, and nutritional monitoring, etc., aiming to provide a reference for the clinical decision-making of early enteral nutrition therapy.

Associação entre adequação calórico-proteica e início precoce da terapia nutricional enteral com o desfecho clínico de pacientes oncológicos na unidade de terapia intensiva

Introduction: Complications associated to cancer may contribute to the admission of oncological patients to the Intensive Care Unit (ICU) and it have association to worst prognosis. Critical patients usually need Enteral Nutrition Therapy (ENT). Early enteral nutrition and the caloric-protein adequacy have associations with good prognosis, reduction of hospitality, costs and mortality. Objective: Evaluate the association between caloric-protein adequacy of enteral nutrition therapy and early enteral nutrition therapy, with the clinical outcomes in oncological patients in the Intensive Care Unit. Methods: It is a cross sectional study with 114 oncological patients admitted to ICU, at a Cancer Center in Brazil between January to December 2017. The inclusion criteria were patients aged 18 years old and over, who received ENT during the length of stay in ICU for at least 72 hours. Data collection was performed based on medical records. Results: Sixty-four percent of patients have early enteral nutrition. Patients who did not have early enteral nutrition had significant statistic association with death in the ICU (p=0,031) and in the clinical outcomes final (p=0,015). Moreover, there was association between late start of enteral nutrition with longer ICU (p=0,001) and hospital stay (p=0,027). Patients who did not get energy (p=0,045) and protein (p=0,020) adequacies had longer length of stay in ICU. Conclusion: The early enteral nutrition has low association with death and with less total ICU and hospital stay. Early enteral nutrition was associated with less total ICU and hospital stay. To prove these results should take more studies, t hat might change the conduct of clinical practice.

Application of Early Enteral Nutrition in Critically Ill Children

Objective: The objective is to investigate the incidence of moderate and severe malnutrition in children in intensive care units, and to analyze the safety and clinical efficacy of early enteral nutrition therapy in critically ill children. Methods: A total of 80 children hospitalized in the pediatric care unit meeting the inclusion criteria were selected and general data were collected, including 48 in the early enteral nutrition (EEN) group and 32 in the late EN group. The two groups were compared in the incidence of moderate to severe malnutrition, feeding tolerance, length of stay in ICU, total length of stay, changes in blood routine and biochemical indicators. Results: After 1 week in ICU, the feeding tolerance of the treatment group was better than that of the control group (P 0.01). After 1 week of treatment in ICU, serum prealbumin in treatment group was significantly higher than that in control group (P albumin was not significantly higher (P > 0.05). The rate of moderate to severe malnutrition at discharge was lower in the treatment group than at admission to the ICU (17 cases vs. 20 cases, 35.4% vs. 41.7%), but higher in the control group (19 cases vs. 16 cases, 59.4% vs. 50.0%). Conclusion: Malnutrition is prevalent in children treated in pediatric intensive care units. Early enteral nutrition therapy for critically ill children is safe and effective, that can significantly improve the nutritional status of critically ill children, reduce inflammatory response, and shorten the hospital stay.

Effects of Micro-Ecological Enteral Nutrition on Systemic Inflammatory Response, Bacterial Translocation, and Immune Function in Patients with Severe Acute Pancreatitis

We have evaluated the effect of early and late micro-ecological enteral nutrition on systemic inflammatory response, bacterial translocation, and immune function in patients with severe acute pancreatitis. Two weeks after treatment, experimental group receiving early nutritional intervention exhibited a significant increase in intestinal lactobacilli and bifidobacteria, fewer staphylococci, and E. coli, and lower levels of serum endotoxin, D-lactic acid, and diamine oxidase than the group receiving late intervention (control group) (P &lt; 0.05). Also, the serum levels of CD3+ and CD4+ and CD4+/CD8+ ratio significantly increase after 2 weeks of intervention. On the other hand, the level of CD8+ and the Acute Physiology and Chronic Health Evaluation II and Modified Computed Tomography Severity Index scores significantly decreased after 2 weeks of treatment (P &lt; 0.05). The early intervention also led to a significant shortening of time needed for abdominal pain relief, anal exhaustion, resumption of peristaltic sound, and hospitalization. Furthermore, there was a significant increase in overall response rate, and decrease in the incidence rate of complications (P &lt; 0.05). Early micro-ecological enteral nutrition therapy can effectively relieve systemic inflammatory response, prevent intestinal bacterial translocation, restore the function of intestinal mucosal barrier, and alleviate nutritional imbalance in severe acute pancreatitis patients leading to improved immune function, mitigation of the disease, and reduced complications benefiting the recovery of patients.

Enteral nutrition bibliometry from 2010 to 2019.

This study aimed to describe and analyze the research outputs on enteral nutrition, which is the administration of food through the gastrointestinal tract for nutrition maintenance. We searched the Web of Science Core Collection database for original publications on enteral nutrition research from 2010 to 2019. HistCite and VOSviewer software were used for analysis and visualization of the publication outputs, journals, institutions, keywords, cocitations, and collaborations among authors in different countries or regions. A total of 963 relevant articles were included. The number of publications in 2010 and 2019 were 68 and 139, respectively. Nutrition in Clinical Practice and the Journal of Parenteral and Enteral Nutrition had the highest number of publications and cocitations (76, 7.89%; 2058), respectively. The United States and China were the top contributors, accounting for 24.1% and 22.3% of the total articles, respectively. Andrew S. Day and Stephen A. McClave were core researchers in this field. Primary authors collaborated closely. Enteral nutrition, parenteral nutrition, and support were the three most common keywords. The top 10 cocited references concerned administering early enteral nutrition therapy in acutely ill patients and patients with acute Crohn's disease. Crohn's disease, acute pancreatitis, upper gastrointestinal malignancy, and other surgical diseases were among the research hotspots. Our findings can help researchers identify notable research trends and clinically relevant articles. New catheterization technologies are a future research direction.

Clinical efficacy of early combined nutrition in neurosurgical intensive patients.

Objective To explore the clinical efficacy of early combined application of parenteral nutrition and enteral nutrition among patients in neurosurgical intensive care unit(NICU). Methods Two hundred fifty-five patients with severe neurological diseases were admitted to NICU of Shanghai Tenth People's Hospital from January 1 to August 31 in 2018. The patients were divided into two groups: traditional enteral nutrition group (control group, n=170), who were treated with enteral nutrition management at the early stage, and early combined application of parenteral and enteral nutrition group (experimental group, n=85), who were at first treated with parenteral nutrition since admission and then enteral nutrition management 72 hours later. The differences of Glasgow outcome scale (GOS), incidence of individual adverse reactions, daily average enteral nutrition, human albumin supplement, daily average fluid supplement, pulmonary infection rate, infection time and albumin level during hospitalization between the two groups were compared. The relationship among the course of enteral nutrition, nutrient content, pulmonary infection and serum albumin level in the experimental group were also discussed. The GOS was predicted by decision tree, random forests, nearest neighbor algorithm, adaboost and bagging. Results There was no significant difference between baseline scores after 1:2 propensity score matching. The dominance ratio of GOS between the two groups was 1.853 (95%CI: 1.018-3.385) (P=0.043). The change of albumin level was not related to the choice of nutritional regimen, but was related to the level of consciousness after admission and the level of basic albumin before admission. The level of consciousness in the experimental group was higher than that of the control group, and the fluid infusion volume was decreased while the daily average enteral nutrition and albumin supplementation were increased, the types of adverse reactions occurred more and earlier (P<0.05). The misjudgment rate of GOS prediction models ranged from 0.482 to 0.606. Conclusions Compared with traditional early enteral nutrition therapy, early combined parenteral nutrition and enteral nutition can improve the prognosis of patients with severe neurological diseases. Key words: Neurosurgical intensive patients; Early combined application; Enteral nutrition; Glasgow outcome scale

Changes of intestinal mucosal barrier function and effects of early enteral nutrition in patients with severe organophosphorus poisoning

Objective: To observe the changes of intestinal barrier function in patients with acute severe organophosphorus pesticide poisoning (ASOPP) and the effect of early enteral nutrition on them. Methods: A single-center, single-sample, prospective, randomized controlled clinical trial was conducted. A total of 50 patients with ASOPP were divided into 24 h enteral nutrition group (group A) and 48 h (48-72 h) enteral nutrition group (B group) according to the order of hospitalization. The two groups received equal calorie nutritional support, and Serum D-lactic acid (D-LA) and serum human diamine oxidase (DAO) were detected immediately after admission and at 48 h, 72 h and 144 h. At the same time, the worst value of APACHE-Ⅱ score was recorded, and the correlation between DAO, D-LA and APACHE-Ⅱ score was analyzed. The serum concentration of D-LA and DAO in 15 healthy adults were detected as healthy control group. Results: There was no statistical difference in gender, age, poisoning time and organophosphorus pesticide components between group A and B (P>0.05). The distribution of D-LA concentration in group A poisoned patients at admission, 48 h, 72 h and 144 h was (66±19) μg/L, (68±21) μg/L, (66±19) μg/L, (63±17) μg/L, while in group B they were (62±15) μg/L, (58±17) μg/L, (58±16) μg/L, (67±9) μg/L. There was no statistical difference between the two groups in D-LA concentration and that of healthy people [(67±17) μg/L, P>0.05]. The distribution of DAO concentration in group A poisoned patients at admission, 48 h, 72 h and 144 h was (2.1±0.6) μg/ml, (2.1±0.5) μg/ml, (2.2±0.4) μg/ml, (2.2±0.5) μg/ml, while in group B they were (2.1±0.5) μg/ml, (2.1±0.5) μg/ml, (2.2±0.5) μg/ml, (2.1±0.4) μg/ml. DAO concentration in the early stage of the intoxication of the two groups were higher than that of healthy people (0.1±0.0 μg/ml) (P<0.05). There is no statistical difference in DAO concentration between group A and B at different time points (P>0.05). The APACHEE-Ⅱ score of 48 hours and 72 hours in group A (12.2+1.7, 5.5+2.1) was significantly lower than that in group B (14.1+2.4, 8.2+2.6) (P<0.05). D-LA, DAO concentration at different time points was not correlated with APACHE-Ⅱ score (P>0.05). D-LA (r, P) was immediate admission (-0.17, 0.24), 48 h (0.04, 0.79), 72 h (0.32, 0.06), 144 h (0.29, 0.07), and DAO (r, P) was immediate admission (-0.12, 0.43), 48 h (0.02, 0.92), 72 h (0.03, 0.85), 144 h (0.03, 0.82). Conclusions: Patients with ASOPP may have obvious injury at intestinal mucosa at early stage (144 h), but the intestinal permeability is normal. Early enteral nutrition therapy can promote the recovery of patients, but has low correlation with intestinal barrier function improvement.

Early enteral nutrition therapy in hospitalized patients: Is it possible?

Early enteral nutrition therapy in hospitalized patients: Is it possible?

Consensus of early enteral nutrition clinical practice in critically ill patients

The benefits of early enteral nutrition (EEN) during critical illness have been widely accepted by global experts. To popularize this new concept and provide standardized, reasonable and effective EEN therapy for critically ill patients in China, more than 20 experts from throughout the country discussed and developed this consensus. We used the GRADE approach for consensus development, focusing on important clinical issues such as nutrition assessment, initiating mode, route selection and tolerance monitoring of EEN support therapy for current critically ill patients. This consensus would be certainly help for intensive care physicians in the clinical application of EEN support therapy for critically ill patients.

重症急性膵炎に対する経鼻胃管チューブ下早中期経腸栄養療法の有用性

重症急性膵炎に対する経鼻胃管チューブ下早中期経腸栄養療法の有用性

Early enteral nutrition therapy in congenital cardiac repair postoperatively: A randomized, controlled pilot study.

Background and Objectives:Adequate nutritional supplementation in infants with cardiac malformations after surgical repair is a challenge. Critically ill infants in the early postoperative period are in a catabolic stress. The mismatch between estimated energy requirement (EER) and the intake in the postoperative period is multifactorial, predisposing them to complications such as immune deficiency, more infection, and growth failure. This study aimed to assess the feasibility and efficacy of enriched breast milk feed on postoperative recovery and growth of infants after open heart surgery.Methodology:Fifty infants <6 months of age were prospectively randomized in the trial for enteral nutrition (EN) postoperatively from day 1 to 10, after obtaining the Institute Ethics Committee's approval. They were equally divided into two groups on the basis of the feed they received: Control group was fed with expressed breast milk (EBM; 0.65 kcal/ml) and intervention group was fed with EBM + energy supplementation/fortification with human milk fortifier (7.5 kcal/2 g)/Simyl medium-chain triglyceride oil (7.8 kcal/ml). Energy need for each infant was calculated as per EER at 90 kcal/kg/day, as the target requirement. The intra- and post-operative variables such as cardiopulmonary bypass and aortic cross-clamp times, ventilation duration, Intensive Care Unit (ICU), and hospital length of stay and mortality were recorded. Anthropometric and hematological parameters and infection control data were recorded in a predesigned pro forma. Data were analyzed using Stata 14.1 software.Results:The duration of mechanical ventilation, length of ICU stay (LOIS), length of hospital stay (LOHS), infection rate, and mortality rate were lower in the intervention group compared to the control group although none of the differences were statistically significant. Infants in control group needed mechanical ventilation for about a day more (i.e., 153.6 ± 149.0 h vs. 123.2 ± 107.0 h; P = 0.20) than those in the intervention group. Similarly, infants in control group stayed for longer duration in the ICU (13.2 ± 8.9 days) and hospital (16.5 ± 9.8 days) as compared to the intervention group (11.0 ± 6.1 days; 14.1 ± 7.0 days) (P = 0.14 and 0.17, respectively). The LOIS and LOHS were decreased by 2.2 and 2.4 days, respectively, in the intervention group compared to control group. The infection rate (3/25; 5/25) and mortality rate (1/25; 2/25) were lower in the intervention group than those in the control group. The energy intake in the intervention group was 40 kcal more (i.e., 127.2 ± 56.1 kcal vs. 87.1 ± 38.3 kcal) than the control group on the 10th postoperative day.Conclusions:Early enteral/oral feeding after cardiac surgery is feasible and recommended. In addition, enriching the EBM is helpful in achieving the maximum possible calorie intake in the postoperative period. EN therapy might help in providing adequate nutrition, and it decreases ventilation duration, infection rate, LOIS, LOHS, and mortality.

Therapeutic effect of gastrotomy on lung infection and dystrophy in patients with traumatic vagus nerve injury

Objective To examine the occurrence of traumatic lower cranial nerve injury and the therapeutic effect of gastrostomy on vagus nerve injury. Methods Clinical data of 45 patients sustaining traumatic lower cranial nerve injury were retrospectively analyzed. There were 32 males and 13 females, with the age of (34.5±8.8)years. Injury resulted from high falls in 22 patients, traffic accidents in 15 patients and other in 8 patients. Non-operative treatments, nutrition and hormone intervention, improving minicirculation, promoting blood circulation and removing stasis for instance, were performed for the patients with the injury involving the glossopharyngeal nerve (n=12), accessory nerve (n=21) and hypoglossal nerve (n=20). Vagus nerve injury was seen in 32 patients. Fifteen out of the 32 patients underwent gastrotomy and early enteral nutrition support and 17 transnasal gastric catheter indwelling and enteral nutrition support. Lung infection and dystrophy were evaluated after operation. Results Two patients had lung infection and one dystrophy after gastrotomy. In contrast, 9 patients had lung infection and one dystrophy after transnasal stomach intubation surgery (P<0.05). At follow-up, the complications were cured in gastrotomy group, but only 7 lung infection and 5 dystrophy were cured in indwelling catheter group. Conclusions Vagus nerve injury is most common in lower cranial nerve injury and manifested with choking on water and dysphagia. Gastrostomy in combination with early enteral nutrition therapy is effective to improve the nutritional status and reduce lung infection in patients with traumatic vagus nerve injury. Key words: Cranial nerve injuries; Traumatic brain injuries; Vagus nerve; Gastrostomy

Perioperative Nutritional Intervention: Where Are We?

As we look forward in 2015, attention to perioperative surgical nutrition continues to play a key role in optimizing outcomes and enhancing surgical recovery. Nutrition therapies for preoperative preparation include high protein intake combined with exercise, immune- and metabolic-modulating nutrients, carbohydrate loading, probiotic therapy and, occasionally, the need for specialized enteral or parenteral nutrition. Early enteral nutrition and probiotic therapy optimize gastrointestinal integrity and function in the postoperative setting. Some questions of who, when and how to optimally feed the surgical patient still exist. Despite these questions, the abundance of evidence supports a determined focus for nutrition optimization prior to major surgery.

Enteral nutrition within 72 h after onset of acute pancreatitis vs delayed initiation.

To explore early (within 72 h) vs delayed enteral nutrition (EN) therapy for patients with acute pancreatitis (AP). A total of 93 patients were allocated to two groups: early enteral nutrition (EEN) group (started within 72 h after onset) and delayed enteral nutrition (DEN) group (started beyond 72 h but within 7 days after onset). Baseline parameters and scores were recorded on admission and on day 3 after the initiation of EN therapy, as were the clinical outcome variables. Hospital mortality, length of stay, number of patients requiring mechanical ventilation and incidence of pancreatic infection in the EEN group were significantly lower than those in the DEN group; all six reported deaths were in the DEN group. In the DEN group, more patients suffered from sepsis, shock or acute kidney injury, and more patients required surgical intervention or continuous renal replacement therapy. On day 3 after EN therapy was initiated, the acute physiology and chronic health evaluation II scores, sequential organ failure assessment scores, C-reactive protein levels and the incidence of bowel wall thickening were lower in the EEN group than in the DEN group. The time when EN therapy was initiated was a prognostic variable for pancreatic infection (odds ratio, 24.08; P=0.014). Compared with the DEN therapy, EEN therapy can accelerate the recovery of disturbed homeostasis, reduce the incidence of pancreatic infection and improve the clinical outcomes of AP patients. For AP patients, EN therapy should be initiated within 72 h after onset.

Parenterale Ernährungsstrategien

Parenteral nutrition is a fundamental part of any therapeutic concept in critically ill patients. Just recently some international prospective randomized controlled trials were investigating the correct indication, optimal timing and dosage of parenteral nutrition regimens. Despite a controversial discussion newer strategies recommend the parenteral nutrition as a very important supplemental component to an early enteral nutrition therapy.