Effect Of Early Enteral Nutrition Research Articles

Effect of early enteral nutrition on the recovery and stress reaction after operation of colon carcinoma

Objective To observe the effect of early enteral nutrition on the recovery and stress reaction after the operation of colon carcinoma.Methods 93 patients with colon carcinoma were divided into enteral nutrition group and parenteral nutrition group.Patients of EN group were given nutrition preparation through the jejunal nutrient canal beginning in the first day after operation and reduced the venous support gradually.Those of PN group were given parenteral nutritional supports from the the first day after operation until oral feeding.Results There were no significant differences between the EN group and PN group in the nutritional status.Both the first postoperative anoretum exhaust time and defecation time(52.9 ± 17.6;67.2 ± 9.3) h in group EN were less than that(71.4 ± 13.8;83.6 ± 10.1) h in group PN,there were significant differences between two groups(t = 2.58,3.56,all P＜0.05).The CRP in EN group after operation was obviously lower than preoperation(P＜0.05).Conclusion The early enteral nutrition could lower the stress reaction and promote the recovery of gastrointestinal tract function. Key words: Colonic neoplasms; Enteral nutrition

Effect of early enteral nutrition on morbidity and mortality in children with burns

Burns increase the metabolic demands of the body and can lead to severe weight loss and increased risk of death. Early enteral support is believed to improve gastrointestinal, immunological, nutritional and metabolic responses to critical injury; however, this premise is in need of further substantiation by definitive data. This research aimed to examine the effectiveness and safety of early enteral feeding in paediatric patients suffering from burns. Materials and methods This clinical trial was carried out with a total number of 688 children with burns hospitalised in the Burn Department across a 2-year period (September 2002–September 2004). The subjects were randomised into two groups. A total of 322 patients received only intravenous resuscitation, in accordance with current treatment protocols, in the first 48 h and were considered as the late enteral nutrition group (LEN group); 366 patients were nourished early enteral nutrition group (EEN group), such that both groups received similar amounts of fluid in the first 48 h. Initiation of enteral nutrition commenced between 3 and 6 h following the burn. The patients were kept in the unit until they were discharged. Wound management did not vary between groups. Results In our study, the mean age was 5 ± 3 years in the LEN group and 5 ± 3.5 years in the EEN group. Hot liquids were the most common cause of burns in both groups. The mean percentage of burn was reported as 20 ± 13 in the LEN group and 22 ± 15 in the EEN group. Mean duration of hospitalisation was 16.4 ± 3.7 days in the LEN group and 12.6 ± 1.3 in the EEN group for cured patients ( P < 0.05). A total of 40 patients (12%) in the LEN group and 31 patients (8.5%) in the EEN group expired ( P < 0.05). Conclusion Our research showed that EEN decreases duration of hospitalisation and mortality in children with burns.

Early vs Delayed Enteral Nutrition in Critically Ill Medical Patients

This study was conducted to identify current practice in provision of enteral nutrition (EN) and to determine effects of early enteral nutrition (EEN) on length of stay in the medical intensive care unit (ICU). In this prospective, observational study, medical ICU patients were evaluated to determine their candidacy for EEN. If patients were candidates for EN and expected to remain nothing-by-mouth for 48 hours, they were classified as receiving EEN (within 24 hours of admission) or delayed EN. Thirty-six patients were candidates for EEN. Eighteen received EEN and 18 received delayed EN. In the delayed group, the median time to start of EN was 2.1 +/- 4.8 days. Median ICU length of stay was 4.7 +/- 3.5 days in the EEN group compared with 8.5 +/- 8.3 days in the delayed group. Although hospital length of stay was shorter in the EEN group, this was not statistically significant (10.4 +/- 6.9 vs 16.9 +/- 11.5 days). Time on the ventilator was significantly shorter in the EEN group vs delayed (n = 30, 3.0 +/- 4.2 vs 6.0 +/- 9.2 days). The incidence of new pneumonia was lower in the EEN group (5.5% vs 44%), but no difference was found in the incidence of bacteremia. Hospital mortality was lower in the EEN group (1 vs 7 deaths). Given its association with numerous benefits, EEN within 24 hours of admission should be encouraged and implemented by clinicians in medical ICU patients, but additional research is needed.

Effect of ICU interventions on gastrointestinal motility

Early detection of gastrointestinal motility disturbances is a major goal to reduce the incidence of this potentially disastrous event by prophylactic managements and early goal-directed therapy in patients at risk. Gastroparesis frequently results in the inability to feed critically ill patients, aggravating problems such as bacterial translocation and stress-induced intestinal damage. Recently published data have advanced our understanding of the pathophysiologic background of gastroparesis, intestinal stress damage and the effect of early enteral nutrition on gastrointestinal function. New techniques, such as ultrasound and the capsule techniques, might help to assess intestinal function beyond the aspiration of gastric residual volumes and the passage of stool. Therapeutic options such as opioid antagonists and the 5-hydroxytryptamine receptor 4 agonist prucalopride might help to restore intestinal function. Gastrointestinal motility disturbances are caused by a myriad of pathological processes. Moreover, bowel integrity is governed by comorbidity, impaired metabolic function and pharmacological interventions in critically ill patients. Restoring gastrointestinal function, therefore, requires a multimodal approach including prophylactic management strategies and the sensible use of substances with inhibitory effects on intestinal motility.

Effectiveness of enteral nutrition support and growth hormone treatment in critically ill patients

Objective To explore the effectiveness of early enteral nutrition (EN) support and growth hormone (GH) treatment in critically ill patients.Methods Seventy critically ill patients were randomly divided into early EN support group and early EN support plus GH treatment group.The nutrition intakes were isonitrogenic and isocalorie in these two groups.Body weight,blood biochemistry,nutritional statues,and lactulose/mannitol levels were measured or analyzed before and after nutrition support.Immunologic functions were analyzed after ten days.Nitrogen balance was measured daily.Results The changes of body weight,albumin level,and transferrin level were more obvious in the EN + GH group than those in the EN group without significant difference (P ＞0.05).The changes of prealbumin and fibronectin in the EN + GH group were significantly higher than those in the EN group (P ＜ 0.05).The level of IgA in the EN + GH group was significantly lower than that in the EN group,while the levels of CD4 and NK in the EN + GH group was significandy higher than those in the EN group (P ＜0.05).The gut barrier function in the EN + GH group was superior to that in the EN group during nutrition support (P ＜0.05).Nitrogen balance was positive in the EN + GH group and negative in the EN group (P ＜ 0.05).Conclusions Early EN can improve the nutritional status and reduce complications in critically ill patients.GH treatment may strengthen the immune function and remarkably decrease the disability and mortality in critically ill patients. Key words: Critical patients; Early enteral nutrition; Growth hormone

Effects of early enteral nutrition supplemented with arginine on intestinal mucosal immunity in severely burned mice

To investigate the effects of early enteral nutrition (EN) supplemented with Arginine (Arg) on intestinal mucosal immunity in severely burned mice. Forty-four mice were randomly assigned into four groups: a sham injury+EN group (n=10), a sham injury+EN+Arg group (n=10), a burn+EN group (n=12), and a burn+EN+Arg group (n=12) and the mice in two experimental groups received a 20% total body surface area (TBSA), full-thickness scald burn on the back. Then, the burned mice were given a 175 kcal/kg body wt/day of conventional enteral nutrition or an isonitrogenous and isocaloric enteral nutrition supplemented with Arg by gastric gavage for 7 days. There was isonitrogenous and isocaloric intake in two experimental groups. The mice in two control groups received the same procedures as above, except for burn injury. On day 7 after injury, all mice among four groups were euthanized and the entire intestine was harvested. Intestinal immunoglobulin A (IgA) levels, total lymphocyte yield, and lymphocyte subpopulations in Peyer's patches were analyzed. Levels of IFN-gamma, IL-2, IL-4 and IL-10 in gut homogenates were also measured by ELISA. Total lymphocyte yield, numbers of lymphocyte subpopulations, and intestinal IgA levels in the EN+ARG group were higher than those in the EN group (p<0.05). Levels of gut tissue cytokines were significantly altered with enteral Arg supplementation: levels of IL-4 and IL-10 were increased, and levels of IFN-gamma and IL-2 declined, when compared with the EN-fed mice (p<0.05). The results of this study suggested that enteral nutrition supplemented with Arg has changed the cytokine concentrations in intestinal homogenates from a pro- to an anti-inflammatory profile, increased sIgA levels and changed lymphocytes in severely burned mice.

Early enteral nutrition in severe acute pancreatitis

Objective To evaluate the therapeutic effects of early enteral nutrition (EN) in the treatment of severe acute pancreatitis.Methods Thirty-six cage of SPA were analyzed and divided into EN group (18 patients)and total parenteral nutrition(TPN) group(18 patients).The immunity,nutrition status,median duration of hospital stay,infection rate and the incidence of hyperglycemia between the two groups were compared.Results After nutrition therapy,the serum contents of albumin were increased obviously.The incidence of infection,median duration of hospital stay and the incidence of hyperglycemia in EN group were lower than those in TPN group(P＜0.05).Conclusion Early EN plays an important role in the treatment of SPA.Reasonable EN could impmve the immunity and Hatrition status of the SPA patients. Key words: Severe acute pancreatitis; Enteral nutrition

Is postoperative early enteral nutrition with regular or disease-specific enteral formula really beneficial in patients undergoing esophagectomy?

Although recent studies have shown that early enteral nutrition (EEN) has certain advantages over parenteral nutrition for preventing postoperative complications, few previous studies have examined the effects of enteral nutrition in patients undergoing esophagectomy. Here we review the effects of EEN with regular polymeric or other disease-specific enteral formulas in patients undergoing esophagectomy. Previously reported data suggest that nutritional management with early enteral feeding may be beneficial and that an appropriate selection of specific enteral formula enriched with disease-specific nutrients is important to prevent postoperative complications in patients undergoing radical esophagectomy. The use of immune-enhancing enteral formula (IEF) showed a certain benefit to enhance postoperative immunological function after esophagectomy. The use of IEF in the critically ill condition is still controversial, however, and thus the indication for using IEF in patients with septic complications after surgery should be considered carefully. IEF without the enrichment of arginine may be another option for patients with septic complications. EEN with a specific enteral formula may be important for patients with esophageal cancer after neoadjuvant chemotherapy or radiation therapy and salvage surgery to prevent postoperative complications and to improve nutritional status. Appropriate perioperative enteral formula enriched with disease-specific nutrients may be an important target of future clinical research for patients undergoing esophagectomy.

Early enteral nutrition and gastric intramucosal pH monitoring in patients with mechanical ventilation

To observe the effect of early enteral nutrition and the significance of gastric intramucosal pH (pHi) monitoring in patients without gastrointestinal trauma or surgery requiring mechanical ventilation in the intensive care unit (ICU). Depending mainly on the vital signs and recovery of intestinal peristalsis sounds, enteral nutrition (25 cases) and parenteral nutrition (15 cases) were respectively given to the 40 patients requiring mechanical ventilation 12-72 hours (early) after operation. The value of gastric pHi was monitored continuously for the following 7 days. In addition, success rate of weaning, and mechanical ventilation duration were compared between the two groups. After 7 days, the success rate of weaning in enteral nutrition group was significantly higher than that in parenteral nutrition group [76% (19/25) vs. 40% (6/15), P < 0.05]. The mechanical ventilation duration in enteral nutrition group was obviously lower than that in parenteral nutrition group [(4.30+/-0.01) days vs. (8.22+/-0.02) days, P < 0.05]. The value of gastric pHi increased in enteral nutrition group on the 7th day (7.39+/-0.03 vs. 7.28+/-0.01, P < 0.05), and the value was higher than that of the parenteral nutrition group (7.30+/-0.02, P < 0.05). In addition, the restoration of passage of flatus in enteral nutrition group was significantly earlier than that of parenteral nutrition group [(47.08+/-8.33) hours vs. (67.03+/-8.03) hours, P < 0.05). Early enteral nutrition can improve the blood perfusion and oxygenation of gastrointestinal mucosa, and the success rate of weaning of mechanical ventilation, help reduce complications, and shorten the mechanical ventilation duration. Enteral nutrition support should be given to ICU patients with mechanical ventilation as early as possible provided that the enteral function is normal.

Effects of early enteral nutrition on prognosis of patients with sustained esophageal caner

Objective To investigate the effect of early enteral nutrition.Methods 248 patients with esophageal and gastric carcinoma were randomly divided into two groups,and received enteral nutrition(EN)and parenteral nutrition(PN)each continuously for 6 days after operation.The body weight,blood routine test,liver function,and postoperative day 8 were compared with those before operation.Results The body weight,red blood cell count,and the levels of hemoglobin,serum albumin and transaminase decreased less in EN group than those in PN group(P＜0.01).The complication rates of anastomotic fistula,pulmonary infection,and delayedincision healing and average volume of pleural effusion were 0,13.8%,0,780ml in EN groups,while 3.2%,28.2%,7.2%,1842ml in PN group.Conclusion Early postoperative enteral nutirtion after esophageal carcinoma surgery can improve nutritional status and reduce complications in comparision with parenteral nutrition. Key words: Esophageal neoplasms; Surgical procedures; Enteral nutrition

Effects of early enteral nutrition on gut mucosal barrier and bacterial translocation after liver transplantation

目的 探讨早期肠内营养对肝移植术后病人肠屏障功能和细菌移位的影响.方法 40名肝移植病人被随机分成早期肠内营养(EN)组、胃肠外营养(PN)组.术前、术后第1天及术后第8天检测血浆内毒素水平、D-乳酸水平及二胺氧化酶(DAO)水平,术前及术后第1～7天每日行外周血细菌聚合酶链反应(PCR)检测及血细菌培养.结果 (1)术后第8天EN组内毒素、D-乳酸及DAO水平显著低于PN组(P＜0.01).(2)术后第1天两组内毒素、D-乳酸及DAO水平显著高于术前(P＜0.05),两组之间无统计学差异.术后第8天EN组内毒素、D-乳酸及DAO水平显著低于术后第1天水平(P＜0.05),低于术前水平(P＜0.05).PN组内毒素、D-乳酸及DAO水平显著高于术前水平(P＜0.05),和术后第1天水平无统计学差异(P＞0.05).(3)40例肝移植病人PCR检测外周血细菌DNA片段阳性总数为25例,阳性率62.5%,术后第4天起两组有显著差异.(4)PCR大肠杆菌检出占所有细菌检出的60%.(5)40名肝移植病人27例出现全身炎症反应综合征(SIRS),其中EN组12例,PN组15例,PCR阳性组SIRS发生率为96%,PCR阴性组SIRS发生率为20%,SIRS发生组PCR阳性率为88.89%,SIRS阴性组PCR阳性率为7.69%.(6)术后血细菌培养阳性率27.5%,显著低于PCR的62.5%(P＜0.01);培养阳性者,PCR均呈阳性.(7)PCR阳性组感染并发症发生率为64%(16/25),阴性组均未发生感染(0/15),二者差异有显著性(P＜0.01).结论 肝移植术后施行早期肠内营养能有效的维护肠黏膜屏障功能、防止细菌及内毒素移位,减少术后感染的发生。

Comparison of early enteral nutrition in severe acute pancreatitis with prebiotic fiber supplementation versus standard enteral solution: A prospective randomized double-blind study

To compare the beneficial effects of early enteral nutrition (EN) with prebiotic fiber supplementation in patients with severe acute pancreatitis (AP). Thirty consecutive patients with severe AP, who required stoppage of oral feeding for 48 h, were randomly assigned to nasojejunal EN with or without prebiotics. APACHE II score, Balthazar's CT score and CRP were assessed daily during the study period. The median duration of hospital stay was shorter in the study group [10 +/- 4 (8-14) d vs 15 +/- 6 (7-26) d] (P < 0.05). The median value of days in intensive care unit was also similar in both groups [6 +/- 2 (5-8) d vs 6 +/- 2 (5-7) d]. The median duration of EN was 8 +/- 4 (6-12) d vs 10 +/- 4 (6-13) d in the study and control groups, respectively (P > 0.05). Deaths occurred in 6 patients (20%), 2 in the study group and 4 in the control group. The mean duration of APACHE II normalization (APACHE II score < 8) was shorter in the study group than in the control group (4 +/- 2 d vs 6.5 +/- 3 d, P < 0.05). The mean duration of CRP normalization was also shorter in the study group than in the control group (7 +/- 2 d vs 10 +/- 3 d, P < 0.05). Nasojejunal EN with prebiotic fiber supplementation in severe AP improves hospital stay, duration nutrition therapy, acute phase response and overall complications compared to standard EN therapy.

The effect of early enteral nutrition on gastric mucosal energy synthesis in severe brain injury rats

目的 探讨早期肠内营养对重型颅脑损伤大鼠胃黏膜能量合成的影响.方法建立大鼠重型颅脑损伤模型,随机分为早期肠内营养组(EN)、单纯损伤组(I)和正常对照组(C).采用高效液相色谱法检测胃黏膜组织腺苷酸含量,并计算能荷.结果 EN组和I组的ATP含量在伤后明显低于对照组(P 0.05).结论重型颅脑损伤后胃黏膜高能磷酸化合物明显减少,早期肠内营养可增加胃黏膜能量贮备,对胃黏膜具有细胞保护作用。

Initial respiratory parameters do not influence effects of early enteral nutrition in critically ill intubated patients

Initial respiratory parameters do not influence effects of early enteral nutrition in critically ill intubated patients

Effect of Early Enteral Nutrition on Intestinal Permeability, Intestinal Protein Loss, and Outcome in Dogs with Severe Parvoviral Enteritis

Effect of Early Enteral Nutrition on Intestinal Permeability, Intestinal Protein Loss, and Outcome in Dogs with Severe Parvoviral Enteritis

Early enteral nutrition in acutely ill patients: a systematic review.

To evaluate the effect of early enteral nutrition on the outcome of critically ill and injured patients. MEDLINE, citation review of relevant primary and review articles, personal files, and contact with expert informants. Randomized, controlled studies that compared early with delayed enteral nutrition in hospitalized adult postoperative, trauma, head-injured, burn, or medical intensive care unit (ICU) patients. From 161 articles screened, 27 were identified as randomized, controlled trials comparing early with delayed enteral nutrition and were included for data extraction. Of these, 12 were excluded. None of the studies included medical ICU patients. Fifteen studies containing 753 subjects were analyzed. Descriptive and outcome data were extracted independently from the articles by the two reviewers. Main outcome measures were infections, noninfectious complications, length of hospital stay, and mortality. The meta-analysis was performed using the random effects model. Early enteral nutrition was associated with a significantly lower incidence of infections (relative risk reduction, 0.45; 95% confidence interval, 0.30-0.66; p =.00006; test for heterogeneity, p =.049) and a reduced length of hospital stay (mean reduction of 2.2 days; 95% confidence interval, 0.81-3.63 days; p =.004; test for heterogeneity, p =.0012). There were no significant differences in mortality or noninfectious complications between the two groups of patients. The results of this meta-analysis support the experimental data demonstrating the benefit of the early initiation of enteral nutrition. The results of this meta-analysis must, however, be interpreted with some caution because of the significant heterogeneity between studies.

Is early enteral nutrition in acute pancreatitis dangerous? About 20 patients fed by an endoscopically placed nasogastrojejunal tube.

Bowel rest during treatment of acute pancreatitis deprives the gut of nutrients and affects its structure and function. Enteral feeding is usually performed late in the course of acute pancreatitis and therefore cannot prevent intestinal barrier dysfunction and possible bacterial translocation. To assess the effect of early enteral nutrition we performed a prospective study on 21 patients (11 males/10 females) presenting with severe acute pancreatitis (13 biliary, 6 alcoholic, and 2 miscellaneous). Severity was established by a mean Ranson score of 3.57. All but one patient could be fed through a double-lumen nasogastrojejunal tube within 60 h after admission. No significant complication of the technique was observed. We conclude that early jejunal feeding can be used safely in severe acute pancreatitis. Further comparative studies are necessary to demonstrate any superiority to total parenteral nutrition.

P.8 Effects of early enteral nutrition with arginine,omega-3-fatty acids and nucleotides supplemented on the systemic inflammatory response syndrome and immune function in severe multiple injury

P.8 Effects of early enteral nutrition with arginine,omega-3-fatty acids and nucleotides supplemented on the systemic inflammatory response syndrome and immune function in severe multiple injury

Impact of enteral nutrition on intestinal bacterial translocation and mortality in burned mice

The aim of these experiments was to study the effect of early enteral nutrition with either standard or enriched (arginine, n-3 fatty acids, RNA) enteral formulas on translocation of bacteria from the gut and acute mortality rate following thermal injury. In the first experiment 60 Balb c mice were gavaged with 10 10 Escherichia coli and received a 20% burn injury. In 40 mice enteral nutrition (20 standard, 20 enriched) was started immediately after injury and stopped 36 h later. In the control group (n = 20) aliquotes of Ringer's solution was administered intragastrically. Mortality rate was observed for 10 days post-injury. In the second experiment 60 Balb c mice were gavaged with 10 10 E. coli labelled with biotin 111 Indium and then burned. In 40 mice enteral nutrition (20 standard, 20 enriched) was started immediately after burn. The control group (n = 20) received aliquotes of Ringer's solution. 4 h after injury all animals were sacrificed and liver, lungs, kidneys, spleen and systemic blood were harvested, and radionuclide counts were measured. No animal died after day 3 post-burn. The mortality rate was significantly lower at day 1 in the groups infused with both enteral solutions (15%) compared to controls (30%; p = 0.05). At day 3 the animals fed with the enriched diets showed a lower mortality (5%) versus the standard and control groups (10%). Bacterial translocation to the liver and lungs was significantly higher in Ringer's group than in both enterally fed groups. Early post-burn enteral nutrition reduces both translocation and acute mortality. Supplementation of the diets with specific nutrients appears to exert additional advantages on outcome.

Early enteral nutrition and length of stay in stroke patients.

The effect of early enteral nutrition on length of stay (LOS) in hospitalized surgical patients has been previously documented. In this study, a sample of a large medical population (stroke patients) was examined to determine if early enteral nutrition affected LOS. A retrospective review of the medical records of nonsurgical stroke patients receiving enteral nutrition, discharged between January 1, 1988 and January 31, 1991, was undertaken. Time to initiation of enteral feeding and LOS were recorded. In patients fed within 72 hours of admission (N = 20), LOS was 20.14 (SD 12.87) days. The LOS for patients fed later than 72 hours from the time of admission (N = 32) was 29.76 (SD 20.05) days. The difference between the groups in LOS was statistically significant (p = 0.036). Although further study is warranted, we concluded that early enteral nutrition may be a factor in shortening LOS in stroke patients.