Enteral Feeding Protocol Research Articles

Ebselen prevents early alcohol-induced liver injury in rats

Oxidants have been shown to be involved in alcohol-induced liver injury. Moreover, 2-phenyl-1,2-benzisoselenazole-3(2H)-one (ebselen), an organoselenium compound and glutathione peroxidase mimic, decreases oxidative stress and protects against stroke clinically. This study was designed to test the hypothesis that ebselen protects against early alcohol-induced liver injury in rats. Male Wistar rats were fed high-fat liquid diets with or without ethanol (10–16 g/kg/d) continuously for up to 4 weeks using the intragastric enteral feeding protocol developed by Tsukamoto and French. Ebselen (50 mg/kg twice daily, intragastrically) or vehicle (1% tylose) was administered throughout the experiment. Mean urine ethanol concentrations were not significantly different between treatment groups, and ebselen did not affect body weight gains or cyclic patterns of ethanol concentrations in urine. After 4 weeks, serum ALT levels were increased significantly about 4-fold over control values (37 ± 5 IU/l) by enteral ethanol (112 ± 7 IU/l); ebselen blunted this increase significantly (61 ± 8 IU/l). Enteral ethanol also caused severe fatty accumulation, mild inflammation, and necrosis in the liver (pathology score: 4.3 ± 0.3). In contrast, these pathological changes were blunted significantly by ebselen (pathology score: 2.5 ± 0.4). While there were no significant effects of either ethanol or ebselen on glutathione peroxidase activity in serum or liver tissue, ebselen blocked the increase in serum nitrate/nitrite caused by ethanol. Furthermore, ethanol increased the activity of NF-κB over 5-fold, the number of infiltrating neutrophils 4-fold, and the accumulation of 4-hydroxynonenal over 5-fold. Ebselen blunted all of these effects significantly. These results indicate that ebselen prevents early alcohol-induced liver injury, most likely by preventing oxidative stress, which decreases inflammation.

Economic Implications of an Early Postoperative Enteral Feeding Protocol

Objective: To study the cost‐effectiveness of an early postoperative feeding protocol for patients undergoing bowel resections. Design: A nonrandomized, prospective, clinical trial. Surgeons elected to participate in the treatment arm before the study's outset. Subjects/setting: Treatment (n = 66) and control (n = 159) patients were admitted to a nonprofit general teaching hospital in the Texas Medical Center for similar diagnoses and subsequent bowel resections during an 18‐month period. Intervention: Treatment patients who met specific inclusion criteria had a jejunal feeding tube placed during surgery. Tube feedings were initiated within 12 hours after surgery. Control patients who met the same inclusion criteria received usual care. Outcomes: A successful outcome was defined as a patient developing no postoperative infection. The average cost of a nosocomial infection is presented. Variable direct and total costs (fixed plus variable) are compared between patient groups. Statistical Analysis: Mean cost was adjusted for rate of success in each patient group according to an analytic model. The mean cost difference between groups was analyzed by independent‐samples t tests. Nonparametric Mann‐Whitney rank sum tests were used to determine the cost significance of a nosocomial infection. Results: The average variable direct cost savings per successful treatment patient was $1,531, which required an additional variable cost of $108.30 for the dietitian's time. The protocol resulted in a total cost savings of $4,450 per success in the treatment group. Conclusion: An early postoperative enteral feeding protocol as part of an outcomes management program for patients undergoing bowel resection is cost‐effective. (J Am Diet Assoc 99:802–807, 1999)

Development of an intragastric enteral model in the mouse: studies of alcohol-induced liver disease using knockout technology.

The establishment of a continuous intragastric enteral feeding protocol in the rat by Tsukamoto and French was a major development in research of alcohol-induced liver disease. Unlike other models which only produce fat, with this model, inflammation, necrosis, and fibrosis can now be studied. However, much of what has been learned to date involves inhibitors or nutritional manipulation which may not be specific. Knockout technology could avoid these potential problems. Therefore, we have adapted a rat long-term intragastric protocol to the mouse so that the knockout technology can be used to study the mechanism of alcohol-induced liver injury. Reactive free radicals are involved in the mechanisms of early alcohol-induced liver injury; however, the key source of these species remains unclear. Cytochrome P450 (CYP) 2E1 is induced predominantly in hepatocytes by ethanol and could be one source of reactive oxygen species leading to liver injury. On the other hand, NADPH oxidase or xanthine oxidase is also a potent source of free radicals. In studies using CYP2E1 and p47phox (NADPH oxidase-deficient) knockout mice with this enteral model, it was reported that oxidants from CYP2E1 play only a small role in the mechanisms of early alcohol-induced liver injury in the mouse. Further, free radicals from NADPH oxidase in Kupffer cells play an important role in early alcohol-induced liver injury. Thus, this new enteral mouse model using knockout technology will provide a powerful tool in alcohol research.

CYP2E1 is not involved in early alcohol-induced liver injury.

The continuous intragastric enteral feeding protocol in the rat was a major development in alcohol-induced liver injury (ALI) research. Much of what has been learned to date involves inhibitors or nutritional manipulations that may not be specific. Knockout technology avoids these potential problems. Therefore, we used long-term intragastric cannulation in mice to study early ALI. Reactive oxygen species are involved in mechanisms of early ALI; however, their key source remains unclear. Cytochrome P-450 (CYP)2E1 is induced predominantly in hepatocytes by ethanol and could be one source of reactive oxygen species leading to liver injury. We aimed to determine if CYP2E1 was involved in ALI by adapting the enteral alcohol (EA) feeding model to CYP2E1 knockout (-/-) mice. Female CYP2E1 wild-type (+/+) or -/- mice were given a high-fat liquid diet with either ethanol or isocaloric maltose-dextrin as control continuously for 4 wk. All mice gained weight steadily over 4 wk, and there were no significant differences between groups. There were also no differences in ethanol elimination rates between CYP2E1 +/+ and -/- mice after acute ethanol administration to naive mice or mice receiving EA for 4 wk. However, EA stimulated rates 1.4-fold in both groups. EA elevated serum aspartate aminotransferase levels threefold to similar levels over control in both CYP2E1 +/+ and -/- mice. Liver histology was normal in control groups. In contrast, mice given ethanol developed mild steatosis, slight inflammation, and necrosis; however, there were no differences between the CYP2E1 +/+ and -/- groups. Chronic EA induced other CYP families (CYP3A, CYP2A12, CYP1A, and CYP2B) to the same extent in CYP2E1 +/+ and -/- mice. Furthermore, POBN radical adducts were also similar in both groups. Data presented here are consistent with the hypothesis that oxidants from CYP2E1 play only a small role in mechanisms of early ALI in mice. Moreover, this new mouse model illustrates the utility of knockout technology in ALI research.

Economic Implications of an Early Postoperative Enteral Feeding Protocol

Objective To study the cost-effectiveness of an early postoperative feeding protocol for patients undergoing bowel resections.Design A nonrandomized, prospective, clinical trial. Surgeons elected to participate in the treatment arm before the study's outset.Subjects/setting Treatment (n=66) and control (n=159) patients were admitted to a nonprofit general teaching hospital in the Texas Medical Center for similar diagnoses and subsequent bowel resections during an 18-month period.Intervention Treatment patients who met specific inclusion criteria had a jejunal feeding tube placed during surgery. Tube feedings were initiated within 12 hours after surgery. Control patients who met the same inclusion criteria received usual care.Outcomes A successful outcome was defined as a patient developing no postoperative infection. The average cost of a nosocomial infection is presented. Variable direct and total costs (fixed plus variable) are compared between patient groups.Statistical analysis Mean cost was adjusted for rate of success in each patient group according to an analytic model. The mean cost difference between groups was analyzed by independent-samples t tests. Nonparametric Mann-Whitney rank sum tests were used to determine the cost significance of a nosocomial infection.Results The average variable direct cost savings per successful treatment patient was $1,531, which required an additional variable cost of $108.30 for the dietitian's time. The protocol resulted in a total cost savings of $4,450 per success in the treatment group.Conclusion An early postoperative enteral feeding protocol as part of an outcomes management program for patients undergoing bowel resection is cost-effective. J Am Diet Assoc. 1999;99:802–807.

Reducing bacterial contamination of enteral feeds

OBJECTIVEIt has previously been shown that microbial contamination of enteral feeds given to children in hospital and at home is common. This study therefore examined the effects of improvements in...

: Economic Implications of an Early Postoperative Enteral Feeding Protocol

LEARNING OUTCOME: To list the improved outcomes and cost savings of an early postoperative feeding protocol for bowel resection patients A nonrandomized, prospective, clinical trial was conducted in which surgeons elected to participate in the treatment arm at the study's outset. A retrospective comparison group from the year prior to the study served as a baseline to evaluate contamination of the treatment to the prospective control group. Treatment (n=81) and control (n=159) patients were admitted during the same 18 month period for similar diagnoses with subsequent bowel resections at this acute care medical center hospital. Treatment patients who met specific inclusion criteria had a jejunal feeding tube placed during surgery. Tube feedings were initiated within 12 hours postoperatively. A favorable outcome was defined as each patient admission with no infectious complication. A Nonparametric Mann-Whitney-Wilcoxin Rank Sum test was utilized to determine the significance of cost differences between groups. Cost analyses utilized hospital cost accounting data. The cost of a dietitian's time was determined since it contributed incremental cost to implement the protocol. Nosocomial infections were significantly reduced by 9.6% in the treatment group (p=.042). The average variable direct cost savings per successful treatment patient was $1,474, which required an additional variable cost of $108.30 for the dietitian's time. When the cost of related readmissions was considered, the total hospital cost reduction was $368,064 for the treatment group. In conclusion, an early postoperative enteral feeding protocol as part of an outcomes management program for patients receiving bowel resection is cost-effective.

EARLY ENTERAL FEEDING PROTOCOLS FOR PRETERM INFANTS. † 1908

We evaluated the use of early enteral feeding protocols (EEFP) for preterm infants with birth weights of 751 - 1200 g (Group I) and 1201 - 1500 g (Group II) during study (S) and retrospective periods (R). Infants were evaluated for growth and nutritional intake at birth and weekly intervals throughout the neonatal period. Hypothesis: EEFP will lead to earlier institution of enteral nutrition (EN), improved caloric intake and growth, and shorter duration of parenteral nutrition (PN). Results are summarized below(M±SD): Table The age at which EN was started was significantly less during the study period in each group; however, the age at which full EN (120 kcal/k/d) was reached was similar within groups. The ages when parenteral carbohydrate (CHO) and protein were added were similar within groups, whereas lipid was added significantly sooner during Group I S. At d7, PN kcal/k/d were significantly higher during the study period in each group, with significantly higher lipid kcal/k/d during the study period in Group II, d7 (19.1±6.4 vs. 12.8±5.0, p=.032) and Group I, d14(25.8±8.1 vs. 16.4±11.3, p=.011). This improved caloric intake did not persist on days 21 and 28. Weight, length, and head circumference were similar within groups at all time periods. The duration of PN nutrition was not significantly less during the study period. Conclusions: Routine utilization of EEFP contributed to more uniform, earlier onset of EN; however, caloric intake and growth were not significantly improved throughout the neonatal period, nor was the duration of PN significantly reduced at our institution.

Successful early enteral feeding in the thermally injured patient

Early enteral feeding has recently been advocated in thermal injury to improve gut blood flow and to reduce risk of bacterial translocation and trauma-induced hypermetabolism. We studied the success of our early enteral feeding protocol in 12 thermally injured patients admitted to the UCSD Regional Burn Center from May 1992 to February 1993. Patients were 36.0 ± 13.1 years of age with a mean burn size of 36.2 ± 17.9% total body surface area. Upon admission, a naso-gastric (NG) feeding tube was passed and feeding was initiated using either half-strength TraumacalR or ImpactR. In all patients, initial attempts to feed were via NG tube, however, three patients developed evidence of gastric ileus and placement of a transpyloric feeding tube was required. Estimation of initial nutrient needs were determined using basal energy expenditure (predicted by the Harris-Benedict equation) multiplied by corresponding activity and injury factors based on percent burn size. Protein requirements were determined based on the severity of burn, and calculated in grams of protein/kg/day. The mean interval from time of burn to time at which feeding was initiated was 7.00 ± 5.85 hours. The mean interval from time feeds were initiated to the time feeds reached the goal rate and strength was 20.58 ± 11.28 hours. Daily caloric intake was within 80% of calculated goals and protein intake met approximately 100% of calculated goal by the second day of feeding for all patients. Nitrogen losses analyzed via 24 hour urinary urea nitrogen on postburn day 5 were 21.25 ± 1.06 gms, placing patients in 5.17± 2.67 gms nitrogen balance. We conclude that early enteral feeding circumvented the development of gastric ileus in most patients and permitted continuos enteral feeding with improved nitrogen balance in spite of severe thermal injury.