Enteral Feeding Techniques Research Articles

Gastrostomies and clinical outcomes: a cohort of different enteral feeding techniques in advanced cancer palliative care

Gastrostomies and clinical outcomes: a cohort of different enteral feeding techniques in advanced cancer palliative care

Efficacy and safety of enteral nutrition in prone position among critically ill ventilated patients: a meta-analysis.

Prone positioning in critical care units may reduce mortality in specific patients who have been admitted with severe conditions. The current meta-analysis aims to assess the impact of prone compared to supine position besides the safety and tolerability of different enteral feeding techniques in critically ill patients regarding mortality, pneumonia, aspiration, and vomiting. A systematic literature search found 25 relevant trials involving 1984 participants at the start of the study. Statistical analysis using the dichotomous analysis methods was used within the fixed model to calculate the odds ratio (OR) with 95% confidence intervals (CIs). In comparison with the post-pyloric nutrition group, gastric feeding had no significant impact on the mortality rate (OR = 1; 95% CI: 0.76-1.32). While the findings showed a significantly higher incidence of pneumonia with gastric feeding compared with post-pyloric nutrition (OR = 1.92; 95% CI: 1.43--2.57), there was no significant difference regarding pulmonary aspiration and vomiting (OR = 1.41; 95% CI: 0.75-2.65 and OR = 0.92; 95% CI:, 0.66-1.27, respectively). Reflux gastric content was significantly higher with gastric nutrition (OR = 8.23; 95% CI: 2.43-27.89). From reduced gastrointestinal events to significantly higher vomiting rates, prone position during enteral feeding showed mixed effects. Post-pyloric feeding is more tolerated and safer compared with gastric feeding. The mortality rate is not significantly different between techniques.

Malnutrition in dogs and cats

Malnutrition is the process of body weight, fat and muscle loss associated with acute and chronic illnesses. This syndrome is well defined in people and its diagnosis is based on specific clinical criteria. Unlike in humans, malnutrition in dogs and cats is poorly recognised. This clinical review will highlight the key features of malnutrition in dogs and cats and discuss the clinical methods (such as body and muscle condition scoring) to assess patients for this problem. The nutritional requirements (including calories, macronutrients, micronutrients) to prevent and correct malnutrition will also be highlighted. Finally, the practical steps that can be taken to address malnutrition, including enteral and parenteral feeding techniques, will be outlined.

Enteral feeding methods for nutritional management in patients with head and neck cancers being treated with radiotherapy and/or chemotherapy

This is an update of a Cochrane review first published in The Cochrane Library in Issue 3, 2010.For many patients with head and neck cancer, oral nutrition will not provide adequate nourishment during treatment with radiotherapy or chemoradiotherapy due to the acute toxicity of treatment, obstruction caused by the tumour, or both. The optimal method of enteral feeding for this patient group has yet to be established. To compare the effectiveness of different enteral feeding methods used in the nutritional management of patients with head and neck cancer receiving radiotherapy or chemoradiotherapy using the clinical outcomes, nutritional status, quality of life and rates of complications. Our extensive search included the Cochrane ENT Group Trials Register, CENTRAL, PubMed, EMBASE, CINAHL, AMED and ISI Web of Science. The date of the most recent search was 13 February 2012. Randomised controlled trials comparing one method of enteral feeding with another, e.g. nasogastric (NG) or percutaneous endoscopic gastrostomy (PEG) feeding, for adult patients with a diagnosis of head and neck cancer receiving radiotherapy and/or chemoradiotherapy. Two authors independently assessed trial quality and extracted data using standardised forms. We contacted study authors for additional information. One randomised controlled trial met the criteria for inclusion in this review. No further studies were identified when we updated the searches in 2012.Patients diagnosed with head and neck cancer, being treated with chemoradiotherapy, were randomised to PEG or NG feeding. In total only 33 patients were eligible for analysis as the trial was terminated early due to poor accrual. A high degree of bias was identified in the study.Weight loss was greater for the NG group at six weeks post-treatment than for the PEG group (P = 0.001). At six months post-treatment, however, there was no significant difference in weight loss between the two groups. Anthropometric measurements recorded six weeks post-treatment demonstrated lower triceps skin fold thickness for the NG group compared to the PEG group (P = 0.03). No statistically significant difference was found between the two different enteral feeding techniques in relation to complication rates or patient satisfaction. The duration of PEG feeding was significantly longer than for the NG group (P = 0.0006). In addition, the study calculated the cost of PEG feeding to be 10 times greater than that of NG, though this was not found to be significant. There was no difference in the treatment received by the two groups. However, four PEG fed patients and two NG fed patients required unscheduled treatment breaks of a median of two and six days respectively.We identified no studies of enteral feeding involving any form of radiologically inserted gastrostomy (RIG) feeding or comparing prophylactic PEG versus PEG for inclusion in the review. There is not sufficient evidence to determine the optimal method of enteral feeding for patients with head and neck cancer receiving radiotherapy and/or chemoradiotherapy. Further trials of the two methods of enteral feeding, incorporating larger sample sizes, are required.

Hallmarks in the History of Enteral and Parenteral Nutrition

Parenteral nutrition (PN) and enteral nutrition (EN) have a very long history, emerging in the ancient world and developing throughout the common epoch. This history dates back as far as 3500 bc to the ancient Egyptians, Indians, and Chinese. Their medical practices were the first reports of enteral feeding therapy, provided via rectum with enemas of wine, milk, whey, wheat, and barley. Hippocrates and Plato, in ancient Greece, were the first personalities to emphasize the importance of diet on health. In the following centuries, Erasistratus and Herophilus described the first notion of the circulatory system, and Oribasius and Celsus described the role of nutrition and disease. There is a great historical gap between the times of Galen (2nd century), who elaborated on the circulatory system; Ibn Zuhr (12th century), who constructed the first model of PN; and Capivacceus (16th century), who placed the first tube for EN. The 17th-19th centuries showed major developments in modern nutrition elements. Steps toward artificial nutrition began in 1628 with the detailed description of blood circulation by William Harvey; however, most of the advances in enteral and parenteral feeding techniques, solutions, and formulas took place in the 20th century. Over the last decade of the 20th century, research focused on metabolic control, multitude formulas, timing and the combination of EN and PN for intensive care patients.

346 Effects of Bolus and Continuous Enteral Feeding on Splanchnic and Cerebral Tissue Oxygenation Evaluated by Near Infrared Spectroscopy

Background and AimsBolus and continuous tube feeding represent the most frequently used enteral feeding techniques in preterm infants, but the best strategy is not yet established. Near-Infrared-Spectroscopy (NIRS) provides a...

Enteral feeding methods for nutritional management in patients with head and neck cancers being treated with radiotherapy and/or chemotherapy (a Cochrane systematic review)

Background: For many patients with head and neck cancer, oral nutrition will not provide adequate nourishment during treatment with radiotherapy or chemoradiotherapy due to the acute toxicity of treatment, obstruction caused by the tumour, or both (Unsal 2006). The optimal method of enteral feeding for this patient group has yet to be established. The aim of this systematic review was to compare the effectiveness of different enteral feeding methods used in the nutritional management of patients with head and neck cancer receiving radiotherapy or chemoradiotherapy using the clinical outcomes, nutritional status, quality of life and rates of complications. Methods: An extensive literature search was undertaken to include the Cochrane ENT Group Trials Register, CENTRAL, PubMed, EMBASE, CINAHL, AMED and ISI Web of Science. The date of the most recent search was May 2009. The selection criteria was randomised controlled trials comparing one method of enteral feeding with another, e.g. nasogastric (NG) or percutaneous endoscopic gastrostomy (PEG) feeding, for adult patients with a diagnosis of head and neck cancer receiving radiotherapy and/or chemoradiotherapy. Two authors independently assessed trial quality and extracted data using standardised forms. Study authors were contacted for additional information. Results: One randomised controlled trial was eligible for inclusion in this review (Corry 2008). However, a high degree of bias was identified in the study. Patients diagnosed with head and neck cancer, being treated with chemoradiotherapy, were randomised to PEG or NG feeding. In total only 33 patients were eligible for analysis as the trial was terminated early due to poor accrual. Weight loss was greater for the NG group at 6 weeks post-treatment than for the PEG group (P = 0.001). At six months post treatment, however, there was no significant difference in weight loss between the two groups. Anthropometric measurements recorded 6 weeks post-treatment demonstrated lower triceps skin fold thickness for the NG group compared to the PEG group (P = 0.03). No statistically significant difference was found between the two different enteral feeding techniques in relation to complication rates or patient satisfaction. The duration of PEG feeding was significantly longer than for the NG group (P = 0.0006). In addition, the study calculated the cost of PEG feeding to be 10 times greater than that of NG. There was no difference in the treatment received by the two groups. Four PEG fed patients and two NG fed patients required unscheduled treatment breaks of a median of 2 and 6 days respectively. No studies were identified of enteral feeding involving any form of radiologically inserted gastrostomy (RIG) feeding or comparing prophylactic PEG versus PEG for inclusion in the review. Discussion: After an extensive literature search one randomised controlled trial was located. Interpretation of the findings from this study was limited due to the small recruitment number of patients and bias was established through missing data. Additionally, no consideration was given to the fact that the distribution of tumour sites was different in each of the two groups, which may impact on the interpretation of the results, especially in relation to the duration of enteral feeding. Conclusions: There is not sufficient evidence to determine the optimal method of enteral feeding for patients with head and neck cancer receiving radiotherapy and/or chemoradiotherapy. Further trials of the two methods of enteral feeding, incorporating larger sample sizes, are required.

Formulation of enteral diets for use in jejunal enteral feeding

Nasogastric enteral feeding is not tolerated in patients with gastric atony and in many critically-ill patients in whom gastric emptying may be delayed and in whom gastro-oesophageal regurgitation may lead to pulmonary aspiration of enteral feed and the development of pneumonia. Initial attempts to overcome these problems led to the development of post pyloric enteral feeding techniques with the infusion port of the tubes positioned in the duodenum. In many centres this technique is still the most practised post-pyloric enteral feeding technique. Nasoduodenal feeding tubes often retroperistalse into the stomach. The technique of choice, therefore, in these difficult patients is to position the infusion port of the feeding tube well distal to the ligament of trietz (post ligament of trietz nasojejunal enteral tube feeding). While nasogastric and nasoduodenal enteral feeding techniques have been shown to elicit a stimulatory exocrine pancreatic response, distal jejunal enteral feeding does not. During this mode of feeding the ileal brake is activated and pancreatic exocrine pancreatic secretion inhibited by the action of the released peptide YY and glucagon-like peptide-1 hormones, in turn the inhibition of pancreatic secretion being the result of inhibition of trypsin secretion. In the light of the findings showing the absence of a stimulatory pancreatic exocrine response to nasojejunal enteral feeding these patients should receive a predigested rather than a polymeric enteral diet.

Physiological response of the human pancreas to enteral and parenteral feeding

Normal digestive physiology is a highly orchestrated process, integrating the mechanical breakdown of food, the secretion of digestive juices, the control of motility, and the efficient absorption of nutrients. As enteral and parenteral feeding techniques bypass many of these control mechanisms, nutritional utilization can be expected to be disturbed. This review examines recent publications that have investigated this question in clinical practice. Studies in healthy volunteers have shown that all forms of oral and enteral tube feeds commonly used, including proximal jejunal elemental diets, stimulate pancreatic secretion. Avoidance of the cephalic phase with duodenal feeding does not reduce the secretory response. 'Pancreatic rest' can, however, be achieved if feeding is delivered 40-60 cm past the ligament of Treitz by activating the ileal brake, or if it is given intravenously by avoiding intestinal cholecystokinin stimulation and the cholinergic reflex. These forms of feeding, however, can cause complications as they will result in malabsorption unless elemental formulae are used, and hyperglycemia as the metabolic utilization of intravenous nutrients is impaired. An understanding of normal pancreatic physiology and how interventional feeding techniques affect it will help prevent complications and improve outcome in hospitalized patients.

An Overview of Tube Feeding: From Ancient Times to the Future

The history of enteral feeding goes back about 3,500 years to the ancient Greeks and Egyptians, who infused nutrient solutions into the rectum to treat various bowel disorders. Over the centuries, experimentation and research have contributed to a greater understanding of nutrient requirements; methods to more accurately access the gastrointestinal tract; development of new materials to use in equipment, tubes, and containers; and the digestion, absorption, and use of macro- and micronutrients. It is notable that while advances were made in one area, progress was being made in another. For example, while enteral access and feeding techniques were being developed, essential amino acids were identified. When new information came together, rapid changes opened up the applications for enteral feeding in new directions, sometimes in unexpected ways such as diets designed for the space program, leading to the use of elemental diets as a therapeutic modality.

Enteral Feeding Without Pancreatic Stimulation

All forms of commonly practiced enteral feeding techniques stimulate pancreatic secretion, and only intravenous feeding avoids it. In this study, we explored the possibility of more distal enteral infusions of tube feeds to see whether activation of the ileal brake mechanism can result in enteral feeding without pancreatic stimulation, with particular reference to trypsin, because the avoidance of trypsin stimulation may optimize enteral feeding in acute pancreatitis. The pancreatic secretory responses to feeding were studied in 36 healthy volunteers by standard double-lumen duodenal perfusion/aspiration techniques over 6 hours. Subjects were assigned to no feeding (n = 7), duodenal feeding with a polymeric diet (n = 7) or low-fat elemental diet (n = 6), mid-distal jejunal feeding (n = 11), or intravenous feeding (n = 5). All diets provided 40 kcal/kg ideal body weight/d and 1.5 g protein/kg ideal body weight/d. Plasma gut peptide responses were monitored in 15 subjects. In comparison with basal fasting trypsin secretion rates (mean = 134 [standard error = 22] U/h), duodenal feeding with the polymeric and elemental formulae stimulated trypsin secretion (mean = 408 [standard error = 51] U/h; P < 0.001), whereas intravenous feeding (mean = 171 [standard error = 34] U/h) and mid-distal jejunal (mean = 119 [standard error = 16] U/h) did not. Stimulation was associated with an increase in plasma cholecystokinin, whereas distal jejunal feeding resulted in an increase in plasma glucagon-like peptide-1 and peptide YY concentrations. Our results suggest that enteral feeding can be given without stimulating pancreatic trypsin secretion provided it is delivered into the mid-distal jejunum. The mechanism may involve activation of the ileal brake mechanism.

Incidence of ventilator associated pneumonia (VAP) according to different enteral feeding techniques

Incidence of ventilator associated pneumonia (VAP) according to different enteral feeding techniques

New options for pumps and tubes: progress in enteral feeding techniques and devices.

In the past, blenderized tube feeds prepared in the hospital kitchen were delivered by bolus or gravity at intervals of 4-6 h. These methods lack consistent steady flow and many times are not a safe mode of delivery for those at risk of vomiting and aspiration, and cause more patient discomfort than nutritional benefit. More recently, enteral feeding administration techniques and devices have been developed for the delivery of commercially prepared enteral formulas designed for specific disease states. These technological advances have improved enteral feeding practices.

Enteral feeding techniques.

Major technical advances in enteral nutrition include the use of erythromycin or magnetic guidance for the placement of the feeding tube into the duodenum, the development of new enteral tubes, and bedside methods to control the tube position. Percutaneous endoscopic jejunostomy is becoming a safe procedure with a high success rate. Specialized diets offer little or no clinical advantages when compared with standard polymeric diets.

Nutrition support in clinical practice: review of published data and recommendations for future research directions. Summary of a conference sponsored by the National Institutes of Health, American Society for Parenteral and Enteral Nutrition, and American Society for Clinical Nutrition

In the last 30 years, marked advances in enteral feeding techniques, venous access, and enteral and parenteral nutrient formulations have made it possible to provide nutrition support to almost all patients. Despite the abundant medical literature and widespread use of nutritional therapy, many areas of nutrition support remain controversial. Therefore, the leadership at the National Institutes of Health, The American Society for Parenteral and Enteral Nutrition, and The American Society for Clinical Nutrition convened an advisory committee to perform a critical review of the current medical literature evaluating the clinical use of nutrition support; the goal was to assess our current body of knowledge and to identify the issues that deserve further investigation. The panel was divided into five groups to evaluate the following areas: nutrition assessment, nutrition support in patients with gastrointestinal diseases, nutrition support in wasting diseases, nutrition support in critically ill patients, and perioperative nutrition support. The findings from each group are summarized in this report. This document is not meant to establish practice guidelines for nutrition support. The use of nutritional therapy requires a careful integration of data from pertinent clinical trials, clinical expertise in the illness or injury being treated, clinical expertise in nutritional therapy, and input from the patient and his/her family. (Journal of Parenteral and Enteral Nutrition 21:133-156, 1997).

Nutrition support in clinical practice: review of published data and recommendations for future research directions

In the last 30 years, marked advances in enteral feeding techniques, venous access, and enteral and parenteral nutrient formulations have made it possible to provide nutrition support to almost all patients. Despite the abundant medical literature and widespread use of nutritional therapy, many areas of nutrition support remain controversial. Therefore, the leadership at the National Institutes of Health, The American Society for Parenteral and Enteral Nutrition, and The American Society for Clinical Nutrition convened an advisory committee to perform a critical review of the current medical literature evaluating the clinical use of nutrition support; the goal was to assess our current body of knowledge and to identify the issues that deserve further investigation. The panel was divided into five groups to evaluate the following areas: nutrition assessment, nutrition support in patients with gastrointestinal diseases, nutrition support in wasting diseases, nutrition support in critically ill patients, and perioperative nutrition support. The findings from each group are summarized in this report. This document is not meant to establish practice guidelines for nutrition support. The use of nutritionaltherapy requires a careful integration of data from pertinent clinical trials, clinical expertise in the illness or injury being treated, clinical expertise in nutritional therapy, and input from the patient and his/her family.

Nutrition support in clinical practice: review of published data and recommendations for future research directions. National Institutes of Health, American Society for Parenteral and Enteral Nutrition, and American Society for Clinical Nutrition.

In the last 30 years, marked advances in enteral feeding techniques, venous access, and enteral and parenteral nutrient formulations have made it possible to provide nutrition support to almost all patients. Despite the abundant medical literature and widespread use of nutritional therapy, many areas of nutrition support remain controversial. Therefore, the leadership at the National Institutes of Health, The American Society for Parenteral and Enteral Nutrition, and The American Society for Clinical Nutrition convened an advisory committee to perform a critical review of the current medical literature evaluating the clinical use of nutrition support; the goal was to assess our current body of knowledge and to identify the issues that deserve further investigation. The panel was divided into five groups to evaluate the following areas: nutrition assessment, nutrition support in patients with gastrointestinal diseases, nutrition support in wasting diseases, nutrition support in critically ill patients, and perioperative nutrition support. The findings from each group are summarized in this report. This document is not meant to establish practice guidelines for nutrition support. The use of nutritional therapy requires a careful integration of data from pertinent clinical trials, clinical expertise in the illness or injury being treated, clinical expertise in nutritional therapy, and input from the patient and his/her family.

Prematüre Bebeğin Beslenmesi I Gastrointestinal Sistem Motilitesinin Gelişimi ve Prematüre Bebeklerde Beslenme Teknikleri

SummaryPremature infants have high energy and nutrient requirements for their rapid growth On the other hand they have many feeding problems caused by motility immaturities such as poor sucking and swallow reflexes a small stomach capacity and a weak gag reflex The purpose of this review is to discuss the enteral feeding techniques and the feeding schedule in premature infants Key words: Premature Infant Development Of Gastrointestinal Motility Feeding Techniques

Liver triglyceride concentration and body protein metabolism in ethanol-treated rats: Effect of energy and nutrient supplementation

The objective of this study was to compare the metabolic effects of long-term ethanol consumption with oral (Lieber-DeCarli) and enteral feeding techniques. Enteral feeding allowed administration of greater amounts of energy and nutrients. After 21 days of treatment using the Lieber-DeCarli technique, the ethanol-treated rats had the following significant (P < 0.05) differences from pair-fed controls: lower cumulative nitrogen balance (days 5–21; 2.8 ± 0.1 g N vs. 3.5 ± 0.1 g N), lower protein content of gastrocnemius muscle (289 ± 17 mg vs. 358 ± 11 mg) and intestinal mucosa (461 ± 19 mg vs. 577 ± 40 mg), higher plasma leucine concentration (147 ± 8 μmol/L vs. 102 ± 8 μmol/L), higher liver protein content (2222 ± 122 mg vs. 1679 ± 58 mg), and higher liver triglyceride concentration (38.4 ± 2.8 mg/g vs. 8.7 ± 1.0 mg/g). When rats received the same amount of nitrogen (1.5 g · kg−1 · day−1) and ethanol (13 g · kg−1 · day−1) but 16.3% more energy and nutrients by a surgically implanted gastric cannula (enterally fed), the effects of ethanol on nitrogen balance, tissue protein content, plasma leucine concentration, and liver triglyceride concentration were similar to those observed in the rats fed orally. It is concluded that the metabolic effects observed using the Lieber-DeCarli feeding technique are due to ethanol per se and not the synergism of ethanol and undernutrition as recently suggested.

Competencies in nutrition that U.S. medical students should acquire

The nutrition education that most medical students receive is inadequate in quantity and quality, according to the National Research Council, which conducted a study of nutrition education in one-third of the medical schools in the United States. This finding stimulated the creation of the present study, which identified basic competencies in the field of nutrition that medical students should acquire and obtained the opinions of 484 medical school faculty members concerning both the importance of these competencies and where in the medical school curriculum students should acquire them. Of 39 competencies, the faculty members judged that 33 should be included in medical school curricula. Those rated most important were competencies in the use of enteral and parenteral feeding techniques in patient therapy, the improvement of fluid and electrolyte imbalances, and knowledge of the role of nutrition in the identification and management of selected disease states. There was significant agreement in ratings and curriculum placements by preclinical and clinical faculty members.