Enteral Nutrition Solution Research Articles

Examination of the Thermal Stability and Swallowing Safety of a Self-Developed Enteral Nutrition Thickening Agent

To experimentally validate the effects of a self-developed heat-stable thickening agent on the textual characteristics of enteral nutrition solutions of standard concentration and its applicability in improving dysphagia. A gradient of different doses of the self-developed thickening agent (1.0 g, 1.5 g, 2.0 g, 2.5 g, and3.0 g) and three commonly used commercial thickeners were mixed with 23.391 g of a complete nutrition formula powder dissolved in 85 mL of purified water to prepare 100 mL standard concentration nutrition solutions. The textual parameters (cohesiveness, viscosity, thickness, and hardness) of these nutrition solutions were measured using a texture analyzer at various temperature gradients (20 ℃, 40 ℃, 60 ℃, and 80 ℃) to compare their thermal stability. A dysphagia rat model was created via epiglottectomy to explore the effects of the thickener on lung tissue damage scores and levels of inflammatory markers. The rats were divided into a test intervention group, a positive control group, a negative control group, and a blank control group (no surgery and normal feeding after fasting for one day), with 15 rats in each group. After fasting for one day post-surgery, the test intervention group was fed with the standard concentration nutrition solution thickened with the self-developed thickener, while the positive control group was given a standard concentration nutrition solution thickened with product 3, and the negative control group was fed a normal diet. All groups were fed for two weeks with food dyed with food-grade green dye. General conditions, body mass, and food intake were observed and recorded. After two weeks, abdominal aorta blood was collected, and heart, liver, spleen, lung, and kidney tissues were harvested and weighed to calculate the lung tissue organ coefficient. The organ conditions were evaluated using routine H&E staining, and lung damage was semi-quantitatively analyzed based on the Mikawa scoring criteria. Blood supernatants were collected to measure the total serum protein and albumin levels to determine the nutritional status of the rats. The expression of IL-6 and TNF-α genes in lung tissues was measured by RT-qPCR. IL-6 and TNF-α protein expression levels in lung tissues, lung tissue homogenate, and serum were measured by ELISA. The aspiration incidence rate was calculated. Within the dosage range of 1.0 g to 3.0 g, the self-developed thickener in the test samples exhibited superior thermal stability in cohesiveness compared to the three commercially available thickeners, with a statistically significant difference (P<0.01). The differences in the thermal stability of viscosity and hardness between the self-developed thickener and the three commercially available thickeners were not statistically significant. The viscosity stability was optimal for the self-developed thickener, followed by the commercially available thickeners 1 and 3, with thickeners 2 being the least stable, though the differences were not statistically significant (P>0.05). Product 1 showed the best thermal stability in thickness, followed by the self-developed thickener and product 2, while the product 3 exhibited the worst performance, with the difference being statistically significant (P<0.01). The self-developed thickener had the best thermal stability in hardness at temperatures ranging from 20℃ to 80 ℃, followed by products 1 and 2, with product 3 being the least stable. However, the differences were not statistically significant (P>0.05). Animal experiment results indicated that the body weight gain in the positive control group and the test intervention group was lower than that in the blank and negative control groups (P<0.01). The spleen coefficient of the intervention group was lower than that of the positive control group and the blank control group (P<0.01), while the heart, liver, and kidney coefficients were lower than those of the blank control group (P<0.01). The differences in the lung coefficient of the intervention group and those of the other three groups were no statistically significant. Levels of TP and ALB in the test intervention group, the positive control group, and the negative control group were all lower than those in the blank control group, with statistically significant differences (P<0.01). ELISA results showed that serum IL-6 levels in the blank and test intervention groups were lower than those in the negative and positive control groups (P<0.05), while the difference in the other indicators across the four groups were not statistically significant (P>0.05). There were no statistically significant differences among the four groups in terms of lung tissue damage pathology scores, or in the levels of IL-6 and TNF-α gene expression in lung tissues. The aspiration incidence rate was 0% in all groups. The self-developed enteral nutrition thickening agent demonstrated excellent thermal stability and swallowing safety. Further research to explore its application in patients with dysphagia is warranted.

Preventive strategies for feeding intolerance among patients with severe traumatic brain injury: A cross-sectional survey

ObjectivesThis study aimed to investigate the application status of preventive measures for feeding intolerance in patients with severe traumatic brain injury (STBI) in China and analysis the differences and their causes. MethodsA cross-sectional survey was conducted. From December 2019 to January 2020, ICU nurses and physicians of 89 hospitals in China were surveyed by using a questionnaire on preventive strategies for feeding intolerance in patients with STBI. The questionnaire included two parts: the general information of participants (10 items) and application of preventive measures for feeding intolerance in STBI patients (18 items). ResultsTotally 996 nurses and physicians completed the questionnaire. Among various methods, gastrointestinal symptoms(85.0%) and injury severity (71.4%) were mostly used to assess gastrointestinal functions and risk of feeding intolerance among STBI patients, respectively. Initiating enteral nutrition (EN) within 24–48 h (61.5%), nasogastric tubes (91.2%), 30°–45° of head-of-bed elevation (89.5%), continuous feeding by pump (72.9%), EN solution temperature of 38–40 °C (65.5%), <500 ml initial volume of EN solution (50.0%), monitoring gastric residual volume with a syringe (93.7%), and assessing gastric residual volume every 4 h (51.5%) were mostly applied for EN delivery among STBI patients. Prokinetic agents (73.3%), enema (73.6%), probiotics (79.0%), antacid agents (84.1%), and non-nutritional preparations as initial EN formula (65.6%) were commonly used for preventing feeding intolerance among STBI patients. ConclusionsThe survey showed that nurses and clinicians in China have a positive attitude towards preventive strategies for feeding intolerance. However, some effective new technologies and methods have not been timely applied in clinical practice. We suggest that managers, researchers, clinicians, nurses, and other health professionals should collaborate to explore effective and standard preventive strategies for feeding intolerance among patients with STBI.

Effects of enteral nutrition semi-curing feeding on nutritional diarrhoea improvement in the patients with severe stroke

The present study aims to explore the effects of enteral nutrition (EN) semi-curing feeding on nutritional diarrhoea in the patients with stroke.The patients admitted to the neurological intensive care unit of a tertiary care hospital with stroke- and EN-related diarrhoea between May 2019 and October 2020 were included in the study. The 60 patients, who met the inclusion criteria were divided into the two groups (30 patients each), the experimental group (EN solution+probiotics+90 ml of pectin) and the control group (EN solution+probiotics), in accordance with the random number table method. The stool number, total stool amount, perineal skin score, and time required to achieve the nutritional target of each patient were recorded at admission and on days 1, 3, and 7 of pectin intervention. The lymphocyte count and the haemoglobin, serum pre-albumin (PA), and total cholesterol (TC) levels were measured in order to assess the patients' nutritional statuses.The stool number and total stool amount on days 1 and 3 of pectin intervention in the experimental group were better than in the control group; the differences were statistically significant (p <0.05). On day 7 of the intervention, the stool number, total stool amount, and perineal skin score had decreased in the experimental group; the differences were statistically significant, when compared to the control group (p <0.05). Furthermore, the PA levels increased, and TC levels decreased in the experimental group; the differences were statistically significant, when compared to the control group (p <0.05). On day 3 of the intervention, the PA levels in the experimental group were increased compared to the control group; the difference was statistically significant (p <0.05).EN semi-curing feeding could improve EN-related diarrhoea and nutritional status levels in patients with stroke (Tab. 3, Ref. 9).

Evaluation of micronutrient levels in children with cerebral palsy.

Many studies evaluating the nutritional status of children with cerebral palsy (CP) have focused on energy requirements and protein intake. The present work aimed to assess nutritional status and micronutrient levels of children with (CP). This multicenter, cross-sectional and observational study was conducted in 10 different cities in Turkey. Data were available for 398 participants. Anthropometric measurements, feeding mode, nutritional status, and micronutrient levels were evaluated. The study was conducted with 398 participants (303 patients and 95 healthy controls). Statistical analysis showed that according to the Gomez Classification, weight-for-age (WFA) revealed malnutrition in 92.6% of children with CP, based on Centers for Disease Control and Prevention percentiles. Measurements of micronutrient levels showed that zinc levels were low in patients, whereas vitamin A levels were low in controls. Phosphorous and manganese levels were significantly lower in malnourished children than in typical children. The results revealed that children consuming enteral nutrition solutions had higher selenium and lower zinc levels than non-consumers. Malnutrition is not only a protein- or calorie-based problem; micronutrient deficiencies might cause severe health problems. Children with chronic neurological disabilities must be carefully evaluated for these issues. Therefore, nutritional interventions should be adapted to nutrition.

Nutrition During Critical Care: An Audit on Actual Energy and Protein Intakes.

Oral nutrition is delivered frequently in intensive care units (ICUs) but rarely studied. The primary objective of this study was to quantify nutrition intakes in patients exclusively orally fed (OF) and in those receiving medical nutrition solutions or both. Adults who stayed in a mixed ICU for ≥3 days were studied. Nutrition deficits were calculated as the difference between estimated energy or protein targets (determined by weight-based formulas) and actual intakes (recorded on a daily basis by nurses). Total volumes of enteral or parenteral nutrition solutions, propofol, and glucose infused over 24hours were collected and energy and protein amounts were calculated. In OF patients, food intake at each meal (breakfast, lunch, and dinner) was estimated using the "one-quarter portion" method. Among the 289 included patients aged 67 (57-75.5) years, 253 were fed and received, on average, 14.3 (7.8-19) kcal/kg/d and 0.53 (0.27-0.8) g/kg/d protein. In OF patients (n = 126), intakes were 9.7 (5.8-19) kcal/kg/d and 0.35 (0.17-0.57) g/kg/d protein. In the subset of OF patients with ICU stay ≥ 7 days (n = 37), respectively, 51% and 94% never received ≥80% of their energy and protein targets. Nutrition intakes were lower by oral feeding compared with other exclusive or combined medical nutrition. Compared with the prescribed amounts, the deficit was larger for proteins than for energy.

Are enteral nutrition solutions effective in patients with diabetic foot wounds?

According to the study entitled “Turkey Diabetes, Hypertension, Obesity and Endocrinology Diseases Prevalence Study-II” that was conducted in Turkey, the prevalence of diabetes was 13.7%. An important complication that concerns most medical disciplines involved in the treatment of diabetes patients group is the development of diabetic foot ulcers. The most important risk factors for the development of this complication are neuropathy, overpressure-induced foot deformity, external trauma, infection, and peripheral arterial disease. In the treatment of diabetic foot ulcers, the ideal treatment goals are effective removal of the necrotic tissues with sharp dissection, if possible; dressing to facilitate the absorption of the exudate and healing of the ulcer area; and selection of appropriate shoes or materials to reduce the pressure on the ulcer floor. If necessary, vacuum wound dressings, hyperbaric oxygen therapy, and granulocyte stimulating factor may be used. Moreover, bypass surgery or angioplasty methods can be used in patients with low peripheral blood flow to reduce the rate of ischemia. In the presence of clinical findings that indicated infection, tissue sampling should be performed from the ulcer tissue, and antibiotic treatment should be given as per the results of the culture antibiogram. Delay in treatment can lead to the progression of infectious agents into deep tissues and undesirable orthopedic interventions. After amputation, the disease starts affecting the social life of the patient. The required long-term physical therapy and rehabilitation program should be planned in consideration of the considerable psychological disruption caused by the condition and treatment. The healthcare cost associated with this disorder also poses a problem. Two important points that need to be remembered during this process, and are easy to control are good glycemic control and healthy food intake. Good glycemic control and effective nutritional support can sometimes heal the ulcer and make treatment possible. In this regard, it is important to understand the value of nutritional supplements that replace glutamine and arginine, which are normally present in sufficient amount in our body but become essential in catabolic processes.

Soluble Dietary Fiber Reduces Feeding Intolerance in Severe Acute Pancreatitis: A Randomized Study.

Feeding intolerance of enteral nutrition (EN) frequently occurs in patients with severe acute pancreatitis (SAP) because of intestinal motility disorders. Soluble dietary fiber (SDF) modulates the intestinal motility. The present study examined whether SDF can improve intestinal motility and permeability, and thereby reduce feeding intolerance, in patients with SAP. This study was a single-blind, randomized, controlled, single-center trial. Forty-nine patients with SAP were included. The control and SDF groups received the same EN solution via a nasojejunal tube. The SDF group additionally received 20-g/d polydextrose. The primary outcome was the time to reach the energy goal. Follow-up was continued for 28 days after admission or until discharge from the hospital. Among 49 randomized patients, 46 patients (n=22, control group; n=24, SDF group) were included in the intent-to-treat analysis. The time to reach the energy goal was 7.00 (6.00, 8.25) days and 5.00 (4.25, 6.00) days in the control and SDF groups, respectively (P<0.001). The rates of feeding intolerance were significantly reduced in the SDF group (59.09% vs 25.00%, P<.05). SDF was associated with decreases in the incidence of abdominal distension (72.73% vs 29.17%, P<.01), diarrhea (40.91% vs 8.33%, P<.05), and constipation (72.73% vs 12.50%, P<.001). The time to first flatus and first defecation were significantly shorter in the SDF group (P<.001). The intestinal mucosal barrier function and levels of gastrointestinal hormone were improved by SDF, as evidenced by significantly reduced blood levels of diamine oxidase, D-lactic acid, endotoxin, and vasoactive intestinal peptide (P<.05). SDF shortens the time to reach the energy goal during EN and improves intestinal permeability and motility disorders, thus reducing the incidence of feeding intolerance in SAP patients.

Reduce medication errors in tube feeding administration by establishing administration standards and standardizing operation procedures

Medication errors are common during tube feeding administration. These errors involve all aspects of safety and drug use. This study aimed to reduce medication errors associated with tube feeding by establishing standards and standardized operation procedures (SOPs) for tube feeding administration in the intensive care unit (ICU) ward of the First Affiliated Hospital of Bengbu Medical College in China. Prescriptions for tube feeding administration from January 2017 to December 2017 were retrospectively collected and analyzed. ICU pharmacists intervened when inappropriate prescribing occurred during ward rounds, as well as during incorrect tube feeding administration by nurses. Medical staff were trained for proper tube feeding administration. Standards for tube feeding administration and SOPs were established and put into effect in the ICU ward. After the established standard protocol and SOPs were used in the ICU ward, medication errors associated with tube feeding decreased from 1666 cases in 2017 to 331 cases in 2018, representing a decrease of 80.1%. The rate of incorrect tube feeding administration was reduced from 39.9% (1666/4176 cases) in 2017 to 5.9% (331/5627 cases) in 2018. Medication errors involving tube feeding administration in 2017 included drug loss caused by use of inappropriate tools and incorrect operations (29.7%), not flushing feeding tubes before or after administration (14.6%), ignorance of interactions between drugs and enteral nutrition solutions (13.8%), improper use of administered drugs (10.8%) or drug dosage forms (13.8%), and ignorance of drug–drug interactions (10.1%). The rate of these medication errors significantly decreased in 2018. Our study shows that establishment and application of standards for tube feeding administration and SOPs can significantly reduce medical errors associated with tube feeding.

Effects of enteral nutrition solution with different temperatures on gastrointestinal dysfunction after severe head injury surgery

Objective To explore the effects of enteral nutrition (EN) solution with different temperatures on gastrointestinal dysfunction after severe head injury surgery. Methods From January 2016 to December 2016, we selected 220 patients with severe head injury surgery in intensive care unit (ICU) at Tianjin Medical University General Hospital. All of the patients were randomly divided into observation group A (n=74) , observation group B (n=73) and observation group C (n=73) according to the sequence of being admitted to hospital. Setting range of temperature of EN was from 35.0 to 36.8℃ in observation group A, from 36.9 to 37.9℃ in observation group B and from 38.0 to 42.0℃ in observation group C. We compared gastric motility, intestinal barrier function, time of EN and of reaching target of EN. Results There were statistical differences in intra-abdominal pressure (IAP) , gastric residual volume (GRV) , serum diamine oxidase activity and D-lactate concentration in three groups (F=63.458, 11.002, 26.972, 18.827; P<0.001) . The IAP and GRV of observation group C were significantly lower than those of observation group A (t=-11.215, -4.694; P<0.001) and observation group B (t=-6.462, -2.452; P<0.05) ; those of observation group B were significantly lower than those of observation group A (t=-4.731, -2.234; P<0.05) . The serum diamine oxidase activity and D-lactate concentration of observation group C were lower than those of observation group A (t=-7.263, -6.115; P<0.001) and observation group B (t=-2.712, -3.471; P<0.05) ; those of observation group B were significantly lower than those of observation group A (t=-4.542, -2.631; P<0.05) . Patients' time of EN and of reaching target of EN were significant differences in three groups (F=41.537, 10.892; P<0.001) . The time of EN of observation group C was significantly lower than that of observation group A and observation group B (t=-8.522, -7.065; P<0.001) ; there was no statistical difference in that of observation group A and observation group B (t=-1.433, P=0.153) . The time of reaching target of EN in observation group C and observation group B was lower than that of observation group A (t=-4.587, -3.108; P<0.05) ; there was no significant difference in that between observation group B and observation group C (t=1.474, P=0.142) . Conclusions EN solution with different temperatures have effects on gastrointestinal function among patients after severe head injury surgery. The nutrient solution with temperature from 38.0 to 42.0 ℃ can effectively improve gastric motility and intestinal barrier function, and is conducive to reducing the time of EN and of reaching target of EN. Key words: Temperature; Enteral nutrition; Severe craniocerebral trauma; Gastrointestinal dysfunction

Особливості бактеріальної контамінації перитонеуму та кишки при різних стадіях гострої злукової тонкокишкової непрохідності та її корекції

Мета дослідження: з’ясувати особливості бактеріальної контамінації перитонеуму та кишки при різних стадіях гострої злукової тонкокишкової непрохідності та її корекції.Матеріали і методи. Обстежено та прооперовано 152 хворі на гостру злукову тонкокишкову непрохідність. З них 58 (38,2 %) пацієнтів були в стадії компенсації та 94 (61,8 %) пацієнтів – у стадії декомпенсації. З метою вивчення рівня бактеріальної транслокації виконували бакпосів виділень із дренажів та назогастроінтестинального (НГІ) зонда в динаміці лікування у післяопераційному періоді.Результати досліджень та їх обговорення. У роботі вивчено кількісний і якісний склад мікрофлори тонкої кишки та перитонеального ексудату під впливом комплексного лікування із застосуванням лаважу кишечника 0,9 % розчином натрію хлориду в поєднанні з оксигенотерапією та ентеральним харчуванням розчином «Пептамен» у хворих на гостру злукову тонкокишкову непрохідність у стадії компенсації та декомпенсації. Виявлено меншу колонізацію кишечника та контамінацію черевної порожнини кишковою паличкою, умовно-патогенними мікроорганізмами, та більш швидке відновлення біоценозу тонкої кишки при застосуванні розробленого комплексу заходів дозволило знизити рівень післяопераційних ускладнень та летальності.

Effect of parenteral glutamine supplementation combined with enteral nutrition on Hsp90 expression and Peyer's patch apoptosis in severely burned rats.

The aim of this study was to investigate the effects of parenteral glutamine (GLN) supplementation combined with enteral nutrition (EN) on heat shock protein (Hsp) 90 expression and Peyer's patch (PP) apoptosis in severely burned rats. Male Sprague-Dawley (SD) rats were randomly assigned to four groups: Sham burn+EN+GLN-free amino acid (AA; n=10), sham burn+EN+GLN (n=10), burn+EN+AA (n=10), and burn+EN+GLN (n=10). Two hours after a 30% total body surface area (TBSA), full-thickness scald burn injury on the back, burned rats in two of the experimental groups (burn+EN+AA and burn+EN+GLN groups) were fed with a conventional EN solution by oral gavage for 7d. Simultaneously, rats in the burn+EN+GLN group were given 0.35g GLN/kg body weight/d once via a tail vein injection for 7d and rats in the burn+EN+AA group were administered isocaloric/isonitrogenous GLN-free amino acid solution (Tyrosine) for comparison. Rats in two sham burn control groups (sham burn+EN+AA and sham burn+EN+GLN groups) were treated in the same manner except for the burn injury. All rats in the four groups were given 175kcal/kg body wt/d. There was isonitrogenous, isovolumic, and isocaloric intake among the four groups. At the end of the seventh day after completion of the nutritional program, all rats were anesthetized and samples were collected for further analysis. PP apoptosis was measured by terminal deoxyuridine nick-end labeling (TUNEL). The expression of Hsp90 in PPs was analyzed by western blotting. Caspase-3 activity of PPs was also assessed. Levels of proinflammatory cytokines of gut tissues were evaluated by enzyme-linked immunosorbent assay (ELISA). The intestinal immunoglobulin A (IgA) content was also determined by ELISA. The results revealed that intestinal IgA content in rats of the burn+EN+GLN group were significantly increased compared with those in the burn+EN+AA group (P<0.05). The expression of Hsp90 of PPs in rats in the burn+EN+GLN group was significantly upregulated compared with those in the burn+EN+AA group (P<0.05). On the other hand, levels of proinflammatory cytokines of gut tissues, caspase-3 activity, and the number of TUNEL-stained cells of PPs in rats of the burn+EN+GLN group were markedly decreased compared with those of the burn+EN+AA group (P<0.05). The results of this study show that parenteral glutamine supplementation combined with EN may upregulate the expression of Hsp90, reduce caspase-3 activity, lessen the release of proinflammatory cytokines, attenuate PP apoptosis, and improve intestinal IgA response in burned rats. Clinically, therapeutic efforts to improve intestinal immunity may contribute to a favorable outcome in severely burned patients.

Successfully implementing and embedding guidelines to improve the nutrition and growth of preterm infants in neonatal intensive care: a prospective interventional study

ObjectivesWe aimed to improve the nutritional care of preterm infants by developing a complex (multifaceted) intervention intended to translate current evidence into practice. We used the sociological framework of Normalization...

Noncompliance/Nonadherence With Home Nutrition Support: An Underrecognized Clinical Dilemma.

Failure to administer enteral nutrition, intravenous fluids, and/or parenteral nutrition solutions can have deleterious effects on patients who have been prescribed such therapies. However, it is not well understood why patients requiring nutrition support would be noncompliant or nonadherent to these often life-benefiting therapies. This article explores these issues in a large home nutrition support population.

Iodine Content of Enteral and Parenteral Nutrition Solutions

Iodine is essential for thyroid hormone synthesis, and iodine deficiency may result in thyroid disorders including goiter and hypothyroidism. Patients on long-term enteral nutrition (EN) or parenteral nutrition (PN) may be at risk for micronutrient deficiencies. The recommended daily allowance for iodine intake is 150 μg for nonpregnant adults. However, there is no current consensus among scientific societies regarding the quantity of iodine to be added in adult EN and PN formulations. The objective of this study was to determine the iodine content of U.S. adult enteral and parenteral nutrition solutions. This study also aimed to determine whether adult patients in the United States who are receiving long-term artificial nutrition may be at risk for iodine deficiency. Ten enteral nutrition solutions and 4 parenteral nutrition solutions were evaluated. The iodine contents of these solutions were measured spectrophotometrically and compared to the labeled contents. Measured and labeled EN iodine contents were similar (range 131-176 μg/L and 106-160 μg/L, respectively). In contrast, PN formulas were found to contain small, unlabeled amounts of iodine, averaging 27 μg/L. Typical fluid requirements are 30 to 40 mL/kg/day for adults receiving either total EN (TEN) or total PN (TPN). Adults on long-term TEN likely consume enough servings to meet their daily iodine requirements. However, patients on long-term TPN would require on average 5.6 L PN/day to meet the recommended daily allowance of iodine. This volume of PN is far in excess of typical consumption. Thus, U.S. patients requiring long-term TPN may be at risk for iodine deficiency. EN = enteral nutrition; PN = parenteral nutrition; TEN = total enteral nutrition; TPN = total parenteral nutrition; UIC = urinary iodine concentration.

Comparison of Energy and Nutrient Contents of Commercial and Noncommercial Enteral Nutrition Solutions.

Background:Nutritional support plays a major role in the management of critically ill patients. This study aimed to compare the nutritional quality of enteral nutrition solutions (noncommercial vs. commercial) and the amount of energy and nutrients delivered and required in patients receiving these solutions.Materials and Methods:This cross-sectional study was conducted among 270 enterally fed patients. Demographic and clinical data in addition to values of nutritional needs and intakes were collected. Moreover, enteral nutrition solutions were analyzed in a food laboratory.Results:There were 150 patients who fed noncommercial enteral nutrition solutions (NCENS) and 120 patients who fed commercial enteral nutrition solutions (CENSs). Although energy and nutrients contents in CENSs were more than in NCENSs, these differences regarding energy, protein, carbohydrates, phosphorus, and calcium were not statistically significant. The values of energy and macronutrients delivered in patients who fed CENSs were higher (P < 0.001). Energy, carbohydrate, and fat required in patients receiving CENSs were provided, but protein intake was less than the required amount. In patients who fed NCENSs, only the values of fat requirement and intake were not significantly different, but other nutrition delivered was less than required amounts (P < 0.001). CENSs provided the nutritional needs of higher numbers of patients (P < 0.001). In patients receiving CENSs, nutrient adequacy ratio and also mean adequacy ratio were significantly higher than the other group (P < 0.001).Conclusion:CENSs contain more energy and nutrients compared with NCENSs. They are more effective to meet the nutritional requirements of entirely fed patients.

Effect of parenteral glutamine supplementation combined with enteral nutrition on Hsp90 expression and lymphoid organ apoptosis in severely burned rats

ObjectiveThe aim of this study is to investigate the effects of parenteral glutamine(GLN) supplementation combined with enteral nutrition (EN) on heat shock protein 90(Hsp90) expression, apoptosis of lymphoid organs and circulating lymphocytes, immunological function and survival in severely burned rats. MethodsMale SD rats were randomly assigned into 4 groups: a sham burn+EN+GLN-free amino acid (AA) group (n=10), a sham burn+EN+GLN group (n=10), a burn+EN+AA group (n=10), and a burn +EN +GLN group (n=10). Two hours after a 30% total body surface area (TBSA), full-thickness scald burn injury on the back was made, the burned rats in two experimental groups (the burn+EN+AA group and the burn+EN +GLN group) were fed with a conventional enteral nutrition solution by oral gavage for 7 days. Simultaneously, the rats in the burn+EN+GLN group were given 0.35g GLN/kg body weight/day once via a tail vein injection for 7 days, whereas those in the burn+EN+AA group were administered isocaloric/isonitrogenous GLN-free amino acid solution (Tyrosine) for comparison. The rats in two sham burn control groups (the sham burn+EN+AA group and the sham burn+EN +GLN group) were treated in the same procedure as above, except for burn injury. All rats in each of the four groups were given 175kcal/kg body wt/day. There was isonitrogenous, isovolumic and isocaloric intake among four groups. At the end of the 7th day after nutritional programme were finished, all rats were anesthetized and samples were collected for further analysis. Serum immunoglobulin quantification was conducted by ELISA. Circulating lymphocyte numbers were counted by Coulter LH-750 Analyzer. The percentages and apoptotic ratio of CD4 and CD8T lymphocytes in circulation were determined by flow cytometry (FCM). The neutrophil phagocytosis index (NPI) was examined. The GLN concentrations in plasma, thymus, spleen and skeletal muscle were measured by high performance liquid chromatography (HPLC). The organ index evaluation and TUNEL analysis of thymus and spleen were carried out. The expression of Hsp90 in thymus and spleen was analyzed by western blotting. Moreover, the survival in burned rats was observed. ResultsThe results revealed that parenteral GLN supplementation combined with EN significantly increased the GLN concentrations of plasma and tissues, the serum immunoglobulin content, the circulating lymphocyte number, the CD4/CD8 ratio, the indexes of thymus and spleen, NPI and survival as compared with the burn+EN+AA group (p<0.05). The expression of Hsp90 in thymus and spleen in the burn+EN+GLN group was significantly up-regulated as compared with the burn+EN+AA group (p<0.05). The apoptosis in circulating CD4 and CD8 lymphocytes, thymus and spleen in the burn+EN+GLN group was significantly decreased as compared with the burn+EN+AA group (p<0.05). ConclusionThe results of this study show that parenteral GLN supplementation combined with EN may increase the GLN concentrations of plasma and tissues, up-regulate the expression of Hsp90, attenuate apoptosis in lymphoid organ and circulating lymphocyte, enhance the immunological function and improve survival in severely burned rats. Clinically, therapeutic efforts at the modulation of the immune dysfunction may contribute to a favorable outcome in severely burned patients.

Carnobacterium divergensBacteremia in Woman

<i>Carnobacterium divergens</i>Bacteremia in Woman

Parenteral glutamine supplementation in combination with enteral nutrition improves intestinal immunity in septic rats

ObjectivesThe gut-associated lymphoid tissue is continuously exposed to antigens in the gut lumen and becomes the first line of defense against enteric bacteria and associated toxin. The aim of this study was to investigate the effects of parenteral glutamine (GLN) supplementation in combination with enteral nutrition (EN) on intestinal mucosal immunity in septic rats by cecal ligation and puncture (CLP). MethodsMale Sprague-Dawley rats were randomly assigned into four groups: A sham CLP + EN + saline group (n = 10), a sham CLP + EN + GLN group (n = 10), a CLP + EN + saline group (n = 10), and a CLP + EN + GLN group (n = 10). At 2 h after CLP or sham CLP, all rats in each of the four groups received an identical enteral nutrition solution as their base formula. Then, the rats in the sham CLP + EN + GLN group and CLP + EN + GLN group were given 0.35 g GLN/kg body weight daily for 7 d, all at the same time, via a tail vein injection; whereas those in the sham CLP + EN + saline group and CLP + EN + saline group were daily administered isovolumic sterile 0.9% saline for comparison. All rats in each of the four groups were given 290 kcal/kg body wt/d for 7 d. At the end of the seventh day after the nutritional program was finished, all rats were euthanized and the entire intestine was collected. Total Peyer's patches (PP) cell yield was counted by a hemocytometer. The percentage of PP lymphocyte subsets was analyzed by flow cytometry. The number of intestinal lamina propria IgA plasma cells was determined by the immunohistochemistry technique. The intestinal immunoglobulin A (IgA) levels were assessed by ELISA. PP apoptosis was evaluated by terminal deoxyuridine nick-end labeling. ResultsThe results revealed total PP cell yield, the numbers of PP lymphocyte subsets, intestinal lamina propria IgA plasma cells, and intestinal IgA levels in the CLP + EN + GLN group were significantly increased when compared with the CLP + EN + saline group (P < 0.05). On the other hand, the number of TUNEL-stained cells within PPs in the CLP + EN + GLN group was markedly decreased as compared with the CLP + EN + saline group (P < 0.05). ConclusionThe results of this study show that parenteral glutamine supplementation in combination with enteral nutrition may attenuate PP apoptosis, increase PP cell yield and intestinal lamina propria IgA plasma cells, and subsequently improve intestinal mucosal immunity. Clinically, these results suggest therapeutic efforts at improving intestinal immunity may contribute to the prevention and treatment of sepsis.

Use of a concentrated enteral nutrition solution to increase calorie delivery to critically ill patients: a randomized, double-blind, clinical trial

Critically ill patients typically receive ∼60% of estimated calorie requirements. We aimed to determine whether the substitution of a 1.5-kcal/mL enteral nutrition solution for a 1.0-kcal/mL solution resulted in greater calorie delivery to critically ill patients and establish the feasibility of conducting a multicenter, double-blind, randomized trial to evaluate the effect of an increased calorie delivery on clinical outcomes. A prospective, randomized, double-blind, parallel-group, multicenter study was conducted in 5 Australian intensive care units. One hundred twelve mechanically ventilated patients expected to receive enteral nutrition for ≥2 d were randomly assigned to receive 1.5 (n = 57) or 1.0 (n = 55) kcal/mL enteral nutrition solution at a rate of 1 mL/kg ideal body weight per hour for 10 d. Protein and fiber contents in the 2 solutions were equivalent. The 2 groups had similar baseline characteristics (1.5 compared with 1.0 kcal/mL). The mean (±SD) age was 56.4 ± 16.8 compared with 56.5 ± 16.1 y, 74% compared with 75% were men, and the Acute Physiology and Chronic Health Evaluation II score was 23 ± 9.1 compared with 22 ± 8.9. The groups received similar volumes of enteral nutrition solution [1221 mL/d (95% CI: 1120, 1322 mL/d) compared with 1259 mL/d (95% CI: 1143, 1374 mL/d); P = 0.628], which led to a 46% increase in daily calories in the group given the 1.5-kcal/mL solution [1832 kcal/d (95% CI: 1681, 1984 kcal/d) compared with 1259 kcal/d (95% CI: 1143, 1374 kcal/d); P < 0.001]. The 1.5-kcal/mL solution was not associated with larger gastric residual volumes or diarrhea. In this feasibility study, there was a trend to a reduced 90-d mortality in patients given 1.5 kcal/mL [11 patients (20%) compared with 20 patients (37%); P = 0.057]. The substitution of a 1.0- with a 1.5-kcal/mL enteral nutrition solution administered at the same rate resulted in a 46% greater calorie delivery without adverse effects. The results support the conduct of a large-scale trial to evaluate the effect of increased calorie delivery on clinically important outcomes in the critically ill.

Conduite à tenir lors d’une diarrhée sous nutrition entérale

Numerous definitions of diarrhoea are found in the literature. The onset of at least three liquid or soft stools per day is the simplest and the most applicable definition for the daily clinical practice. Aetiologies of diarrhoea are multiple. The context is sometimes obvious: recent intestinal surgery (short bowel syndrome), digestive disease leading to malabsorption (e.g., Crohn's disease), or digestive infection (e.g., Clostridium difficile). Once these different aetiologies ruled out, drug intake (e.g., laxatives, antibiotics) or enteral nutrition (EN) can be suspected. EN constitutes the first choice of nutritional support when the gastrointestinal tract is functional. The onset of EN-associated diarrhoea should not be systematically considered as a non-functionality of the gastrointestinal tract, and should not lead to a systematic stop of EN. The management of EN-associated diarrhoea is mandatory, because of the several consequences of diarrhoea on the patient, the daily work of health care professionals, and finally, health-related costs. The maintaining of fluid and electrolytes balance is a priority. This article proposes a flow chart for the management of EN-associated diarrhoea. If EN is considered as the primary cause of diarrhoea, changes in the administration flow rate or replacement of the EN solution have to be considered. The best management of EN-associated diarrhoea is its prevention, based on the respect of EN initiation and administration rules.