Tube Feeding In Patients Research Articles

Evaluation of early feeding through nasogastric tube in patients after cardiovascular surgery at the Hanoi Heart Hospital

Objectives: The goal of the study was to describle and understand the factors related to the nasogastric tube feeding in patients after cardio-vascular surgery. Methods: The study involved 100 consecutive patients who underwent cardio-vascular surgery at Hanoi Heart Hospital from April 1 to August 3, 2019..All subjects underwent assessed with the early feeding through nasogastric tube after 6 hours operation. Main results: The mean age of the patients was 54.4 ± 14.5 years old. The percentage of men were 48%, BMI <18.5 were 25%, used inotropic drug were 46% and sedative were 27%. The incidence of patients with abdominal distension and vomiting were 13%. No complications related to early feeding. Factors related to the residual index were sedation and duration of mechanical ventilation. Conclusion: Early nasogastric tube feeding in patients after cardiac and vascular surgery is safe, feasible and feasible.

Tube feeding in patients with dementia is associated with a longer palliative care unit stay

AbstractBackgroundTube feeding (TF) was reported to alter the length of stay (LOS) in a palliative care unit (PCU) in patients with dementia. Admission of dementia patients to the PCU for many reasons including respite is tried to be kept as short as possible due to limited reimbursement in Turkey. Our past observations in our unit have suggested that patients with dementia on TF may be prone to a longer stay in the PCU. Therefore, our objective in this study was to explore the association of TF with the LOS in the PCU in patients with home discharge.MethodIn this single center study at a PCU of a tertiary training hospital, we retrospectively enrolled patients with dementia with a diagnosis on admission, between April 2017 and December 2020. Subjects with a history of intracranial surgery, brain tumors, hemiplegic stroke, hypoxic brain injury, and other neurodegenerative diseases were excluded. Very early (within 4 days) or extremely late (beyond 45 days of hospitalization) discharges were also excluded. The association between TF and LOS in the PCU was examined using logistic regression analysis.ResultThe study included 71 home discharges [mean (SD) age: 82.5 (7.0) years], females 58.1%]. Median (IQR) LOS was 15 (13.0) days (4‐44), and 45 patients (63.4%) were on TF. Median age, gender, and the ration of cancer, infectious etiology, renal failure, hypertension, diabetes mellitus, composite cardiovascular disease, sleep disturbance, depression symptoms, and pain (VAS≥1) were similar patients with and without TF. All patients on TF were bed‐bound and had more pressure ulcers (73.2% vs. 50%) compared to those without TF. Multivariate logistic regression analysis showed that controlling for study covariates TF on admission or TF placement in the PCU was independently associated with highest tertile of LOS in the PCU (OR:4.29, 95%CI: 1.03 ‐ 17.77, P=0.045, Nagelkerke R2=%28.5, Hosöer Lemeshow test p=0.643).ConclusionThe present study showed that, in patients with an established diagnosis of dementia, TF is common and independently associated with a longer length of PCU stay. Nevertheless, the study was underpowered and the results deserve confirmation in larger studies.

Blenderized food tube feeding in patients with head and neck cancer

BackgroundPatients with headand neck cancer (HNC) are at high risk for malnutrition before and during chemoradiation treatment. Many will also require tube feeding to address declines in energy intake, weight, and quality of life (QOL) caused by the impact of treatment on gastrointestinal (GI) symptoms. Blenderized tube feeding (BTF) may ameliorate these adverse conditions.MethodsIn this open‐label, prospective pilot study, 30 patients with HNC who required feeding tube placement were recruited to switch from standard commercial formula after 2 weeks to a commercially prepared BTF formula. Weight, body mass index (BMI), GI symptoms, and QOL scores were tracked for 6 weeks from the first week of feeding tube placement.ResultsOf the 16 patients who completed the 6‐week assessment period, weights and BMI scores for 15 patients trended upward. For most patients, QOL and oral intake increased and GI symptoms decreased over the 6‐week period, particularly during weeks 3 and 4, when the impact of treatment is particularly exacting on patients with HNC.ConclusionBTF effectively mitigated weight loss, GI symptoms, QOL scores, and total energy intake in this group of patients with HNC who received tube feeding for 6 weeks.

Incidence and risk factor of vocal cord paralysis following slide tracheoplasty for congenital tracheal stenosis: a retrospective observational study.

Slide tracheoplasty for congenital tracheal stenosis (CTS) has been shown to improve post-operative outcomes, but the incidence and risk factors of vocal cord paralysis (VCP) following slide tracheoplasty remain unclear. This study aimed to review our experience of slide tracheoplasty for CTS with a focus on post-operative VCP. Twenty-eight patients, who underwent tracheal reconstruction with or without cardiovascular repair at Kobe Children's Hospital between June, 2016 and March, 2020 were enrolled in this retrospective observational study. They were divided into two groups based on the presence of a pulmonary artery sling (PA sling). Perioperative variables were compared between the two groups. Twenty-one of the 28 patients underwent concomitant repair for associated cardiovascular anomalies, including 15 patients with PA sling. The overall incidence of VCP following slide tracheoplasty was 28.6%. The incidences of VCP were 46.7% in patients with CTS and PA sling, which were 14.3% in CTS patients without cardiovascular anomalies. The only risk factor associated with VCP following slide tracheoplasty was a concomitant repair for PA sling. Post-operatively, the duration of nasogastric tube feeding in patients with VCP was significantly longer than that in patients without VCP. The incidence of VCP following slide tracheoplasty for CTS was high, especially in concomitant repair cases for PA sling. Routine screening and evaluation of VCP soon after post-operative extubation is required for its appropriate management.

Feeding Tube Placement Following Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma.

To identify factors that may predict the need for feeding tubes in patients undergoing transoral robotic surgery (TORS) in the perioperative setting. Retrospective chart review. Academic tertiary center. A retrospective series of patients undergoing TORS for oropharyngeal squamous cell carcinoma (OPSCC) was identified between October 2016 and November 2019 at a single tertiary academic center. Patient data were gathered, such as frailty information, tumor characteristics, and treatment, including need for adjuvant therapy. Multiple logistic regression was performed to identify factors associated with feeding tube placement following TORS. A total of 138 patients were included in the study. The mean age was 60.2 years (range, 37-88 years) and 81.9% were male. Overall 82.9% of patients had human papilloma virus-associated tumors, while 28.3% were current or former smokers with a smoking history ≥10 pack-years. Eleven patients (8.0%) had a nasogastric or gastrostomy tube placed at some point during their treatment. Five patients (3.6%) had feeding tubes placed perioperatively (<4 weeks after TORS), of which 3 were nasogastric tubes. Six patients (4.3%) had feeding tubes placed in the periadjuvant treatment setting for multifactorial reasons; 5 of which were gastrostomy tubes. Only 1 patient (0.7%) was gastrostomy dependent 1 year after surgery. Multiple logistic regression did not demonstrate any significant predictive variables affecting perioperative feeding tube placement following TORS for OPSCC. Feeding tubes are seldom required after TORS for early-stage OPSCC. With appropriate multidisciplinary planning and care, patients may reliably avoid the need for feeding tube placement following TORS for OPSCC.

Growth and nutritional status of pediatric patients treated with the ketogenic diet.

Ketogenic diet (KD), a well-known nonpharmacologic treatment of intractable epilepsy, could adversely affect growth and nutritional status; however, such data are limited in Thailand. This study aimed to assess growth and nutritional status of Thai children treated with KD together with dietary adherence and its related factors. The records of children treated with KD for more than 1 month between January 2009 to September 2020 were reviewed. Weight, height, and biochemical indices were retrieved at baseline, 1, 3, 6, 12, 18, and 24 months. Type of KDs, compliance and adverse effects were extracted. Forty-eight patients (21 male) were enrolled. Median age was 3.5 years (IQR 0.9, 10.1). There was no significant decrease in weight-for-age z-score (WAZ) despite a trend toward minimal reduction in WAZ at 3 months. Median follow-up time was 13 months (IQR 7, 29.5). Height-for-age z-score (HAZ) significantly decreased at 12 months [median -1.55 (IQR -3.35, -0.43) vs baseline median -0.6 (IQR -2.07, 0.29)]. Adherence of KD in tube feeding patients was better than oral feeding. Thirty seven percent (18/48) of the patients continued the diet beyond 2 years. Early discontinuation before 6 months was mostly due to poor compliance from patients and families (6/11, 55%). Common adverse effects were GI problems (77%), dyslipidemia (64%) and hypercalciuria (29%). Under close monitoring, KD can be administered in Thai children with minimal adverse effects on growth and nutritional status. Adherence depends on route of feeding, clinical response, and cooperation of the families.

Practice patterns and adherence to nutrition guidelines in acute pancreatitis: An international physician survey

BackgroundThere is agreement among GI society guidelines for recommending early oral nutrition with non-liquid diet in patients with mild acute pancreatitis (AP). There is less agreement regarding administration of tube feedings (TF) in AP. Data on physicians’ adherence to nutrition guidelines and practice variations are limited. AimsTo report practice patterns in the nutritional management of different severity profiles of AP. MethodsWe conducted an anonymous electronic survey among physician members of the International Association of Pancreatology and the American Pancreatic Association. We assessed nutrition practices based on severity of AP, and asked relevant questions regarding the preferred administration strategies for enteral nutrition. Responses were compared by practice location and subspecialty. ResultsA total of 178 physicians, mostly medical pancreatologists (40.4%) and surgeons (34.8%) from Europe (43.4%) and North America (32%) responded. Overall, only 26.7% initiated oral nutrition in mild AP on day 1, 40.9% waited >48 h, and 57.3% initiated nutrition with liquid diets. Physicians reported frequently using TF in patients with moderately-severe (30–75%, depending on the amount and location of necrosis) and severe AP (75–80%). Two-thirds of physicians preferred initiating TF after 48 h, administering it post-pylorically, and using semi-elemental or polymeric formulas. Median TF duration was 11 days (IQR, 7–21). Significant variations were noted based on geographic location and physician subspecialty for several aspects of nutritional practices in both mild and non-mild AP. ConclusionAdherence to oral nutrition guideline recommendations for mild AP is low. There is significant variability in the use of TF in AP. Our study highlights opportunities for improving consistency of nutrition care in AP and identify potential areas for research.

Enteral tube feeding in patients receiving dietary treatment for metabolic diseases: A retrospective analysis in a large French cohort

ContextA strictly controlled diet (often involving enteral tube feeding (ETF)) is part of the treatment of many inherited metabolic diseases (IMDs). ObjectiveTo describe the use of ETF in a large cohort of patients with IMDs. DesignA retrospective analysis of ETF in patients with urea cycle disorders (UCDs), organic aciduria (OA), maple syrup disease (MSUD), glycogen storage diseases (GSDs) or fatty acid oxidation disorders (FAODs) diagnosed before the age of 12 months. SettingThe reference center for IMDs at Necker Hospital (Paris, France). Results190 patients born between January 1991 and August 2017 were being treated for OA (n = 60), UCDs (n = 55), MSUD (n = 32), GSDs (n = 26) or FAODs (n = 17). Ninety-eight of these patients (52%) received ETF (OA subgroup: n = 40 (67%); UCDs: n = 12 (22%); MSUD: n = 9 (28%); GSDs: n = 23 (88%); FAODs: n = 14 (82%)). Indications for ETF were feeding difficulties in 64 (65%) patients, cessation of fasting in 39 (40%), and recurrent metabolic decompensation in 14 (14%). Complications of ETF were recorded in 48% of cases, more frequently with nasogastric tube (NGT) than with gastrostomy. Among patients in whom ETF was withdrawn, the mean duration of ETF was 5.9 (SD: 4.8) years (range: 0.6–19.8 years). The duration of ETF was found to vary from one disease subgroup to another (p = 0.051). While the longest median duration was found in the GSD subgroup (6.8 years), the shortest one was found in the UCD subgroup (0.9 years). ConclusionETF is an integral part of the dietary management of IMDs. The long duration of ETF and the specific risks of NGT highlights the potential value of gastrostomy.In this study at a French tertiary hospital, we documented the indications, modalities, duration and complications of enteral tube feeding in a cohort of patients with inherited metabolic diseases.

Home Nasogastric Tube Feeding in Patients with Traditional Indications for Gastrostomy Tube Placement

<i>Background</i>: Gastrostomy tube placement (GTP) has become standard of care in infants with esophageal atresia, severe neurologic impairment, evidence of severe dysphagia with aspiration, and tracheostomy; all other indications are considered non-traditional indications with little evidence of benefit. <i>Objective</i>: The aim of the study is to identify a select group of infants with non- traditional indications for GTP who may benefit from home nasogastric feeds (HNGF) with a pre-established protocol and algorithm. <i>Methods</i>: We performed a retrospective study of all infants who underwent GTP between January 2015 and December 2017. Infants were categorized as having traditional or non-traditional indications for GTP. Parents or designated caregivers were prospectively contacted by phone and interviewed to determine gastrostomy tube (GT) use status, time to full per oral (PO) feeds, and related complications after discharge. <i>Results</i>: 111 infants had GTP during the study period and 51 (46%) of these were classified as non-traditional indications: term infants with chronic oral aversion, preterm infants with mild to moderate dysphagia, infants of diabetic mothers with feeding problems, post-op cardiac patients with oral aversion, and patients with isolated Pierre Robin sequence. The average days of PO trial before GTP in this group was 41 (±30.5) days, average oral intake and average age at GTP was 32% and 75±42.4 days respectively. Average duration of GT use was 403.4±390.7 days. After discharge, 100% of preterm infants with oral aversion or dysphagia, 100% of infants with isolated Pierre Robin sequence, and 75% of infants of diabetic mothers reached full feeds by mouth in less than 90 days. Only 30% of infants with complex congenital heart defects met this goal. Thirty percent of infants with mild to moderate aspiration reached full PO feeds on average at 22.5 months post-conception age. All infants with neurodevelopmental abnormalities and feeding problems were still on GT feeds at the time of parental interview. <i>Conclusion</i>: We identified a cohort of infants with non-traditional indications for GTP who may benefit from HNGF. Future quality improvement initiatives and randomized controlled studies with HNGF should include infants with the probability of reaching full feeds before 6 months of life to avoid the complications and costs associated with GT placement.

Outcomes of transoral laser microsurgery and transoral robotic surgery in oropharyngeal squamous cell carcinoma

ObjectiveTransoral robotic surgery (TORS) has evolved to a standard therapy modality for oropharyngeal carcinoma, especially in T1/ T2 tumors involving the base of the tongue due to its advantages compared with open surgery. However, knowledge about its benefits compared with transoral laser microsurgery (TLM) are scarce. This study compares oncological and functional results of TLM or TORS in the treatment of oropharyngeal squamous cell carcinoma (OPSCC). MethodsThis retrospective analysis comprises all patients with OPSCC treated with TLM (n = 30) or TORS (n = 24) between April 2003 and May 2018 (follow-up 43 ± 38.3 months). Both treatment groups (TLM and TORS) were comparable in terms of the stage of the disease, prognosis-determining factors, and adjuvant therapy modalities. ResultsThere were no significant differences regarding to the resection status (p = 0.272), the rate of local- (p = 0.834) and distant- recurrence (p = 0.416), with a disease-free survival of 86.7 % and 87.5 %, respectively (p = 0.892). In addition, we could not confirm any differences regarding to operating time (p = 0.860), intraoperative blood loss (p = 0.660), inpatient stay (p = 0.585) and postoperative bleeding rate (p = 0.245). The frequency of tracheostomy and percutaneous endoscopic gastrostomy between both groups is comparable, with a longer duration of tube feeding in patients who have received TLM (p = 0.030). ConclusionIn conclusion, TORS allows for similar oncological outcomes compared with TLM at comparable perioperative risks. The postoperative swallowing function may benefit from TORS.

Risk factors for perioperative bleeding in percutaneous endoscopic gastrostomy construction: A case series and retrospective preliminary investigation.

Percutaneous endoscopic gastrostomy (PEG) is one of the methods of tube feeding in patients who are incapable of oral intake. There are no reports on risk factors for bleeding at PEG construction. Our main objective was to investigate the risks and predictors of bleeding associated with PEG construction. This retrospective, observational study included patients who had undergone PEG construction at our institution. To investigate the risks of bleeding associated with PEG construction, we compared the baseline characteristics between bleeding and non-bleeding patients. In terms of early predictors of post-PEG bleeding, we evaluated whether there had been a decrease from baseline of >10% in hemoglobin levels on the day after the procedure. The median preoperative albumin levels were 22.5 g/L (range 20-29 g/L) and 30 g/L (range 18-40 g/L) in the bleeding and non-bleeding groups, respectively (P = 0.014, Mann-Whitney U-test). The median preoperative platelet counts were 177 500 (range 87 000-265 000) and 271 000 (83 000-749 000) in the bleeding and non-bleeding groups, respectively (P = 0.043, Mann-Whitney U-test). The number of patients for whom hemoglobin levels decreased >10% from baseline on the day after the procedure differed significantly between the bleeding and non-bleeding groups (2/4, 50% and 3/58, 5.45%), respectively (P = 0.002, Pearson's χ2 -test). Low serum albumin and preoperative platelet counts might be risk factors for bleeding. Rigorous follow up is necessary for patients showing a decrease in hemoglobin level ≥10% of their baseline the day after the procedure. Geriatr Gerontol Int 2020; 20: 932-937.

Patterns of oral mucositis in advanced oral squamous cell carcinoma patients managed with prophylactic photobiomodulation therapy-insights for future protocol development.

To characterize oral sites affected by radiation-induced oral mucositis (OM) and related clinical outcomes in oral cancer patients subjected to prophylactic photobiomodulation therapy (PBMT). This study included advanced oral squamous cell carcinoma (OSCC) patients treated with prophylactic PBMT for OM. The site distribution of OM, OM grading (CTCAE NCI, Version 4.0, 2010), OM-related pain (VAS), analgesic protocol (WHO Analgesic Ladder), and use of enteral nutrition were evaluated weekly during treatment. Data analysis was performed using descriptive statistics expressed as median values and percentages. A total of 145 OSCC patients were included. OM most frequently affected the lateral border of the tongue (44.1%), buccal mucosa (37.2%), and labial mucosa (33.8%). Keratinized oral mucosa sites, including the tongue dorsum (6.21%), retromolar trigone (8.3%), and hard palate (2.76%), were less frequently affected. Peak OM scores were observed at weeks 5, 6, and 7, with severe OM (NCI grades 3 and 4) rates of 11%, 20%, and 25%, respectively. The cumulative occurrence of severe OM was 23%, which developed as early as week 3 and as late as week 7. The highest mean value of OM-related pain (2.7) was observed at the sixth week, and 13.8% of the patients required feeding support. This study showed, compared with studies that did not provide PBMT, reduced severity of mucositis, reduced pain and analgesic use, and reduced tube feeding in patients treated with PBMT. OM involving keratinized and non-keratinized surfaces should be included in the prophylactic PBMT to reduce severe OM in future studies.

Study of percutaneous endoscopic gastrostomy compared to nasogastric tube feeding in patients requiring prolong enteral nutritional support

Background: The aims and objectives of this article were to compare the advantages, disadvantages associated with percutaneous endoscopic gastrostomy (PEG) and nasogastric (NG) tube and also to compare complications, to measure the outcomes in terms of hospital stay, mortality and improvement in nutritional status.Methods: In this prospective and interventional study 25 patients were selected in each group on an alternate basis. Study was conducted on cases of traumatic brain injury and cerebrovascular accident patients admitted in Department of General Surgery, IGGMC for a period of November 2013- November 2015 with a need to provide prolonged enteral nutritional support. Each patient was assessed by a dietician and received a standard enteral feeding according to their body weight. The main outcome was measures at 4 weeks were complications (tube dislodgement, aspiration pneumonia, tube blockade and peristomal infections) and nutritional status.Results: The anthropometric parameters (mid arm circumference, biceps skin fold thickness and triceps skin fold thickness) and serum albumin showed a rise in PEG group at 4 weeks when compared to baseline (0 week) whereas they showed a decline in NG group at follow up (4 weeks). The NG group has got higher mortality 4 (17%) when compared to PEG group 2 (7%) due to aspiration pneumonia. Hence, PEG is better tolerated with lesser complications better nutritional support as assessed by the anthropometric parameters at 4 weeks.Conclusions: We conclude that whenever feasible percutaneous endoscopic gastrostomy (PEG) feeding is a choice over nasogastric (NG) feeding in patients requiring long term enteral support.

Early Observation and Mitigation of Challenges in Diabetes Management of COVID-19 Patients in Critical Care Units

Clinical studies of patients with coronavirus disease 2019 (COVID-19) have found diabetes to be a major risk factor for disease severity and mortality (1,2). One new study showed that COVID-19 patients with diabetes and/or uncontrolled hyperglycemia had a longer length of stay and markedly higher mortality than patients without diabetes or uncontrolled hyperglycemia (3). Given rising numbers of cases of patients with COVID-19 and diabetes, understanding their interaction on insulin requirement and glycemic control is prudent. As seen in other infections, blood glucose starts to rise with the beginning of clinical symptoms. By the time the patient is admitted to the intensive care unit (ICU), insulin requirement is at its highest, and blood glucose remains high if not properly managed. Treating physicians face several challenges that need careful attention. Here are some of the potential issues that we encountered in our ICUs and their suggested mitigating plans. We thought that sharing them at this early stage is important. ##### Continuous tube feeding in patients on artificial ventilation. Continuous tube feeding is the ideal nutrition method for intubated patients with COVID-19. Typically, this has been managed by a combination of continuous intravenous insulin infusion and frequent glucose testing to improve glycemic control and reduce glucose variability to the minimum in order to reduce mortality in ICU (4). However, this method significantly increases contact frequency by health care providers, especially ICU nurses. The other common …

Intermittent versus continuous tube feeding in patients with hemorrhagic stroke: a randomized controlled clinical trial.

The arguments about whether intermittent or continuous tube feeding was preferred in patients with hemorrhagic stroke exist yet. This study aimed to examine the effects of intermittent versus continuous tube feeding on its intolerance performance and efficiency of calorie intake. A convenience sample was selected from January 2018 to January 2019 in the Neurosurgery Department of West China Hospital, Sichuan Province. The participants were randomly allocated to either intermittent or continuous tube feeding group, fed four times or 24 h a day using electric feeding pump, respectively. The incidence of the intolerance and calorie intake were recorded and analyzed. 78 patients took part in this study: 40 in the intermittent group and 38 in the continuous group. The incidence of the diarrhea was significantly lower in the continuous group (7.9 vs 37.5%, p = 0.002). The total intolerance rate was significantly lower in the continuous group compared with the intermittent group (63.2 vs 85.0%, p = 0.027). There was no significant difference in calorie intake between the intermittent and continuous group during the first 3 days (2595.4 ± 394.5 kcal vs 2317.8 ± 645.1 kcal, p = 0.099). No significant difference in total calorie intake was found between two groups (6265.6 ± 1261.3 kcal vs 6429.4 ± 1452.4 kcal, p = 0.597). Continuous tube feeding was an effective way to improve the tolerance of enteral nutrition. But no enough evidence was found to support the advantage in calorie intake of continuous tube feeding in this study.

Physicians' Knowledge of Medical Nutrition for Patients with Advanced Dementia (QI624)

•Describe the gaps in education of the benefits and harms of medical nutrition for patients with dementia.•Identify areas for further research in education around medical nutrition for patients with progressive dementia. Dementias are progressive and incurable, leading to a profound loss of cognitive function with a final phase characterized by reduced oral intake. The availability of medical nutrition has made treatment decisions more complex for surrogates, and despite studies and National Society recommendations to the contrary, many physicians continue to place feeding tubes in patients with dementia. Describe the gaps in education around medical nutrition for patients with progressive dementia. After IRB approval, we conducted a crosssectional, anonymous survey of residents' and attending physicians' knowledge of medical nutrition for patients with advanced dementia. Fifty physicians of 160 surveyed responded for a response rate of approximately 32%. Almost 23% (n=11) of respondents believe that medical nutrition is the standard of care, and less than 10% feel that there are no other alternatives. Only 39% (n=19) of respondents correctly answered that medical nutrition can increase the risk of aspiration pneumonia, while 25% (n=12) correctly answered that there is an increased 30-day mortality. Close to 25% (n=11) of respondents believed that they were medically or ethically obligated to offer medical nutrition to patients with advanced dementia. There were no statistically significant distributional differences in total knowledge scores for age group, gender, or role. There was a marginal positive association with years since medical school (Spearman p=0.05); if grouped according to < 3 years vs. 3+ years, there was a statistically significant difference in knowledge scores (p=0.03). Residents and hospitalists at our institution have limited knowledge of the evidence and recommendations for best practices for medical nutrition in patients with advanced dementia. The results of our study suggest that both resident and attending physicians maintain misconceptions about their medical and ethical obligations to offer medical nutrition. Further investigation is warranted to explore if improving education around the harms and benefits of medical nutrition could impact practice patterns and change physicians' concerns around ethical obligation.

The care environment and risk of complications among home enteral tube feeding patients

The care environment and risk of complications among home enteral tube feeding patients

Effects of Semi-Solid Enteral Formula on Aspiration Pneumonia and Diarrhea

Objective: The effects of semi-solid enteral formula were investigated in tube feeding patients with aspiration pneumonia and/or diarrhea caused by liquid enteral formula. Methods: In 25 cases of aspiration pneumonia and 10 cases of diarrhea (5 cases had both aspiration pneumonia and diarrhea) caused by liquid enteral formula, the rate of improvement by changing the liquid enteral formula to semi-solid enteral formula was studied. The semi-solid enteral formula (PG Soft® EJ) was infused via the nasogastric tube (16Fr) or percutaneous endoscopic gastrostomy (PEG) tube (20Fr). Results: The semi-solid enteral formula was effective in 72% of aspiration pneumonia cases and in 80% of diarrhea cases. Constipation was observed in one case but was controlled with magnesium oxide. Conclusion: In cases of aspiration pneumonia and/or diarrhea, changing liquid enteral formula to semi-solid enteral formula frequently shows improvement.

Clinical Effects of a Pectin-Containing Oligomeric Formula in Tube Feeding Patients: A Multicenter Randomized Clinical Trial.

A pectin-containing oligomeric formula (POF) is a unique type of enteral formula that transforms from a liquid to a gel after reacting with gastric acid. Reports on its clinical effects have been limited. The present study was conducted to examine and verify the clinical effects of POF. The study subjects were 201 stable patients receiving intragastric tube feeding. They were randomized into 2 groups to receive either POF or a standard polymeric formula (SPF) as a control. The duration of observation was 1 week. Analyses were conducted for the incidence of predefined composite events, including diarrhea, defecation treatments, and other enteral nutrition (EN) management-related events. Composite events occurred in 15 of 98 patients in the POF group and 30 of 100 patients in the SPF group, with a significantly lower incidence in the POF group compared with the SPF group (P=0.011). In particular, diarrhea occurred in 2 patients in the POF group and 13 patients in the SPF group, with a significantly lower incidence in the POF group compared with the SPF group (P=0.003). The results of this study suggest that POF is less likely to cause EN-related events, especially diarrhea, than SPF is.

Healthcare Professionals' Perceptions of Feeding Tube Practices for Patients With Head and Neck Cancer Across 4 International Radiation Oncology Departments.

Malnutrition is common and debilitating among patients with head and neck cancer (HNC). A feeding tube (FT) can help to minimize this. However, there is debate on FT use, including whether a reactive nasogastric tube (NGT) or prophylactic gastrostomy tube (PGT) approach is best. This study aimed to explore interdisciplinary healthcare professionals' perspectives of FT practices for patients with HNC, across 4 radiation departments in Australia and the United States. Healthcare professionals involved in the clinical care of patients undergoing radiotherapy for HNC were recruited from 2 radiation-oncology departments in Australia and 2 in the United States. Individual interviews were recorded and analyzed using a grounded theory approach. Seventeen radiation oncologists, 12 nurses, 11 dietitians, and 6 speech pathologists participated. "Perspectives of FTs for patients with HNC" comprised 4 categories: a valued support, more individualized, no universal practice, and PGT vs NGT. "Placement considerations" comprised 6 patient categories (planned treatment, tumor characteristics, nutrition and swallow status, tube-dependence risk, psychosocial status, and patient preferences) and 4 service-structure categories (dietetic access, speech-pathology access, interdisciplinary collaboration, and nutrition-support infrastructure). Although the targeted use of FTs was valued by healthcare professionals, several patient and service-structure factors may influence whether the PGT or reactive NGT approach is perceived to be more efficacious. Further research is needed to explore patient preferences, tube dependence, interdisciplinary collaboration, and department infrastructure to promote consistent evidence-based and patient-centered FT practices.