Gastric Feeding Research Articles

Impact of Using a Novel Gastric Feeding Tube Adaptor on Patient's Comfort and Air Leaks During Non-invasive Mechanical Ventilation

IntroductionThe presence of oral or naso-enteral probes during non-invasive mechanical ventilation (NIMV) increases the risk of leakage and patient discomfort. The objective of this study was to evaluate the effectiveness of a novel tube adapter for NIMV (TA-NIMV) in relation to leakage and comfort level. MethodsA non-randomized quasi-experimental design was performed in an adult intensive care unit of a highly complex hospital, in which patients were their own controls. We included adult patients who required NIV with oronasal mask and who simultaneously had oral or naso-enteric tubes. The interventions were as follows: every participant received two therapies, one with the TA-NIMV and one conventional therapy of NIMV (CT-NIMV). Comfort could be evaluated in 99 patients with a Glasgow Coma Scale of 15. The outcomes of interest was the average percentage of air leak and patient comfort during each intervention. Results196 patients were included in the study during a 16-month period. The mean air leak percentage was 9.2% [standard deviation (SD), 7.7] during TA-NIMV and 32.5% (SD, 12.5) during CT-NIMV (p<0.001). 84.9% reported being comfortable or very comfortable during TA-VMNI. 66.7% Uncomfortable or Very uncomfortable during CT-NIMV (p<0.001). ConclusionHigher comfort levels and lower air leakage volume percentages were achieved using the TA-NIMV than those achieved by CT-NIMV.

Laparoscopic tubularized continent gastrostomy: an alternative to tube gastrostomies.

Gastrostomy tubes, placed either endoscopically or laparoscopically, are the most widely used method to deliver enteral feeding to patients unable to be fed by mouth. Tube gastrostomy is quick and low cost and allows the health care professionals for a convenient route to deliver enteral nutrition to their patients. Nevertheless, bearing an indwelling gastric tube could not be as convenient for patients. Complications, such as bowel perforation, tube dislodgement, peristomal infection or bleeding occur in up to 17% of patients, and some other drawbacks of gastric tubes, such as peristomal pain, are often understated. We present our technique for laparoscopic creation of a tubularized continent gastrostomy, originally conceived for the emergency treatment of patients with a dislodged percutaneous endoscopic gastrostomy, to provide them with a reliable new route for gastric feeding. After healing, this gastrostomy does not need an indwelling tube to stay patent, requires only a light gauze dressing and can be used by intermittent catheterization at conventional feeding times during the day. Laparoscopic tubularized continent gastrostomy can be offered to patients as a reliable alternative to tube gastrostomy.

Gastrointestinal Complications in Critically Ill Patients With COVID-19.

Extrapulmonary disease has been observed in patients with coronavirus disease 2019 (COVID-19).1–3 We describe here the gastrointestinal (GI) complications of patients with severe COVID-19 admitted to the intensive care unit (ICU) at the Massachusetts General Hospital between March 13 and April 12, 2020. During this time period, 141 patients were admitted to the ICU with severe acute respiratory syndrome coronavirus 2 infection confirmed by reverse-transcriptase–polymerase-chain-reaction testing. The median (interquartile range) age was 57 (47, 70) years, 65% of them were men, and 45% had GI symptoms (eg, abdominal pain, diarrhea, vomiting) on hospital presentation (Table 1). The median (interquartile range) Sequential Organ Failure Assessment Score upon admission to the ICU was 5 (4, 7.5), and 128 (91%) required mechanical ventilation. A total of 104 patients (74%) developed at least 1 GI complication.TABLE 1: Characteristics of Patients With Severe Coronavirus Disease 2019 Admitted to the Intensive Care UnitWe stratified the GI complications into 4 categories: hepatobiliary, hypomotility, bowel ischemia, and other. Among the hepatobiliary complications, transaminitis was the most common (67%). The mean highest values recorded for aspartate aminotransferase and alanine aminotransferase were 420.7 and 479.0 U/L respectively, representing a 7.5- and 12-fold increase from the physiological values. Four patients (4%) developed acute acalculous cholecystitis and 1 patient (1%) developed acute pancreatitis during their ICU stay. Half of the patients developed hypomotility-related complications of variable severity. Almost all patients with GI complications required nasogastric or orogastric tubes. Forty-six percent of patients had gastric feeding held for at least 24 hours due to high gastric residuals, and 58 (56%) developed an ileus diagnosed clinically and/or radiologically. Four of the patients with severe ileus had clinical and radiologic findings concerning for bowel ischemia and were taken to the operating room on days 11, 14, 15, and 22 of hospitalization, respectively, for an exploratory laparotomy. Two patients were found to have extensive patchy bowel necrosis involving half to two thirds of the total bowel length, despite patent proximal mesenteric vessels on the computed tomography scan, perhaps suggesting microvascular thrombosis. Intraoperatively, the necrotic bowel had a distinct bright yellow color in contrast to the common finding of purple-black color [(Fig. 1 in the Supplementary Appendix (Supplemental Figure 1. Diffuse patchy areas of necrosis of the entire small bowel and right colon, involving large and short stretches of the wall. Note the clear demarcation, the round shape, and the antimesenteric location, https://links.lww.com/SLA/C197)]. Another patient was found to have ischemia without frank necrosis of the terminal ileum. The fourth patient developed liver ischemia and necrosis, and had similar areas of yellow discoloration on the antimesenteric side of the small bowel, without frank transmural necrosis. Two additional patients were diagnosed with a colonic paralytic ileus, clinically identical to colonic pseudoobstruction (Ogilvie syndrome) on days 6 and 14 of hospitalization. Figure 2 in the Supplementary Appendix (Supplemental Figure 2. Abdominal x-ray of a patient with an Ogilvie-like syndrome showing significant distention of the colon, https://links.lww.com/SLA/C198.) shows an abdominal x-ray of 1 of these 2 patients demonstrating significant colonic dilation with cecal wall pneumatosis. On exploratory laparotomy, patchy areas of necrosis of the entire colon were noted; a total colectomy and an end ileostomy were performed. The pathology of the resected bowel showed focal transmural areas of necrosis with acute fibrinopurulent serositis. The overall 14-day patient mortality was 15%. The mortality rate of the subset of patients who required abdominal surgery was as high as 40%. In this series of critically ill patients with COVID-19, we report a high incidence of hepatobiliary, hypomotility, and ischemic GI complications. Of 141 patients, 58 had ileus, 2 had an Ogilvie-like syndrome, 1 had extensive hepatic necrosis, and 4 had bowel ischemia necessitating emergent surgery and bowel resection. Although these GI complications could be attributed to pharmacologic adverse events and metabolic and electrolyte disturbances occasionally encountered in critically ill patients, severe acute respiratory syndrome coronavirus 2–induced small vessel thrombosis or viral enteroneuropathy are 2 possible hypotheses that warrant further investigation.4,5 In summary, critically ill COVID-19 patients have a high incidence of GI complications with a subset that progress to bowel ischemia requiring emergent surgical intervention. Front-line clinicians should be made aware of these complications and should keep a high index of suspicion for GI symptoms warranting surgical consultation.

Evaluation of a Nasoenteral Feeding Tube With Balloon to Facilitate Placement.

Enteral feeding is essential for critically ill, head trauma, and burn patients who are unable to swallow. To evaluate a new nasoenteral feeding tube with distal tip balloon designed to facilitate post-pyloric migration and avoid misplacement in the trachea. A case series was conducted in 50 critically ill patients aged 19 to 89 years receiving mechanical ventilation and requiring enteral nutrition in a teaching hospital. Patients received a soft, flexible, kink-resistant nasoenteral feeding tube with a balloon near the distal tip to enhance postpyloric migration by peristalsis. The feeding tube was inserted with a novel thread technique to reduce posterior nasopharyngeal trauma and tube misplacement. Pulse oximetry provided early detection of misplacement into the trachea. Placement was verified by abdominal radiography performed shortly after the procedure and repeated within 24 hours if needed. Postpyloric placement was achieved at 30 minutes in 24% of patients and by the following morning in 70% of patients. Tracheal intubation occurred in 1 patient but was recognized and corrected without injury. No tube occlusion from kinking occurred. Early gastric or postpyloric feeding can be provided with this novel feeding tube. Its use facilitates quick bedside recognition of accidental misplacement in the trachea, reducing the chance of pneumothorax. The tip balloon reduces deeper placement into a lung and promotes distal migration into the small intestine. The design prevents occlusion from kinking, which is common with conventional feeding tubes. Nurses easily adopted the tube and insertion technique.

Tolerance in Preterm Infants Fed Exclusively with Human Milk. Prospective Analytic Study

Human milk is the best feeding for premature infants. When Own Mother’s Milk (OMM) is insufficient or unavailable, the alternative is represented by the Donor Milk (DM). OMM and DM must be fortified to support the adequate growth. Objectives: Evaluation of the food tolerance on preterm fed exclusively with fortified Human Milk (HM). Materials and Methods: This prospective analysis has been performed on a sample of 48 preterm with GA ≤ 32 weeks. Gastric Residual (GR), Vomiting (V) and Feeding Suspension (FS) are the parameters performed. We identified two categories (OMM/DM) and 4 groups: newborns fed exclusively with OMM (EOMM), with prevalent OMM (POMM), with exclusively DM (EDM) and with prevalent DM (PDM). Results: The overall incidence of GRs was 18%, the incidence of bilious residuals was 4%, the incidence of Vs was 4.5%, there was no indication of blood in the stool, the total percentage of days of FS was 12.7%. There was no statistical correlation between the incidence of GR, V, FS in the two categories (OMM/DM). The relationship between the kind of feeding and the GA or the BW was not statistically significant. Conclusions: The study highlights the irreplaceability of the OMM in feeding the preterm and that the DM is a valid substitute of OMM.

Continuous Versus Bolus Gastric Feeding in Children Receiving Mechanical Ventilation: A Systematic Review

Nutrition guidelines recommend enteral nutrition in the form of gastric feedings for critically ill children and acknowledge a lack of evidence describing an optimal method for providing these feedings. To determine the state of the science regarding the efficacy of bolus (intermittent) or continuous gastric feedings to improve nutrition delivery in critically ill children receiving mechanical ventilation. Five hundred seventy-nine abstracts met the inclusion criteria and were screened by 2 reviewers according to prespecified criteria. Full-text reviews were performed on 28 articles; 11 studies were selected for detailed analysis. Because of the small number of eligible studies, broader searches were conducted. Only 5 studies with a collective enrollment of fewer than 200 children closely addressed the specific research question. These 5 studies did not report any similarity in feeding regimens, nor did they report nutritional outcomes. Two of the articles described findings from the same study population. Although 4 of the 5 studies randomized children to bolus versus continuous feedings, only 3 studies described attainment of nutrient delivery goals in both the intervention and the control groups; the remaining study did not report this outcome. The heterogeneity in methodology and outcomes among the 5 studies did not allow for a meta-analysis. The dearth of evidence regarding best practices and outcomes related to bolus versus continuous gastric feedings in critically ill children receiving mechanical ventilation requires additional rigorous investigation.

Maternal Milk and Relationships to Early Neurobehavioral Outcome in Preterm Infants.

The purpose of this study was to (1) define medical and sociodemographic factors related to maternal milk feedings and (2) explore relationships between maternal milk feeding and early neurobehavioral outcome. Ninety-two preterm infants born ≤ 32 weeks gestation had maternal milk feeding and breastfeeding tracked in this retrospective analysis. At 34 to 41 weeks postmenstrual age (PMA), neurobehavior was assessed with the NICU Network Neurobehavioral Scale. Maternal milk feeding was often delayed by the use of total parenteral nutrition, administered for a median of 11 (7-26) days, impacting the timing of gastric feeding initiation. Seventy-nine (86%) infants received some maternal milk during neonatal intensive care unit (NICU) hospitalization. Twenty-one (27%) infants continued to receive maternal milk at 34 to 41 weeks PMA, with 10 (48%) of those receiving maternal milk exclusively. Among mothers who initiated maternal milk feeds, 20 (25%) put their infants directly at the breast at least once during hospitalization. Mothers who were younger (P = .02), non-Caucasian (P < .001), or on public insurance (P < .001) were less likely to provide exclusive maternal milk feedings by 34 to 41 weeks PMA. Infants who received maternal milk at 34 to 41 weeks PMA demonstrated better orientation (P = .03), indicating they had better visual and auditory attention to people and objects in the environment. Our findings demonstrate a relationship between maternal milk feedings and better neurobehavior, which is evident before the infant is discharged home from the NICU.

Has new technology of use of disposable suction liners reduced ventilator associated pneumonia in the Nairobi hospital intensive care unit?

Introduction: Patients who are admitted in the intensive care units (ICU) are at risk of hospital-acquired (nosocomial) infection as a secondary illness. The second most common nosocomial infection on these critically ill patients after urinary tract infections is pneumonia. Majority of the nosocomial pneumonias are from the use of mechanical ventilation. The pneumonia from the mechanical ventilation is often referred to as ventilator-associated pneumonia (VAP) Objectives/Aims: The aim of this study was to evaluate the impact of the use of disposable suction liners at the Nairobi hospital intensive care unit. The specific objective was to determine and compare the incidence of VAP in the ICU of The Nairobi Hospital before and after introduction of the disposable suction liners. Methods: This retrospective cohort study research was undertaken at The Nairobi Hospital which is a private hospital in the capital city of Kenya. The study included data from all the patients admitted in the intensive care unit (ICU) between the year 2012 and 2015. Results: The study cohort had a population of 2504 patients; 1208 (48.2%) were from the exposed group (2014 and 2015) while 1296 (51.8%) were from the unexposed group (2012 and 2013). Overall the incidences of VAP for the exposed and unexposed groups respectively were 5.0 and 63.3 per 1000 patients; RR [95% CI]; 12.74 [5.58-29.07] (p<0.001). Conclusion: The study concluded that VAP can be significantly reduced by the introduction of suction liners in ICUs. This is evident from the data as VAP was reduced by 13 times between the two cohorts. Additionally, it can be concluded that certain known practices like early gastric feeding; nasal intubation in preference to other modes of intubation and isolation practice reduced the risk of VAPs in ventilated patients in critical care units. These practices should be enhanced when and as applicable in all ventilated patients. Importantly, the use of disposable suction liners had the best outcome of reduced VAPs in ventilated patients and therefore was highly recommended

Gastric and Jejunal Enteral Feeding Differently Affect Vitamin B12 Status in Subjects with Severe Motor and Intellectual Disabilities.

The absorption of vitamin B12 is a complex process involving gastric acid and intrinsic factor as the indispensable components. In this study, we have investigated the effects of the administration site in enteral feeding on vitamin B12 status in subjects with severe motor and intellectual disabilities (SMID). This is a cross-sectional study conducted from January to June 2016. Blood concentrations of vitamin B12, folate, vitamin B6, and homocysteine (Hcy) were measured in a total of 82 subjects (38 men, 44 women). Also, nutrients intake was assessed. Subjects with enteral feeding (EF) had significantly higher intakes of vitamin B12, folate, and vitamin B6 than those with oral ingestion (OI). Serum folate and vitamin B6 concentrations in subjects with EF were significantly higher than those with OI. Among the EF subjects, serum vitamin B12 concentration was significantly higher in those fed with gastric tube than those fed with jejunal tube in spite of similar vitamin B12 intakes. No significant difference was observed between the two groups regarding the circulating concentrations of folate, vitamin B6, or Hcy. Although each administration route has its own benefit, gastric tube is advantageous in the absorption of vitamin B12.

Impact of Using a Novel Gastric Feeding Tube Adaptor on Patient's Comfort and Air Leaks During Non-invasive Mechanical Ventilation

IntroductionThe presence of oral or naso-enteral probes during non-invasive mechanical ventilation (NIMV) increases the risk of leakage and patient discomfort. The objective of this study was to evaluate the effectiveness of a novel tube adapter for NIMV (TA-NIMV) in relation to leakage and comfort level. MethodsA non-randomized quasi-experimental design was performed in an adult intensive care unit of a highly complex hospital, in which patients were their own controls. We included adult patients who required NIV with oronasal mask and who simultaneously had oral or naso-enteric tubes. The interventions were as follows: every participant received two therapies, one with the TA-NIMV and one conventional therapy of NIMV (CT-NIMV). Comfort could be evaluated in 99 patients with a Glasgow Coma Scale of 15. The outcomes of interest was the average percentage of air leak and patient comfort during each intervention. Results196 patients were included in the study during a 16-month period. The mean air leak percentage was 9.2% [standard deviation (SD), 7.7] during TA-NIMV and 32.5% (SD, 12.5) during CT-NIMV (p<0.001). 84.9% reported being comfortable or very comfortable during TA-VMNI. 66.7% Uncomfortable or Very uncomfortable during CT-NIMV (p<0.001). ConclusionHigher comfort levels and lower air leakage volume percentages were achieved using the TA-NIMV than those achieved by CT-NIMV.

Interrupted Nutrition Support in Patients With Burn Injuries: A Single-Centre Observational Study.

Enteral nutrition (EN) is essential to meet the increased metabolic requirements of burn-injured patients. However, feeds are often suspended for care. This study examines the interruptions in EN (IEN). To determine the frequency and duration of IEN and whether these interruptions are predictable or unpredictable. This retrospective chart review of 27 adult burn patients examined age, sex, body mass index, percentage of total body surface area, length of hospital stay, predicted energy requirements from equations and indirect calorimetry, EN start time, time EN reached goal rate, and interruptions to EN. Predictable interruptions accounted for 74.5% (frequency) and 81.6% (duration) of total interruptions. The most frequent and time-consuming interruptions were perioperative period, extubation, and tests/procedures (predictable) versus high gastric residual volume, emesis/nausea, and feeding tube displacement (unpredictable). Most IEN were due to predictable events. Based on these findings, compensating for predictable interruptions to meet nutritional requirements in burn patients is recommended.

2950 Gastrostomy Tube Placement in Patients With Ascites: A National Inpatient Sample Analysis

INTRODUCTION: As the treatment of liver diseases progress, patients with cirrhosis are living longer, and physicians are facing an increasing need for gastric feeding tube placement to provide enteral nutritional support to these patients. Cirrhotic patients are usually considered as a poor surgical risk candidates, making a surgically placed gastrostomy tube an undesirable option; thus, percutaneous endoscopic gastrostomy (PEG) is often considered to an alternate route to provide enteral nutrition. Cirrhotic patients with portal hypertension often have varices or ascites and are inherently more prone to procedural complications. There is limited data on the safety of the gastrostomy tube in patients with ascites. The aim of our study is to assess the outcomes of gastrostomy tube placement in patients with ascites. METHODS: We conducted a retrospective review of patients with ascites who underwent gastrostomy tube placement using the largest all-payer database, national inpatient sample (NIS) from 2007-2014 using validated ICD-9 codes. Primary and secondary outcomes included in-patient mortality, length of stay (LOS) and total hospital charges, respectively. We adjusted for confounding factors including age, gender, insurance, zip income, and hospital size and location by using multivariate regression. RESULTS: Out of total 2,603,539 hospitalizations for adult patients with ascites, 29,001 patients underwent gastrostomy tube on that hospitalization. Mean age of patients with ascites with gastrostomy 64 ± 2 years with male predominance (55% vs. 45%). The patients with ascites who had gastrostomy tube placed were more likely to die in the hospital (adjusted OR 1.84; 95% CI 1.7-1.9, P = 0.00) as compared to ascites patients without gastrostomy tube. Also, we found a significant increase in mean LOS (28.83 days vs 8.34 days) and mean total charges ($277,404.5 vs $71,874.73). CONCLUSION: Our study is the largest evaluation to date of cirrhotic patients who have undergone PEG. This study suggests that patients with ascites who undergo gastrostomy tube placement have increased mortality, length of stay, and hospital charges. The results of this study point towards caution for the use of PEG in patients with ascites.

A Natural History of Gastrojejunostomy Tubes in Children

BackgroundGastrojejunostomy (GJ) tubes are frequently used to provide nutrition in patients who do not tolerate gastric feeding. Despite their widespread use, there is little literature on the lifespan of GJ tubes, reasons for failure, and recommendations for optimal techniques and timing of replacement. We aimed to evaluate the natural history of GJ tubes in pediatric patients. Materials and methodsWe reviewed all pediatric patients who underwent GJ tube placement or exchange at our institution from January 2012 to July 2018. Demographic data, time, and indication for replacement or removal of GJ tubes were collected. End points were permanent removal of GJ tube or mortality. ResultsSeventy-nine patients underwent 205 GJ tube procedures with a median of 2 GJ tubes per patient. Median GJ tube lifespan was 98 d (interquartile range = 54-166). The two most common indications for tube exchange were structural or mechanical problems (43.1%) and GJ tube dislodgement (34.6%). Although most GJ tube exchanges (66%) were performed under general anesthesia or with moderate sedation, 34% of exchanges were done without sedation. During the study period, 12 patients (15.2%) died from their primary disease, nine patients (11.4%) required subsequent fundoplication, one (1.3%) underwent a jejunostomy, and 23 (29.1%) progressed to gastric feeds without fundoplication at a median time of 208 d. ConclusionsGJ tubes offer a safe and effective feeding option in patients intolerant of gastric feeding. GJ tubes fail most commonly from intrinsic structural or mechanical issues, and many patients ultimately tolerate gastric feeds without need for further intervention. Exchange of tubes without anesthesia is a viable option.

MON-PO353: Equal Efficacy of Gastric and Jejunal Tube Feeding in Liver Cirrhosis and/or Alcoholic Hepatitis – a Randomised Controlled Trial

MON-PO353: Equal Efficacy of Gastric and Jejunal Tube Feeding in Liver Cirrhosis and/or Alcoholic Hepatitis – a Randomised Controlled Trial

Effect of post-pyloric feeding by spiral nasoenteric tubes on ventilator-associated pneumonia in neurocritical care patients: a retrospective analysis of three clinical randomized controlled trials

To explore the effect of post-pyloric feeding by spiral nasoenteric tubes on ventilator-associated pneumonia (VAP) in neurocritical care patients. A retrospective study was performed to analyze the clinical data of 175 neurocritical care adult patients with mechanical ventilation (MV) more than 48 hours, who were enrolled in three randomized controlled trials (RCT) conducted by Guangdong Provincial People's Hospital for post-pyloric tube placement between April 2012 to March 2019. The following patient clinical data were collected when patients were enrolled: gender, age, neurologic diagnosis, comorbidities, medication, endotracheal reintubation, bronchoscope treatment, the distal site of nasoenteric tubes, and acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score, Glasgow coma scale (GCS) score, and acute gastrointestinal injury (AGI) grade assessed. Patients were divided into VAP group and non-VAP group according to the occurrence of VAP, and the differences of each index between the two groups were compared. Then the influencing factors of P < 0.1 were included in multivariate Logistic regression analysis to identify the potential risk factors affecting the incidence of VAP. Furthermore, patients were divided into gastric feeding group and post-pyloric feeding group according to the distal site of nasoenteric tubes, and subgroup analysis was performed to evaluate the variety of VAP in patients with different tube sites and status. (1) Forty-two patients occurred VAP in 175 MV patients, and the incidence of VAP was 24.0%. (2) Univariate analysis showed the P value of post-pyloric feeding, APACHE II score, GCS score and bronchoscope treatment were less than 0.1, and post-pyloric feeding and GCS score in VAP group were significantly lower than those in non-VAP group [post-pyloric feeding: 19.0% (8/42) vs. 36.8% (49/133), GCS: 5 (3, 7) vs. 6 (4, 9), both P < 0.05]. Multivariate Logistic regression analysis indicated that post-pyloric feeding was independent protective factor [odds ratio (OR) = 0.360, 95% confidence internal (95%CI) = 0.151-0.857, P = 0.021] and bronchoscope treatment was the independent risk factor (OR = 2.210, 95%CI = 1.051-4.647, P = 0.036) for VAP. (3) The incidence of VAP was 28.8% (34/118), 0% (0/4), 8.3% (1/12), 26.7% (4/15), 22.2% (2/9) and 5.9% (1/17) respectively when tube tip in stomach, D1, D2, D3, D4 and jejunum confirmed by abdominal radiography. Post-pyloric feeding in each proportion seemed to present lower VAP rate compared with gastric feeding, however, no significant difference was found (all P > 0.05). (4) The incidence of VAP in post-pyloric feeding group was significantly lower than that in gastric feeding group [14.0% (8/57) vs. 28.8% (34/118), OR = 0.403, 95%CI = 0.173-0.941, P = 0.032]. Lower VAP rate appeared on patients with SOFA < 12 (OR = 0.392, 95%CI = 0.154-0.995, P = 0.044) and AGI grade ≥ II (OR = 0.086, 95%CI = 0.011-0.705, P = 0.006) fed by post-pyloric route according to the result of subgroup analysis stratified by age, gender, APACHE II score, SOFA score and AGI grade. Post-pyloric feeding would decrease the incidence of VAP in neurocritical care patients on MV.

A Randomized, Pilot Study Comparing Cost Effectiveness on Two Commercially Available Gastric Feeding Tubes

A Randomized, Pilot Study Comparing Cost Effectiveness on Two Commercially Available Gastric Feeding Tubes

A Comparison of Gastric and Jejunal Feeding in Hypercatabolism Associated With Hypothalamic AMPK-Autophagy-POMC in Endotoxemic Rats.

Hypercatabolism is associated with increased infectious rates and mortality in critically ill patients. Enteral nutrition (EN) is usually used to counteract hypercatabolism. However, the impact of different routes of EN on hypercatabolism remains unknown. Here, we compared the impact of gastric feeding (GF) and jejunal feeding (JF) on gastrointestinal hormones and hypercatabolism, which is associated with hypothalamic adenosine 5'-monophosphate-activated protein kinase (AMPK)-autophagy-proopiomelanocortin (POMC). Sixty adult male Sprague-Dawley rats were divided into 5 groups: Sham and lipopolysaccharide (LPS) groups fed a standard chow diet, a pair-fed group that was a subset of saline-treated rats pair-fed with the LPS group, and LPS + JF and LPS + GF groups (received EN via jejunal and gastric tube, respectively, for 3 days [100 kcal/kg/d]). Hypercatabolism was measured by insulin resistance, muscle protein synthesis, and atrophy. Serum gastrointestinal hormones, hypothalamic ghrelin, growth hormone secretagogue receptor-1α (GHS-R1α), and AMPK-autophagy-POMC markers were also detected. GF increased serum total, acylated, desacylated, and hypothalamic ghrelin and decreased glucagon-like peptide-1 (GLP-1). But no effect on pancreatic polypeptide (PYY) and hypothalamic GHS-R1α was observed. JF showed no effect on hypothalamic ghrelin, GHS-R1α, and serum total, acylated, and desacylated ghrelin and even further aggravated GLP-1 and PYY. GF could effectively augment hypothalamic AMPK-autophagy-POMC and hypercatabolism. However, JF showed no effect on hypothalamic AMPK-autophagy-POMC and hypercatabolism. GF could activate hypothalamic AMPK-autophagy and suppress POMC expression via gastrointestinal hormones to ameliorate hypercatabolism compared with JF, which suggested that GF may be the preferred route of EN in endotoxemic rats.

Family-Centered Care Improves Clinical Outcomes of Very-Low-Birth-Weight Infants: A Quasi-Experimental Study.

Background: Survival of very-low-birth-weight infants is improving in neonatology and family-centered-care might contribute to premature infants' clinical outcomes.Aim: To evaluate a family-centered care intervention on clinical outcomes of very-low-birth-weight infants.Methods: A quasi-experimental study was conducted in a Chinese NICU between June 2016 and June 2017. The intervention included parental education of basic care knowledge and skills followed by active participation in care for at least 4 h a day. A total of 319 very-low-birth-weight infants were recruited by convenience sampling; intervention group n = 156 and control group n = 163. Primary outcome measures were weight at discharge, length-of-stay, breastfeeding, nasal feeding, total parental nutrition, re-admission, hospital expenses. Secondary outcome measures were infant complications.Results: Infants' weight at discharge was higher in the interventions group (2,654 g vs. 2,325 g, p < 0.001). Nutritional outcomes improved significantly: breastfeeding rate 139 vs. 91, p < 0.001; days of total parental nutrition 25 d vs. 32 d, p < 0.001; gastric feeding days 23 d vs. 35 d, p < 0.001. Length-of-stay and hospital expenses did not differ between both groups. Improved infants' complications were bronchopulmonary dysplasia (32 vs. 51, p = 0.031), retinopathy of prematurity (between groups no/mild and moderate/severe, p = 0.003), necrotizing enterocolitis (6 vs. 18, p = 0.019), and re-admission rate (21 vs. 38, p = 0.023). No differences were observed in intraventricular hemorrhage and nosocomial infections.Conclusion: Very-low-birth-weight premature infants might experience improved clinical health outcomes when parents are present and caring from them. Family-centered care is as a beneficial care model for premature infants and should be recognized and implemented by NICUs where parents have currently limited access.

Safety and efficacy of intraoperative gastric feeding during burn surgery

BackgroundLarge burns are associated with a dramatic increase in metabolic demand, and adequate nutrition is vital to prevent poor wound healing and septic complications. However, enteral nutrition (EN) support is frequently withheld perioperatively, risking nutritional deficits. We retrospectively examined the safety and feasibility of continuing EN during surgery in patients with an established airway, and estimated the impact of perioperative fasting on overall caloric intake. MethodsMechanically ventilated patients admitted to our urban, verified burn center between January 2012 and July 2017 with greater than 20% total body surface area (TBSA) burns were included in this retrospective analysis. The total volume of EN received by the patient during each 24-h period and goal EN volume as determined by a clinical dietitian were collected. ResultsA total of 45 patients met criteria with mean TBSA of 44% (range 20–84%). Most patients had a gastric feeding tube (86%). Each patient underwent a median of 4 operations (range 1–33) for a total of 249 operative days and 991 non-operative days. There were no aspiration events. On non-operative days, patients met 85% of estimated caloric needs. EN was held on 170 operative days (69%), and on these days, only 34% of total caloric needs were met. EN was continued on 77 operative days (31%), and on these days, 95% of total caloric needs were met (p<0.001). Patients who had EN held for at least 50% of operative procedures (n=30) met only 69% of caloric goals while intubated. By comparison, patients who had EN continued for a majority of procedures (n=15) met 81% of caloric goals (p=0.002). ConclusionsContinuing EN intraoperatively in patients with an established airway appears to be a safe and efficacious way to meet patients’ nutritional needs, including when feeding is delivered via a gastric route. This is particularly important given that placement of nasojejunal feeding tubes can be difficult, particularly in resource-poor settings where endoscopic or fluoroscopic-guided placement may not be practical.

THU-253-Equal efficacy of gastric and jejunal tube feeding in liver cirrhosis and/or alcoholic hepatitis: A randomised controlled trial

THU-253-Equal efficacy of gastric and jejunal tube feeding in liver cirrhosis and/or alcoholic hepatitis: A randomised controlled trial