Nutritional Support In Surgical Patients Research Articles

Is the restoration of bowel sounds a prerequisite for initiating enteral feeding following pediatric laparotomy? A randomized control trial

IntroductionEnteral nutrition is the mainstay of nutritional support in surgical patients. Ileus is the temporary inhibition of peristalsis. Primary post-operative ileus (PPI) occurs postoperatively; thence patients are traditionally kept on nil per oris (NPO) until PPI resolves, due to safety concerns. This study aims to determine the necessity or otherwise of this practice in paediatric surgical patients. Materials and methodsA prospective, randomized control trial, in patients younger than 15 years. The early feeding group (EFG) commenced enteral feeding on the first post-operative day while controls commenced feeding after resolution of PPI. Data was analyzed using SPSS version 20.0, P ≤ 0.05 was regarded as significant. The primary outcome was tolerability of enteral feeds while secondary outcomes were complication rates, time to full enteral diet, and duration of hospital stay. ResultsThere were 56 patients, 28 in each study group. Tolerability of oral feeds at initial commencement was similar in both groups (24 (85.7%) EFG versus 27 (96.4%) controls P = 0.16). Full enteral feeding was achieved faster in EFG than in controls (71.1 ± 28.7 hours versus 92.5 ± 31.4 hours, p=0.011). Post-operative hospital stay was shorter in EFG than controls (7.46 ± 3.8 days versus11.1 ± 5.2 days, p=0.009). ConclusionsEarly enteral feeding was well tolerated, brought about a faster return to a full enteral diet, and shorter post-operative hospital stay, it also did not cause a higher complication rate. Therefore, delaying feeding until the resolution of PPI after laparotomy appears unnecessary.

Perioperative nutritional support for surgical patients

The article presents an algorithm for perioperative nutritional support of surgical patients operated on as planned. Today, planned surgical care is provided in accordance with the canons of the accelerated rehabilitation Program (ARP). The relevance of the problem of nutritional insufficiency, which is an important component of ARP, is due to the dependence of the results of surgical treatment on the initial nutritional status of the patient. Methods of screening for nutritional deficiency and options for correcting protein-energy disorders are described. The predominant method is the enteral delivery of nutrients and energy. Oral supplemental nutrition by sipping is a convenient way to correct nutritional disorders at all stages of the perioperative period.

Nutrition in surgical patients: how soon is too soon?

Preoperative nutrition support has been extensively studied; however, data on the timing of postoperative nutrition initiation are scarce. The current review focuses on the importance of early nutritional support in surgical patients and their impact on outcomes. Early nutrition support during the postoperative course may be the most important step that can be taken toward preventing subsequent malnutrition-related complications. European Society for Parenteral and Enteral Nutrition guidelines recommends early nutrition to improve outcomes after surgery and accelerates the recovery. Moreover, nutritional support should be personalized, and disease process-based. Existing studies appear to focus mostly on abdominal and gastrointestinal surgery. Further prospective observational and randomized clinical trials across different surgical populations will aid surgeons to better understand how early feeds in either form can reduce morbidity, quality of life, and increase recovery rates.

Peri-operative nutritional management

The metabolic response to surgical trauma is mainly characterised by an increase in BMR, a negative N balance, increased gluconeogenesis and increased synthesis of acute-phase proteins. These reactions aim at ensuring the availability of endogenous substrates for healing wounds while the synthesis of acute-phase proteins enhances the scavenging process and helps repair. However, if this process is excessive or continues for too long, it leads to a progressive depletion of body compartment with a consequent adverse outcome. Obviously, the severity of such depletion is magnified if the patient is starving or is already malnourished and the consumption of lean body mass is not compensated by an exogenous supply of nutrients. The nutritional control of this metabolic reaction represents the traditional rationale for nutritional support of surgical patients. Subsequent data have shown that the negative effects of starvation are not simply due to the starvation per se but due to the starving gut, and peri-operative enteral nutrition has proven successful in blunting the metabolic response after injury and improving protein kinetics, net balance and amino acid flux across peripheral tissue and consequently in decreasing the complications. Finally, further clinical research has shown that many post-operative infections may result from immune suppression and that such state might be reversed to some degree by modulation of the immune response through specialised nutritional support in surgical patients, regardless of their nutritional status. This paper will focus on the updated evidence-based research on peri-operative nutrition (parenteral, enteral and immune-enhancing) in patients undergoing major surgery.

Nutrición enteral frente a nutrición parenteral en el período preoperatorio

The association between malnutrition and poor postoperative outcome suggests that preoperative nutritional support in surgical patients with malnutrition should have a beneficial effect on outcome. In addition, nutritional support through enteral nutrition (EN) has numerous advantages over parenteral nutrition (PN). We performed a systematic review of the literature (MEDLINE, Cochrane Database) published from 1980-2004, to compare the effect of preoperative PN versus preoperative EN on patient outcomes in terms of complications, mortality and length of hospital stay. No meta-analyses comparing the efficacy of EN versus PN in the preoperative period were found. Only two randomized controlled clinical trials that met the inclusion criteria were found. Both studies had methodological flaws and a small number of patients. Neither of these two studies demonstrated the superiority of one preoperative nutritional modality over the other. We performed a critical analysis of both studies. Differences in the method of nutritional evaluation used, the energy requirements covered with artificial nutrition, the nutritional formulas used, postoperative maintenance of total PN and the diagnoses of the patients included were found. New studies evaluating the efficacy of two comparable nutritional strategies through the enteral and parenteral routes are required.

Role of specific amino acids in nutritional support.

Attempts have been made over the past decade to evaluate the role of specific amino acids in the nutritional support of surgical patients. Particular attention has been paid to the branched-chain amino acids, glutamine, and a collection of compounds that have been referred to as 'immunonutrients'. The present review provides an overview of the rationale behind the use of these nutrients and reviews information about their role in patients undergoing surgery. In general, although the use of immunonutrients enhances the nutritional status of patients, and although a number of clinical trials have claimed clinical advantages, there are still doubts about their clinical utility and concerns about their high cost.

Nutrition

This chapter reviews the prevalence of hospital undernutrition with particular reference to surgical patients, discusses how nutrition can be assessed and used to predict surgical outcome, considers the physiological penalties of undernutrition and critically presents the evidence on which rational use of nutritional support in surgical patients can be based, with emphasis on randomized controlled trials.

Controlled study of early postoperative parenteral nutrition in children

Background/Purpose: Nutritional support of surgical patients has improved in recent years because of the possibility of modulating catabolism and anabolism, thus enhancing the immune response and repair processes. The objective of this study was to evaluate metabolic effects of early parenteral nutrition (PN) after major surgery. Methods: The authors studied 63 children aged 4 to 14 years with diffuse peritonitis caused by perforated-suppurative appendicitis. They were assigned randomly to a study group (SG, n = 31), which received PN for 5 days, starting 24 to 48 hours after surgery or to a control group (CG, n = 32), that received standard treatment (fluids). Weight, C-reactive protein (CRP), albumin, prealbumin, glycemia, nitrogen balance (NB), and insulinlike growth factor (IGF-I), were evaluated on postoperative days 1, 4, and 6. Results: Early nutritional support was associated with a significant improvement in NB and IGF-I (Repeat measures analysis of variance IGF-I, P < .001 and NB P < .01). Conclusions: The authors conclude that early parenteral nutrition has a positive effect on the anabolic response as shown by improved NB and higher IGF-I levels in pediatric patients after major surgery.

Parenteral solutions for nutritional support in surgical patients: A comparison of nitrogen gains employing 5 per cent and 10 per cent amino acid solutions

A 10 per cent amino acid solution accompanied by 10 per cent Intralipid and 50 per cent glucose could be infused by peripheral veins. This safe and practical method induced positive nitrogen balance of 7 to 8 gm daily in five of six septic patients.