Prolonged Enteral Nutrition Research Articles

Gastric feed intolerance is not increased in critically ill patients with type II diabetes mellitus

To examine the occurrence of feed intolerance in critically ill patients with previously diagnosed type II diabetes mellitus (DM) who received prolonged gastric feeding. Retrospective study in a level 3 mixed ICU. All mechanically ventilated, enterally fed patients (n = 649), with (n = 118) and without type II DM (n = 531) admitted between January 2003 and July 2005. Patients with at least 72 h of gastric feeding were identified by review of case notes and ICU charts. The proportion that developed feed intolerance was determined. All patient received insulin therapy. The proportion of patients requiring gastric feeding for at least 72 h was similar between patients with and without DM (42%, 50/118, vs. 42%, 222/531). Data from patients with DM were also compared with a group of 50 patients matched for age, sex and APACHE II score, selected from the total non-diabetic group. The occurrence of feed intolerance (DM 52% vs. matched non-DM 50% vs. unselected non-diabetic 58%) and the time taken to develop feed intolerance (DM 62.6 +/- 43.8 h vs. matched non-DM 45.3 +/- 54.6 vs. unselected non-diabetic 50.6 +/- 59.5) were similar amongst the three groups. Feed intolerance was associated with a greater use of morphine/midazolam and vasopressor support, a lower feeding rate and a longer ICU length of stay. In critically ill patients who require prolonged enteral nutrition, a prior history of DM type II does not appear to be a further risk factor for feed intolerance.

Progressive severe anemia due to copper deficiency five years after subarachnoid hemorrhage

Patients with neurological illnesses often require prolonged enteral or parenteral nutrition. The complications of this type of feeding may be unfamiliar to neurosurgeous and neurologists, however, these complications may be an important source of ongoing morbidity. We present a case of severe anemia due to copper deficiency in a patient requiring enteral nutrition after SAH. The anemia resolved with copper supplements. A high index of suspicion is needed to recognise and treat complications of enteral nutrition.

Radiologic Gastrojejunostomy and Percutaneous Endoscopic Gastrostomy: A Prospective, Randomized Comparison

To compare the efficacy of radiologic guided placement of percutaneous gastrojejunostomy (PGJ) and percutaneous endoscopic gastrostomy (PEG). Patients were randomized to PGJ (n = 66) or PEG (n = 69). Indications for gastrostomy were need for prolonged enteral nutrition (97%) or gastrointestinal decompression (3%), with etiologies of neurologic impairment (81%), head and neck neoplasm (12%), bowel obstruction (3%), or other (4%). Mean follow-up was 202 days and 30-day follow-up was obtained for 85% of patients. PEG was successful in 63 of 69 (91%) patients, while PGJ established access in all of 66 attempts (100%) (P = .014). Average procedural time was 53 minutes for PGJ and 24 minutes for PEG (P = .001). At 30-day follow-up, there were 33 and 45 complications in the PGJ and PEG groups, respectively. This difference was due to the greater incidence of pneumonia in the PEG group (P = .013). Long-term tube-related complications occurred with 17 PGJs and four PEGs (P = .007). The PGJ cost more than PEG, but this advantage was offset by the cost of complications. PGJ had higher success rate and fewer complications, due to a lower incidence of pneumonia. PEG took less time to perform, cost less, and required less tube maintenance.

Fluoroscopically placed percutaneous gastrostomies in the head and neck patient.

At our institution, percutaneous gastrostomy tubes have been inserted under fluoroscopic guidance (fluoroscopic cutaneous gastrostomy [FPG]), thereby avoiding the need to traverse the pharynx and esophagus with a large-bore esophagoscope. For this reason, placement in the postoperative patient does not jeopardize the surgical reconstruction. Thirty-five patients underwent percutaneous gastrostomy placement under fluoroscopic guidance. These included 12 patients whose cervical esophagus could not be entered safely because of a lesion in the head neck, 11 patients who had recently undergone resection of a head and neck cancer with pharyngeal reconstruction where traditional percutaneous enteral gastrostomy (PEG) placement was contraindicated, and two patients with postoperative fistulae. Thirty-four of 35 patients underwent successful gastrostomy or gastrojejunostomy placement. One patient had an intrathoracic position of the stomach, and one patient required repeat placement because the tube dislodged 5 days after insertion. No tube occluded. Percutaneous gastrostomy under fluoroscopic guidance (FPG) is an effective, safe method for access for prolonged enteral feeding of the patient whose cervical esophagus cannot be accessed for a variety of reasons. It also allows the safe placement of a gastrostomy catheter when the patient's postoperative course becomes complicated and prolonged enteral nutrition is required.

Feeding Jejunostomy for Post Operative Nutritional Support M. CARMON, D. SEROR, R. UDASSIN, ET AL. Clinical Nutrition 10:298–301, 1991

The authors describe their experience using jejunostomy tubes placed during a primary surgical procedure in 19 adult patients during a 2‐year period. All but one patient underwent a laparotomy (the one exception had a thoracotomy) for gastrointestinal cancer, peptic ulcer disease, or trauma. Large‐bore (16 or 18 French) red rubber catheters were used for feeding jejunostomies. Patients were fed according to a standard protocol that included (1) use of commercially available formulas, (2) infusion pumps, (3) liberal use of antidiarrheal agents, and (4) initiation of feeding on the second postoperative day. Patients were fed by tube for a mean of 22 days and received a mean of 1850 calories with 62 g of protein per day. Feeding tubes remained in place (insertion to removal) for an average of 59 days. Seven of the 19 patients had the tubes removed during hospitalization; for the remaining patients, tubes were removed after discharge. After removal of the tube, the tract closed spontaneously and uneventfully in all patients.No mortality was associated with feeding tube insertion. One patient developed intestinal obstruction believed to be due to angulation of the bowel caused by the jejunostomy tube; the obstruction resolved after removal of the tube. Another patient exhibited paralytic ileus that necessitated discontinuation of the formula; upon resolution of the ileus, administration of the formula resumed. Five patients (26%) developed diarrhea, and two patients had clogged feeding tubes (one had the tube removed and a new tube was inserted under fluoroscopy). Four patients (21%) had inadvertent removal of their tubes, and all tubes were immediately reinserted. Three patients required home enteral support; one experienced a minor skin irritation at the catheter site that resolved by replacement with a larger feeding tube.In conclusion, the authors have successfully employed enteral feeding in the hospital setting with low morbidity. They selected jejunostomy feeding tubes rather than gastrostomy tubes for patients requiring prolonged enteral nutrition support because of the reduced risk of aspiration of gastric contents.

Modified presternal esophagogastroplasty in the treatment of esophageal cancer.

Six male patients with locally advanced esophageal cancer underwent surgical treatment including modified presternal esophagogastroplasty. The main reason for this kind of esophagogastroplasty was anticipated risk of transplant gangrene or anastomotic leak. Esophagoplasty technique provides a possibility for prolonged enteral nutrition and facilitates the further reconstruction in case of partial transplant gangrene. There was no hospital mortality. All patients, despite postoperative complications, began their oral food intake with good tolerance of the regular diet.

Prolonged enteral nutrition in malnourished patients with nonelemental feeding: Reappraisal of surgical technique, safety, and costs

In a 2 year period, 60 consecutive feeding enterostomies were placed in malnourished patients. The major complication rate was 1.6 percent. Total complications were 8 percent. Thirty day mortality was 13 percent. Nearly all patients were given isosmotic nonelemental diets. The incidence of diarrhea was 2 percent with this regimen. Four of five patients given elemental diets had diarrhea. Serum albumin levels increased significantly from a preoperative mean of 2.75 to 3.03 g/dl. Best overall results were achieved in patients undergoing upper gastrointestinal surgery or pancreatobilary procedures for nonmalignant lesions. More than $60,000 was saved in 2 years by substituting isosmotic formulas for elemental ones. It appears that many patients are given elemental formulas who do not actually require them. Since isosmotic solutions will not infuse through needle catheters, we advocate placing 12 F. catheters and have documented the safety of this change. By using these larger catheters, the surgeon will not lose the option of using isosmotic preparations. We have shown these preparations to be nutritionally effective with a marked lessening of diarrhea and a cost approximately a sixth of that of elemental products.

Vitamin and mineral status during prolonged enteral nutrition : [formula omitted]. Surg.Nutr.Adv.Group, Dept.of Biochem. & Surgery, Royal Infirmary, Glasgow, UK

Vitamin and mineral status during prolonged enteral nutrition : [formula omitted]. Surg.Nutr.Adv.Group, Dept.of Biochem. & Surgery, Royal Infirmary, Glasgow, UK