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Sun C, Yuan K, Gao Q, Liu F, Long Y, Wang L. Blind versus endoscopy-guided postpyloric feeding tube placement in adults with ischemic stroke: A retrospective cohort study. JPEN J Parenter Enteral Nutr 2024; 48:597-604. [PMID: 38806291 DOI: 10.1002/jpen.2645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 05/06/2024] [Accepted: 05/06/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND This study compared the one-time success rate of blind and endoscopy-guided postpyloric feeding tube placement after implementing a comprehensive nursing scheme of intestinal blind placement for patients with ischemic stroke. METHODS This retrospective cohort study included 179 patients with blind bedside placement and 118 with endoscopy-guided placement. The primary outcome was the one-time success rate of radiologically confirmed postpyloric placement. The secondary endpoints included the position of the tube tip, length of insertion, time of placement, and expenses. The safety endpoints were the incidence of complications caused by placement. RESULTS The results showed that the method of tube placement did not significantly affect the outcome of the first tube placement (odds ratio [OR] = 0.41; 95% CI = 0.137-1.207; P = 0.105). Compared with endoscopy-guided placement, blind placement was half the cost. We also found that a history of abdominal surgery (OR = 0.003; 95% CI = 0.000-0.059; P < 0.001) and longer intensive care unit (ICU) days (OR = 0.94; 95% CI = 0.903-0.981; P = 0.004) were inversely associated with the one-time success rate. CONCLUSION Our study suggested that blind intestinal feeding tube placement has an equivalent one-time success rate compared with endoscopy-guided placement in hospitalized patients with ischemic stroke if operators can be trained well. However, the expenses of endoscopy-guided placement were twice those of blind bedside methods. We also found that patients with abdominal surgery history and longer ICU stay were more likely to fail at the first placement. Further research is needed to replicate our single-center observations in a larger population of patients.
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Affiliation(s)
- Chun Sun
- Neurology Intensive Care Unit, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, China
- Neurology Intensive Care Unit, Wuhan No 1 Hospital, Wuhan, China
| | - Kangyi Yuan
- The College of Post and Telecommunication, Wuhan Institute of Technology, Wuhan, China
| | - Qiyuan Gao
- Manchester Metropolitan Joint Institute, Hubei University, Wuhan, China
| | - Fang Liu
- Neurology Intensive Care Unit, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, China
- Neurology Intensive Care Unit, Wuhan No 1 Hospital, Wuhan, China
| | - Yuanxi Long
- Neurology Intensive Care Unit, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, China
- Neurology Intensive Care Unit, Wuhan No 1 Hospital, Wuhan, China
| | - Li Wang
- Nursing Department, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, China
- Nursing Department, Wuhan No 1 Hospital, Wuhan, China
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Cikwanine JPB, Yoyu JT, Alumeti DM, Mugisho B, Kivukuto JM, Iteke RF, Longombe Ahuka O, Kalau Arung W. Benefits of Early Enteral Feeding with a Locally Prepared Protein-Energy Ration after Surgery for Acute Generalised Peritonitis: A Randomised Trial in Two Hospitals in Bukavu, Eastern Democratic Republic of Congo. Gastroenterol Res Pract 2023; 2023:1764242. [PMID: 38024526 PMCID: PMC10673662 DOI: 10.1155/2023/1764242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/15/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Background Acute generalised peritonitis (AGP) is a common and serious digestive surgery pathology. Undernutrition exacerbates patient condition and compromises their postoperative prognosis. Early enteral nutrition is recommended to reduce postoperative complications, but its availability and cost are problematic in low-income countries. The objective of this study was to evaluate the impact of providing early enteral feeding (EEF) to postoperative patients with intestinal perforation AGP using a locally prepared protein-energy food ration in two hospitals in Bukavu, a city of South Kivu, in the eastern part of the Democratic Republic of Congo. Methods A prospective, randomised controlled trial with two groups of patients was conducted to investigate the effects of EEF with a local mixture versus enteral feeding after peristalsis had returned (control group) in patients who underwent laparotomy for AGP caused by ileal perforation. The local mixture consisted of soybean, maize, white rice, and pineapple. The trial included 66 patients with ileal perforation peritonitis. Results The results comparing early enteral fed and nonfed patients showed significant differences in peristalsis recovery time (2.1 (0.6) days vs. 3.8 (1.2) days, p < 0.0001) and length of hospital stay (25.5 (14.9) days vs. 39.4 (25.3) days, p = 0.0046). Bivariate analyses indicated a significant early enteral feeding (EEF) reduced of 9.1% (vs. 36.4%, p = 0.0082) in parietal infections and 3.4% (28.1%, p = 0.009) in fistulas (p = 0.009) when EEF was included. In addition, EEF significantly reduced reintervention rates by 9.1% (p = 0.0003) and eliminated evisceration rates. EEF was also shown to reduce the incidence of malnutrition by 63.6% (p < 0.0001). Multivariate analysis showed that enteral nutrition significantly reduced the time to recovery of peristalsis (p = 0.0278) with an ORa of 0.3 and a 95% CI of 0.1-0.9. Moreover, EEF reduced malnutrition (p = 0.0039) with an ORa of 0.1 and a 95% CI of 0-0.4. Conclusion EEF with locally sourced protein-energy rations can enhance a patient's nutritional status and facilitate postoperative recovery. This procedure is advantageous and involved early enteral nutrition using locally manufactured rations, especially for those operated on for acute generalised peritonitis in the Democratic Republic of Congo.
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Affiliation(s)
- Jean Paul Buhendwa Cikwanine
- Faculty of Medicine, Evangelical University in Africa, Bukavu, Democratic Republic of the Congo
- Panzi Hospital, Bukavu, Democratic Republic of the Congo
| | - Jonathan Tunangoya Yoyu
- International Centre for Advanced Research and Training, Bukavu, Democratic Republic of the Congo
- Progressive Medical Systems/Department of Works and Medical Research, Goma, Democratic Republic of the Congo
| | - Désiré Munyali Alumeti
- Faculty of Medicine, Evangelical University in Africa, Bukavu, Democratic Republic of the Congo
- Panzi Hospital, Bukavu, Democratic Republic of the Congo
| | - Bernard Mugisho
- Rau Ciriri Hospital, Bukavu, Democratic Republic of the Congo
| | | | - Rivain Fefe Iteke
- University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Ona Longombe Ahuka
- Faculty of Medicine, Evangelical University in Africa, Bukavu, Democratic Republic of the Congo
- Department of Surgery, University of Kisangani, Democratic Republic of the Congo
| | - Willy Kalau Arung
- University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
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Salvage nasoduodenal feeding for severely burned patients after the failure of nasogastric feeding: A medical center experience in a mass casualty burn disaster. ADVANCES IN DIGESTIVE MEDICINE 2018. [DOI: 10.1002/aid2.13094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Koc D, Gercek A, Gencosmanoglu R, Tozun N. Percutaneous Endoscopic Gastrostomy in the Neurosurgical Intensive Care Unit: Complications and Outcome. JPEN J Parenter Enteral Nutr 2017; 31:517-20. [PMID: 17947610 DOI: 10.1177/0148607107031006517] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Demet Koc
- From the Anesthesiology Unit, Marmara University
Institute of Gastroenterology, Istanbul, Turkey;
Anesthesiology Unit, Marmara University
Institute of Neurological Science, Istanbul, Turkey;
Department of General Surgery and
Sub-department of Gastroenterology, Marmara
University School of Medicine, Istanbul, Turkey; and the
Unit of Gastrointestinal Surgery and
Unit of Clinical Gastroenterology, Marmara
University Institute of Gastroenterology, Istanbul, Turkey
| | - Arzu Gercek
- From the Anesthesiology Unit, Marmara University
Institute of Gastroenterology, Istanbul, Turkey;
Anesthesiology Unit, Marmara University
Institute of Neurological Science, Istanbul, Turkey;
Department of General Surgery and
Sub-department of Gastroenterology, Marmara
University School of Medicine, Istanbul, Turkey; and the
Unit of Gastrointestinal Surgery and
Unit of Clinical Gastroenterology, Marmara
University Institute of Gastroenterology, Istanbul, Turkey
| | - Rasim Gencosmanoglu
- From the Anesthesiology Unit, Marmara University
Institute of Gastroenterology, Istanbul, Turkey;
Anesthesiology Unit, Marmara University
Institute of Neurological Science, Istanbul, Turkey;
Department of General Surgery and
Sub-department of Gastroenterology, Marmara
University School of Medicine, Istanbul, Turkey; and the
Unit of Gastrointestinal Surgery and
Unit of Clinical Gastroenterology, Marmara
University Institute of Gastroenterology, Istanbul, Turkey
| | - Nurdan Tozun
- From the Anesthesiology Unit, Marmara University
Institute of Gastroenterology, Istanbul, Turkey;
Anesthesiology Unit, Marmara University
Institute of Neurological Science, Istanbul, Turkey;
Department of General Surgery and
Sub-department of Gastroenterology, Marmara
University School of Medicine, Istanbul, Turkey; and the
Unit of Gastrointestinal Surgery and
Unit of Clinical Gastroenterology, Marmara
University Institute of Gastroenterology, Istanbul, Turkey
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Jimenez LL, Ramage JE. Benefits of Postpyloric Enteral Access Placement by a Nutrition Support Dietitian. Nutr Clin Pract 2017; 19:518-22. [PMID: 16215148 DOI: 10.1177/0115426504019005518] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Although enteral nutrition is considered the preferred strategy for nutrition support, it is often precluded by nasogastric feeding intolerance or the inability to place feeding access into the postpyloric position. In an effort to improve enteral nutrition (EN) outcomes at our institution, the nutrition support dietitian (NSD) began placing postpyloric feeding tubes (PPFT) in intensive care unit patients. METHODS Intensive care unit patients who received blind, bedside PPFT placements by the NSD (n = 18) were compared with a concurrent age- and diagnosis-matched control group that received standard nutritional care without NSD intervention (n = 18). Interruption of EN infusion, appropriateness of parenteral nutrition (PN) prescription (based on American Society of Parenteral and Enteral Nutrition guidelines), and incidence of ventilator-associated pneumonia (VAP), as defined by the American College of Chest Physicians practice guidelines, were determined in each group. RESULTS The NSD was successful in positioning the PPFT at or distal to the third portion of the duodenum in 83% of attempts. The PPFT group demonstrated no interruption of enteral feeding compared with 56% in the control group (p < .01) and required 1 (6%) PN initiation in contrast to 8 (44%) in the control group (p < .01). There was a trend toward reduced VAP in the PPFT group (6% vs 28%, p = .07). Of the PN initiations in the control group, 88% were deemed to be potentially avoidable; 6 of 8 PNs were initiated because of gastric residuals. CONCLUSIONS Enteral nutrition facilitated by NSD placement of postpyloric feeding access is associated with improved tube feeding tolerance and reduced PN use. Further studies are needed to evaluate a possible effect of postpyloric feeding on the incidence of VAP.
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Affiliation(s)
- L Lee Jimenez
- Department of Nutrition, Memorial Health University Medical Center, Savannah, Georgia, USA.
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Makkar JK, Gauli B, Jain K, Jain D, Batra YK. Comparison of erythromycin versus metoclopramide for gastric feeding intolerance in patients with traumatic brain injury: A randomized double-blind study. Saudi J Anaesth 2016; 10:308-13. [PMID: 27375386 PMCID: PMC4916815 DOI: 10.4103/1658-354x.174902] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: No randomized controlled trial demonstrates the efficacy of erythromycin or metoclopramide in patients with traumatic brain injury (TBI). This study was conducted to determine the efficacy of metoclopramide and erythromycin for improving gastric aspirate volume (GAV) in patients with TBI. Materials and Methods: Patients with Glasgow coma score more than 5 admitted to trauma Intensive Care Unit within 72 h of head injury were assessed for eligibility. 115 patients were prospectively randomized to receive metoclopramide, erythromycin, or placebo eighth hourly. Gastric feeding intolerance was defined as GAV more than 150 ml with abdominal symptoms. Two consecutive high GAV was defined as feeding failure. Feeding failure was treated by increasing the frequency of dose to 6 hourly in metoclopramide and erythromycin group. Combination therapy with both drugs was given as rescue in the placebo group. Results: Incidence of high GAV was as high as 60.5% in placebo group. Use of erythromycin was associated with a decrease in the incidence of feeding intolerance to 28.9% (P = 0.006). Although feed intolerance decreased to 43.6% in metoclopramide group, values did not reach statistical significance. The proportion of patients not having high GAV at different days were significantly higher in erythromycin group (P = 0.027, log-rank test). There was no difference in the proportion of patients not having feeding failure in three groups with increasing number of days. Conclusion: There was a significant decrease in the incidence of high GAV with the use of erythromycin when compared to metoclopramide and placebo.
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Affiliation(s)
- Jeetinder Kaur Makkar
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Basanta Gauli
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kajal Jain
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Divya Jain
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Yatinder Kumar Batra
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Toh Yoon EW, Yoneda K, Nakamura S, Nishihara K. Percutaneous endoscopic transgastric jejunostomy (PEG-J): a retrospective analysis on its utility in maintaining enteral nutrition after unsuccessful gastric feeding. BMJ Open Gastroenterol 2016; 3:e000098. [PMID: 27486522 PMCID: PMC4947708 DOI: 10.1136/bmjgast-2016-000098] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 05/19/2016] [Accepted: 05/24/2016] [Indexed: 12/27/2022] Open
Abstract
Background/aims Although percutaneous endoscopic gastrostomy (PEG) is the method of choice for long-term enteral nutrition, feeding-related adverse events such as aspiration pneumonia and peristomal leakage can impede the use of PEG. Percutaneous endoscopic transgastric jejunostomy (PEG-J) using large-bore jejunal tubes may help by circumventing gastric passage during enteral nutrition and improving drainage of gastric secretions. Methods 20 patients (12 males and 8 females) who received PEG-J after unsuccessful PEG feeding during a 6-year period in our institution were analysed retrospectively to evaluate the efficacy of large-bore jejunal feeding tubes in maintaining enteral nutrition. Results The median age was 83.5 (71–96) years. The median period between PEG and PEG-J was 33 (14–280) days. Indications were aspiration due to gastro-oesophageal reflux in 18 patients and severe peristomal leakage in 2 patients. Tube placements were successful in all patients. There were 6 (30%) in-hospital mortalities, with 3 (15%) occurring within 30 days after procedure. Conclusions PEG-J can be performed safely in patients with PEG and may facilitate the maintenance of enteral nutrition in most of the patients. Patients with unsuccessful PEG feeding can be offered the option of jejunal feeding before considering termination of enteral nutrition.
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Affiliation(s)
| | - Kaori Yoneda
- Endoscopy Center, Hiroshima Kyoritsu Hospital , Hiroshima , Japan
| | - Shinya Nakamura
- Department of Internal Medicine , Hiroshima Kyoritsu Hospital , Hiroshima , Japan
| | - Kazuki Nishihara
- Department of Internal Medicine , Hiroshima Kyoritsu Hospital , Hiroshima , Japan
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8
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Nzamushe JR, Sozanski JP, De Jonckheere J, Jeanne M, Logier R. Performance evaluation of the extra corporeal enteral prosthesis (ECEP) vs a By-Pass. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:4793-6. [PMID: 26737366 DOI: 10.1109/embc.2015.7319466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Intestinal stoma constitutes a symptomatic treatment in a wide range of digestive diseases, such as rectal cancer, digestive traumatic perforation and inflammatory intestinal diseases. It affects a patient's life causing physiologic and social constraints. The stoma can lead to involution of the downstream digestive tissue, impairing his function in case of restored continuity. Some technical solutions have been developed in order to maintain intestinal continuity, reduce inflammatory risk and to increase patient's quality of life. In this paper, we describe a smart intestinal prosthesis equipped with a pump working as an intestinal segment and creating a bypass between the upstream and downstream intestinal sides. We also evaluate the performance the digestive prosthesis ECEP vs a simple digestive By-Pass.
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Saran D, Brody RA, Stankorb SM, Parrott SJ, Heyland DK. Gastric vs Small Bowel Feeding in Critically Ill Neurologically Injured Patients: Results of a Multicenter Observational Study. JPEN J Parenter Enteral Nutr 2014; 39:910-6. [PMID: 24947058 DOI: 10.1177/0148607114540003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 05/20/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND To evaluate gastric compared with small bowel feeding on nutrition and clinical outcomes in critically ill, neurologically injured patients. MATERIALS AND METHODS International, prospective observational studies involving 353 intensive care units (ICUs) were included. Eligible patients were critically ill, mechanically ventilated with neurological diagnoses who remained in the ICU and received enteral nutrition (EN) exclusively for at least 3 days. Sites provided data, including patient characteristics, nutrition practices, and 60-day outcomes. Patients receiving gastric or small bowel feeding were compared. Covariates including age, sex, body mass index, and Acute Physiology and Chronic Health Evaluation II score were used in the adjusted analyses. RESULTS Of the 1691 patients who met our inclusion criteria, 1407 (94.1%) received gastric feeding and 88 (5.9%) received small bowel feeding. Adequacy of calories from EN was highest in the gastric group (60.2% and 52.3%, respectively, unadjusted analysis; P = .001), but this was not significant in the adjusted model (P = .428). The likelihood of EN interruptions due to gastrointestinal (GI) complications was higher for the gastric group (19.6% vs 4.7%, unadjusted model; P = .015). There were no significant differences in the rate of discontinuation of mechanical ventilation (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.66-1.12; P = .270) or the rate of being discharged alive from the ICU (HR, 0.94; 95% CI, 0.72-1.23; P = .641) and hospital (HR, 1.16; 95% CI, 0.87-1.55; P = .307) after adjusting for confounders. CONCLUSIONS Despite a higher likelihood of EN interruptions due to GI complications, gastric feeding may be associated with better nutrition adequacy, but neither route is associated with better clinical outcomes.
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Affiliation(s)
- Delara Saran
- Department of Nutritional Sciences, School of Health Related Professions, Rutgers, The State University of New Jersey, Newark, New Jersey Food & Nutrition Services, Fraser Health Authority, British Columbia, Canada
| | - Rebecca A Brody
- Department of Nutritional Sciences, School of Health Related Professions, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Susan M Stankorb
- Department of Nutritional Sciences, School of Health Related Professions, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Scott J Parrott
- Department of Nutritional Sciences, School of Health Related Professions, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Daren K Heyland
- Clinical Evaluation Research Unit, Kingston General Hospital, Ontario, Canada Department of Medicine, Queen's University, Kingston, Ontario, Canada
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SHIGEMORI M, ABE T, ARUGA T, OGAWA T, OKUDERA H, ONO J, ONUMA T, KATAYAMA Y, KAWAI N, KAWAMATA T, KOHMURA E, SAKAKI T, SAKAMOTO T, SASAKI T, SATO A, SHIOGAI T, SHIMA K, SUGIURA K, TAKASATO Y, TOKUTOMI T, TOMITA H, TOYODA I, NAGAO S, NAKAMURA H, PARK YS, MATSUMAE M, MIKI T, MIYAKE Y, MURAI H, MURAKAMI S, YAMAURA A, YAMAKI T, YAMADA K, YOSHIMINE T. Guidelines for the Management of Severe Head Injury, 2nd Edition Guidelines from the Guidelines Committee on the Management of Severe Head Injury, the Japan Society of Neurotraumatology. Neurol Med Chir (Tokyo) 2012; 52:1-30. [PMID: 22278024 DOI: 10.2176/nmc.52.1] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Despott EJ, Gabe S, Tripoli E, Konieczko K, Fraser C. Enteral access by double-balloon enteroscopy: an alternative method of direct percutaneous endoscopic jejunostomy placement. Dig Dis Sci 2011; 56:494-8. [PMID: 20585980 DOI: 10.1007/s10620-010-1306-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Accepted: 06/14/2010] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although direct percutaneous endoscopic jejunal feeding tube placement is an increasingly accepted method of providing small-bowel access for long-term enteral nutrition, it is reliant on push enteroscopy and remains a technically challenging procedure with significant failure rates. Double-balloon enteroscopy, with its ability to provide controlled small-bowel intubation may facilitate direct percutaneous endoscopic jejunal tube placement. AIMS AND METHODS We report a prospective series of ten consecutive cases of double-balloon enteroscopy-assisted direct percutaneous endoscopic jejunal placement, accompanied by a step-by-step illustrated overview of the technique. RESULTS Direct percutaneous endoscopic jejunal tube placement by double-balloon enteroscopy was successful in nine of the ten attempted cases. In the first case, direct percutaneous endoscopic jejunal placement was abandoned due to inadequate transillumination; there were no procedure-related complications in any of our patients. CONCLUSIONS This first reported prospective case series of double-balloon enteroscopy-assisted direct percutaneous endoscopic jejunal placement shows a promisingly high success rate; larger comparative studies are required to clearly establish any advantages over the originally described push enteroscopy method.
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Affiliation(s)
- E J Despott
- St. Mark's Hospital and Academic Institute, Imperial College, London, UK
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12
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Abstract
MOTIVATION The American Society of Parenteral and Enteral Nutrition (ASPEN) guidelines advise use of enteral nutrition (EN) for critically ill hospital patients requiring nutritional support, but no studies have comprehensively estimated economic benefits from adherence to this recommendation. METHODS We systematically reviewed studies comparing EN to alternative nutritional support therapies among adult, critically ill patients. We reviewed 1200 abstracts, selected 243 for further review, and included 48 studies in our analysis. Most retained studies compared EN and parenteral nutrition (PN). Using meta-analysis, we estimated the absolute impact of EN on adverse event risk and its impact on treatment duration and length of stay. These estimates were converted to population economic impacts by assuming 10% of PN patients are suitable candidates for EN. RESULTS Compared to PN, EN reduces the risk of major, potentially life-threatening infections (RR = 0.58, 95% confidence interval [CI] 0.44 to 0.77), the risk of major, potentially life-threatening non-infection events (RR = 0.73, CI 0.59 to 0.91), and suggests a reduction in mortality, although this result did not achieve statistical significance (RR = 0.70, CI 0.45 to 1.09). EN also reduces inpatient length of stay, time in the ICU, and length of nutritional treatment. Compared to PN, EN savings from reduced adverse event risks average nearly $1500 per patient; savings from reduced hospital length of stay amount to nearly $2500 per patient. Shifting 10% of parenterally treated adult patients in the U.S. to EN would save $35 million annually due to reduced adverse events and another $57 million due to shorter hospital stays. CONCLUSION The evidence of both clinical and economic gains from EN is consistent with ASPEN guidelines recommending use of EN in critically ill hospital patients when possible.
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Affiliation(s)
- Michael J Cangelosi
- Center for Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA 02111, USA
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[Postpyloric feeding tubes for surgical intensive care patients. Pilot series to evaluate two methods for bedside placement]. Anaesthesist 2010; 60:214-20. [PMID: 21057767 DOI: 10.1007/s00101-010-1814-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2010] [Revised: 09/26/2010] [Accepted: 10/07/2010] [Indexed: 01/15/2023]
Abstract
Bedside placement of postpyloric feeding tubes in surgical intensive care patients: a pilot series to evaluate two methods. Early enteral feeding is thought to be a key factor in maintaining the integrity of the gastrointestinal tract mucosal barrier associated with less bacterial translocation and decreased stimulation of the systemic inflammatory response and subsequent improved outcome in intensive care patients. Thus enteral feeding by nasogastric tubes is the preferred route of nutritional support for most surgical intensive care patients. However, intensive care patients with delayed gastric emptying and poor intestinal motility may not tolerate gastric feeding and may therefore benefit from postpyloric feeding. Postpyloric feeding tube placement may be achieved by endoscopic procedures or different bedside techniques with variable success. In the present study two feeding tubes for bedside postpyloric placement without endoscopic assistance were compared. The time to successful positioning was compared for jejunal feeding tubes from the companies Cook (Tiger 2™) and PortaMedical (Corflo-Tube®). The description for the Tiger 2™ states that because of its design slight residual peristalsis can cause it to migrate from the stomach to the jejunum. The Corflo-Tube® is also positioned at the bedside with the help of a detector and a monitor which maps the movements of the magnetic tip of the mandrin as it is pushed forward. Patients receiving early enteral nutrition through a gastric tube and exhibiting enhanced reflux, in spite of the head of the bed being raised and the administration of prokinetics randomly received either a Tiger 2™ or a Corflo-Tube®. The study included 41 patients from an intensive care ward for surgical patients and 13 out of 20 Tiger 2™-Tubes (65%) and 16 out of 21 Corflo-Tubes® (76%) were successfully positioned (p>0.05). The median time to successful positioning with the Corflo-Tubes® was 0.83 h (range 0.06-2.5 h), which was significantly shorter than the 24 h (range 2-72 h) found with the Tiger 2™ (p<0.001). There was no significant difference between the groups with respect to the period between the insertion of the tubes and the attainment of complete enteral nutrition, corresponding to the calculated individual calorie requirements. These tubes offer a good alternative to more demanding procedures as they are easy to handle and rapidly available. They confer clinical and cost advantages in terms of the early establishment of enteral feeding, no routine X-ray confirmation in the case of the Corflo-Tube® and avoidance of endoscopic guidance for tube placement or parenteral nutrition. In addition they are always justified in the event of a lack of endoscopic positioning.
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Kwon RS, Banerjee S, Desilets D, Diehl DL, Farraye FA, Kaul V, Mamula P, Pedrosa MC, Rodriguez SA, Varadarajulu S, Song LMWK, Tierney WM. Enteral nutrition access devices. Gastrointest Endosc 2010; 72:236-48. [PMID: 20541746 DOI: 10.1016/j.gie.2010.02.008] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 02/03/2010] [Indexed: 12/12/2022]
Abstract
The ASGE Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Evidence-based methodology is used, performing a MEDLINE literature search to identify pertinent clinical studies on the topic and a MAUDE (U.S. Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported complications of a given technology. Both are supplemented by accessing the "related articles" feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but, in many cases, data from randomized, controlled trials are lacking. In such situations, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. Technology Status Evaluation Reports are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the committee as a whole, and approved by the ASGE Governing Board. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. For this review, the MEDLINE database was searched through August 2009 for articles related to endoscopy in patients requiring enteral feeding access by using the keywords "endoscopy," "percutaneous," "gastrostomy," "jejunostomy," "nasogastric," "nasoenteric," "nasojejunal," "transnasal," "feeding tube," "enteric," and "button." Technology Status Evaluation Reports are scientific reviews provided solely for educational and informational purposes. Technology Status Evaluation Reports are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment.
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Dickerson RN, Mitchell JN, Morgan LM, Maish GO, Croce MA, Minard G, Brown RO. Disparate response to metoclopramide therapy for gastric feeding intolerance in trauma patients with and without traumatic brain injury. JPEN J Parenter Enteral Nutr 2010; 33:646-55. [PMID: 19892902 DOI: 10.1177/0148607109335307] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Patients with traumatic brain injury (TBI) have delayed gastric emptying and often require prokinetic drug therapy to improve enteral feeding tolerance. The authors hypothesized that metoclopramide was less efficacious for improving gastric feeding tolerance for trauma patients with TBI compared to trauma patients without TBI. A retrospective analysis was conducted of patients admitted to the trauma or neurosurgical intensive care unit who received gastric feeding from January 2006 to April 2008. Gastric feeding intolerance was defined by a gastric residual volume >200 mL or emesis with abdominal distension or discomfort. Patients with gastric feeding intolerance were given metoclopramide 10 mg intravenously every 6 hours, followed by a dose escalation to 20 mg, and then combination therapy with metoclopramide and erythromycin 250 mg intravenously every 6 hours if intolerance persisted. In total, 882 trauma patients (49% with TBI) were evaluated. TBI patients had a higher incidence of gastric feeding intolerance than those without TBI (18.6% vs 10.4%, P < or = .001). Efficacy rates for metoclopramide 10 mg, metoclopramide 20 mg, and metoclopramide-erythromycin were 55%, 62%, and 79%, respectively (P < or = .03). Metoclopramide failure occurred in 54% of patients with TBI compared to 35% of patients without TBI, respectively (P < or = .02), due to a greater prevalence of tachyphylaxis. Single-drug therapy with metoclopramide was less effective for TBI trauma patients compared to trauma patients without TBI. Combination therapy with erythromycin as first-line therapy for TBI trauma patients with gastric feeding intolerance is indicated if there are no contraindications or significant drug interactions.
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Affiliation(s)
- Roland N Dickerson
- Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA.
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Plurad D, Green D, Inaba K, Belzberg H, Demetriades D, Rhee P. A 6-year review of total parenteral nutrition use and association with late-onset acute respiratory distress syndrome among ventilated trauma victims. Injury 2009; 40:511-5. [PMID: 19117556 DOI: 10.1016/j.injury.2008.07.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Revised: 06/02/2008] [Accepted: 07/10/2008] [Indexed: 02/02/2023]
Abstract
AIM To establish whether total parenteral nutrition (TPN) for ventilated trauma victims is associated with late-onset acute respiratory distress syndrome (ARDS) independent of ventilation and transfusion parameters. METHOD Intensive care unit data over 6 years from a level I centre regarding all trauma victims > or = 16 years old who underwent mechanical ventilation within the first 48 h of admission were examined. Patients were prospectively followed for late ARDS. Variables were examined for significant changes over time and independent associations with late ARDS were determined. RESULTS Of 2346 eligible patients among whom 404 (17.2%) were exposed to TPN, 192 (8.2%) met criteria for late ARDS. The incidence of late ARDS among those exposed to TPN was 28.7% (116/404) compared with 3.9% (76/1942) among those not so exposed. Adjustments for potential confounding associated risk factors were made. CONCLUSIONS TPN administration is independently associated with late ARDS, and its use among critically ill trauma victims should be carefully scrutinised.
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Affiliation(s)
- David Plurad
- University of Southern California and Los Angeles County Hospital Division of Trauma/Surgical Critical Care, Los Angeles, CA 90033, USA.
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O'Keefe GE, Shelton M, Cuschieri J, Moore EE, Lowry SF, Harbrecht BG, Maier RV. Inflammation and the host response to injury, a large-scale collaborative project: patient-oriented research core--standard operating procedures for clinical care VIII--Nutritional support of the trauma patient. THE JOURNAL OF TRAUMA 2008; 65:1520-8. [PMID: 19077652 PMCID: PMC4004065 DOI: 10.1097/ta.0b013e3181904b0c] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Grant E O'Keefe
- Department of Surgery, University of Washington, Seattle, Washington, USA.
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Santos A, Gonçalves P, Araújo JR, Martel F. Intestinal Permeability to Glucose after Experimental Traumatic Brain Injury: Effect of Gadopentetate Dimeglumine Administration. Basic Clin Pharmacol Toxicol 2008; 103:247-54. [DOI: 10.1111/j.1742-7843.2008.00272.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Schröder S, van Hülst S, Raabe W, Bein B, Wolny A, von Spiegel T. [Nasojejunal enteral feeding tubes in critically ill patients. Successful placement without technical assistance]. Anaesthesist 2008; 56:1217-22. [PMID: 17882387 DOI: 10.1007/s00101-007-1260-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Critically ill patients with early enteral feeding seem to profit from post-pyloric administration. Two feeding tubes were studied that, due to their construction, are able to move into the duodenum without the necessity of technical support. The duration until successful positioning, time until total enteral feeding and possible complications were compared. PATIENTS AND METHOD Patients with naso-gastric tubes and early enteral feeding, who had an increased reflux despite head of bed elevation and prokinetic drugs, were randomly assigned to either a Tiger tube (Cook) or a Bengmark tube (Pfrimmer Nutricia). RESULTS A total of 28 patients from the surgical intensive care ward were included. Of the 16 Tiger tubes 14 could be successfully placed but only 2 out of the 12 Bengmark tubes. With Tiger tubes total enteral feeding was established within 6 days (median), with Bengmark tubes within 4 days. CONCLUSION In comparison to the Bengmark tube the Tiger tube has a higher success rate in terms of positioning in intensive care patients with impaired abdominal motility.
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Affiliation(s)
- S Schröder
- Klinik für Anästhesie und operative Intensivmedizin, Westküstenklinikum Heide, Heide, Deutschland.
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Bratton SL, Chestnut RM, Ghajar J, McConnell Hammond FF, Harris OA, Hartl R, Manley GT, Nemecek A, Newell DW, Rosenthal G, Schouten J, Shutter L, Timmons SD, Ullman JS, Videtta W, Wilberger JE, Wright DW. XII. Nutrition. J Neurotrauma 2007; 24 Suppl 1:S77-82. [PMID: 17511551 DOI: 10.1089/neu.2006.9984] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Krakau K, Hansson A, Karlsson T, de Boussard CN, Tengvar C, Borg J. Nutritional treatment of patients with severe traumatic brain injury during the first six months after injury. Nutrition 2007; 23:308-17. [DOI: 10.1016/j.nut.2007.01.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Revised: 12/12/2006] [Accepted: 01/23/2007] [Indexed: 11/29/2022]
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Krakau K, Omne-Pontén M, Karlsson T, Borg J. Metabolism and nutrition in patients with moderate and severe traumatic brain injury: A systematic review. Brain Inj 2006; 20:345-67. [PMID: 16716982 DOI: 10.1080/02699050500487571] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PRIMARY OBJECTIVE To examine the evidence on the metabolic state and nutritional treatment of patients with moderate-to-severe traumatic brain injury (TBI). RESEARCH DESIGN A systematic review of the literature. METHODS AND PROCEDURES From 1547 citations, 232 articles were identified and retrieved for text screening. Thirty-six studies fulfilled the criteria and 30 were accepted for data extraction. MAIN OUTCOMES AND RESULTS Variations in measurement methods and definitions of metabolic abnormalities hampered comparison of studies. However, consistent data demonstrated increased metabolic rate (96-160% of the predicted values), of hypercatabolism (-3 to -16 g N per day) and of upper gastrointestinal intolerance in the majority of the patients during the first 2 weeks after injury. Data also indicated a tendency towards less morbidity and mortality in early fed patients. CONCLUSIONS The impact of timing, content and ways of administration of nutritional support on neurological outcome after TBI remains to be demonstrated.
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Affiliation(s)
- Karolina Krakau
- Centre for Clinical Research Dalarna, Dummy institution, Sweden.
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Marino LV, Ramchandra P, Nathoo N. Blind transpyloric nasojejunal versus nasogastric tube intubation in severe head injuries: A preliminary report. J Clin Neurosci 2005; 12:435-7. [PMID: 15925776 DOI: 10.1016/j.jocn.2004.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2003] [Accepted: 04/19/2004] [Indexed: 11/22/2022]
Abstract
AIM To compare the efficacy of blind transpyloric placement using a specifically designed nasojejunal tube (NJT) versus a standard nasogastric tube (NGT) in severe head injury (SHI). METHODS This was a randomised trial conducted in a neurosurgical intensive care unit. Fourteen patients were enrolled with a Glasgow Coma Score (GCS) less than 8 (mean 6.8 SEM+/-0.36). Patients were randomised to receive either NJT or NGT. RESULTS There was an 83% (5/6 patients) spontaneous jejunal placement rate of NJT past the ligament of Treitz. The 17% (1/6 patients) jejunal placement failure rate for NJT was due to inappropriate technique. A 100% (8/8 patients) failure of the unweighted NGTs to pass through the pylorus into the jejunum was recorded (P=0.002). CONCLUSION In SHI, the specifically designed self-propelling NJT was effective in spontaneous transpyloric placement past the ligament of Treitz within 12h of introduction into the gastric cavity. The standard un-weighted NGT was ineffective. Additional studies are warranted to determine the clinical efficacy of this self-propelling NJT.
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Affiliation(s)
- L V Marino
- Department of Dietetics, Wentworth Hospital, Nelson R Mandela School of Mdicine, University of Natal, Durban, South Africa
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Boulton-Jones JR, Lewis J, Jobling JC, Teahon K. Experience of post-pyloric feeding in seriously ill patients in clinical practice. Clin Nutr 2004; 23:35-41. [PMID: 14757391 DOI: 10.1016/s0261-5614(03)00086-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Maintaining nutrition is an integral part of patient care and when it is possible enteral nutrition is regarded as superior to parenteral nutrition. Post-pyloric feeding may enable enteral feeding to be maintained in patients who cannot tolerate nasogastric feeding. The success of post-pyloric feeding in routine clinical practice is uncertain. METHODS One hundred and forty six consecutive patients who had 150 separate episodes of post-pyloric feeding were identified. Casenotes were reviewed to assess indication for post-pyloric feeding, prior use of alternative methods of feeding, success of achieving nutritional requirements and patient outcome. RESULTS A post-pyloric tube was successfully placed in 138 (92%) and nutritional requirements were met by post-pyloric feeding alone in 124 (83%). Post-pyloric feeding was used for between 2 and 254 days (median 14 days). Conditions for which post-pyloric feeding was used to administer nutritional support included burn injury, pancreatitis, sepsis, post-operative gastric stasis, bone marrow transplantation and chemotherapy induced vomiting. Fifty (33%) patients had an attempt at nasogastric feeding and 33 (22%) were on total parenteral nutrition before post-pyloric feeding was commenced. There was one major complication of a jejunal ulcer bleed in the series. Minor complications included displacement of the nasojejunal tube and failure to absorb feed related to gastrointestinal dysfunction. CONCLUSIONS Post-pyloric feeding can be successfully used to maintain enteral nutrition in patients who would otherwise require parenteral nutrition.
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Affiliation(s)
- J R Boulton-Jones
- Department of Gastroenterology, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PD, UK.
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Iapichino G, Rossi C, Radrizzani D, Simini B, Albicini M, Ferla L, Bassi G, Bertolini G. Nutrition given to critically ill patients during high level/complex care (on Italian ICUs). Clin Nutr 2004; 23:409-16. [PMID: 15158305 DOI: 10.1016/j.clnu.2003.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2003] [Accepted: 09/05/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND & AIMS Within a prospective study on costs in 45 Italian intensive units we reviewed nutrition support practice given during critical illness. METHODS From June to October 1999, patients with an ICU stay longer than 47 h were studied. Nutrition (i.e. fasting, parenteral, enteral and mixed) and calorie supply by the enteral route were monitored during the first consecutive days (up to seven) of invasive support of organ failure (high-care). RESULTS 388 patients received high-care for at least 1 day, 200 patients had seven consecutive high-care-days. Some form of nutrition was given in 90.7% of patients, 9.3% were never fed (25.8% of the cardiac patients). Parenteral nutrition was given in 13.9% of patients (78.9% of the abdominal surgery patients), 39.7% received only enteral nutrition, and 36.4% received mixed nutrition. Finally, 77.1% of the patients received nutrient by gut. Nutrition was given in 78.5% of 2115 collected days, 44.1% of the first high-care-days and 93.5% of the 7th days were positive for nutrition. Enteral calorie load on the first day was similar for enteral and mixed nutrition (range 8-14 kcal/kg), it was higher for exclusive enteral nutrition between the 4th and the 7th day (15-19 vs. 11-14 kcal/kg). It differed according to diagnosis group. CONCLUSIONS In Italian ICUs, in complex critically ill patients, nutrition is consistently given in critical illness, gut is widely used except in abdominal surgery patients.
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Affiliation(s)
- G Iapichino
- Istituto di Anestesiologia e Rianimazione dell'Università degli Studi di Milano: Azienda Ospedaliera, Polo Universitario San Paolo, Milan, Italy.
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Nicholas JM, Cornelius MW, Tchorz KM, Tremblay LN, Spiegelman ER, Easley KA, Small W, Feliciano DV, Powell MA, Poklepovic J. A two institution experience with 226 endoscopically placed jejunal feeding tubes in critically ill surgical patients. Am J Surg 2004; 186:583-90. [PMID: 14672762 DOI: 10.1016/j.amjsurg.2003.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Early jejunal feeding after surgery or trauma reduces infectious complications. Although not ideal gastric and postpyloric feedings are often used, however, because of difficulty in placing feeding tubes distal to the ligament of Treitz (LOT). Our hypothesis was that feeding tube placement distal to the LOT can be accomplished using a bedside transendoscopic technique. METHODS Transendoscopic jejunal (TEJ) tube placement and TEJ tubes inserted simultaneously through percutaneous gastrostomy (PEG) tubes (PEG/TEJ) were attempted to be placed distal to the LOT. RESULTS In all, 226 feeding tubes (185 TEJ, 41 PEG/TEJ) were placed in 179 trauma and 47 nontrauma patients over 3 years (August 20, 1998 to July 15, 2001). Tube location was jejunal in 93.8% of trauma patients, 76.6% of nontrauma patients, and 90.3% of all patients. (Confidence intervals were 89.3% to 96.5%, 62.8% to 86.4%, and 85.7% to 93.5%). Days of total parenteral nutrition were reduced 71.3% in trauma patients, 22.8% in nontrauma patients, and 45% overall at one institution. CONCLUSIONS Bedside TEJ and PEG/TEJ placement is safe and successful in placing feeding tubes distal to the LOT in more than 90% of critically ill surgical patients.
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Affiliation(s)
- Jeffrey M Nicholas
- Department of Surgery, Emory University/Grady Memorial Hospital/Rollins School of Public Health, Atlanta, GA, USA.
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Marino LV, Kiratu EM, French S, Nathoo N. To determine the effect of metoclopramide on gastric emptying in severe head injuries: a prospective, randomized, controlled clinical trial. Br J Neurosurg 2003. [PMID: 12779198 DOI: 10.3109/02688690309177968] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
To determine the effect of 8-hourly administration of 10 mg intravenous metoclopramide, over a 48-h period on gastric emptying in severe head injury (SHI), 22 patients were prospectively randomized (Glasgow Coma Score of 3-8) to receive 2 ml of intravenous metoclopramide or 2 ml of 5% saline 8-hourly for 48 h. Baseline and serial blood paracetamol absorption assays were performed at time (t) = 0, 15, 30, 45, 60, 90 and 120 min on day 0 and day 2. The area under the curve between the day 0 and day 2 was used to measure the degree of gastric emptying. In SHI, sequential doses of metoclopramide did not appear to improve gastric motility within subject comparisons (p = 0.65) and between subject comparisons (placebo p = 0.4 and drug p = 0.12). Metoclopramide has no significant prokinetic effect on gastric emptying in SHI patients when given in the early postinjury period.
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Affiliation(s)
- L V Marino
- Department of Dietetics, Wentworth Hospital, Nelson R. Mandela School of Medicine, University of Natal, Durban, South Africa
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Sefton EJ, Boulton-Jones JR, Anderton D, Teahon K, Knights DT. Enteral feeding in patients with major burn injury: the use of nasojejunal feeding after the failure of nasogastric feeding. Burns 2002; 28:386-90. [PMID: 12052379 DOI: 10.1016/s0305-4179(02)00006-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Patients with major burn injury have increased protein and energy requirements and early feeding is an established part of their management. The optimal method of feeding is unknown. Nasogastric feeding is often unsuccessful and total parenteral nutrition has a number of potential disadvantages. Post pyloric feeding is an alternative means of providing enteral nutrition. We report our experience of enteral feeding of patients with significant burn injury. Nasogastric feeding was successful in only 7 of 17 patients (41%). The commonest reason that nasogastric feeding failed was gastric stasis. All patients who failed nasogastric feeding were commenced on nasojejunal feeding and a further two patients were fed by this route initially. Ten of these 12 patients (83%) were successfully fed nasojejunally. No major adverse events attributable to nasojejunal feeding were identified, a nasojejunal tube was successfully placed in all but 1 patient and the tubes were well tolerated. We conclude that nasojejunal tube feeding should be considered in all patients with significant burn injury who cannot tolerate nasogastric tube feeding.
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Affiliation(s)
- E J Sefton
- Institution, Burns Unit, Nottingham City Hospital, UK
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31
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Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN J Parenter Enteral Nutr 2002. [PMID: 11841046 DOI: 10.1177/0148607102026001011] [Citation(s) in RCA: 365] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Early Enteral Nutrition in the Intensive Care Unit. Intensive Care Med 2002. [DOI: 10.1007/978-1-4757-5551-0_44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Barrera R, Schattner M, Nygard S, Ahdoot M, Ahdoot A, Adeyeye S, Groeger J, Shike M. Outcome of direct percutaneous endoscopic jejunostomy tube placement for nutritional support in critically ill, mechanically ventilated patients. J Crit Care 2001; 16:178-81. [PMID: 11815903 DOI: 10.1053/jcrc.2001.30667] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE Gastrointestinal function is adversely affected in critically ill mechanically ventilated patients. The most common abnormality is delayed gastric emptying. Among the options for postpyloric feeds, direct percutaneous endoscopic jejunostomy (PEJ) provides a permanent, reliable, and direct access to the small bowel and can be used for full enteral feedings, thus eliminating the need for parenteral nutrition. PATIENTS AND METHODS All patients who underwent direct PEJ tube placement while mechanically ventilated in the intensive care unit (ICU) were evaluated. For each patient the following factors were identified: age, indication for ICU admission and PEJ placement, nutritional support before and after PEJ placement, calories received, complications, and outcome. RESULTS Seventeen patients underwent the procedure. All had successful placement of direct PEJ tube. There was a single complication. Within 24 hours of PEJ placement, 16 of 17 patients tolerated jejunal feedings. All patients progressed to their established nutritional goals. There were no cases of aspiration of enteral feedings. In the 16 patients, total parenteral nutrition (TPN) was not required once PEJ tubes were placed. Thirteen patients were discharged home or to a rehabilitation facility with jejunal feedings. CONCLUSIONS Direct PEJ placement is a safe and reliable device that can be successfully placed in critically ill, mechanically ventilated patients. With this procedure, all patients can meet their nutritional requirements and eliminate the need for TPN.
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Affiliation(s)
- R Barrera
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Abstract
Preservation or restoration of optimal neurologic function following traumatic brain injury (TBI) requires timely and aggressive therapeutic interventions. Effective diagnostic tools, together with an armamentarium of treatment modalities, have augmented the treatment strategies utilized today. In addition, the Guidelinesfor the Management of Severe Head Injury have established a standardized approach for the TBI patient. This article will provide current information regarding the resuscitation priorities, appropriate interventions, and pharmacological agents used in the treatment required by the complex nature of TBI. Also, a review of the occurrences associated with TBI will be discussed.
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Affiliation(s)
- J R Yanko
- Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
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Stone SJ, Pickett JD, Jesurum JT. Bedside placement of postpyloric feeding tubes. AACN CLINICAL ISSUES 2000; 11:517-30. [PMID: 11288416 DOI: 10.1097/00044067-200011000-00005] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Postpyloric placement of feeding tubes into the duodenum or jejunum is often recommended to support early feeding, improve tolerance of enteral nutrition, and decrease the risk of aspiration pneumonia. Achieving small bowel feeding tube placement can be a difficult, time-consuming, and costly process that may delay the initiation of enteral nutrition. Various bedside techniques, including air insufflation, pH assisted, and spontaneous passage with or without motility agents are available to facilitate transpyloric feeding tube passage. A discussion of these methods is presented in this article, including a hospital-based quality initiative project designed to facilitate early enteral nutrition.
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Affiliation(s)
- S J Stone
- Swedish Medical Center, 747 Broadway, Seattle, WA 98122-4307, USA
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Wassef W, O'keefe S. Interventional procedures. Curr Opin Gastroenterol 2000; 16:508-15. [PMID: 17031129 DOI: 10.1097/00001574-200011000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
During the past year, numerous articles were published on interventional procedures of the stomach, focusing on upper gastrointestinal tract bleeding, gastric cancer, gastric outlet obstruction, and benign disease. In the area of upper gastrointestinal tract bleeding, early endoscopy is warranted for early therapeutic intervention and for triage. In patients with bleeding related to peptic ulcer disease, combination therapy (epinephrine injection in conjunction with electrocoagulation therapy) remains the standard of care. Hemoclipping is a new technique that may be helpful in cases in which conventional therapy fails. Repeat endoscopy should always be considered in patients in whom the first attempt at endoscopic therapy fails. In patients with bleeding related to portal hypertension, prophylactic antibiotics may decrease the risk of infections. Banding remains the therapy of choice for this group of patients. There is no documented benefit for combination therapy (banding and sclerotherapy). Transjugular intrahepatic portosystemic shunts may be helpful in the treatment of hypertensive portal gastropathy but not gastric vascular ectasias. In the area of gastric cancer, management revolves around staging. This can be accomplished best through the use of CT scan and endoscopic ultrasound. In patients with early limited disease, attempt at endoscopic mucosal resection should be considered. This technique can be performed in a variety of ways: the most common method seems to be through the use of a saline injection, to separate the mucosa-submucosal layer, followed by a cap-assisted snare resection with suction. The safety, efficacy, and outcome of this technique are reviewed. Gastric outlet obstruction remains a difficult problem to treat endoscopically. However, there is some evidence that endoscopic therapy may be successful in benign disease and should be considered prior to surgical intervention.
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Affiliation(s)
- W Wassef
- Division of Digestive Diseases and Nutrition, University of Massachusetts Medical School, Worchester, Massachusetts 01655, USA.
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Abstract
Data regarding the use of both parenteral and enteral specialized nutritional support (SNS) are available for a variety of common clinical scenarios. Herein, the data are reviewed for SNS in the context of critical illness, perioperative care, wasting syndromes (including HIV disease and cancer), and gastrointestinal disease (including short bowel syndrome, inflammatory bowel disease, and pancreatitis).
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Affiliation(s)
- C Ashley
- Department of Medicine, Albany Medical College, NY 12208-3479, USA
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The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Nutrition. J Neurotrauma 2000; 17:539-47. [PMID: 10937899 DOI: 10.1089/neu.2000.17.539] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Data show that starved head-injured patients lose sufficient nitrogen to reduce weight by 15% per week. Class II data show that 100-140% replacement of resting metabolism expenditure with 15-20% nitrogen calories reduces nitrogen loss. Data in non-head injured patients show that a 30% weight loss increased mortality rate. Class I data suggests that nonfeeding of head-injured patients by the first week increases mortality rate. The data strongly support feeding at least by the end of the first week. It has not been established that any method of feeding is better than another or that early feeding prior to 7 days improves outcome. Based on the level of nitrogen wasting documented in head-injured patients and the nitrogen sparing effect of feeding, it is a guideline that full nutritional replacement be instituted by day 7.
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