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The Tricks and Traps of Enteral Nutrition

  • G. J. Dobb
Conference paper

Abstract

Many aspects of the approach to nutrition of critically ill patients have changed over the last decade even though the clinical problems are unchanged. Surgery, sepsis, trauma, burns and other causes of critical illness increase metabolic rate but sick patients are unable to eat because of impaired consciousness, sedation or recent surgery, or because their appetite is decreased. A large negative nitrogen balance can accumulate quickly with loss of muscle, delayed wound healing and reduced resistance to infection. It is now clear that the negative nitrogen balance cannot be reversed completely even with active nutritional support, but this should not prevent nutritional issues being considered in every patient needing intensive care.

Keywords

Enteral Nutrition Enteral Feeding Protein Energy Malnutrition Gastric Aspirate Enteral Feeding Tube 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    American Society for Parenteral and Enteral Nutrition Board of Directors (1993) Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. FPEN 14:1SA–52SAGoogle Scholar
  2. 2.
    Nightingale JMD, Walsh N, Bullock ME et al (1996) Three simple methods of detecting malnutrition on medical wards. J Roy Soc Med 89: 144–148PubMedGoogle Scholar
  3. 3.
    Manning EMC, Shenkin A (1995) Nutritional assessment in the critically ill. Crit Care Clin 11: 603–634PubMedGoogle Scholar
  4. 4.
    Chan S, McCowen KC, Blackburn GL (1999) Nutrition management in the ICU. Chest 115: 145S - 1485PubMedCrossRefGoogle Scholar
  5. 5.
    Chiarelli A, Enzi G, Casadei A et al (1990) Very early nutrition supplementation in burned patients. Am J Clin Nutr 51: 1035–1039PubMedGoogle Scholar
  6. 6.
    Moore E, Jones T (1986) Benefits of immediate jejunostomy feeding after major abdominal trauma: a prospective randomised study. J Trauma 26: 874–880PubMedCrossRefGoogle Scholar
  7. 7.
    Revelly JP, Berger M, Chiolero R (1999) The haemodynamic response to enteral nutrition. In: Vincent JL (ed) Yearbook of intensive care and emergency medicine. Springer, Berlin, pp 105–114Google Scholar
  8. 8.
    Dobb GJ (1992) Enteral nutrition for the critically ill. In: Vincent JL (ed) Yearbook of intensive care and emergency medicine. Springer, Berlin, pp 609–619Google Scholar
  9. 9.
    Guedon C, Schmitz J, Lerebours E et al (1986) Decreased brush border hydrolase activities without gross morphologic changes in human intestinal mucosa after prolonged total par-enteral nutrition of adults. Gastroenterology 90: 373–378PubMedGoogle Scholar
  10. 10.
    Shelly MP, Church JJ (1987) Bowel sounds during intermittent positive pressure ventilation. Anaesthesia 42: 207–209PubMedCrossRefGoogle Scholar
  11. 11.
    Can CS, Ling KDE, Boulos P et al (1996) Randomised trial of safety and efficacy of immediate postoperative enteral feeding in patients undergoing gastrointestinal resection. BMJ 312: 869–871CrossRefGoogle Scholar
  12. 12.
    McClare SA, Greene LM, Snider HL et al (1997) Comparison of the safety of early enteral vs parenteral nutrition in mild acute pancreatitis. JPEN 21: 14–20CrossRefGoogle Scholar
  13. 13.
    Norton JA, Olt LG, McClain C et al (1988) Intolerance to enteral feeding in the brain injured patient. J Neurosurg 68: 62–66PubMedCrossRefGoogle Scholar
  14. 14.
    Moore F, Feliciano D, Andrussy R et at (1992) Early enteral feeding, compared with parenteral, reduces septic complications: the results of a meta-analysis. Ann Surg 216: 172–183Google Scholar
  15. 15.
    Pomposelli JJ, Bistrian BR (1994) Is total parenteral nutrition immunosuppressive? New Horizons 2: 224–229PubMedGoogle Scholar
  16. 16.
    Sandstrom R, Drott C, Hyltander A et al (1993) The effect of postoperative intravenous feeding ( TPN) on outcome following major surgery evaluated in a randomised study. Ann Surg 217: 185–195PubMedCrossRefGoogle Scholar
  17. 17.
    Spapen HD, Duinslaeger L, Diltoer M et al (1995) Gastric emptying in critically ill patients is accelerated by adding cisapride to a standard enteral feeding protocol: results of a prospective, randomised, controlled trial. Crit Care Med 23: 481–485PubMedCrossRefGoogle Scholar
  18. 18.
    Jooste CA, Mustoe J, Colle G (1999) Metoclopramide improves gastric motility in critically ill patients. Intensive Care Med 25: 464–468PubMedCrossRefGoogle Scholar
  19. 19.
    Paz HL, Weinar M, Sherman MS (1996) Motility agents for the placement of weighted and unweighted feeding tubes in critically ill patients. Intensive Care Med 22: 301–304PubMedCrossRefGoogle Scholar
  20. 20.
    Spain DA, DeWeese C, Reynolds MA et al (1995) Transpyloric passage of feeding tubes in patients with head injuries does not decrease complications. J Trauma 39: l100–1102PubMedCrossRefGoogle Scholar
  21. 21.
    Dobb GJ (1990) Enteral nutrition. Clin Anaesthesio 14: 531–557Google Scholar
  22. 22.
    Harrison AM, Clay B, Grant MJ et al (1997) Nonradiographic assessment of enteral feeding tube position. Crit Care Med 25: 2055–2059PubMedCrossRefGoogle Scholar
  23. 23.
    Mizrahi S (1988) Use of grooved needle in catheter jejunostomy technique. JPEN 12: 419CrossRefGoogle Scholar
  24. 24.
    Adams MB, Seabrook GR, Quebbeman EA et al (1986) Jejunostomy. A rarely indicated procedure. Ann Surg 121: 236–238Google Scholar
  25. 25.
    Mowatt-Larssen CA, Brown RO, Wojtysiak SL et al (1992) Comparison of tolerance and nutritional outcome between a peptide and a standard enteral formula in critically ill hypoalbuminaemic patients. JPEN 16: 20–24CrossRefGoogle Scholar
  26. 26.
    Playford RJ, Woodman RC, Clark P et al (1993) Effect of luminal growth factor preservation on intestinal growth. Lancet 341: 866–867CrossRefGoogle Scholar
  27. 27.
    Hall JC, Keel K, McCauley R (1996) Glutamine. Br J Surg 83: 305–312CrossRefGoogle Scholar
  28. 28.
    Zapata-Sirvent RL, Hansbrough JF, Ohara MM et al (1994) Bacterial translocation in burned mice after administration of various diets including fiber-and glutamine-enriched enteral formulas. Crit Care Med 22: 690–696PubMedCrossRefGoogle Scholar
  29. 29.
    Gianotti V, Alexander JW, Gennari R et al (1995) Oral glutamine decreases bacterial translocation and improves survival in experimental gut-origin sepsis. JPEN 19: 69–74CrossRefGoogle Scholar
  30. 30.
    Jones C, Palmer TE, Griffiths RD (1999) Randomised clinical outcome study of critically ill patients given glutamine-supplemented enteral nutrition. Nutrition 15: 108–115PubMedCrossRefGoogle Scholar
  31. 31.
    Hammarqvist F (1999) Randomised trial of glutamine-enriched enteral nutrition on infectious morbidity in patients with multiple trauma. JPEN 23: 43–44CrossRefGoogle Scholar
  32. 32.
    Jensen GL, Miller RH, Talabiska DG et al (1997) A double-blind, randomised study of glutamine-enriched compared with standard peptide-based feeding in critically ill patients. Am J Clin Nutr 64: 615–621Google Scholar
  33. 33.
    Barbul A (1986) Arginine: biochemistry, physiology and therapeutic implications. JPEN 10: 227–238CrossRefGoogle Scholar
  34. 34.
    Daly JM, Reynolds JV, Thorn A et al (1988) Immune and metabolic effects of arginine in the surgical patient. Ann Surg 208: 512–523PubMedCrossRefGoogle Scholar
  35. 35.
    Brown AO, Hunt H, Mowatt-Larssen CA et al (1994) Comparison of specialised and standard enteral formulas in trauma patients. Pharmacotherapy 14: 314–320PubMedGoogle Scholar
  36. 36.
    Daly JM (1995) Specific nutrients and the immune response: from research to clinical practices. J Crit Care Nutr 2: 24–29Google Scholar
  37. 37.
    Alexander JW (1998) Immunonutrition: the role of omega-3 fatty acids. Nutrition 14: 627–633PubMedCrossRefGoogle Scholar
  38. 38.
    Zaloga GP (1998) Immune-enhancing enteral diets: where’s the beef? Crit Care Med 26: 1143–1146PubMedCrossRefGoogle Scholar
  39. 39.
    Scheppach W, Burghardt W, Bartram P et al (1990) Addition of dietary fiber to liquid formula diets: the pros and cons. JPEN 14: 204–209CrossRefGoogle Scholar
  40. 40.
    Demling RH, DeBiasse MA (1995) Micronutrients in critical illness. Crit Care Clin 11: 61–673Google Scholar
  41. 41.
    Ponec RJ, Saunders MD, Kimmey MB (1999) Neostigmine for the treatment of acute colonic pseudo-obstruction. N Engl J Med 341: 137–141PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2000

Authors and Affiliations

  • G. J. Dobb

There are no affiliations available

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