Enteral Nutrition Therapy: Historical Perspective, Utilization, and Complications.

PURPOSE OF REVIEW: Enteral nutrition (EN) therapy can provide vital nutrition support for patients with various medical conditions as long as it is indicated and supported by ethical reasoning. This review seeks to offer a detailed account of the history of EN development, highlighting key milestones and recent advances in the field. Additionally, it covers common complications associated with EN and their management. RECENT FINDINGS: After years of research and development, we have reached newer generations of enteral feeding formulations, more options for enteral tubes and connectors, and a better understanding of EN therapy challenges. Given the availability of many different formulas, selecting a feeding formula with the best evidence for specific indications for enteral feeding is recommended. Initiation of enteral feeding with standard polymeric formula remains the standard of care. Transition to small-bore connectors remains suboptimal. Evidence-based practices should be followed to recognize and reduce possible enteral feeding complications early.

[The XI SENPE Jesús Culebras Lecture. Enteral nutrition in critically ill patients. History of an evolution]. / XI Lección Jesús Culebras. Nutrición enteral en el paciente crítico. Historia de una evolución.

INTRODUCTION: Enteral nutrition is part of the treatment plan designed for a great number of critically ill patients. After a first description in ancient Egypt, enteral nutrition was only rapidly developed during the last century. Advances in indications, tube feeding methods, enteral formula selection, diagnosis and treatment of gastrointestinal-related complications, efficacy monitorization, and use of protocols for enteral nutrition administration in clinical practice make this nutritional technique more feasible and secure for critically ill patients. Nevertheless, several issues in this field need more investigation to increase enteral nutrition development, efficacy, and safety in these patients.

INTRODUCCIÓN: Actualmente, la nutrición enteral forma parte de las medidas de tratamiento que se aplican a los pacientes críticos. Es una técnica que, procedente del antiguo Egipto, solo tuvo un rápido desarrollo desde principios del siglo XX hasta nuestros días. Los diferentes avances en este campo, relacionados con las indicaciones, la metodología de aplicación, la selección de las dietas, el manejo de las complicaciones, el seguimiento de la eficacia y el diseño y aplicación de los protocolos asistenciales, han permitido que la nutrición enteral pueda aplicarse con seguridad y eficacia a los pacientes críticos. A pesar de ello, quedan aún muchos aspectos por desarrollar con el fin de conseguir que los pacientes se beneficien de manera óptima del tratamiento con nutrición enteral.

Blenderized Tube Feeding: Health Outcomes and Review of Homemade and Commercially Prepared Products.

The popularity of homemade blenderized tube feeding (HBTF) continues to increase among enteral nutrition (EN) consumers and healthcare providers alike, citing improved feeding tolerance over standard commercial enteral formulas, among other health outcomes. Within the past 5-10 years, there has been a surge in the development of commercial blenderized tube feeding (CBTF) products. CBTF products promote similar benefits from whole foods like those used in HBTF while being a nutritionally-consistent, easy to use, and shelf-stable option for EN consumers. Research is improving but is still limited for HBTF and virtually nonexistent for CBTF products. This review aims to summarize current health outcomes of HBTF, compare HBTF with CBTF, evaluate CBTF products, and provide considerations for future research and practices.

Nutrition for Preterm Infants: 75 Years of History.

As technology has advanced, survival rates of preterm infants have improved dramatically. Human milk was the primary source of enteral nutrition during the early days of neonatology, but the HIV/AIDS epidemic resulted in an increased use of preterm formula. More recently, the benefits of human milk were rediscovered, resulting in increased use of donor human milk as well. The awareness that human milk does not contain the amounts of nutrients to meet the high requirements of infants born premature resulted in the development of human milk fortifiers. The development of these fortifiers is still ongoing, as are alternative methods of pasteurization of donor milk. Those initiatives will increase the use of human milk with consequently short- and long-term benefits for preterm infants.

Enteral Nutrition: Options for Short-Term Access.

The preferred method of nutrition support in the presence of a functional gastrointestinal tract is enteral nutrition (EN). Many factors contribute to the selection process for the type of enteral access device to be used. Short-term enteral access tubes are placed into the nares or, sometimes, orally, usually at bedside. The short-term access provides a means to meet patient nutrient needs and can provide a chance to assess tolerance of the tube feedings if more permanent long-term placement is determined to be required. Access for nutrition support does not come without a risk; it can be challenging, requiring an individualized approach for each patient. The selection type and access location can greatly impact the success of EN. The most advantageous tube choice must be determined carefully, taking into account the multiple considerations reviewed in this paper.

Feeding the feeble: steps towards nourishing preterm infants.

This paper describes historic steps in feeding techniques and knowledge on the nutritional needs of premature infants. Devices to overcome weak sucking and swallowing were developed from 1851 to 1920, including tube feeding by gavage, medicine droppers and pipettes, feeding bottles with an air inlet, and beaked spoons for nasal feeding. Indwelling nastrogastric tubes were in use from 1951. For alleged safety concerns in the 1950s, postnatal feeding was postponed until a week of starvation was reached, and studies showed an association with neurological handicaps. The premature infant's elevated need for energy, protein, and minerals has been established since 1919. However, these remained controversial, and nutritional practices continued to lag behind theoretical knowledge. Concentrated formula was developed in the 1940s, parenteral supplementation in the 1960s, and human milk fortifiers in the 1970s. In the 1990s, necrotizing enterocolitis was found to be more frequent in infants who were fed formula than in those who were fed human milk. Recently, probiotics were shown to reduce the risk of necrotizing enterocolitis. Nevertheless, compared with other aspects of neonatal medicine, there is still remarkably little evidence on how to feed preterm infants.

Forcible feeding in English prisons. 1910.

Editor's note: From its first issue in 1900 through to the present day, AJN has unparalleled archives detailing nurses' work and lives for more than a century. These articles not only chronicle nursing's growth as a profession within the context of the events of the day, but they also reveal prevailing societal attitudes about women, health care, and human rights. Today's nursing school curricula rarely include nursing's history, but it's a history worth knowing. To this end, From the AJN Archives will be a frequent column, containing articles selected to fit today's topics and times. This month's article, from the March 1910 issue, addresses the force-feeding of female political prisoners in Great Britain. It was written by nurse and social activist Lavinia Dock, a cofounder of the Nurses Associated Alumnae (which later became the American Nurses Association) and the International Council of Nurses and a contributing editor to AJN. Dock wrote, "Among the prisoners thus cruelly treated have been several nurses." She shared physicians' outrage that the Home Office ordered the force-feeding but tried to place responsibility for the practice entirely on prison physicians. More than a century later, the force-feeding of political prisoners continues to raise ethical and legal issues within the nursing and medical communities (see "Ethical Issues for Nurses in Force-Feeding Guantánamo Bay Detainees" in this issue).

Enteral feeding misconnections in the NICU: a continuing patient safety threat.

Although the first case of tubing misconnection was reported in 1972, this patient safety issue received little national attention until The Joint Commission issued a Sentinel Event Alert in the spring of 2006. This was followed by a "Money and Policy" article in the New York Times in the summer of 2010 that initiated a public awareness outcry against the healthcare system's delayed responsiveness in creating fail safe solutions. Since that time, many manufacturers have devised oral syringes, feeding tubes, and feeding "systems" for patients in the neonatal intensive care unit, but these devices' ability to minimize risk is not well delineated. This article reviews the history of tubing misconnections and provides an in-depth look at current recommendations for manufacturing and device design, human factors contributing to misconnections, and specific strategies for minimizing patient safety risk.

Hallmarks in the history of enteral and parenteral nutrition: from antiquity to the 20th century.

Parenteral nutrition (PN) and enteral nutrition (EN) have a very long history, emerging in the ancient world and developing throughout the common epoch. This history dates back as far as 3500 bc to the ancient Egyptians, Indians, and Chinese. Their medical practices were the first reports of enteral feeding therapy, provided via rectum with enemas of wine, milk, whey, wheat, and barley. Hippocrates and Plato, in ancient Greece, were the first personalities to emphasize the importance of diet on health. In the following centuries, Erasistratus and Herophilus described the first notion of the circulatory system, and Oribasius and Celsus described the role of nutrition and disease. There is a great historical gap between the times of Galen (2nd century), who elaborated on the circulatory system; Ibn Zuhr (12th century), who constructed the first model of PN; and Capivacceus (16th century), who placed the first tube for EN. The 17th-19th centuries showed major developments in modern nutrition elements. Steps toward artificial nutrition began in 1628 with the detailed description of blood circulation by William Harvey; however, most of the advances in enteral and parenteral feeding techniques, solutions, and formulas took place in the 20th century. Over the last decade of the 20th century, research focused on metabolic control, multitude formulas, timing and the combination of EN and PN for intensive care patients.

Historical highlights of the development of enteral nutrition.

The most significant events and discoveries regarding the development of enteral nutrition (EN) dating back to 1500 BC are chronicled. A more detailed description and discussion of subsequent more recent progress during the past two decades is focused primarily on 3 of the most dynamic areas of endeavor: tight glycemic control; timing and combining of EN and total parenteral nutrition to meet early target nutrition goals in intensive care unit patients; and the role, advances, and future of immunonutrition. An abridged classification of solutions for enteral feeding, and a brief outline of key prudent oral dietary guidelines are also presented.

[Hunger strike and forced feeding: a historical look at medical practices]. / Jeûne de protestation et alumentation forcée: relevé de pratiques historiques.

Hunger strike is not a disease but a common situation in prisons. This article takes a historical look at medical practices in connection with the forced feeding of hunger strikers. We now know the fate of the strikers who were subjected to forced feeding. Depending on the context and the political situation in the country, the fate of these people, mostly political prisoners, is described as humiliating and abominable frequently ending in death or irreparable consequences. Particularly difficult for health professionals, this act raises clinical, ethical and legal questions and refers to the fundamental principles of medicine.

Intestinal failure: A new era in clinical management.

Only 50 years ago intestinal failure was considered incompatible with life. Since then, developments in parenteral nutrition, and, more recently, small intestinal transplantation, have provided new therapeutic options with the potential to offer long-term survival with a good quality of life. Current medical and surgical strategies are aimed at enhancing intestinal adaptation, improving absorption to achieve nutritional independence, and minimizing the complications of parenteral nutrition therapy. An integrated, multidisciplinary approach to the management of patients with intestinal failure, closely linked to a transplantation program to facilitate early referral, is recognized as a key factor in optimizing patient outcomes.

Brief history of parenteral and enteral nutrition in the hospital in the USA.

The meteoric rise in parenteral and enteral nutrition was largely a consequence of the development of total parenteral nutrition and chemically defined diets in the late 1960s and early 1970s and the recognition of the extensive prevalence of protein calorie malnutrition associated with disease in this same period. The establishment of Nutrition Support Services (NSS) using the novel, multidisciplinary model of physician, clinical nurse specialist, pharmacist, and dietitian, which, at its peak in the 1990s, approached 550 well-established services in about 10% of the US acute care hospitals, also fostered growth. The American Society of Parenteral and Enteral Nutrition, a multidisciplinary society reflecting the interaction of these specialties, was established in 1976 and grew from less than 1,000 members to nearly 8,000 by 1990. Several developments in the 1990s initially slowed and then stopped this growth. A system of payments, called diagnosis-related groups, put extreme cost constraints on hospital finances which often limited financial support for NSS teams, particularly the physician and nurse specialist members. Furthermore, as the concern for the nutritional status of patients spread to other specialties, critical care physicians, trauma surgeons, gastroenterologists, endocrinologists, and nephrologists often took responsibility for nutrition support in their area of expertise with a dwindling of the model of an internist or general surgeon with special skills in nutrition support playing the key MD role across the specialties. Nutrition support of the hospitalized patient has dramatically improved in the US over the past 35 years, but the loss of major benefits possible and unacceptable risks of invasive nutritional support if not delivered when appropriate, delivered without monitoring by nutrition experts, or employed where inappropriate or ineffective will require continued attention by medical authorities, hospitals, funding agencies, and industry in the future.