Necrosis y perforación intestinal asociada a alimentación por yeyunostomía / Necrosis and intestinal perforation associated with feed ing by jejunostomy

Resumen La nutrición enteral por yeyunostomía es una prác tica frecuente en cualquier servicio de cirugía general, esta conlleva bajo riesgo de complicaciones y morbi mortalidad. Presentamos el caso de una paciente con antecedente inmediato de gastrectomía subtotal que inició nutrición por yeyunostomía y complicó con ne crosis intestinal por isquemia no oclusiva en el corto lapso. La finalidad de este trabajo es informar sobre esta complicación, su fisiopatología y factores de riesgo para tenerla en cuenta y poder tomar precozmente una conducta terapéutica adecuada.

Abstract Enteral nutrition through jejunostomy is a common practice in any general surgery service; it carries a low risk of complications and morbidity and mortality. We present the case of a patient with an immediate history of subtotal gastrectomy that began nutrition through jejunostomy and complicated with intestinal necrosis due to non-occlusive ischemia in the short period. The purpose of this work is to report on this complication, its pathophysiology and risk factors to take it into account and be able to take appropriate therapeutic action early.

Nutrición enteral en pacientes críticos con COVID-19 ventilados en decúbito prono

Introducción: el SARS-CoV-2 desde el 2020 generó innumerables desafíos. El decúbito prono se utilizó para mejorar la oxigenación, y la terapia nutricional se adaptó para cubrir los requerimientos y reducir complicaciones. Objetivos: evaluar la tolerancia de la nutrición enteral y su adecuación energética en pacientes ventilados en decúbito prono con infección por SARS-CoV-2, en sala respiratoria del Departamento de Cuidados Intensivos Adultos del Hospital de Clínicas-Facultad de Ciencias Médicas - Universidad Nacional de Asunción, de marzo a julio 2021. Metodología: estudio observacional, descriptivo, retrospectivo, de corte transversal, de casos consecutivos, con información obtenida de fichas de pacientes de terapia intensiva, que recibieron soporte nutricional en posición prona. Se tomaron datos demográficos, clínicos y nutricionales. Se evaluó la tolerancia nutricional durante la posición prona, definiéndola como la presencia de un volumen de residuo gástrico < 500 mL cada 6 h.. La adecuación energética fue determinada teniendo en cuenta el porcentaje cumplido de la prescripción nutricional. Resultados: se reclutaron 41 pacientes. El 60,9 % eran hombres; la mediana de edad fue 55 años (RIC=23). Las principales comorbilidades fueron obesidad (57,3 %) e hipertensión arterial (43,9 %). El 85,4 % presentó buena tolerancia gástrica en posición prono, con residuo gástrico menor a 500 ml. El porcentaje de adecuación energética fue de 84 %. Conclusión: la terapia nutricional enteral en decúbito prono fue bien tolerada por la mayoría de nuestros pacientes, posibilitando alcanzar los requerimientos nutricionales indicados.

Introduction: SARS-CoV-2 since 2020 has generated countless challenges. Prone position was used to improve oxygenation, and nutritional therapy was adapted to meet requirements and reduce complications. Objectives: evaluate the tolerance of enteral nutrition and its energetic adequacy in ventilated patients in the prone position with SARS-CoV-2 infection, in the respiratory room of the Adult Intensive Care Department of the Hospital de Clínicas - Facultad de Ciencias Médicas - Universidad Nacional de Asunción, from March to July 2021. Methodology: observational, descriptive, retrospective, cross-sectional study of consecutive cases, with information obtained from records of intensive care patients, who received nutritional support in a prone position. Demographic, clinical and nutritional data were taken. Nutritional tolerance was evaluated during the prone position, defining it as the presence of a volume of gastric residue < 500 mL every 6 h. Energy adequacy was determined taking into account the percentage fulfilled of the nutritional prescription. Results: 41 patients were recruited. 60.9 % were men; the median age was 55 years (IQR=23). The main comorbidities were obesity (57.3 %) and high blood pressure (43.9 %). 85.4 % had good gastric tolerance in the prone position, with gastric residue less than 500 ml. The percentage of energy adequacy was 84 %. Conclusion: enteral nutritional therapy in the prone position was well tolerated by the majority of our patients, making it possible to achieve the indicated nutritional requirements.

Instruments to evaluate the profile of food and enteral formulation hardlers

To know the profile of food and enteral formulation handlers is important to promote more effective health education actions for these individuals. This study aimed to develop instruments to evaluate the profile of food handlers in households (PFH) and in food service establishments (PFSE), as well as the profile of handlers of enteral formulations in households (PEFHH). A scoping review was carried out to identify questions about the profile of food and enteral formulation handlers evaluated in studies in thein the main national and international databases. From 47 selected articles, 66 questions were identified. Of these, 17, 22, and 18 questions were established to assess the PFH, PFSE, and PEFHH, respectively. The instrument questions were subdivided by subject into personal data, sociodemographic and professional characteristics, and general information. Some questions differ between instruments due to segment specificities. The proposed instruments are novel tools. Through a scoping review and expert consultations, a comprehensive set of questions was identified and organized into instruments tailored to each specific segment. These tools will be valuable for nutritionists, researchers, and other professionals involved in assessing and addressing the needs of food handlers. (AU)

Conhecer o perfil do manipulador de alimentos e de formulações enterais é importante para promover ações de educação sanitária mais efetiva para esses indivíduos. Este estudo teve como objetivo elaborar instrumentos para avaliação do perfil do manipulador de alimentos em domicílios (PFH), em serviço de alimentação (PFSE) e de formulações enterais em domicílios (PEFHH). Realizou-se uma revisão de literatura do tipo Scoping review para identificar as questões sobre o perfil do manipulador de alimentos e de formulações enterais avaliadas nos estudos nas principais bases de dados nacionais e internacionais. A partir de 47 artigos selecionados, foram identificadas 66 questões. Destas, foram estabelecidas 17, 22 e 18 questões para avaliar o PFH, PFSE e PEFHH, respectivamente. As questões dos instrumentos foram subdivididas por assunto nas seguintes categorias: dados pessoais; características sociodemográficas e profissionais; e informações gerais. Algumas questões se diferenciam entre os instrumentos devido à particularidade de cada segmento. Os instrumentos propostos são ferramentas inovadoras. Através de uma revisão abrangente e consultas com especialistas, um conjunto abrangente de perguntas foi identificado e organizado em instrumentos adaptados a cada segmento específico. Essas ferramentas serão valiosas para nutricionistas, pesquisadores e outros profissionais envolvidos na avaliação e atendimento das necessidades dos manipuladores de alimentos. (AU)

Application effect of multimodal exercise on enteral nutrition during radiotherapy in patients with esophageal cancer complicating diabetes / 重庆医学

Objective To explore the effect of multimodal exercise combined with enteral nutrition dur-ing radiotherapy in the patients with esophageal cancer complicating diabetes.Methods A total of 52 patients with esophageal cancer complicating diabetes in Zhejiang Provincial Tumor Hospital from January to Decem-ber 2021 were selected as the study subjects and divided into the control group(n=27)and intervention group(n=25)by using the random number table method.The control group implemented the routine exercise scheme,while the intervention group was given the multimodal exercise intervention on the basis of routine exercise.The blood glucose metabolism indicators,related biochemical indicators during radiotherapy and the incidence rate of adverse events during exercise were compared between the two groups.Results The levels of fasting blood glucose,random blood glucose and blood glucose before sleep in the intervention group during radiotherapy were(7.79±1.61)mmol/L,(9.47±1.77)mmol/L and(9.97±3.02)mmol/L,which were lower than(11.84±3.47)mmol/L,(14.18±5.42)mmol/L and(14.62±3.83)mmol/L in the control group with statistically significant differences(P<0.05).During the radiotherapy period,the levels of albumin,total protein and prealbumin in the intervention group were(37.96±2.13)g/L,(68.13±5.02)g/L and(232.89±41.11)g/L,which were lower than(36.05±2.89)g/L,(64.96±5.95)g/L and(207.76±47.59)g/L in the control group with statistically significant differences(P<0.05).The incidence rates of adverse e-vents such as falls,hypoglycemia and accidental extubation during multimodal exercise in the intervention group were lower than those in the control group,and the differences were statistically significant(P<0.05).Conclusion The multimodal exercise could significantly improve the nutritional status during radiotherapy in the patients with esophageal cancer complicating diabetes,stabilize the blood glucose level of the patients,and has good feasibility and safety.

Analysis of the application value of ultrasound measuring gastric sinus cross-sectional area to guide the implementation of early individualized enteral nutrition in patients with sepsis / 中华急诊医学杂志

Objective:To explore the value of ultrasound measuring gastric sinus cross-sectional area (CSA) to guide early individualized enteral nutrition implementation strategies in sepsis patients.Methods:Thirty septic patients admitted to the EICU and comprehensive ICU of The Second Affiliated Hospital of Nanjing University of Chinese Medicine between January 2021 and December 2022 each were included. EICU patients used bedside ultrasound for gastric sinus CSA to guide the implementation of early enteral nutrition in septic patients, and a routine nutritional support strategy was adopted in the integrated ICU. The correlation of CSA and feeding intolerance in patients with septic gastrointestinal dysfunction, the ROC curve and other relevant indicators of gastrointestinal dysfunction gastrointestinal dysfunction score, SOFA score, APACHEⅡ score, intra-abdominal pressure (IAP), serum protein (PA), [albumin (Alb)]. By comparing the indicators related to inflammation, nutritional status and days of ICU stay after different strategies of the two groups, the advantages of different strategies were analyzed.Results:The baseline data of the two groups were balanced and comparable; the incidence of feeding intolerance was significantly higher (36.67%) than the conventional group (10.00%), with aggressive and early individualized treatment, the incidence rate on the third day was only 10.00%, significantly lower than that in the conventional treatment group (40.00%). Treatment up to the 5th day, the related function scores (gastrointestinal dysfunction score, APACHEⅡ score, SOFA score, IAP), nutritional status indicators (5 d hot card reaching the standard rate, PA, Alb) and inflammation indicators (WBC, PCT, hs-CRP) were significantly improved compared with admission, and is better than the conventional treatment group. In addition, the ICU hospital days and the incidence of aspiration were lower in the ultrasound treatment group ( P <0.05). CSA showed favorable correlation with gastrointestinal dysfunction score, APACHEⅡ score, SOFA score, IAP, PA and Alb, correlation coefficients were 0.79、0.60、0.66、0.71、-0.6 and -0.64( P <0.05). The ROC curve for predicting feeding intolerance by CSA showed the AUC was 0.828, 95% CI was 0.737-0.919, its optimal cutoff value for predicted feeding intolerance was 7.835 cm 2, the sensitivity and specificity were 88.20% and 71.80%. Conclusions:Ultrasound measuring CSA can early and effectively found the feeding intolerance in the patients with sepsis , via giving individualized enteral nutrition implementation strategy, significantly improve the organ function score, nutritional status and inflammation index, reduce the ICU hospital days and aspiration, and correlate with the conventional evaluation index, and sensitivity and specificity are high, worthy of the clinical further promotion.

Application value of early enteral nutrition management based on severe feeding process in patients with acute exacerbation of chronic obstructive pulmonary disease after mechanical ventilation / 中国实用护理杂志

Objective:To explore the effects of early enteral nutrition (EEN) management based on severe feeding process on nutritional status and gastrointestinal tolerance in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) after mechanical ventilation.Methods:In the quasi trial study, 30 patients with AECOPD undergoing mechanical ventilation between January 2020 and June 2021 and other 30 patients undergoing mechanical ventilation between July 2021 and December 2022 in Liu′an Hospital of Traditional Chinese Medicine were enrolled as control group and observation group, respectively. The control group was given routine EEN intervention, while the observation group was given EEN management based on severe feeding process. The intakes of calorie and proteins within 7 d after intervention were compared between the two groups. The gastrointestinal tolerance and prognosis were recorded. The levels of hemoglobin, albumin and prealbumin were compared between the two groups before intervention and at 7 d after intervention.Results:In the control group, there were 17 males and 13 females, with age of (66.37±6.09) years old. In the observation group, there were 16 males and 14 females, with age of (65.49 ± 6.35) years old. After intervention, intakes of calorie and proteins within 7 d in the observation group were (3 513.62 ± 94.56) kJ/d and (51.06 ± 5.03) g/d, more than those in the control group (2 859.41 ± 87.23) kJ/d, (36.78 ± 3.14) g/d, the differences were statistically significant ( t=27.85, 13.19, both P<0.05). There were no significant difference in the levels of hemoglobin, albumin and prealbumin before intervention between the two groups (all P>0.05). After intervention, levels of albumin, hemoglobin and prealbumin were (37.16 ± 3.42), (135.43 ± 12.64) g/L and (218.54 ± 15.38) mg/L in the observation group, higher than those in the control group (34.25 ± 4.01), (127.51 ± 11.12) g/L and (201.33 ± 15.04) mg/L, the differences were statistically significant ( t=3.02, 2.58, 4.38, all P<0.05). The incidence rates of reflux aspiration and enteral nutrition interruption in the observation group were 6.67% (2/30), 6.67% (2/30), lower than those in the control group 26.67% (8/30), 30.00% (9/30), the differences were statistically significant ( χ2=4.32, 5.46, both P<0.05). The mechanical ventilation time and stay time in ICU in the observation group were (7.62 ± 1.35), (11.17 ± 2.04) d, shorter than those in the control group (8.57 ± 1.01), (12.83 ± 2.19) d, the differences were statistically significant ( t=3.09, 3.04, both P<0.05). Conclusions:EEN management based on severe feeding process can improve nutritional status, gastrointestinal tolerance and prognosis of AECOPD patients after mechanical ventilation.

Analysis of the knowledge,belief,and practice levels of enteral nutrition tolerance among nursing staff in intensive care units and its influencing factors / 沈阳医学院学报

Objective:To explore the level of knowledge,belief,practice,and influencing factors of tolerance to enteral nutrition(EN)among nursing staff in intensive care units(ICU).Methods:A total of 70 nursing staff who worked in the ICU of our hospital from Jan 2022 to Dec 2022 were selected as the research subjects.The current level of nurses'knowledge,belief,and practice was evaluated using the"ICU Nurse EN Tolerance Knowledge,Belief,and Practice Scale"and a general information questionnaire was self-designed.Linear regression analysis was conducted to analyze the influencing factors of ICU nursing staff's knowledge,belief,and conduct of EN tolerance.Results:The score of ICU Nurse EN Tolerance Knowledge,Belief,and Practice Scale in 70 ICU nursing staff was(72.85±6.94).The scores for knowledge,attitude,and behavior dimensions were(10.69±2.11),(13.65±2.61),and(48.51±4.69),respectively.The results of linear regression analysis showed that working experience＜5 years,non-EN group members,and low self-efficacy were influencing factors(P＜0.05)on the knowledge,belief and practice of EN tolerance of ICU nursing staff.The equation was Y=65.162+5.077X1+ 6.551X2+10.218X3.Conclusion:The knowledge,belief and practice level of EN tolerance of ICU nursing staff may be affected by working years,self-efficacy,and whether they are members of EN study group.

The latest developments in nutritional therapy pathways for patients in critical condition / 实用医学杂志

In the ICU,nutritional status is intimately related to the prognosis of critically ill patients and cannot be neglected;nonetheless,between 38%～78%of critically ill patients are malnourished.Individualized nutritional monitoring and therapy is recommended for critically ill patients to improve prognosis.Nutritional treatment includes enteral and parenteral nutrition.Enteral nutrition can be provided by prepyloric feeding through a nasogastric tube,which is simple and generally applicable,or by retropyloric feeding through a nasojejunal tube,which can reduce the risk of reflux aspiration.Parenteral feeding can be administered by creating peripheral venous access for convenient administration or central venous access for the delivery of nutritional solutions with high osmotic pressure.In addition to the patient's condition,the choice of nutrition route should take into account the initiation time,ability to meet nutritional needs,and potential feeding related complications.Current guidelines are not united,and previ-ous research has not fully addressed existing conflicts.In this paper,problems associated with each nutrition pathway are reviewed to provide a clinical reference.

Application of electromagnetic-guided placement of nasoenteral feeding tubes among aged bedridden patients / 中华护理杂志

Objective To investigate the application effect of electromagnetic navigation bedside nasoenteral intubation technology in elderly bedridden patients.Methods A total of 92 elderly patients with tube feeding in bed in a tertiary A hospital in Beijing from June 2021 to December 2022 were selected by convenience sampling method,and they were divided into an experimental group and a control group with 46 patients in each group by random number table method.The experimental group adopted the electromagnetic navigation bedside nasoenteral catheterization technique and the control group adopted the blind catheterization method.The total success rate of catheterization,the success rate of the first catheterization,the time taken for catheterization,the proportion of catheter tip reaching jejunum,and the incidence of catheter-related complications were compared between the 2 groups.Results There were no shedding cases in both groups.The success rate of total catheterization was 95.7％in the experimental group and 80.4％in the control group.The success rate of first catheterization was 95.7％in the experimental group and 71.7％in the control group.The time taken for catheterization was(12.37±4.19)min in the experimental group and(19.22±5.48)min in the control group.The proportion of catheter tip reaching the jejunum was 60.9％in the experimental group and 28.3％in the control group.The above data were compared between the 2 groups,and the differences were statistically significant(P＜0.05).In terms of the incidence of catheter-related complications,the incidence of epistaxis in the experimental group was 6.5％and it was 21.7％in the control group,and the difference was statistically significant(P=0.036).The positive rate of fecal occult blood test was 2.2％in the experimental group and 17.4％in the control group,and the difference was statistically significant(P=0.030).There was no significant difference in the incidence of nausea,vomiting and abdominal distension between the 2 groups(P＞0.05).No serious complications such as catheter ectopic placement,pneumothorax and perforation occurred in the 2 groups.Conclusion The application of electromagnetic navigation bedside nasoenteral intubation technology for elderly bedridden patients has a high success rate and takes a short time,which can improve the proportion of catheter tip reaching the jejunum and reduce the incidence of epistaxis and fecal occult blood test.

Construction and application of a management process for enteral nutrition-associated diarrhea in postoperative esophageal cancer patients / 中华护理杂志

Objective To explore the application effect of enteral nutrition-related diarrhea in postoperative esophageal cancer patients.Methods Based on literature search and expert meeting,a management process for enteral nutrition-associated diarrhea in postoperative esophageal cancer patients was constructed.A convenience sampling method was used to select a total of 68 patients with enteral nutrition-related diarrhea after esophageal cancer surgery admitted to the thoracic surgery department of a tertiary A cancer hospital in Jiangsu Province.Among them,patients admitted from January 2022 to December 2022 were set as an experimental group.The experimental group was implemented the management process for enteral nutrition-associated diarrhea in postoperative esophageal cancer patients.Those admitted from January 2021 to December 2021 were set as a control group with routine nursing.Then,the time of stopping diarrhea,the King's of Stool Chart(KSC-Tr)diarrhea score,and abnormal incidence of nutrition-related indexes,electrolytes abnormalities(low sodium,low potassium,and low calcium)were compared between 2 groups.Results The time of stopping diarrhea,KSC diarrhea score after 3 days of intervention and the time to achieve target feeding volume of the experimental group were lower than those in the control group,and the difference was statistically significant(P＜0.05).There were no significant differences in hemoglobin,albumin,prealbumin after 3 days of intervention,the incidence of electrolyte abnormalities(low sodium,low potassium,and low calcium)after 3 days of intervention,and the BMI index after 7 days of intervention between 2 groups(P＞0.05).Conclusion The management process for enteral nutrition-associated diarrhea in postoperative esophageal cancer patients can reduce the time of diarrhea,improve the severity of diarrhea,and shorten the time to achieve the target feeding,but has no significant change in the incidence of electrolyte abnormalities.

Experience of home enteral nutritional support in the diagnosis and treatment of patients with high intestinal fistulae / 中华普通外科杂志

Objective:To explore the impact of home enteral nutrition (HEN) on the treatment strategy of patients with high position intestinal fistula.Methods:The clinical and follow-up data of 36 patients with high position intestinal fistula requiring HEN treated in Beijing Tsinghua Changgung Hospital from Jan 2021 to Sep 2023 was retrospectively analyzed.Results:Among the 36 cases, 2 had indwelling nasogastric tubes, 12 had indwelling nasojejunal nutritional tubes, and 22 had percutaneous jejunostomy. The incidence of HEN-related complications in patients was 13.9%, and there were no serious catheter complications.During HEN, high position intestinal fistula healed in 19 cases (52.8%), returned to the hospital for the next stage of intestinal fistula treatment in 11 cases (30.6%), needed to return to the hospital for nutritional support in 1 case (2.8%), and intestinal fistula aggravated to terminate HEN in 2 cases (5.6%).Conclusion:Under the management of professional team, HEN via nasogastric/jejunal nutritional tube or percutaneous jejunostomy is safe and feasible in patients with high intestinal fistula.

Comparison of the short-term outcomes in very/extremely low birth weight infants supplemented with fortified donor human milk or preterm formula / 中华围产医学杂志

Objective:To compare the short-term outcomes of very low birth weight (VLBW) and extremely low birth weight (ELBW) infants supplementarily fed with fortified donor human milk (DHM) or preterm formula (PF) when the mother's own milk (MOM) is insufficient.Methods:This retrospective cohort study included 91 VLBW or ELBW preterm infants with birth weight<1 500 g who were hospitalized in Peking Union Medical College Hospital from October 1, 2017, to September 30, 2020. Based on the supplemental feeding method when MOM was insufficient, these infants were divided into the DHM group ( n=51) and PF group ( n=40). Mann-Whitney U, t-test, Chi-square test, or Fisher's exact test were used to compare the short-term clinical outcomes during hospitalization between the two groups. Results:(1) There were no statistically significant differences between the 91 preterm infants in the DHM group and PF group in their gestational age, birth weight, sex ratio, birth mode, mothers' age at delivery, or the proportion of infants of small gestational age (all P>0.05). (2) The feeding volume in the DHM group was significantly greater than that in the PF group on the 14th day after birth [(108.2±53.1) vs. (81.0±47.8) ml/(kg·d), t=0.78, P=0.020]. Moreover, the time to achieve the feeding amounts up to 120 ml/(kg·d) and 150 ml/(kg·d) for infants in the DHM group were significantly shorter than those in the PF group [(17.5±10.2) vs. (30.0±12.0) d, t=4.38; (22.1±13.3) vs. (32.3±11.9) d, t=0.02; both P<0.05]; (3) Lower proportion of peripherally inserted central catheter (PICC) [58.8% (30/51) vs. 100% (40/40), χ 2=21.88, P<0.001] and shorter PICC duration were observed in the DHM group [10.0 (0.0-19.0) vs. 29.0 (17.0-40.5) d, Z=5.56, P<0.001] compared to the PF group. The times of red blood cell transfusions and the incidence of late sepsis in the DHM group were less than those in the PF group [0.0 (0.0-2.0) vs. 2.0 (1.0-3.0) times, Z=4.44, P<0.001; 23.5% (12/51) vs. 50.0% (20/40), χ 2=6.39, P=0.011]. There were no statistically significant differences observed in the incidence of bronchopulmonary dysplasia, neonatal necrotizing enterocolitis, retinopathy of prematurity, and the length of hospitalization (all P>0.05). Conclusion:When MOM is insufficient, supplementing VLBW and ELBW infants with fortified donor human milk can shorten the time to achieve enteral nutrition and reduce the use rate and time of PICC, the incidence of late-onset sepsis, and the times of red blood cell transfusion.

A pair of siblings with congenital short bowel syndrome and intestinal malrotation caused by a novel variation in the CLMP gene / 中华围产医学杂志

This paper reports a pair of siblings with congenital short-bowel syndrome (CSBS) complicated with intestinal malrotation. Case 1 was born with a birth weight of 2 550 g and a length of 48 cm. On September 10, 2017, emergency Ladd's procedure and appendectomy were performed on the infant 23 days after birth due to intestinal obstruction at the Women and Children's Hospital, School of Medicine, Xiamen University. The small intestine of the infant had a total length of 65 cm. Postoperative enteral and parenteral nutrition supports were provided for six months. Whole exome sequencing revealed a homozygous variant (NM 024769; nucleotide deletion in the exon 3-5) in the CLMP gene (chr11:122953792-122955421), with the parents being the heterozygous carriers but without phenotype. Case 2, the younger sibling of Case 1, was born in the same hospital on March 20, 2020, with a birth weight of 2 932 g and a body length of 49 cm. Prenatal single-gene sequencing on the amniotic fluid identified the same gene variation as his sister's. The baby boy received Ladd's procedure and appendectomy on the second day after birth which found the length of his small intestine was 51 cm. Full enteral nutrition was achieved six months after the operation. Both cases were followed up for 12 months. The body weight and length of Case 1 were both below the first percentile (< P1). The body weight of Case 2 was 8.03 kg ( P3- P5) and the length was 76.0 cm ( P25- P50).

Progress of nutrition therapy for gastric cancer patients with chemotherapy / 肿瘤研究与临床

Gastric cancer is the fifth most common cancer in the world, and chemotherapy is one of its main treatments. However, due to the side effects of chemotherapy drugs, about 87% of patients have malnutrition. Although the concept of nutrition therapy continues to advance, it still lacks sufficient attention, resulting in a low cure rate of malnutrition in gastric cancer patients. As an independent risk factor of death for gastric cancer patients, malnutrition not only leads to poor clinical outcomes, but also causes a huge social and economic burden. This review summarized the nutritional support treatment of gastric cancer patients undergoing chemotherapy in recent years, including the selection of nutrition evaluation tools, methods and effects of nutritional treatment, and made a prospect for its widespread clinical application in the future.

Effect analysis of information-guided enteral nutrition-associated diarrhea treatment process in patients with chronic obstructive pulmonary disease undergoing continuous non-invasive assisted ventilation: a mixed cohort study of pre- and post-control / 中华危重病急救医学

Objective:To clarify the application effect of information-guided enteral nutrition-associated diarrhea (ENAD) management process in patients with chronic obstructive pulmonary disease (COPD) undergoing non-invasive assisted ventilation.Methods:A mixed cohort study of pre- and post-control was conducted. Thirty-nine patients with COPD who were admitted to the emergency intensive care unit (ICU) of Huzhou First People's Hospital from July 1, 2021 to July 31, 2022 were enrolled. Taking the completion of the software development of ENAD management software for critically ill patients on January 28, 2022 as the time node, 20 patients admitted from July 1, 2021 to January 28, 2022 were set as the control group, and 19 patients admitted from January 29 to July 31, 2022 were set as the observation group. The two groups of patients received the same enteral nutrition support treatment, and the control group implemented the conventional ENAD treatment process with enteral nutrition intolerance disposal process as the core. On the basis of the control group, the observation group implemented the information-guided ENAD treatment process, and the system software actively captured the information of ENAD patients and reminded the medical team to improve the patient's diarrhea-related examination and provide alternative treatment plans. The duration of antidiarrhea, feeding interruption rate, and energy and protein intake, blood biochemical indexes, incidence of abnormal blood electrolyte metabolism, daily continuous non-invasive assisted ventilation and endotracheal intubation after 7 days of targeted diarrhea intervention were compared between the two groups.Results:Except for the basal pulse rate, there were no significant differences in gender distribution, age, and vital signs, basic nutritional status, arterial blood gas analysis and blood biochemistry at admission between the two groups, indicating comparability between the two groups. When ENAD occurred, the patients in the observation group obtained earlier cessation of diarrhea than those in the control group [days: 3.00 (2.00, 3.25) vs. 4.00 (3.00, 5.00), P < 0.01], and the feeding interruption rate was significantly lower than that in the control group [10.53% (2/19) vs. 65.00% (13/20), P < 0.01]. After 7 days of diarrhea intervention, the energy intake of the observation group was significantly higher than that of the control group [kJ·kg -1·d -1: 66.28 (43.34, 70.36) vs. 47.88 (34.60, 52.32), P < 0.01], the levels of hemoglobin (Hb), albumin (Alb) and serum prealbumin (PAB) were significantly higher than those in the control group [Hb (g/L): 119.79±10.04 vs. 110.20±7.75, Alb (g/L): 36.00 (33.75, 37.25) vs. 31.00 (30.00, 33.00), PAB (mg/L): 155.79±25.78 vs. 140.95±14.97, all P < 0.05], the daily continuous non-invasive assisted ventilation duration was significantly shorter than that of the control group [hours: 14 (12, 16) vs. 16 (14, 18), P < 0.01], and the arterial partial pressure of carbon dioxide (PaCO 2) was significantly lower than that of the control group [mmHg (1 mmHg ≈ 0.133 kPa): 66.00 (62.00, 70.00) vs. 68.00 (67.50, 70.05), P < 0.05]. However, there were no significant differences in protein intake, incidence of abnormal electrolyte metabolism, and incidence of endotracheal intubation due to acute respiratory failure between the two groups. Conclusion:The information-guided ENAD treatment process can enable the COPD patients undergoing continuous non-invasive assisted ventilation who experience ENAD to receive earlier cessation of diarrhea, and improve the protein energy metabolism and respiratory function of the patients.

The dynamic monitoring of gastric residual volume by ultrasound was used to guide the early nutritional treatment of patients with severe mechanical ventilation to gradually achieve the standard / 中华危重病急救医学

Objective:To explore the application value of dynamic monitoring of gastric residual volume (GRV) in achieving different target energy in severe mechanical ventilation patients.Methods:A prospective randomized controlled study was conducted. Forty-two patients with mechanical ventilation admitted to the department of critical care medicine of General Hospital of Ningxia Medical University from July to December 2022 were enrolled. According to the random number table method, patients were divided into GRV guided enteral nutrition by traditional gastric juice pumpback method (control group, 22 patients) and GRV guided enteral nutrition by bedside ultrasound (test group, 20 patients). General data were collected from both groups, and clinical indicators such as hypersensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), neutrophil percentage (Neut%), procalcitonin (PCT), absolute lymphocytes (LYM), prealbumin (PA), and retinol-binding protein (RBP) were dynamically observed. Inflammation, infection, immunity, nutritional indicators, and the incidence of reflux/aspiration, ventilator-associated pneumonia (VAP) were compared between the two groups, and further compared the proportion of patients with respectively to reach the target energy 25%, 50%, and 70% on days 1, 3, and 5 of initiated enteral nutrition.Results:① There were no significant differences in gender, age, body mass index (BMI), duration of mechanical ventilation, and acute physiology and chronic health evaluationⅡ(APACHEⅡ), sequential organ failure assessment (SOFA), severe nutritional risk score (NUTRIC) at admission between the two groups, indicating comparability. ② On day 1 of initiated enteral nutrition, there were no significant differences in infection, inflammation, immunity and nutrition indicators between the two groups. On day 3 of initiated enteral nutrition, the hs-CRP in the test group was lower than that control group, LYM and PA were higher than those control group [hs-CRP (mg/L): 129.60±75.18 vs. 185.20±63.74, LYM: 1.00±0.84 vs. 0.60±0.41, PA (mg/L): 27.30±3.66 vs. 22.30±2.55, all P < 0.05]. On day 5 of initiated enteral nutrition, the hs-CRP, Neut%, PCT in the test group were lower than those control group, LYM and PA were higher than those control group [hs-CRP (mg/L): 101.70±54.32 vs. 148.40±36.35, Neut%: (85.50±7.66)% vs. (92.90±6.01)%, PCT (μg/L): 0.7 (0.3, 2.7) vs. 3.6 (1.2, 7.5), LYM: 1.00±0.68 vs. 0.50±0.38, PA (mg/L): 27.10±4.57 vs. 20.80 ± 3.51, all P < 0.05]. There were no significantly differences in IL-6 and RBP between the two groups at different time points. ③ The proportion of 50% and 70% of achieved target energy in the test group on day 3, day 5 of initiated enteral nutrition were higher than those of the control group (70.0% vs. 36.4%, 70.0% vs. 36.4%, both P < 0.05). ④ The incidence of reflux/aspiration and VAP in the test group on day 5 of initiated enteral nutrition were significantly lower than those control group (incidence of reflux/aspiration: 5.0% vs. 28.6%, incidence of VAP: 10.0% vs. 36.4%, both P < 0.05). Conclusion:Dynamic monitoring of GRV by bedside ultrasound can accurately improve the proportion of 50% of achieved target energy on day 3 and 75% on day 5 in severe mechanical ventilation patients, improve the patient's inflammation, immune and nutritional status, and can prevent the occurrence of reflux/aspiration and VAP.

A systematic review on phased surgical management of in-testinal fistula / 中国现代普通外科进展

Objective:To summarize the surgical management experience on intestinal fistula(IF)patients with phasedtherapy and staged operation.Methods:Retrospectively analyzing the clin-ical data of 255 IF patientsin Beijing Tsinghua Changgung Hospital from January 2016 to December 2019,including age,gender,primary disease,IF causes,IF locations,IF numbers,IF natures,IF times,IF diagnoses and evaluations,nutritional risks,nutritional support,and infection statuses.Ac-cording to the pathophysiological characteristics of IF patients,IF therapy included three phases:Phase Ⅰ(IF acute onset),Phase Ⅱ(IF stable maintenance),Phase Ⅲ(IF deterministic operation).The IF deterministic operation included one-stage operation and multi-stage operation.The relationship between strategies and effects were analyzed in each treatment stage.Results:All 141 patients in Phase Ⅰ entered into Phase Ⅱ,in which 112 cases received complete treatment,28 cases gave up,and 1 case died.In 112 caseswho received complete treatment,75 cases were cured(83.7％),37 cases remained infected.The 37 cases that remained infected were combined with the 114 cases who were primarily hospitalized at Phase Ⅲ,were classified into 151 cases who received IF deter-ministic operations,in which 134 cases received stage Ⅰ surgery,and 17 cases received multi-stage surgery.138 cases were cured(91.4％).Conclusion:Intestinal fistula patients could exhibit a better cure ratio throughphasestherapy,which include the acute onset phase,stable maintenance phase,and deterministic operation phase.It is important to classify IF patients into the correct phase and conduct the corresponding treatment.The staged operations are also the key to the intestinal fistula-surgical strategy.

Risk prediction model of enteral nutrition intolerance in elderly patients with severe pneumonia in intensive care unit / 中国现代医生

@#Objective To analyze the risk factors of enteral nutrition intolerance in elderly patients with severe pneumonia(SP)in intensive care unit(ICU)and construct its prediction model.Methods A total of 140 elderly patients with severe pneumonia in ICU ward of the First Affiliated Hospital of Ningbo University from January 2021 to December 2022 were selected.According to the tolerance of enteral nutrition,they were divided into tolerance group(n=82)and intolerance group(n=58).Univariate and multivariate Logistic regression analysis was used to analyze the risk factors of enteral nutrition intolerance in elderly patients with severe pneumonia in ICU.The risk prediction model was constructed,and the receiver operating characteristic(ROC)curve was drawn to evaluate the prediction effect of the model.Results Multivariate Logistic regression analysis showed that acute gastrointestinal injury(AGI),intra-abdominal pressure(IAP),and the use of antibiotics≥2 were independent influencing factors of enteral nutrition intolerance in elderly patients with severe pneumonia in ICU(P<0.05).The Hosmer-Lemeshow goodness-of-fit test was used to evaluate the fitting effect of the equation.The area under the curve was 0.867(95%CI:0.750-0.984),the sensitivity was 87.8%,and the specificity was 85.1%.Conclusion The risk prediction model constructed in this study can effectively predict the risk of enteral nutrition intolerance in elderly patients with severe pneumonia in ICU.

Anthropometric profile and body composition of children and adolescents with cerebral palsy on enteral diet / Perfil antropométrico e composição corporal de crianças e adolescentes com paralisia cerebral em uso de dieta enteral

ABSTRACT Objective To investigate the anthropometric variables and body composition of children and adolescents with cerebral palsy based on the type of enteral diet received. Methods A case-series study involving 38 individuals with spastic quadriparetic cerebral palsy, aged four to 18 years, fed only by the enteral route, followed up at a Reference Hospital in the city of Recife (PE), Brazil. One group received an exclusively industrialized enteral diet, while the other received a mixed diet (industrialized and homemade). Weight, stature, arm circumference, and arm muscle area were measured. Body composition was assessed using bioelectrical impedance analysis. Results There was no significant difference between the groups receiving industrialized and mixed diets, with a high stature deficit frequency (63.6% versus 68.7%; p=0.743), excess fat mass (93.3% versus 58.3%; p=0.060), and fat free mass deficit (73.3% versus 66.7%; p=1.000) observed in both groups. Regarding the nutritional composition of the enteral diet, 54.5% and 53.8% of the individuals in the industrialized and mixed diet groups, respectively, received an industrialized enteral diet with a hypercaloric, hyperlipidic, and hypoproteic nutritional composition. Conclusion It was concluded that there was no difference in anthropometric parameters and body composition based on the type of diet received. It should be considered that the nutritional composition of the most commonly used industrialized diet among the individuals in this study may have influenced the unfavorable outcomes, such as the high frequency of low muscle mass and excess fat mass. This highlights the need for the formulation and availability of an enteral diet that meets the nutritional needs of this population.

RESUMO Objetivo Investigar os parâmetros antropométricos e a composição corporal de crianças e adolescentes com paralisia cerebral em função do tipo de dieta enteral recebida. Métodos Estudo tipo série de casos, envolvendo 38 indivíduos com paralisia cerebral tetraparética espástica entre 4 e 18 anos, alimentados apenas por via alternativa, acompanhados em um Hospital de Referência em Recife, Pernambuco, Brasil. Um grupo recebia dieta enteral industrializada exclusiva e outro, dieta mista (industrializada e artesanal). Foram aferidos, peso, estatura, circunferência e área muscular do braço. A composição corporal se deu por meio da utilização de bioimpedância elétrica. Resultados Não houve diferença significante entre os grupos dieta industrializada e dieta mista, sendo constatada elevada frequência de déficit estatural (63,6% versus 68,7%; p=0,743), excesso de massa gorda (93,3% versus 58,3%; p=0,060) e déficit de massa livre de gordura (73,3% versus 66,7%; p=1,000), em ambos os grupos. Quanto à composição nutricional da dieta enteral ofertada, 54,5% e 53,8% dos indivíduos nos grupos dieta industrializada e dieta mista, respectivamente, recebiam dieta enteral industrializada de composição nutricional hipercalórica, hiperlipídica e hipoproteica. Conclusão Conclui-se que não houve diferença nos parâmetros antropométricos e na composição corporal em função do tipo de dieta recebida. Deve-se considerar que a composição nutricional da dieta industrializada mais utilizada pelos indivíduos dessa pesquisa pode ter influenciado os resultados desfavoráveis, como a elevada frequência de baixa massa muscular e excesso de massa gorda. Surgindo por sua vez, a necessidade da formulação e disponibilização de uma dieta enteral que atenda às necessidades nutricionais dessa população.

Development and validity of audiovisual technology for medication preparation and administration via feeding tube / Desarrollo y validación de tecnología audiovisual para la preparación y administración de medicamentos vía sonda enteral / Desenvolvimento e validação de tecnologia audiovisual para preparo e administração de medicamentos via sonda enteral

ABSTRACT Objective: to develop and validate an audiovisual educational technology in the form of video to add scientific and practical knowledge to nursing professionals during oral medication preparation and administration via feeding tube. Method: this is a methodological study based on the theoretical framework of Fleming, Reynolds and Wallace, held in Ribeirão Preto, São Paulo, Brazil, from September 2022 to August 2023. The population was made up of seven experts, three nurses, two pharmacists and two nutritionists. The study was developed in three phases: "Pre-production" - literature review and script preparation; "Production" - script validity and video recording; and "Post-production" - video validity. Material appearance and content were validated using the Delphi technique and a Content Validity Index greater than or equal to 70% (CVI ≥0.7). Results: the video script/storyboard was developed and validated by seven experts, with 94.2% agreement. The video was validated and reached 99.2% agreement among experts in terms of functionality, usability, efficiency, audiovisual technique, environment and procedures. Experts suggested organizing the video into three parts, which involved general considerations related to feeding tubes (Video 1), nursing care related to preparation (Video 2) and medication administration in adult and elderly patients with a tube (Video 3). Conclusion: the audiovisual educational technology developed in this study in the form of video can contribute to training high school and higher education professionals as well as students of vocational training and undergraduate courses in nursing.

RESUMEN Objetivo: desarrollar y validar una tecnología educativa audiovisual en forma de video para agregar conocimientos científicos y prácticos a los profesionales de enfermería durante la preparación y administración de medicamentos orales vía sonda enteral. Método: se trata de un estudio metodológico, basado en el marco teórico de Fleming, Reynolds y Wallace. Realizado en Ribeirão Preto, São Paulo, Brasil, de septiembre de 2022 a agosto de 2023. La población estuvo compuesta por siete especialistas, tres enfermeros, dos farmacéuticos y dos nutricionistas. Estudio desarrollado en tres fases: "Preproducción" - revisión de literatura y preparación de guión; "Producción" - validación de guión y grabación de vídeo; y "Postproducción" - validación de vídeo. La apariencia y contenido del material fueron validados mediante la técnica Delphi y el Índice de Validez de Contenido mayor o igual al 70% (IVC ≥0,7). Resultados: el guión/script/storyboard del vídeo fue desarrollado y validado por siete expertos, con un 94,2% de acuerdo. El vídeo fue validado y alcanzó un 99,2% de acuerdo entre expertos en cuanto a funcionalidad, usabilidad, eficiencia, técnica audiovisual, entorno y procedimientos. Los expertos sugirieron organizar el video en tres partes, que involucraron consideraciones generales relacionadas con las sondas enterales (Video 1), cuidados de enfermería relacionados con la preparación (Video 2) y administración de medicamentos en pacientes adultos y ancianos portadores de sonda (Video 3). Conclusión: la tecnología educativa audiovisual desarrollada en este estudio en forma de video puede contribuir a la formación de profesionales de la educación secundaria y superior, así como de estudiantes de cursos técnicos y de pregrado en enfermería.

RESUMO Objetivo: desenvolver e validar uma tecnologia educativa audiovisual na forma de vídeo para agregar conhecimentos científicos e práticos aos profissionais de Enfermagem durante o preparo e a administração de medicamentos orais via sonda enteral. Método: trata-se de um estudo metodológico, alicerçado no referencial teórico de Fleming, Reynolds e Wallace. Realizado em Ribeirão Preto, São Paulo, Brasil, de setembro de 2022 a agosto de 2023. A população foi composta por sete especialistas, sendo três enfermeiras, duas farmacêuticas e duas nutricionistas. Estudo desenvolvido em três fases: "Pré-produção" - revisão da literatura e elaboração do roteiro; "Produção" - validação do roteiro e gravação do vídeo; e, "Pós-produção" - validação do vídeo. A aparência e o conteúdo do material foram validados pela técnica Delphi e pelo Índice de Validade de Conteúdo maior ou igual a 70% (IVC ≥0,7). Resultados: o roteiro/script/storyboard do vídeo foi desenvolvido e validado por sete especialistas, com 94,2% de concordância. O vídeo foi validado e atingiu 99,2% de concordância entre os especialistas nos quesitos funcionalidade, usabilidade, eficiência, técnica audiovisual, ambiente e procedimentos. Os especialistas sugeriram organizar o vídeo em três partes, as quais envolveram considerações gerais relacionadas às sondas enterais (Vídeo 1), cuidados de Enfermagem relacionados ao preparo (Vídeo 2) e à administração de medicamentos em pacientes adultos e idosos com sonda (Vídeo 3). Conclusão: a tecnologia educativa audiovisual desenvolvida neste estudo na forma de vídeo pode contribuir com a capacitação de profissionais de nível médio e superior, bem como de estudantes dos cursos técnicos e de graduação em Enfermagem.