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1.
Surg Clin North Am ; 99(6): 1083-1094, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31676049

RESUMO

Patients with ulcerative colitis and Crohn's disease often present to surgery malnourished and on combination immunosuppression. These factors affect operation selection and postoperative outcomes. Corticosteroids have a well-established detrimental effect on postoperative outcomes, whereas the impact of biologic agents is more controversial. In a patient exposed to these medications, and in the presence of other risk factors, temporary intestinal diversion is likely the best choice. Enteral nutrition may help optimize malnourished patients at high risk of adverse postoperative outcomes.


Assuntos
Corticosteroides/uso terapêutico , Produtos Biológicos/uso terapêutico , Colectomia/métodos , Colite Ulcerativa/tratamento farmacológico , Doença de Crohn/tratamento farmacológico , Progressão da Doença , Tomada de Decisão Clínica , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/cirurgia , Doença de Crohn/diagnóstico , Doença de Crohn/cirurgia , Nutrição Enteral/métodos , Feminino , Humanos , Imunossupressores/uso terapêutico , Doenças Inflamatórias Intestinais/tratamento farmacológico , Doenças Inflamatórias Intestinais/cirurgia , Masculino , Desnutrição/terapia , Período Pré-Operatório , Prognóstico , Resultado do Tratamento
2.
N Engl J Med ; 381(15): 1434-1443, 2019 10 10.
Artigo em Inglês | MEDLINE | ID: mdl-31597020

RESUMO

BACKGROUND: Observational data have shown that slow advancement of enteral feeding volumes in preterm infants is associated with a reduced risk of necrotizing enterocolitis but an increased risk of late-onset sepsis. However, data from randomized trials are limited. METHODS: We randomly assigned very preterm or very-low-birth-weight infants to daily milk increments of 30 ml per kilogram of body weight (faster increment) or 18 ml per kilogram (slower increment) until reaching full feeding volumes. The primary outcome was survival without moderate or severe neurodevelopmental disability at 24 months. Secondary outcomes included components of the primary outcome, confirmed or suspected late-onset sepsis, necrotizing enterocolitis, and cerebral palsy. RESULTS: Among 2804 infants who underwent randomization, the primary outcome could be assessed in 1224 (87.4%) assigned to the faster increment and 1246 (88.7%) assigned to the slower increment. Survival without moderate or severe neurodevelopmental disability at 24 months occurred in 802 of 1224 infants (65.5%) assigned to the faster increment and 848 of 1246 (68.1%) assigned to the slower increment (adjusted risk ratio, 0.96; 95% confidence interval [CI], 0.92 to 1.01; P = 0.16). Late-onset sepsis occurred in 414 of 1389 infants (29.8%) in the faster-increment group and 434 of 1397 (31.1%) in the slower-increment group (adjusted risk ratio, 0.96; 95% CI, 0.86 to 1.07). Necrotizing enterocolitis occurred in 70 of 1394 infants (5.0%) in the faster-increment group and 78 of 1399 (5.6%) in the slower-increment group (adjusted risk ratio, 0.88; 95% CI, 0.68 to 1.16). CONCLUSIONS: There was no significant difference in survival without moderate or severe neurodevelopmental disability at 24 months in very preterm or very-low-birth-weight infants with a strategy of advancing milk feeding volumes in daily increments of 30 ml per kilogram as compared with 18 ml per kilogram. (Funded by the Health Technology Assessment Programme of the National Institute for Health Research; SIFT Current Controlled Trials number, ISRCTN76463425.).


Assuntos
Deficiências do Desenvolvimento/prevenção & controle , Nutrição Enteral/métodos , Fórmulas Infantis , Doenças do Prematuro/prevenção & controle , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Leite Humano , Pré-Escolar , Nutrição Enteral/efeitos adversos , Enterocolite Necrosante/prevenção & controle , Seguimentos , Humanos , Recém-Nascido , Recém-Nascido Prematuro/crescimento & desenvolvimento , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Unidades de Terapia Intensiva Neonatal , Tempo de Internação , Sepse/prevenção & controle
3.
Br J Nurs ; 28(18): 1170-1174, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31597070

RESUMO

BACKGROUND: safe placement and securement of feeding tubes are essential to establishing early enteral nutrition. Nasogastric or nasojejunal feeding tubes are often inadvertently removed, and using a nasal bridle can reduce the number of tube replacements required. AIM: to review current nasal bridle practices on one intensive care unit. Over a 3-month period, nasal bridle use was recorded to measure unintentional tube loss and tube duration (the time a tube remained in situ). METHOD: an observational service evaluation. FINDINGS: 109 patients were recruited; 205 tubes were passed and 77 bridles were inserted, with 42% (n=46) of the bridles placed on day 1. Tubes secured with tape were more likely to be dislodged than tubes secured with a bridle, P=0.0001. Duration of tubes remaining in situ was significantly longer in patients who had a bridle fitted on day 1, P=0.0001 compared with tubes secured with tape. CONCLUSION: securing a tube with a nasal bridle from day 1 is independently associated with reduced tube loss, increased duration of tube use, and likelihood that the tube would reach redundancy when it was no longer required.


Assuntos
Nutrição Enteral/instrumentação , Falha de Equipamento/estatística & dados numéricos , Unidades de Terapia Intensiva , Intubação Gastrointestinal/instrumentação , Nutrição Enteral/métodos , Humanos , Intubação Gastrointestinal/métodos
4.
Nutr. hosp ; 36(5): 1019-1026, sept.-oct. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184621

RESUMO

Introducción: la desnutrición en el paciente neurológico presenta una alta prevalencia, aumentando las complicaciones y disminuyendo la calidad de vida. La nutrición artificial minimiza el riesgo de malnutrición. En los últimos años, en Murcia, se pone en marcha una vía clínica de adecuación a la Guía Nacional de Nutrición Enteral Domiciliaria (NED) para optimizar este recurso y reducir la variabilidad de prescripción. Objetivo: analizar las características de la NED en el paciente neurológico, de un área de salud de Murcia, antes y después de la adecuación a las directrices nacionales. Método: diseño observacional de corte transversal. Análisis y comparación de las muestras NED de adultos del Área 1 de salud de Murcia, en 2010 y 2014. Resultados: la patología más asociada a las prescripciones de NED fue la neurológica. La vía de administración más utilizada fue la oral, aunque desciende en la muestra de 2014 a favor de la sonda de nutrición y ostomía. El tipo de fórmula más usado en 2010 fue la no específica. Tras la vía clínica se reduce el uso de fórmulas específicas, disminuyendo especialmente las fórmulas hiperproteicas y/o hipercalóricas. Conclusiones: la implementación de una vía clínica de adecuación a la Guía Nacional NED ha provocado un cambio en la realidad de este tipo de nutrición artificial en el Área 1 de salud del Servicio Murciano de Salud, consiguiendo normalizar su uso bajo criterios unificados y profesionales especializados. Finalmente, estos logros se han generalizado a toda la región


Introduction: malnutrition in patients with neurological disease is very prevalent, worsening their complications and diminishing their quality of life. For that reason, nutritional support can provide a reduction in comorbidities. Over the past years, in Murcia (southeast of Spain), a clinical pathway has been stablished in accordance to the National Home Enteral Nutrition guide (HEN) to optimize this resource and reduce the prescription gap. Objective: to analyze the HEN characteristics in neurological patients in an area of Murcia, before and after the adequacy of the national recommendations. Method: observational cross-sectional study. Analysis and comparison of HEN in health area no. 1 in Murcia in 2010 and 2014. Results: the most prevalent cause for HEN was neurological disease. In 2010, oral nutrition was the most used way compared with 2014, when it had changed to enteral nutrition through feeding tube or ostomy. Non-specific formula was the most frequently used in 2010. However, after the establishment of the clinical pathway there was a reduction in specific enteral formula use, specially hypercaloric and hyperproteic. Conclusions: the implementation of a clinical pathway according to the National HEN guide has caused a change in the reality of artificial nutrition in health area no. 1 in Murcia (Spain), which means a standardization of its use under unified criteria made by specialized professionals. Finally, due to these results, this clinical pathway has been generalized to the rest of the region


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Nutrição Enteral/métodos , Terapia por Infusões no Domicílio/métodos , Apoio Nutricional , Qualidade de Vida , Alimentos Formulados , Estudos Transversais , Estomia , Doenças do Sistema Nervoso Central/complicações , Doenças do Sistema Nervoso Central/dietoterapia , Acidente Vascular Cerebral/dietoterapia , Demência/dietoterapia , Desnutrição/prevenção & controle
5.
Nutr. hosp ; 36(5): 1027-1036, sept.-oct. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-184622

RESUMO

Objective: to investigate whether the caloric and protein deficits, the diagnosis and the NUTRIC score, behaved as risk factors associated to the survival time. Methods: prospective study with 82 critically ill patients in intensive care unit (ICU), with exclusive enteral nutritional therapy (EENT). We investigated the calorie and protein deficiencies of EENT, the NUTRIC score, and the inflammatory-nutritional index by the C-reactive protein-CRP/albumin. The data were analyzed using the Chi-square, Fisher, Mann-Whitney, Kruskal-Wallis, univariate and multiple Cox regressions and the Kaplan-Meyer method. Results: in the univariate Cox regression, one-year increase in age increased the risk of death by 4.1% (p=0.0009; HR=1.041) and one-day increase with intercurrent events, by 1.8% (p = 0.0485; HR = 1.018). In the multiple Cox regression, the clinical diagnosis (p = 0.0462, HR = 2.091) and the NUTRIC score ≥ 5 (p < 0.0001; HR = 5.740) were the variables that together were associated with the survival time. The critical caloric and protein deficits did not behave as death risk factors in this population. Kaplan-Meier curves showed that the probability of survival in 40 days was 28.1% with clinical diagnosis and 40.2% with surgical diagnosis. The mean survival time with NUTRIC score ≥ 5 was 17.4 days. The probability of survival at 40 days was 72.8% with NUTRIC score < 5 and 6.4% with NUTRIC score ≥ 5. Conclusion: caloric and protein deficits are not risk factors for mortality. Only the diagnosis and the NUTRIC score were considered risk factors associated with the survival time


Objetivo: investigar si el déficit calórico y proteico, el diagnóstico y la puntuación nutricional se comportaron como factores de riesgo asociados al tiempo de supervivencia. Métodos: estudio prospectivo con 82 pacientes en estado crítico en la Unidad de Cuidados Intensivos (UCI), con terapia nutricional enteral exclusiva (EENT). Investigamos las deficiencias de calorías y proteínas de EENT, el puntuación NUTRIC y el índice inflamatorio-nutricional por la proteína C-reactiva-CRP / albúmina. Los datos se analizaron utilizando las regresiones de Chi-cuadrado, Fisher, Mann-Whitney, Kruskal-Wallis, univariadas y múltiples de Cox y el método de Kaplan-Meyer. Resultados: en la regresión de Cox univariada, el aumento de un año en la edad aumentó el riesgo de muerte en un 4,1% (p = 0,0009; HR = 1,041) y el aumento de un día con eventos intercurrentes, en un 1,8% (p = 0,0485; HR = 1,018). En la regresión múltiple de Cox, el diagnóstico clínico (p = 0,0462, HR = 2,091) y la puntuación nutricional ≥ 5 (p < 0,0001; HR = 5,740) fueron las variables que juntas se asociaron con el tiempo de supervivencia. Los déficits críticos de calorías y proteínas no se comportaron como factores de riesgo de muerte en esta población. Las curvas de Kaplan-Meier mostraron que la probabilidad de supervivencia en 40 días fue del 28,1% con diagnóstico clínico y del 40,2% con diagnóstico quirúrgico. El tiempo medio de supervivencia con puntuación NUTRIC ≥ 5 fue de 17,4 días. La probabilidad de supervivencia a los 40 días fue del 72,8% con una puntuación nutricional < 5 y del 6,4% con una puntuación NUTRIC ≥ 5. Conclusión: los déficits calóricos y proteicos no son factores de riesgo para la mortalidad. Solo el diagnóstico y la puntuación NUTRIC se consideraron factores de riesgo asociados con el tiempo de supervivencia


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Cuidados Críticos/métodos , Nutrição Enteral/métodos , Fatores de Risco , Desnutrição Proteico-Calórica/dietoterapia , Estado Terminal , Sobrevivência , Estudos Prospectivos , Desnutrição Proteico-Calórica/prevenção & controle
6.
Soins Pediatr Pueric ; 40(310): 20-26, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31543230

RESUMO

The feeding of the premature infant, even when this is done by gastric tube, should be a moment of sharing. However, the way care is normally organised and at times the availability of the parents turn the process into something the baby passively endures. But an enteral nutrition by tube feeding in the arms of the parents who push the feeding syringe by hand reveals a benefit for the premature newborn and the parents.


Assuntos
Nutrição Enteral/métodos , Recém-Nascido Prematuro , Intubação Gastrointestinal , Humanos , Recém-Nascido , Pais/psicologia
8.
Medicine (Baltimore) ; 98(32): e16750, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393390

RESUMO

RATIONALE: Crohn disease includes 3 phenotypes, inflammatory, stricturing, and penetrating. In cases where corticosteroids and immunosuppressive agents are not suitable treatment options, enteral nutrition (EN) can be used to reduce disease severity and enhance barrier defense with fewer potential adverse effects. PATIENT CONCERNS: A 23-year-old man with abdominal pain and diarrhea presented at our hospital in 2014. The frequency of defecation was 3 or 4 times a day without mucus or blood in the stool. His body mass index was 15.8, and in laboratory tests the erythrocyte sedimentation rate was 42.4 mm/h, serum C reactive protein was 65.2 mg/L, the leukocyte count was 11.64 × 109/L, and hemoglobin was 111 g/L. DIAGNOSIS: In computed tomography (CT) enterography the ascending colon was thickened, and there was effusion and enlarged lymph nodes around the colon. Colonoscopy revealed ulcer, polypoid proliferation, and bowel stenosis in many segments. Chronic inflammation was evident in multiple biopsies. Crohn disease was diagnosed based on the above observations. INTERVENTIONS: Mesalazine was administered at a dose of 4 g daily for 2 years. The patient was hospitalized again due to severe abdominal pain and ongoing fever. Intestinal perforation was detected via CT. Percutaneous drainage was performed followed by administration of intravenous metronidazole (0.5 g) and ciprofloxacin (0.2 g) twice a day. Peptison liquid was used as exclusive EN. After 2 weeks the antibiotics regimen was changed to metronidazole 0.4 g twice a day and ciprofloxacin 0.25 g 3 times a day, both administered orally. OUTCOMES: CT revealed that the infection was eliminated and the fistula was healed after 10 weeks, at which point antibiotics and exclusive EN was discontinued. Azathioprine was prescribed at a dose of 2 mg/kg daily to maintain clinical remission. The patient did not report any pain or diarrhea at a 1-year follow-up visit. LESSONS: The present case suggests that exclusive EN combined with antibiotics is useful in inducing remission in Crohn disease patients with active disease and penetrating complications.


Assuntos
Doença de Crohn/complicações , Doença de Crohn/terapia , Nutrição Enteral/métodos , Perfuração Intestinal/etiologia , Perfuração Intestinal/terapia , Adulto , Antibacterianos/uso terapêutico , Doença de Crohn/tratamento farmacológico , Humanos , Perfuração Intestinal/tratamento farmacológico , Masculino , Indução de Remissão , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X
9.
Clin Interv Aging ; 14: 1255-1264, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31371931

RESUMO

Background: Patients with severe dysphagia after stroke are usually fed using a nasogastric tube. However, this method is inconvenient and causes complications. The oro-esophageal (OE) tube has been used as an alternative parenteral feeding method for patients for whom safe oral feeding is impossible. This study aimed to evaluate the therapeutic effects and complications of OE tube feeding in stroke patients with dysphagia. Methods: This study was designed as a retrospective medical chart review of dysphagic stroke patients who were recommended for OE tube feeding. Thirty-eight stroke patients were recommended for OE tube feeding according to videofluoroscopic swallowing study (VFSS) findings. Of those patients, 17 received OE tube feeding training and conventional dysphagia therapy. Follow-up VFSSs were performed sequentially based on the patients' conditions. When a patient was able to swallow therapeutic foods with specific viscosities during the VFSS, oral feeding was considered to be initiated. Patients were divided into two groups according to final feeding methods. Results: Seventeen patients attempted OE tube feeding. Among them, 64.7% of the patients could change to full oral feeding at their follow-up VFSS evaluation. Additionally, 70.6% of the patients showed gastroesophageal reflux disease regardless of whether they changed to oral feeding. On individual items of the Functional Dysphagia Scale, both groups showed significant improvements in the triggering of pharyngeal swallowing, the amount of residue, and the pharyngeal transit time. These functions were better improved in the patients who could change to oral feeding than in those who could not. Both groups showed significant aggravation of nasal penetration. Conclusion: Our study quantitatively shows the therapeutic effects and complications of OE tube training. OE tube feeding can facilitate the swallowing process and assist patients in transitioning to oral feeding. This easy-to-apply technique may significantly impact future treatment strategies in stroke patients with severe dysphagia.


Assuntos
Transtornos de Deglutição/terapia , Nutrição Enteral/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Idoso , Deglutição , Transtornos de Deglutição/etiologia , Monitoramento do pH Esofágico , Métodos de Alimentação , Feminino , Seguimentos , Refluxo Gastroesofágico/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações , Resultado do Tratamento
10.
Surg Clin North Am ; 99(5): 921-939, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31446918

RESUMO

This article reviews a few surgical palliative care procedures that can be performed by surgeons and interventional radiologists using image-guided techniques. Treatment of recurrent pleural effusions, gastrostomy feeding tube maintenance, percutaneous cholecystostomy, and transjugular intrahepatic portosystemic shunts (TIPS) with embolotherapy of bleeding stomal varices is discussed.


Assuntos
Cuidados Paliativos/métodos , Sistema Biliar/diagnóstico por imagem , Colecistostomia/métodos , Drenagem/métodos , Embolização Terapêutica/métodos , Nutrição Enteral/métodos , Varizes Esofágicas e Gástricas/terapia , Vesícula Biliar/diagnóstico por imagem , Humanos , Pulmão/diagnóstico por imagem , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/terapia , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Radiografia , Toracentese/métodos , Ultrassonografia
11.
Artigo em Inglês | MEDLINE | ID: mdl-31416171

RESUMO

BACKGROUND: This study was carried out to evaluate enteral feeding advancement and tolerance in preterm infants receiving one of two marketed formulas: intact protein preterm formula (IPF) or extensively hydrolyzed formula (EHF) for the first 14 feeding days. METHODS: Primary outcome was days to full enteral feeding (≥140 mL/kg/day). Per protocol analyses included the following: all participants who met study entrance criteria and completed study feeding (primary) and those who received ≥75% enteral intake from study formula (subset). Mothers were encouraged to provide their breast milk. RESULTS: Of the 65 enrolled (IPF: n = 32; EHF: n = 33), 60 completed study feeding per protocol (IPF: n = 30; EHF: n = 30), 37 (62%) received predominantly breast milk, and 23 (38%) received ≥75% study formula intake (IPF: n = 11; EHF: n = 12). No group differences were detected in tolerance measures. No necrotizing enterocolitis (NEC) was reported. Median time to achievement of full enteral feeding was significantly shorter for the IPF vs. EHF group (day 10 vs. 14, p < 0.05) (subset analysis). Mean enteral intake significantly increased by day 14 for the IPF group (p < 0.05), reflecting group divergence as achieved feeding volumes increased. CONCLUSIONS: Results suggest shorter time to full enteral feeding and higher feeding volume achieved by study end in preterm infants receiving intact protein preterm formula versus extensively hydrolyzed formula.


Assuntos
Nutrição Enteral/métodos , Fórmulas Infantis/química , Recém-Nascido Prematuro/crescimento & desenvolvimento , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Leite Humano/química , Feminino , Humanos , Lactente , Recém-Nascido , Itália , Fatores de Tempo
12.
Int J Clin Pract ; 73(11): e13405, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31408231

RESUMO

BACKGROUND: Patients with head and neck cancer (HNC) are at high risk for malnutrition because of tumour localisation and therapy. Prophylactic percutaneous endoscopic gastrostomy (PEG) tube placement is common practice to prevent malnutrition. OBJECTIVE: To investigate the benefits of prophylactic PEG tube placement for HNC patients in terms of the influence on patients' nutritional status, utilisation rate, complications and to identify the predictors of PEG tube utilisation. METHODS: All consecutive HNC patients who underwent prophylactic PEG tube insertion between 1 January 2011 and 31 December 2012 prior to therapy were enrolled. The PEG tube utilisation rate, complications, the patients' nutritional status and tumour therapy were evaluated with the help of electronic patient charts and telephone interviews. RESULTS: A total of 181 patients (48 female, median 67.5 years) were included. The PEG utilisation rate in the entire cohort was 91.7%. One hundred and forty-nine patients (82.3%) used the PEG tube for total enteral nutrition, 17 patients (9.4%) for supplemental nutrition and 15 patients (8.3%) made no use of the PEG tube. Peristomal wound infections were the most common complications (40.3%) in this study. A high Nutritional Risk Screening (NRS) score prior to tube insertion was found to be independently associated with PEG utilisation. No significant weight changes were observed across the three patient subgroups. CONCLUSIONS: The overall PEG tube utilisation rate was high in this study. However, given the high rate of infections, diligent patient selection is crucial in order to determine which patients benefit most from prophylactic PEG tube insertion.


Assuntos
Nutrição Enteral/métodos , Gastrostomia/métodos , Neoplasias de Cabeça e Pescoço/terapia , Intubação Gastrointestinal/métodos , Desnutrição/prevenção & controle , Idoso , Nutrição Enteral/efeitos adversos , Feminino , Gastrostomia/efeitos adversos , Humanos , Intubação Gastrointestinal/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Estudos Retrospectivos
13.
Medicine (Baltimore) ; 98(35): e16944, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464933

RESUMO

INTRODUCTION: Head and neck cancer patients are at a high risk to suffer from malnourishment, a risk that increases in postoperative condition and with the use of enteral nutrition (EN). Until now patients who are suffering from indigestion in the intensive care unit (ICU) received treatment in the form of prokinetic drugs, drugs that can lead to serious side effects and only can partially improve digestion functions. Acupuncture was used successfully in several clinical trials to improve postoperative indigestion in cancer patients without any reported adverse events. The study aims are to investigate acupuncture effect in combination with prokinetic drugs in the treatment of indigestion in postoperative oral and hypopharyngeal cancer patients in the ICU. METHODS: Single-center, double-blind randomized control trial will compare between 2 equal groups. A total of 28 patients that will meet the inclusion criteria: age 30 to 80, postplastic surgery for oral cancer or hypopharyngeal cancer, developed feeding intolerance 2 times in the first postoperative day, Apache score <20, and needed EN. Patients will be randomly divided (1:1) into treatment group or control group for 3 treatments in 3 days along with routine ICU treatment. The main outcome measurement will be the number of days a patient needs to reach his total energy expenditure. EXPECTED OUTCOME: The results will shed light on the effectiveness and safety of acupuncture in a double-blind design treating postoperative ICU cancer patients. In addition, the study presents a revolutionary double-blind design that if, will prove as successful might influence the way double-blind acupuncture studies are performed today. OTHER INFORMATION: The study will be conducted in the surgical ICU department, of China medical university hospital, Taichung 404, Taiwan. The study is conducted on stable ICU patients and is anticipated to have minimum risk for adverse events. Patients enrollment and data collection will start from May 15, 2019. The study expected completion time: June 2021.


Assuntos
Terapia por Acupuntura/métodos , Cuidados Críticos/métodos , Dispepsia/terapia , Neoplasias Hipofaríngeas/cirurgia , Neoplasias Bucais/cirurgia , APACHE , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Dispepsia/etiologia , Nutrição Enteral/métodos , Feminino , Humanos , Neoplasias Hipofaríngeas/complicações , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/complicações , Cuidados Pós-Operatórios , Projetos de Pesquisa , Taiwan
14.
Khirurgiia (Mosk) ; (8): 69-73, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31464278

RESUMO

Percutaneous endoscopic gastrostomy (PEG) was developed in 1980. Since that time this method has become preferable for long-term enteral nutrition. PEG is an effective and relatively safe procedure for enteral nutrition of patients with impaired enteral feeding. However, complications and mortality are also observed. Indications, contraindications and potential complications of PEG are reviewed in the article.


Assuntos
Nutrição Enteral/métodos , Gastrostomia/efeitos adversos , Contraindicações , Nutrição Enteral/efeitos adversos , Gastroscopia , Gastrostomia/métodos , Humanos
15.
Curr Gastroenterol Rep ; 21(9): 47, 2019 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-31368086

RESUMO

PURPOSE OF REVIEW: To discuss the different forms of enteral nutrition, while outlining available evidence for its use in specific conditions and how enteral nutrition composition may or may not influence relevant outcomes. RECENT FINDINGS: Enteral nutrition formulas were originally conceived as a liquid form of nutrition for individuals who otherwise could not consume adequate calories through solid food. Over time, the emergence of specialty formulas marketed to benefit specific diseases or conditions has led to a broad range of potentially confusing options. While most options have theoretical benefit for their marketed conditions, the evidence demonstrating practical benefit is not consistent. Overall, the certainty of evidence for specialty formulas remains low or very low. In most instances, one could begin with standard polymeric formula, except in cases where disease-specific formulas are recommended. Much research is nonetheless still needed to clarify whether some disease-specific formulas are truly beneficial or merely theoretical features.


Assuntos
Nutrição Enteral , Cuidados Críticos/métodos , Diabetes Mellitus/terapia , Nutrição Enteral/classificação , Nutrição Enteral/métodos , Gastroenteropatias/terapia , Humanos , Nefropatias/terapia , Pneumopatias/terapia , Obesidade/terapia
16.
Drug Discov Ther ; 13(3): 157-163, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31327790

RESUMO

Enteral nutrition is beneficial support administered as oral supplements or via tube feeding for patients with long-term inability to meet nutritional requirements orally. However, because of the high volumes administered, vomiting and gastroesophageal reflux are often encountered in patients receiving enteral nutrition. EN-P05 is a novel, highly concentrated enteral nutrition formula that was developed to reduce dosing volume and that satisfies the Japanese recommended daily allowance for most vitamins and trace elements, even in patients who require low-calorie control, such as home-care patients. However, whether EN-P05 can provide nutritional management equivalent to that provided by approved formulas has remained unknown. To investigate the nutritional effectiveness of EN-P05, we evaluated body weight gain, serum chemistry parameters, nitrogen balance, and fat absorption in 7-week-old gastrostomized rats that received either EN-P05 or OSN-001 for 2 weeks. No difference in organ or carcass weight was found between the groups. No significant between-group differences were observed in serum albumin, total protein, triglycerides, or total cholesterol, nor in nitrogen retention or fat absorption rate. No adverse effects associated with administration of EN-P05 were found. These results suggest that EN-P05 can provide the same nutritional management as approved formulas, even when administered in smaller volume.


Assuntos
Nutrição Enteral/métodos , Estado Nutricional , Animais , Peso Corporal , Gastrostomia , Japão , Masculino , Modelos Animais , Necessidades Nutricionais , Ratos , Recomendações Nutricionais
17.
Cochrane Database Syst Rev ; 7: CD001198, 2019 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-31328789

RESUMO

BACKGROUND: Enteral tube feeding is routinely used in many cystic fibrosis centres when oral dietary and supplement intake has failed to achieve an adequate nutritional status. The use of this method of feeding is assessed on an individual basis taking into consideration the patients age and clinical status. This is a final update of a previously published review. OBJECTIVES: To examine the evidence that in people with cystic fibrosis, supplemental enteral tube feeding improves nutritional status, respiratory function, and quality of life without significant adverse effects. SEARCH METHODS: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. We also contacted the companies that market enteral feeds and reviewed their databases.Date of the most recent search of the Group's Cystic Fibrosis Trials Register: 10 July 2019.Date of the most recent hand search of PubMed: 26 October 2018. SELECTION CRITERIA: All randomised controlled trials comparing supplemental enteral tube feeding for one month or longer with no specific intervention in people with cystic fibrosis. DATA COLLECTION AND ANALYSIS: The searches identified 44 trials; however, none were eligible for inclusion in this review. MAIN RESULTS: There are no trials included in this review. AUTHORS' CONCLUSIONS: Supplemental enteral tube feeding is widely used throughout the world to improve nutritional status in people with cystic fibrosis. The methods mostly used, nasogastric or gastrostomy feeding, are expensive and may have a negative effect on self-esteem and body image. Reported use of enteral tube feeding suggests that it results in nutritional and respiratory improvement; but, efficacy has not been fully assessed by randomised controlled trials. It is acknowledged, however, that performing a randomised controlled trial would be difficult due to the ethics of withholding an intervention in a group of people whose nutritional status necessitates it.


Assuntos
Fibrose Cística/terapia , Nutrição Enteral/métodos , Suplementos Nutricionais , Humanos , Estado Nutricional , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
18.
Cochrane Database Syst Rev ; 7: CD004080, 2019 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-31329285

RESUMO

BACKGROUND: This is an update of the review last published in 2011. It focuses on early postoperative enteral nutrition after lower gastrointestinal surgery. Traditional management consisted of 'nil by mouth', where patients receive fluids followed by solids after bowel function has returned. Although several trials have reported lower incidence of infectious complications and faster wound healing upon early feeding, other trials have shown no effect. The immediate advantage of energy intake (carbohydrates, protein or fat) could enhance recovery with fewer complications, and this warrants a systematic evaluation. OBJECTIVES: To evaluate whether early commencement of postoperative enteral nutrition (within 24 hours), oral intake and any kind of tube feeding (gastric, duodenal or jejunal), compared with traditional management (delayed nutritional supply) is associated with a shorter length of hospital stay (LoS), fewer complications, mortality and adverse events in patients undergoing lower gastrointestinal surgery (distal to the ligament of Treitz). SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library 2017, issue 10), Ovid MEDLINE (1950 to 15 November 2017), Ovid Embase (1974 to 15 November 2017). We also searched for ongoing trials in ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform (15 November 2017). We handsearched reference lists of identified studies and previous systematic reviews. SELECTION CRITERIA: We included randomised controlled trials (RCT) comparing early commencement of enteral nutrition (within 24 hours) with no feeding in adult participants undergoing lower gastrointestinal surgery. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study quality using the Cochrane 'Risk of bias' tool tailored to this review and extracted data. Data analyses were conducted according to the Cochrane recommendations.We rated the quality of evidence according to GRADE.Primary outcomes were LoS and postoperative complications (wound infections, intraabdominal abscesses, anastomotic dehiscence, pneumonia).Secondary outcomes were: mortality, adverse events (nausea, vomiting), and quality of life (QoL).LoS was estimated using mean difference (MD (presented as mean +/- SD). For other outcomes we estimated the common risk ratio (RR) and calculated the associated 95% confidence intervals. For analysis, we used an inverse-variance random-effects model for the primary outcome (LoS) and Mantel-Haenszel random-effects models for the secondary outcomes. We also performed Trial Sequential Analyses (TSA). MAIN RESULTS: We identified 17 RCTs with 1437 participants undergoing lower gastrointestinal surgery. Most studies were at high or unclear risk of bias in two or more domains. Six studies were judged as having low risk of selection bias for random sequence generation and insufficient details were provided for judgement on allocation concealment in all 17 studies. With regards to performance and deception bias; 14 studies reported no attempt to blind participants and blinding of personnel was not discussed either. Only one study was judged as low risk of bias for blinding of outcome assessor. With regards to incomplete outcome data, three studies were judged to be at high risk because they had more than 10% difference in missing data between groups. For selective reporting, nine studies were judged as unclear as protocols were not provided and eight studies had issues with either missing data or incomplete reporting of results.LOS was reported in 16 studies (1346 participants). The mean LoS ranged from four days to 16 days in the early feeding groups and from 6.6 days to 23.5 days in the control groups. Mean difference (MD) in LoS was 1.95 (95% CI, -2.99 to -0.91, P < 0.001) days shorter in the early feeding group. However, there was substantial heterogeneity between included studies (I2 = 81, %, Chi2 = 78.98, P < 0.00001), thus the overall quality of evidence for LoS is low. These results were confirmed by the TSA showing that the cumulative Z-curve crossed the trial sequential monitoring boundary for benefit.We found no differences in the incidence of postoperative complications: wound infection (12 studies, 1181 participants, RR 0.99, 95%CI 0.64 to 1.52, very low-quality evidence), intraabdominal abscesses (6 studies, 554 participants, RR 1.00, 95%CI 0.26 to 3.80, low-quality evidence), anastomotic leakage/dehiscence (13 studies, 1232 participants, RR 0.78, 95%CI 0.38 to 1.61, low-quality evidence; number needed to treat for an additional beneficial outcome (NNTB) = 100), and pneumonia (10 studies, 954 participants, RR 0.88, 95%CI 0.32 to 2.42, low-quality evidence; NNTB = 333).Mortality was reported in 12 studies (1179 participants), and showed no between-group differences (RR = 0.56, 95%CI, 0.21 to 1.52, P = 0.26, I2 = 0%, Chi2 = 3.08, P = 0.96, low-quality evidence). The most commonly reported cause of death was anastomotic leakage, sepsis and acute myocardial infarction.Seven studies (613 participants) reported vomiting (RR 1.23, 95%CI, 0.96 to 1.58, P = 0.10, I2 = 0%, Chi2 = 4.98, P = 0.55, low-quality evidence; number needed to treat for an additional harmful outcome (NNTH) = 19), and two studies (118 participants) reported nausea (RR 0.95, 0.71 to 1.26, low-quality evidence). Four studies reported combined nausea and vomiting (RR 0.94, 95%CI 0.51 to 1.74, very low-quality evidence). One study reported QoL assessment; the scores did not differ between groups at 30 days after discharge on either QoL scale EORTC QLQ-C30 or EORTC QlQ-OV28 (very low-quality evidence). AUTHORS' CONCLUSIONS: This review suggests that early enteral feeding may lead to a reduced postoperative LoS, however cautious interpretation must be taken due to substantial heterogeneity and low-quality evidence. For all other outcomes (postoperative complications, mortality, adverse events, and QoL) the findings are inconclusive, and further trials are justified to enhance the understanding of early feeding for these. In this updated review, only a few additional studies have been included, and these were small and of poor quality.To improve the evidence, future trials should address quality issues and focus on clearly defining and measuring postoperative complications to allow for better comparison between studies. However due to the introduction of fast track protocols which already include an early feeding component, future trials may be challenging. A more feasible trial may be to investigate the effect of differing postoperative energy intake regimens on relevant outcomes.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Nutrição Enteral/métodos , Tempo de Internação , Complicações Pós-Operatórias/prevenção & controle , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo
19.
Medicine (Baltimore) ; 98(30): e16472, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348251

RESUMO

BACKGROUNDS: Patients with central nervous system injuries present with dysphagia and may require non-oral feeding methods, like percutaneous endoscopic gastrostomy, nasogastric (NG) tube, or oroesophageal (OE) tube. The prevalence of pneumonia in patients with gastroesophageal reflux (GER) is significantly higher than that in patients without GER. We aimed to determine the most appropriate tube feeding with low risk of GER by comparing the results of 24-hour pH monitoring studies in patients who were administered 2 types of feeding: NG tube and OE tube. METHODS: In this pilot study, 6 stroke patients underwent 24-hour esophageal pH monitoring during NG tube feeding and OE tube feeding, sequentially. Parameters collected included acid exposure time, mean esophageal pH, number of reflux episode, time of bolus reflux for both total 24-hour pH study data and postprandial data, and deMeester composite score. RESULTS: Total acid reflux time (minutes) decreased more with OE tube feeding than that with NG tube feeding in the total 24-hour pH study. The number of reflux episodes decreased in both total and postprandial data with OE tube feeding versus NG tube feeding (P < .05). There were no significant differences in mean esophageal pH and total time of bolus reflux between the 2 groups. CONCLUSIONS: Although we could not definitively conclude that OE tube feeding decreased the severity of GER compared with NG tube feeding, there were significant differences in 4 out of 9 parameters. OE tube can be a substitute for NG tube in patients with dysphagia after stroke leading to GER disease.


Assuntos
Nutrição Enteral/métodos , Esôfago , Refluxo Gastroesofágico/etiologia , Intubação/efeitos adversos , Intubação/métodos , Adulto , Idoso , Monitoramento do pH Esofágico , Feminino , Humanos , Intubação Gastrointestinal/efeitos adversos , Intubação Gastrointestinal/métodos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Reabilitação do Acidente Vascular Cerebral , Fatores de Tempo
20.
Nutr. hosp ; 36(extr.3): 63-69, jul. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184438

RESUMO

Los pacientes con insuficiencia renal crónica presentan frecuentemente malnutrición calórico-proteica, y esta situación es un predictor de morbilidad y mortalidad. En este artículo, se resumen las causas de la desnutrición y las diferentes aproximaciones terapéuticas para revertirla, entre las que se incluyen la suplementación nutricional oral o parenteral, especialmente durante la diálisis


Chronic kidney disease patients often also present protein-calorie malnutrition, and it is a powerful predictor of morbidity and mortality. In this article, causes and management are shown, highlighting oral and parenteral nutritional supplementation, especially during dialysis process


Assuntos
Humanos , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/dietoterapia , Desnutrição Proteico-Calórica/complicações , Suplementos Nutricionais , Indicadores de Morbimortalidade , Diálise , Desnutrição Proteico-Calórica/etiologia , Nutrição Enteral/métodos , Nutrição Parenteral/métodos , Apoio Nutricional
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