Добірка наукової літератури з теми "Nasojejunal feeding"

Enteral nutrition in the early phase of predicted severe acute pancreatitis can be administered via a nasogastric or nasojejunal tube. Finding the most effective method in terms of daily balance, the volume of feeding and residual gastric volume in the early period of moderate and severe acute pancreatitis is a current challenge.The aim of the study was to estimate the efficacy of nasogastric and nasojejunal early enteral feeding duringthe early phase of predicted severe acute pancreatitis.Material and methods. The study was prospective, single-center, and randomized. The data were collected from November 2012 to October 2018. The study included 64 ICU patients in the early period of acute pancreatitis exhibiting predictors of severity. During randomization, the patients were assigned to either nasogastric (group 1) or nasojejunal (group 2) feeding for the next four days. The volume of enteral feeding on Day 1 was 250 ml/day, and on each successive day it was increased by 250 ml/day. During group allocation, the disease severity and the way of nutrient administration were taken into account. Daily balance was calculated using the difference between enterally administered and residual gastric volume. Statistical analysis was performed using SPSS v.23 software package. The null hypothesis was rejected at P0.05.Results. The volume of enteral nutrition administered over 4 days did not differ between the study groups. Patients with severe acute pancreatitis had significantly better nutrient absorption over 4 days when the postpyloric route was used (1.63±0.98 l/d) vs the nasogastric one (0.55±0.29 l/d) (P=0.001). In moderate pancreatitis, the enteral nutrition absorption over 4 days did not differ (P=0.107) between the groups with nasogastric (2.06±0.87 l/day) and nasojejunal (2.6±0.45 l/day) feeding.Conclusion. Nasojejunal route is the preferred way to start enteral feeding in patients with severe acute pancreatitis. In moderate acute pancreatitis, feeding can be initiated via the gastric route and only in case of intolerance it should be switched to the nasojejunal one.

Interest in noninvasive feeding tube placement in companion animals led to the adaption of a human technique utilizing endoscopy to place nasojejunal feeding tubes. Data from medical records in which nasojejunal feeding tubes were attempted were reviewed. Feeding tubes were attempted and successfully placed in five dogs within a median of 35 min. Feeding tubes remained in place for approximately 7 days. Complications included facial irritation (5/5), sneezing (5/5), fractured facial sutures (4/5), vomiting (3/5), diarrhea (3/5), crimping of feeding tube (3/5), regurgitation (1/5), epistaxis (1/5), clogging of the feeding tube (2/5), and oral migration with premature removal of the feeding tube (1/5). The deployment technique used in this study was found to be cumbersome. Despite minor complications, endoscopy can be used to rapidly and accurately place nasoenteric feeding devices.

This systematic review was undertaken as a result of a clinical question. The question being, “what is the optimum perioperative fasting/feeding regime for patients with burn injuries?” Fasting for theatre has been identified in research to have deleterious effects on surgical patients’ nutrient intake, wellbeing and insulin resistance. Perioperative fasting is however intended to protect patients from regurgitation and pulmonary aspiration during surgery and immediately thereafter. Within the burns specialty, it was noted that some published research existed which investigated either short fasting or intraoperative feeding on clinical outcomes in patients with burn injuries. This systematic review aimed to synthesise all of the available research evidence and provide evidenced-based recommendations as to whether perioperative nutrition was safe for patients with burn injuries and whether it influenced patient outcomes. A quantitative review of effectiveness, in keeping with JBI methodology, was identified as the most appropriate approach to address the aims and objectives of this research. The population of interest in this systematic review was people admitted for primary management of an acute burn injury which required surgical management. The intervention of either intraoperative enteral feeding or short fasting (less than 2 hours before surgery) was compared to perioperative fasting. Outcome measures were mortality, wound infection, length of stay, pulmonary aspiration events, pneumonia, Calorie delivery, ventilator days, wellbeing as well as any other relevant outcomes (e.g. bacteremia, clinical sepsis, antibiotic days, intensive care length of stay, supplemental albumin and length of stay per percentage of full-thickness burn). Key databases searched were PubMed, CINAHL, Embase, Web of Science and Cochrane Central Register of Controlled Trials. Only studies published in English were considered. There were no date limits. Full texts of selected studies were retrieved and assessed against inclusion criteria. Studies that did not meet the inclusion criteria were excluded and reasons provided. Where possible, data synthesis was pooled in a statistical meta-analysis. When statistical pooling was not possible, the findings are presented in narrative form. The systematic search identified 327 studies for potential inclusion (after duplicates were removed) however 320 studies were excluded. Seven studies were identified to have met the inclusion criteria. Two of the included studies were randomised controlled trials, three were retrospective cohort studies, one was a case series and one was a case report. The results of the systematic review indicate intraoperative post pyloric feeding was safe in the patient groups investigated, since there were nil aspiration events in a combined intervention population of 509 patients. The safety of short fasting (feeds up to 1 hour before surgery) on aspiration events in non-ventilated patients with nasogastric enteral nutrition was less clear. There were nil aspiration events recorded but there was only one included study with 7 patients who received short fasting for nasogastric nutrition. The effectiveness of perioperative nutrition was demonstrated by the consistent result of increased Caloric provision in patients who received intraoperative post pyloric feeding. Other outcome measures relating to the effectiveness of perioperative nutrition had varied results. Patient wellbeing was improved with shorter perioperative fasting in the singular case report and this result is consistent with literature for other surgical patients, but the certainty of the results from the included case report was very low. The outcomes of mortality, wound infection, length of stay, and ventilator days were inconsistent, with some studies showing improvements with perioperative feeding and others indicating worsening of these outcome measures. Two studies reported on pneumonia and both reported a slightly higher occurrence of pneumonia in the patient groups who received intraoperative post pyloric enteral feeding. Small sample sizes, high heterogeneity and major confounding factors between control and intervention groups contributed to very low certainty of findings. Although this systematic review indicated perioperative enteral nutrition is safe and improves Caloric intake in patients with burn injuries, further research is needed to determine whether perioperative feeding has an impact on other patient outcomes. A recommendation for future research could be a large-scale multi-centre research project where patients are randomly allocated to receive either standard treatment or post pyloric perioperative feeding. Outcome measures could include patient wellbeing, insulin resistance, as well as wound infection, length of stay, mortality, pneumonia, ventilator days and Caloric intake.
Thesis (MClinSc) -- University of Adelaide, Adelaide Medical School, 2020

This study evaluated whether starting nasojejunal tube feeding within 24 hours of presentation would reduce the rate of death or major complications in patients with acute pancreatitis. This strategy was compared to allowing patients to take an “on demand” oral diet and only initiating nasojejunal tube feeding if there was poor oral intake by 96 hours after presentation. There was no difference between the two groups in any of the measured outcomes, though the study may have been underpowered. We conclude it is acceptable to allow an on-demand oral diet and reserve nasoenteric feeding for patients who have not achieved adequate nutrition by 96 hours after presentation. It is not necessary or beneficial to start nasojejunal tube feeds in the first 24 hours.