Effects of enteral nutrition beginning at different time on aspiration rate and immune function in patients with severe traumatic brain injury / 中国康复理论与实践

@#Objective To investigate the effect of enteral nutritional support beginning at different time on aspiration events and immune function in the early post-traumatic (within 14 days) period in patients with severe traumatic brain injury.Methods From June, 2018, to February, 2021, 75 patients with acute traumatic brain injury admitted in the Department of Neurosurgery of the Second People's Hospital of Lianyungang were randomly divided into early feeding group (24 to 48 hours, n=35) and delayed feeding group (48 to 120 hours, n=40). The 14-day reflux rate, aspiration rate, incidence of aspiration pneumonia, immune indexes and complications were compared between two groups.Results There was no significant difference in the reflux rate, aspiration rate and the incidence of aspiration pneumonia between the two groups (P > 0.05). The levels of IgG, IgA, and complements C3 and C4 were significantly higher in the early feeding group than in the delayed feeding group (|t| > 1.720, P<0.001). The incidence of non-aspiratory lung infections was significantly lower in the early feeding group than in the delayed feeding group (χ2=4.728, P<0.05).Conclusion Initiating enteral nutrition within 24 to 48 hours after injury may preserve immune function and reduce the incidence of non-aspiratory lung infections in patients with severe traumatic brain injury.

Is perioperative fasting associated with complications, length of hospital stay and mortality among gastric and colorectal cancer patients? A cohort study

ABSTRACT BACKGROUND: During a surgical procedure, patients are often subjected to fasting for times that are more prolonged than the ideal, which may lead to complications. OBJECTIVE: To evaluate the duration of perioperative fasting and its association with postoperative complications, length of hospital stay (LOS) and mortality among gastric and colorectal cancer patients. DESIGN AND SETTING: Cohort study developed in a surgical oncology hospital in the city of Natal (Rio Grande do Norte, Brazil). METHODS: Patients aged over 18 years were included. The Clavien-Dindo surgical complication scale was used to evaluate occurrences of postoperative complications. LOS was defined as the number of days for which patients stayed in the hospital after surgery, or until the day of death. RESULTS: Seventy-seven patients participated (59.8 ± 11.8 years; 54.5% females; 70.1% with bowel tumor). The incidences of postoperative complications and death were 59.7% and 3.9%, respectively. The duration of perioperative fasting was 59.0 ± 21.4 hours, and it was higher among non-survivors and among patients with prolonged hospital stay (≥ 6 days). For each one-hour increase in the durations of perioperative and postoperative fasting, the odds of prolonged hospitalization increased by 12% (odds ratio, OR = 1.12; 95% confidence interval, CI 1.04-1.20) and 5% (OR = 1.05; 95% CI 1.02-1.08), respectively. CONCLUSION: Prolonged perioperative fasting, especially in the postoperative period, was observed in a sample of patients with gastric and colorectal cancer, and this was an independent predictor of LOS.

Effectiveness of Early Enteral Feeding in Major Burn Patient

PURPOSE: Early enteral feeding is recommended in cases of critical illness. However, it is unclear whether this recommendation is of most benefit to extremely ill patients. From our experiences, our authors believed that early enteral nutrition can lead to better prognosis of ICU patients. We aim to clarify the efficacy of early enteral feeding. METHODS: Eighty six critically ill patients were enrolled and grouped as "Early enteral feeding (EF)" and "Delayed enteral feeding (DF)" for this cross-sectional, prospective randomized observational study. To reduce the selection bias, we compare our groups to 20~39% (group A) TBSA (total body surface area, and 40~59% (group B) TBSA burned. BMI (body mass index), length of ICU stay, length of hospital stay, hospital mortality, serum prealbumin, serum transfferin and lymphocyte count data were collected over 28 days. RESULTS: There were no statistical differences in measured outcomes between early and late feeding groups. In serologic test; prealbumin, transferrin and lymphocyte, there is also no statistical difference except 2nd, 4th week of lymphocyte. EF group has higher lymphocyte than DF group. In the group A, however, prealbumin and transferrin was high in EF group during the whole 4 weeks of study. Comparing the ICU stay and hospital mortality, there was also no statistical significance. CONCLUSION: In this study, there is no significant association between hospital outcomes and timing of enteral feeding initiation. More active trials and many-sided studies will be needed to maximize the effect of early enteral nutritional support as a method to improve treatment for major burned patients.

a comparative study between early enteral feeding (within 24 hours) versus conventional enteral feeding after enteric anastomosis.

Background: Traditionally, enteric feeds are withheld for a period of 48-72 hrs, sometimes even more following enteric anastomosis depending upon return of full peristaltic sounds. This results in a period of nonstimulation of gut –‘Gut Rest’, which was supposed to result in better anastomotic healing. But this same also deprives the intestinal mucosa of surface nutrients as well as prolongs parenteral fluid therapy, thereby depriving the patients of adequate nutrition. Along with it, prolonged parenteral therapy also keeps the patients bound to bed with its resultant complications like, prolonged hospital stay and increased cost of therapy. Objectives: To compare the benefits of early enteral feeding over conventional enteric feeding following enteric anastomosis with special regards to patients recovery and complications. Methods and materials: The selection of patients into group A (60) and group B (60) was done after having fulfilled inclusion and exclusion criteria. Informed consent was obtained. The patients of group A were fed via enteral route within 24 hrs of enteric anastomosis. The patients of group B were fed via enteral route after 48-72 hrs or appearance of full peristaltic sounds following enteric anastomosis. These patients were followed in post operative period for their drain output, any nausea, vomiting or significant abdominal distension, prolonged ileus, post operative duration of shospital stay, post operative infective complications (e.g. wound infection, UTI, RTI), and different haematological and biochemical examinations. Results: This study shows that post operative nausea-vomiting, anastomotic leakage rate, re-exploration , wound infection and RTI rates are higher in group A than those of group B. In this study, the incidence of UTI in post operative period is higher in group B. But the differences in above mentioned variables are not statistically significant. Whereas appearance of intestinal peristaltic sound is earlier in group A (42.8 ± 10.68 hours) compare to that of group B (52.6 ± 13.46 hours). Here, the difference is statistically significant (p value = 0.000022) The duration of post operative hospital stay is shorter in group A (8.45 ± 5.143 days) than that of group B (10.533 ± 4.952 days). The difference of duration post operative hospital stay is statistically significant (p value = 0.0257). Removal of nasogastric tube, resumption of oral feeding, and passage of first flatus and/or defecation were earlier in the group A than that of the group B; the differences were statistically significant. The post operative day-5 albumin level is better in group A (3.147 ± 0.4409 gm/dl) than that of group B (2.935 ± 0.3124 gm/dl). This difference is also statistically significant (p value = 0.0029). There are three mortalities in group Awhereas one mortality in group B. This difference in mortality in two groups is not statistically significant.

The Effects of Early Enteral Feeding in Extremely Low Birth-Weight Infants / 소아과

PURPOSE: With the recent improved survival of extremely low birth weight infants (ELBWI), enteral feeding has become a major issue. This study investigates the effects of early enteral feeding in ELBWI on their morbidity, duration of hospitalization, and mortality. METHODS: ELBWI admitted to the neonatal intensive care unit at Samsung Medical Center from November 1994 to April 2004 who survived more than 14 days were enrolled. ELBWI were divided into two groups: an early feeding group (EF), in which enteral feeding was started within 3 days after birth; and a late feeding group (LF), in which enteral feeding was started beyond 3 days after birth. 80 ELBWI came under EF, and 131 ELBWI under LF. RESULTS: Birth weight and gestational age did not differ between the two groups. In EF, the time to achieve full enteral feeding and the duration of parenteral nutrition were significantly shorter than in LF. The incidence of bronchopulmonary dysplasia was significantly lower in EF, but the incidences of sepsis, necrotizing enterocolitis, and cholestasis were not different between the two groups. There was no difference in the survival rate between the two groups, but the duration of hospitalization was significantly shorter in EF. CONCLUSION: Early enteral feeding in ELBWI did not increase the incidence of necrotizing enterocolitis and sepsis, but rather decreased the incidence of bronchopulmonary dysplasia and shortened the duration of hospitalization.

Investigation of Early Enteral Feeding in Patients with Major Burns

PURPOSE: Severe burns induce multiple derangements in normal homeostasis. In this conditions, the value of proper nutritional supports can not be overemphasized. The purpose of this study was to evaluate the nutritional, immunological, catabolic and clinical effects of early enteral support in major burn patients. METHODS: The subjects were 49 major burned adults admitted to the Hangang Sacred Heart Hospital between June 1, 2003 and August 31, 2003. The patients qualified for study participation if they were over 20 years of age, sustained burns in excess of a 35% total body surface area or a 25% full-thickness burn. The early feeding (EF) group started enteral feeding within 48 hours of injury, and the delayed feeding (DF) group started after 48 hours. Each patients received entreral feeing through a nasogastric tube. The calorifice requirements were calculated by a modified Long's formula. Enteral feeding was discontinued when the patients could voluntarily orally take at least 60~70 percent of their estimated calorific or protein needs. The serum prealbumin, transferrin and immunoglobulin (IgG, IgA and IgM) concentrations, total lymphocyte counts and cortisol were monitored as a nutritional, immunological and catabolic marker. The clinical outcomes of the two groups were compared. RESULTS: Several of the markers were in an arithmtically high state for the EF group, but these were not statistical significance. There were no significant differences in the clinical outcomes between the two groups. CONCLUSION: More active trials and many-sided studies will be needed to maximize the effect of early enteral nutritional support as a method to improve treatment for major burned patients.

Gastrointestinal Problems and Early Enteral Feeding in Mechanically Ventilated Preterm Infants

Extremely low birth weight (ELBW) infants in neonatal intensive care units often receive overriding attention to their acute respiratory illness that appropriate attention to certain other "adjunctive" needs, like adequate nutrition, is often delayed. Clinical reluctance to attempt this enterally includes concerns involving immaturity of gastrointestinal tract, severe medical problems like respiratory distress syndrome (RDS) with the need for assisted ventilation, and fear of necrotizing entrocolitis (NEC). As a consequence, ill newborns may experience periods of moderate to severe under-nutrition during the most acute phase of their respiratory problems. We are now at a juncture where the optimal time to begin enteral feedings in our smallest and sickest preterm infants is being re- evaluated. The practical aspects of how to proceed in providing ideal energy, protein, and specific nutrients for these infants are not easy. The purpose of this article is to review and scrutinize nutritional decisions that need to be made in these critically ill neonates on assisted ventilation. In the first part of this article, Enteral Nutrition such as minimal enteral feeding (MEF), osmolarity, choice of milk, methods of delivery, when to start, etc. will be discussed. In the second part of this article, gastrointestinal (GI) problem such as GI motility, gastroesophageal reflux (GER), tracheal aspiration, gastric hemorrhage or perforation, necrotizing enterocolitis, etc. will be discussed. Though many physiologic studies have supported MEF in preterm infants, clinical studies have not sufficiently addressed the questions of "How early?" "How much?" "For how long?". But most enteral feeding in preterm infants, especially ventilated ELBW infant, must be individualized.

Effects of Early Enteral Feeding on the Preservation of Intestinal Mucosal Barrier in Severely Burned Patients / 中国医师杂志

Objective To study the effects of early enteral feeding on the preservation of intestinal mucosal barrier in severely burned patients. Methods Twenty-two patients with severe burn were randomly divided into early enteral feeding group (EF) and delayed enteral feeding group (DF). The levels of serum endotoxin and TNF-? were dynamically detected in the patients of both groups, and two unmetabolized sugars (lactose and mannitol) were orally administered in these patients on 1d, 3d and 5d of postburn. The concentrations of lactose and mannitol in urinary and the L/M ratio were observed. Intestinal permeability was assessed by the L/M ratio. Results The levels of serum endotoxin and TNF-? in severely burned patients were significantly higher than in normal (P

The effects of early enteral feeding on rats after hermorrhagic shock / 肠外与肠内营养

Objectives:To investigate the effects of early enteral feeding(EEF) after hemorrhagic shock(HS) on gut structure and function,hormones for stress and metabolism and nutritional conditions. Methods:Seventy two Wistar rats were randomly divided into sham shock group(SS),HS group(HS) and post HS EEF gorup(HSE).HSE group was fed with ENSURE and HS group was fed with normal saline.EEF was started within 1 hour after resuscitation.The body weight,liver weight,musculus gastrocnemius weight,nitrogen content in liver and musculus gastrocnemius,total plasma protein level,albumin level,MDA(malondialdehyde) and Na + K + ATPase activity in stomach and jejunum mucosa, the change of liver function, the levels of glucagon,cortisol and insulin,and the pathological changes in stomach, small intestine and liver were investigated at 2,6,24,48 h after resuscitation. Results:When compared with HS group,the weight of body,liver and musculus gastrocnemius,the nitrogen content in liver and musculus gastrocnemius,the levels of total plasma protein and albumin and the liver function were significantly better in the HSE group.MDA content was less and Na + K + ATPase activity was higher in HSE group than those in HS group.The glucagon and cortisol levels were significantly lower and the insulin level was significantly higher in HSE group than those in HS group.The pathological changes in the stomach,intestine and liver in HSE group got an obvious improvement. Conclusions:After HS,EEF is helpful to maintain visceral organ function,reduce the stress and hypermetabolic response and improve the nutritional conditions.