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)

Teaching and learning strategies in Home Enteral Nutritional Therapy: Knowledge gains perceived by caregivers / Estratégias de ensino e aprendizagem na Terapia Enteral domiciliar: ganhos de conhecimentos percebidos por cuidadores / Estrategias de enseñanza y aprendizaje en Terapia Enteral domiciliaria: adquisición de conocimiento percibida por los cuidadores

Abstract Objective: to evaluate how different educational strategies contribute to knowledge gains perceived by caregivers of people using Enteral Nutritional Therapy. Method: a quasi-experimental study conducted in two stages: the first one included an interactive lecture class (LC) and the second was carried out in two groups: in-situ simulated skills training (ST) and reading of an educational booklet (EB). The caregivers answered a self-administered questionnaire to assess knowledge before and after the interventions; for the analysis, a generalized linear model with Poisson distribution was proposed and the comparisons were carried out using orthogonal contrasts. Results: the participants were 30 caregivers; evidence of a difference in knowledge between the t1and t0 moments is evidenced. The analysis of the final comparison about the knowledge gain between the EB and ST groups, according to Student's t, evidenced an estimated difference of -1,33, with 95% CI (-4.98; 2.31) and p-value=0.46. Conclusion: knowledge was further increased between the t1 and t0 moments, when compared to the t2 and t1 moments in both groups. When compared, we cannot conclude that one of the groups changed more than the other in relation to moment t0 and t2; thus, the study evidenced the knowledge gain after all the educational strategies in both groups.

Resumo Objetivo: avaliar como diferentes estratégias educativas contribuem para ganhos de conhecimento percebidos por cuidadores de pessoas em uso da Terapia Nutricional Enteral. Método: estudo quase-experimental realizado em duas etapas; a primeira contemplou uma aula expositiva dialogada (AE) e a segunda aconteceu em dois grupos: treino de habilidades (TH) simulado in situ e leitura da cartilha educativa (CE). Os cuidadores responderam um questionário autoaplicável para avaliação de conhecimentos em pré e pós-intervenções; para a análise foi proposto um modelo linear generalizado com distribuição Poisson e as comparações foram realizadas por contrastes ortogonais. Resultados: participaram 30 cuidadores, observou-se evidência de diferença de conhecimento entre os tempos t1 e t0. A análise da comparação final sobre o aumento do conhecimento entre os grupos CE e TH, por teste t-Student, evidenciou uma diferença estimada de -1,33, com IC 95% (-4,98; 2,31) e valor de p de 0,46. Conclusão: ocorreu uma maior elevação de conhecimento entre os tempos t1 e t0, quando comparada os tempos t2 e t1 em ambos os grupos. Quando comparados, não podemos concluir que um dos grupos mudou mais que o outro em relação aos tempos t0 e t2; assim, o estudo evidenciou o ganho de conhecimento após todas as estratégias educativas nos dois grupos.

Resumen Objetivo: evaluar cómo las diferentes estrategias educativas contribuyen a la adquisición de conocimiento percibida por los cuidadores de personas que utilizan Terapia Nutricional Enteral. Método: estudio cuasiexperimental realizado en dos etapas; la primera incluyó una clase expositiva dialogada (CE) y la segunda se desarrolló en dos grupos: entrenamiento de habilidades (EH) simuladas in situ y lectura del folleto educativo (FE). Los cuidadores respondieron un cuestionario autoadministrado para evaluar el conocimiento pre-posintervenciones; para el análisis se propuso un modelo lineal generalizado con distribución de Poisson y las comparaciones se realizaron mediante contrastes ortogonales. Resultados: participaron 30 cuidadores, había evidencias de la diferencia de conocimiento entre los tiempos t1 y t0. El análisis de la comparación final sobre el aumento de conocimientos entre los grupos FE y EH, mediante la prueba t de Student, mostró una diferencia estimada de -1,33, con un IC del 95% (-4,98; 2,31) y un valor de p de 0,46. Conclusión: hubo un mayor aumento del conocimiento entre los tiempos t1 y t0, que entre los tiempos t2 y t1 en ambos grupos. Al compararlos, no podemos concluir que uno de los grupos cambió más que el otro entre t0 y t2; por lo tanto, el estudio demostró que hubo adquisición de conocimiento después de todas las estrategias educativas en ambos grupos.

Fatores associados à indicação de via alternativa de alimentação após câncer de língua: uma revisão sistemática / Factors associated with the indication of alternative feeding following tongue cancer: a systematic review / Factores asociados a la indicacíon de via alternativa de nutrición después del cáncer de lengua: una revisión sistemática

Introdução: O câncer de cavidade oral constitui lesões da superfície da mucosa oral, e, devido às sequelas da doença e de seu tratamento, frequentemente ocorrem quadros de disfagia. Quando a alimentação por via oral se torna impossibilitada, é fundamental a indicação de vias alternativas de alimentação. Objetivo: verificar a ocorrência e os fatores associados ao uso de via alternativa de alimentação após câncer de língua. Método: A busca foi conduzida por dois pesquisadores independentes nas bases de dados Medline (Pubmed), LILACS, SciELO, Scopus, WEB OF SCIENCE e BIREME sem restrição de idioma e localização, no período de 2010 a 2021. Para complementar e evitar viés de risco foi realizada uma busca por literatura cinza no Google Scholar. Critérios de Seleção: A revisão sistemática foi conduzida conforme as recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Foram incluídos na pesquisa estudos que obtiveram pontuação ≥ a 6 pontos segundo o protocolo para pontuação qualitativa proposto por Pithon. Resultados: Os estudos mostram que a maioria dos indivíduos com câncer oral desenvolvem uma perda significativa de peso, necessitando de intervenção. O estágio geral da doença é um preditor significativo de perda de peso crítica em pacientes em tratamento. Conclusão: A indicação de via alternativa de alimentação após câncer de língua foi de 19,3% a 68,2%, e os fatores associados a essa indicação de VAA foram o estágio geral, cirurgia associada à terapia adjuvante, má adesão ao tratamento multidisciplinar, presença de complicações e baixa sobrevida. (AU)

Introduction: Oral cavity cancer constitutes lesions on the surface of the oral mucosa and, due to the consequences of the disease and its treatment, dysphagia often occurs. When oral feeding becomes impossible, it is essential to indicate alternative feeding routes. Objective: to verify the occurrence and factors associated with the use of an alternative feeding route after tongue cancer. Method: The search was conducted by two independent researchers in the Medline (Pubmed), LILACS, SciELO, Scopus, WEB OF SCIENCE and BIREME databases without language and location restrictions, from 2010 to 2021. To complement and to avoid risk bias, a search for gray literature on Google Scholar was performed. Selection Criteria: The systematic review was conducted in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies that scored ≥ 6 points according to the protocol for qualitative scoring proposed by Pithon. Results: Studies show that most individuals with oral cancer develop significant weight loss, requiring intervention. The overall stage of the disease is a significant predictor of critical weight loss in patients undergoing treatment. Conclusion: The indication of an alternative feeding route after tongue cancer was 19.3% to 68.2%, and the factors associated with this indication of AAV were the general stage, surgery associated with adjuvant therapy, poor adherence to multidisciplinary treatment, presence of complications and poor survival. (AU)

Introducción: El cáncer de cavidad oral constituye lesiones en la superficie de la mucosa oral y, debido a las consecuencias de la enfermedad y su tratamiento, es frecuente que se presente disfagia. Cuando la alimentación oral se hace imposible, es imprescindible la indicación de vías alternativas de alimentación. Objetivo: verificar la ocurrencia y los factores asociados al uso de una vía alternativa de alimentación después del cáncer de lengua. Método: La búsqueda fue realizada por dos investigadores independientes en las bases de datos Medline (Pubmed), LILACS, SciELO, Scopus, WEB OF SCIENCE y BIREME, sin restricciones de idioma y ubicación, de 2010 a 2021. Para complementar y Evitar riesgo de sesgo, se realizó una búsqueda de literatura gris en Google Scholar. Criterios de selección: La revisión sistemática se llevó a cabo de acuerdo con las recomendaciones de Elementos de informe preferidos para revisiones sistemáticas y metanálisis (PRISMA). Los estudios que puntuaron ≥ 6 puntos según el protocolo de puntuación cualitativa propuesto por Pithon et al. (2015). Resultados: Los estudios muestran que la mayoría de las personas con cáncer oral desarrollan una pérdida de peso significativa, lo que requiere intervención. El estadio general de la enfermedad es un predictor significativo de pérdida de peso crítica en pacientes que reciben tratamiento. Conclusión: La indicación de vía alternativa de alimentación tras cáncer de lengua varió del 19,3% al 68,2%, y los factores asociados a esta indicación de AAV fueron el estadio general, cirugía asociada a terapia adyuvante, mala adherencia al tratamiento multidisciplinario, presencia de complicaciones y baja supervivencia. (AU)

Terapia medico nutricional en pacientes que reciben terapia de oxigenación por membrana extracorpórea: conocimiento en progreso / Medical nutrition therapy in patients receiving extracorporeal membrane oxygenation: knowledge in progress

Resumen El soporte nutricional (SN) en pacientes adultos que reciben terapia de oxigenación por membrana extracorpórea (ECMO, extracorporeal membrane oxygenation) es controvertido. Si bien existen guías para el SN en pacientes pediátricos con ECMO, en adultos no se cuenta con estos lineamientos para el uso, tipo, ruta y momento de la terapia nutricional. En pacientes críticamente enfermos es bien sabido que la nutrición enteral (NE) temprana es beneficiosa, no obstante existe la posibilidad de que en pacientes con ECMO la NE temprana condicione complicaciones gastrointestinales. Asimismo, no se han establecido metas calóricas, proteicas y dosis o tipos de micronutrimentos que usar para esta población en específico, siendo un reto para el clínico encargado de brindar el SN. Aunado a esto los pacientes con ECMO son algunos de los más gravemente enfermos en las unidades de cuidados intensivos, donde la desnutrición se asocia con una mayor morbilidad y mortalidad. En cuanto al uso de nutrición parenteral (NP), no se tiene descrito si implica riesgo de falla en el circuito al momento de introducir lípidos al oxigenador. Por lo anterior es imperativa una correcta evaluación e intervención nutricional específica, realizada por expertos en el tema para mejorar el pronóstico y la calidad de vida en esta población, siendo un objetivo primordial en los cuidados de los pacientes adultos que reciben terapia de ECMO.

Abstract Nutritional support in adult patients receiving extracorporeal membrane oxygenation (ECMO) therapy is controversial. Although there are guidelines for the NS (Nutritional support) in pediatric patients with ECMO, in adults these guidelines are not available for the use, type, route and timing of nutritional therapy. In critically ill patients it is well known that early enteral nutrition is beneficial, however there is the possibility that in patients with ECMO early enteral nutrition leads to gastrointestinal complications. Likewise, there have not been established caloric targets, proteins and doses or types of micronutrients to use for this specific population being a challenge for the clinician. In addition, patients with ECMO are some of the most seriously ill in intensive care units, where malnutrition is associated with increased morbidity and mortality. Regarding the use of parenteral nutrition (NP) it has not been described if it implies a risk of circuit failure at the time of introducing lipids to the oxygenator. Therefore, a correct evaluation and specific nutritional intervention by experts in the field is imperative to improve the prognosis and quality of life in this population, which is a primary goal in the care of adult patients receiving extracorporeal membrane oxygen.

Nasogastric versus nasojejunal tube feeding for severe acutepancreatitis: A systematic review of randomized controlled trials

Early enteral nutrition through a feeding tube is essential for the management of severe acute pancreatitis (SAP). Nasojejunal tube nutrition has been preferred on the assumption that it provided pancreatic rest in comparison to the nasogastric tube. However, nasojejunal tube placement is complex, may delay feeding initiation and can increase hospital costs. Our aim was to compare the efficacy and safety of enteral feeding with a nasogastric tube versus nasojejunal tube in patients with SAP. We searched four databases (PubMed, Web of Science, Scopus, and Embase) until December 1, 2022. We included randomized controlled trials (RCTs) comparing enteral feeding by nasogastric and nasojejunal tubes in patients with SAP. Primary outcome was all-cause mortality. Secondary outcomes were organ failure, infection, complications, surgical intervention, duration of tube feeding and length of hospital stay. Risk of bias assessment was completed independently by two investigators using the Cochrane RoB 2.0 tool. We performed random effects model meta-analyses using the inverse variance method. Effect measures were reported as relative risks (RR) and their 95% CIs for dichotomous outcomes and mean differences (MD) and their 95% CIs for continuous outcomes. We included four RCTs involving 192 patients with SAP. The mean ages ranged between 36 and 62 years old. There was no significant difference in all-cause mortality between the nasogastric and nasojejunal feeding arms (18/98 vs. 23/93; RR 1.34, 95%CI 0.77-2.30; p=0.30). There were no significant differences in all secondary outcomes between feeding arms. There were three RCTs with some concerns of bias, in the randomization process. In conclusion, in patients with SAP, enteral feeding delivered by nasogastric tube was as efficacious and safe as nasojejunal tube. Further randomized controlled trials with more participants and better design are needed to confirm these findings.

La nutrición enteral temprana a través de una sonda de alimentación es esencial para el tratamiento de la pancreatitis aguda severa (PAS). Se ha preferido la nutrición por sonda nasoyeyunal, bajo el supuesto de que proporciona descanso pancreático en comparación con la sonda nasogástrica. Sin embargo, la colocación de la sonda nasoyeyunal es compleja, puede retrasar el inicio de la alimentación y aumentar los costos hospitalarios. Nuestro objetivo fue comparar la eficacia y seguridad de la alimentación enteral con sonda nasogástrica versus sonda nasoyeyunal en pacientes con PAS. Se realizaron búsquedas en cuatro bases de datos (PubMed, Web of Science, Scopus y Embase) hasta el 1 de diciembre de 2022. Se incluyeron ensayos controlados aleatorios (ECA) que compararon la alimentación enteral mediante sondas nasogástricas y nasoyeyunales en pacientes con PAS. El resultado primario fue la mortalidad por todas las causas. Los resultados secundarios fueron insuficiencia orgánica, infección, complicaciones, intervención quirúrgica, duración de la alimentación por sonda y duración de la estancia hospitalaria. Dos investigadores completaron de forma independiente la evaluación del riesgo de sesgo mediante la herramienta Cochrane RoB 2.0. Realizamos metanálisis de modelos de efectos aleatorios utilizando el método de varianza inversa. Las medidas del efecto se informaron como riesgos relativos (RR) y sus IC del 95% para resultados dicotómicos y diferencias de medias (DM) y sus IC del 95% para resultados continuos. Se incluyeron cuatro ECA con 192 pacientes con PAS. La edad media osciló entre 36 y 62 años. No hubo diferencias significativas en la mortalidad por todas las causas entre los brazos de alimentación nasogástrica y nasoyeyunal Cambiar lo resaltado por: (18/98 vs. 23/93; RR 1.34, 95%CI 0.77-2.30; p=0.30). No hubo diferencias significativas en todos los resultados secundarios entre los brazos de alimentación. Hubo tres ECA con algunas preocupaciones de sesgo en el proceso de asignación aleatorizado. En conclusión, en pacientes con PAS, la alimentación enteral administrada por sonda nasogástrica fue tan eficaz y segura como la sonda nasoyeyunal. Se necesitan más ensayos controlados aleatorios con más participantes y mejor diseño para confirmar estos hallazgos.

Inicio de nutrición enteral luego de una gastrostomía endoscópica, ¿es necesario esperar?

Tradicionalmente, el inicio de nutrición enteral, luego de una gastrostomía endoscópica percutánea (GEP) se realiza entre 12 a 24 horas. Diferentes investigaciones sugieren que iniciarla más temprano podría ser una opción segura. El objetivo es determinar si el inicio de nutrición enteral a las 4 horas después de realizar GEP es una conducta segura en cuanto al riesgo de intolerancia, complicaciones o muerte, comparado con iniciarla a las 12 horas. Realizamos un estudio prospectivo, aleatorizado, multicéntrico en instituciones de tercer y cuarto nivel de Bogotá y Cundinamarca, entre junio de 2020 y mayo de 2022, se incluyeron 117 pacientes que fueron aleatorizados en 2 grupos, el grupo A de inicio temprano de nutrición (4 horas), y el grupo B de inicio estándar (12 horas). El mecanismo más frecuente de disfagia fue la enfermedad cerebrovascular (43%), seguido por complicaciones de infección por COVID-19 (26%). No hubo diferencias estadísticamente significativas entre los grupos evaluados respecto al porcentaje de intolerancia a la nutrición, RR = 0,93 (IC 0,30-2,90), tampoco hubo diferencias en términos de complicaciones posoperatorias, (RR) = 0,34 (IC 0,09-1,16), y no se encontraron diferencias en la mortalidad entre los grupos evaluados, (RR) = 1,12 (IC 0,59 - 2,15). En conclusión, el inicio de nutrición a través de la gastrostomía de forma temprana, 4 horas después de la realización de la GEP es una conducta segura que no se relaciona con una mayor intolerancia a la nutrición, complicaciones o muerte, en comparación con un inicio más tardío.

Traditionally, the initiation of enteral nutrition after a percutaneous endoscopic gastrostomy (PEG) is performed between 12 and 24 hours. Different research suggests that early initiation might be a safe option. Our aim was to determine whether starting enteral nutrition 4 hours after performing PEG is a safe practice in terms of risk of intolerance, complications, or death, compared to starting it at 12 hours. We carried out a prospective, randomized, multicenter study in third and fourth level institutions in Bogotá and Cundinamarca, between June 2020 and May 2022, 117 patients were included who were randomized into 2 groups, group A with early nutrition initiation (4 hours), and standard group B (12 hours). The most frequent mechanism of dysphagia was cerebrovascular disease (43%), followed by complications of COVID19 infection (26%). There were no statistically significant differences between the groups evaluated regarding the percentage of intolerance to nutrition, RR = 0.93 (CI 0.30-2.90), there were also no differences in terms of postoperative complications, (RR) = 0.34 (CI 0.09-1.16), and no differences were found in mortality between the evaluated groups, (RR) = 1.12 (CI 0.59-2.15). In conclusion, early initiation of nutrition through the gastrostomy, 4 hours after performing the PEG, is a safe behavior that is not related to greater intolerance to nutrition, complications, or death, compared to later initiation.

Cumplimiento de los objetivos nutricionales durante el uso de dispositivos de asistencia ventricular / Nutritional objectives in patients with ventricular assist devices

Antecedentes: Los dispositivos de asistencia ventricular (VAD, sigla en inglés) se utilizan cada vez más para el manejo de la insuficiencia cardíaca descompensada en unidades de cuidados intensivos. El manejo nutricional es fundamental para la evolución clínica de estos pacientes. Objetivos: El objetivo fue evaluar en cuánto tiempo se puede alcanzar las necesidades nutricionales, utilizando distintas modalidades de apoyo nutricional, en pacientes que requirieron asistencia con VAD por insuficiencia cardíaca aguda en una clínica privada del país. Métodos: En una clínica privada se efectuó un estudio observacional retrospectivo analizando los datos clínicos relacionados al aporte nutricional de 12 pacientes que requirieron asistencia con VAD. Las vías de aporte nutricional evaluadas fueron la nutrición enteral (NE) y/o nutrición parenteral (NP). Se midió el tiempo de implementación del apoyo nutricional y su efecto se estimó por una valoración nutricional subjetiva y por la medición de indicadores de laboratorio. Además, se vigilaron las complicaciones asociadas al aporte nutricional. Resultados: El estudio incluyó a 12 pacientes. Los objetivos nutricionales se alcanzaron por completo en el 91% de los pacientes (n=11) en 3,7 ± 1 días después de iniciado el apoyo nutricional. En ese momento, 5 pacientes recibían NE exclusiva, 4 pacientes NP complementaria a la NE, 1 paciente NE complementaria a la alimentación oral y 1 paciente con vía oral. Al momento de alcanzar los requerimientos nutricionales ningún paciente tenía NP exclusiva. Conclusión: Concluimos que el apoyo nutricional precoz es factible y seguro en pacientes con VAD. Alcanzar los objetivos nutricionales es posible sin efectos adversos graves. Se necesitan estudios futuros para determinar el beneficio a largo plazo del apoyo nutricional agresivo para pacientes en estado crítico que requieren apoyo hemodinámico.

Background: Ventricular assist devices (VAD) are being used more frequently in patients with severe heart failure. Nutritional support is a critical factor for the outcome in these patients. Aim: to evaluate the time required and mode of nutritional support in patients with severe cardiac dysfunction being treated with VAD. Methods: 12 patients with VAD being treated in an intensive care unit were evaluated to determine the time and mode of support required to achieve adequate nutrition. Enteral and / or parenteral modes of nutritional support were used. The outcomes were evaluated by subjective appreciation, weight measurement and serum levels of albumin, pre-albumin and vitamin D. Results: Adequate nutritional support was achieved in 91% of patients a mean of 3 days after beginning of treatment (SD 1 day). At that time 5 patients were receiving only enteral nutrition, 4 patients enteral and parenteral nutrition, 1 patient enteral nutrition in addition to oral nutrition and 1 patients was receiving only oral nutrition. No patient was receiving only parenteral nutrition. Conclusion: early nutritional support is posible and safe in patients with an VAD. Further studies are needed to evaluate long term benefits of this strategy of nutritional support.

Registros de enfermagem referentes à inserção de cateteres nasogástricos e nasoenterais: não conformidades e sub-registro / Nursing records regarding the insertion of nasogastric and nasoenteral catheters: nonconformities and sub-recording / Registros de enfermería respecto a la inserción de sondas nasogástricas y nasoenterales: no conformidades y subregistros

Objetivo: O registro dos dados referentes a Terapia Nutricional Enteral (TNE) é importante para assegurar o procedimento e comunicação sistemática da assistência. Com o estudo, objetivou-se analisar os registros de enfermagem referentes à inserção de cateteres nasogástricos (CNG) e nasoenterais (CNE) considerando o sub-registro e não conformidades encontradas em prontuários e durante observação dos pacientes. Métodos: estudo observacional, transversal com abordagem quantitativa, mediante a aplicação de instrumento para coleta de dados de pacientes internados em um Hospital Universitário no Pará entre agosto de 2019 a julho de 2020. Resultados: Foram identificadas 191 inserções de cateteres por enfermeiros, sendo 43 (22,52%) reinserções sub-registradas e 148 (77,48%) apresentaram não conformidades. Discussão: O sub-registro e as não conformidades interferem na qualidade da assistência de enfermagem, fragilizam as ações de segurança do paciente, além de apresentarem repercussões legais. Conclusão: Os dados apresentados neste artigo foram primordiais para a detecção de lacunas na assistência de enfermagem. (AU)

Objective: The recording of data referring to Enteral Nutrition Therapy (ENT) is important to ensure the procedure and systematic communication of care. The objective was to analyze the nursing records regarding the insertion of nasogastric (CNG) and nasoenteral (CNE) catheters, considering the under-recording and non-conformities found in medical records and during patient observation. Methods: observational, cross-sectional study with a quantitative approach, through the application of an instrument to collect data from patients admitted to a University Hospital in Pará between August 2019 and July 2020. Results: 191 insertions of catheters by nurses were identified, of which 43 (22.52%) underreported reinsertion and 148 (77.48%) presented non-conformities. Discussion: Under-registration and non-compliance interfere with the quality of nursing care, weaken patient safety actions, in addition to having legal repercussions. Conclusion: The data presented in this article were essential for the detection of gaps in nursing care. (AU)

Objetivo: El registro de los datos referentes a la Terapia de Nutrición Enteral (ENT) es importante para garantizar el procedimiento y la comunicación sistemática de los cuidados. El objetivo fue analizar los registros de enfermería con respecto a la inserción de catéteres nasogástricos (GNC) y nasoenterales (CNE), considerando el subregistro y las no conformidades encontradas en los registros médicos y durante la observación de los pacientes. Métodos: estudio observacional, transversal con abordaje cuantitativo, mediante la aplicación de un instrumento para recolectar datos de pacientes internados en un Hospital Universitario de Pará entre agosto de 2019 y julio de 2020. Resultados: fueron identificadas 191 inserciones de catéteres por enfermeros, de de los cuales 43 (22,52%) subreportaron reinserción y 148 (77,48%) presentaron no conformidades. Discusión: El subregistro y el incumplimiento interfieren en la calidad de la atención de enfermería, debilitan las acciones de seguridad del paciente, además de tener repercusiones legales. Conclusión: Los datos presentados en este artículo fueron esenciales para la detección de lagunas en el cuidado de enfermería. (AU)

Emotional aspects of parents of children with dysphagia / Aspectos emocionais dos pais de crianças com disfagia

Dysphagia is a common swallowing disorder in the pediatric population, which may influence the quality of life and well-being of the family. The literature points to stress, guilt, and social isolation of family members. However, the management of psychosocial aspects involved in the treatment of pediatric dysphagia is rarely discussed. This study aimed to carry out an integrative review of the literature regarding the emotional aspects of parents of children with dysphagia. Therefore a search in the databases SciELO and PubMed was made, from January 2013 to June 2020, using the descriptors in Health Sciences (DeCs): "deglutition disorders" and "child". The search was performed with English and Portuguese language limiters using associated descriptors. The selection of the studies was performed by reading the title, abstract and, if necessary, full text, applying the inclusion and exclusion criteria. There were 2,169 publications, and 8 met the inclusion criteria. The included studies were examined according to the author, type of study, goals, emotional aspects involved in the treatment of swallowing disorders, and conclusions. The analysis was performed according to the presence of certain variables of the emotional aspects presented in the face of swallowing disorders, namely, parental stress, negative impact on parent/child interaction, guilt and frustration, and social isolation. The literature points out that pediatric dysphagia causes an emotional impact on the parents; indicating that it is necessary to offer emotional support and to adapt the clinical management to the different demands present in the clinic.

A disfagia é um distúrbio de deglutição comum na população pediátrica, podendo influenciar na qualidade de vida e no bem-estar da família. A literatura aponta estresse, culpa e isolamento social dos familiares. Entretanto, o manejo dos aspectos psicossociais envolvidos no tratamento da disfagia pediátrica raramente é discutido. Este estudo teve como objetivo realizar uma revisão integrativa da literatura sobre os aspectos emocionais de pais de crianças com disfagia. Para tanto, foi realizada uma busca nas bases de dados SciELO e PubMed, no período de janeiro de 2013 a junho de 2020, utilizando os descritores em Ciências da Saúde (DeCs): "distúrbios da deglutição" e "criança". A busca foi realizada com limitadores dos idiomas inglês e português usando descritores associados. A seleção dos estudos foi realizada por meio da leitura do título, resumo e, se necessário, texto completo, aplicando-se os critérios de inclusão e exclusão. Houve 2.169 publicações e 8 preencheram os critérios de inclusão. Os estudos incluídos foram examinados quanto ao autor, tipo de estudo, objetivos, aspectos emocionais envolvidos no tratamento dos distúrbios da deglutição e conclusões. A análise foi realizada de acordo com a presença de algumas variáveis ​​dos aspectos emocionais apresentados diante dos distúrbios da deglutição, a saber, estresse parental, impacto negativo na interação pais/filhos, culpa e frustração e isolamento social. A literatura aponta que a disfagia pediátrica causa impacto emocional nos pais; indicando que é necessário oferecer suporte emocional e adequar o manejo clínico às diferentes demandas presentes na clínica.

Construction and validity of scripts for skills training on enteral nutritional therapy in dehospitalization / Construcción y validación de guiones para entrenamiento de habilidades en terapia nutricional enteral en deshospitalización / Construção e validação de roteiros para treinamento de habilidades sobre terapia nutricional enteral na desospitalização

ABSTRACT Objective: to construct and validate the content of two multidisciplinary scripts for the care of patients with chronic diseases using enteral nutrition therapy, based on skills training, using clinical simulation, in the dehospitalization process. Method: this is a methodological study carried out at a federal public hospital in the Brazilian Midwest, between January and September 2022, in two phases: script construction and validity with 19 and 11 expert judges, respectively. Analysis occurred through the Content Validity Coefficient, the Content Validity Index and the Agreement Index. Results: two scripts were constructed and validated for caregivers' skills training and qualification to care for patients using home enteral nutrition therapy in the process of dehospitalization by nasogastric tube and/or by gastrostomy. For construction, the study had the active participation of six experts, from a multidisciplinary perspective. For script validity, the following values of Content Validity Coefficient, Content Validity Index and Agreement Index were reached, respectively: 0.998, 1.000, and 100%. Most experts' suggestionswere met. Conclusion: the scripts were considered valid in their content. They can be used by health professionals to carry out educational activities in the hospital environment regarding caregivers' preparation the management of home enteral nutrition therapy, when leaving the hospital.

RESUMEN Objetivo: construir y validar el contenido de dos guiones multidisciplinarios para el cuidado de pacientes con condiciones crónicas en terapia de nutrición enteral, basados ​​en el entrenamiento de habilidades, utilizando simulación clínica en el proceso de deshospitalización. Método: estudio metodológico realizado en un hospital público federal del Medio Oeste brasileño, entre enero y septiembre de 2022, en dos fases: construcción y validación de los guiones con 19 y 11 jueces expertos, respectivamente. El análisis se realizó utilizando el Coeficiente de Validez de Contenido, el Índice de Validez de Contenido y el Índice de Concordancia. Resultados: se construyeron y validaron dos guiones para la formación de habilidades y cualificación de cuidadores para el cuidado de pacientes que utilizan terapia de nutrición enteral domiciliaria en proceso de deshospitalización por sonda nasogástrica y/o por gastrostomía. Para la construcción, el estudio contó con la participación activa de seis especialistas, desde una perspectiva multidisciplinaria. Para la validación de los guiones se alcanzaron los siguientes valores de Coeficiente de Validez de Contenido, Índice de Validez de Contenido e Índice de Concordancia, respectivamente: 0.998, 1.000 y 100%. La mayoría de las sugerencias realizadas por los expertos se cumplieron. Conclusión: los guiones fueron considerados válidos en su contenido. Pueden ser utilizados por profesionales de la salud para realizar actividades educativas en el ambiente hospitalario, en cuanto a la preparación de los cuidadores para el manejo de la terapia de nutrición enteral en el domicilio, al egreso del hospital.

RESUMO Objetivo: construir e validar o conteúdo de dois roteiros multiprofissionais para cuidados de pacientes com condições crônicas em uso de terapia de nutrição enteral, baseados em treinamento de habilidades, com utilização de simulação clínica, no processo de desospitalização. Método: estudo metodológico realizado em um hospital público federal do Centro-Oeste brasileiro, entre janeiro e setembro de 2022, em duas fases: construção e validação dos roteiros junto a 19 e 11 juízes especialistas, respectivamente. A análise ocorreu por meio do Coeficiente de Validade de Conteúdo, do Índice de Validade de Conteúdo e do Índice de Concordância. Resultados: foram construídos e validados dois roteiros para treinamento de habilidades e capacitação de cuidadores para os cuidados com pacientes em uso de Terapia de Nutrição Enteral Domiciliar, no processo de desospitalização por sonda nasoenteral e/ou por gastrostomia. Para construção, o estudo contou com a participação ativa de seis especialistas, na perspectiva multiprofissional. Para a validação dos roteiros, foram alcançados os seguintes valores de Coeficiente de Validade de Conteúdo, Índice de Validade de Conteúdo e Índice de Concordância, respectivamente: 0,998, 1,000, e 100%. Foi atendido a maior parte das sugestões realizadas pelos especialistas. Conclusão: os roteiros foram considerados válidos em seu conteúdo. Poderão ser utilizados por profissionais de saúde para a condução de atividades educativas no âmbito hospitalar, quanto ao preparo de cuidadores para o manejo da Terapia de Nutrição Enteral no domicílio, quando da desospitalização.

Neumotórax a tensión secundario a colocación de sonda enteral: reporte de caso / Tension pneumothorax secondary to enteral tube: a case report / Pneumotórax hipertensivo secundário à colocação de sonda enteral: relato de caso

Resumen: La colocación de una sonda enteral es un procedimiento invasivo rutinario que puede presentar complicaciones graves. Presentamos el caso de un hombre de 54 años de edad que presentó paro cardiorrespiratorio secundario a infarto de miocardio y que, después de la colocación de una sonda nasoyeyunal, desarrolló neumotórax, por lo que ameritó su retiro, la colocación de una sonda endopleural y la administración de antibióticos. El paciente mostró adecuada expansión pulmonar, lo cual permitió el retiro de la sonda endopleural a los seis días de su instalación, la extubación del enfermo y finalmente su egreso por mejoría. El neumotórax asociado a la colocación de la sonda enteral se presenta en 1.2% de los pacientes. Los factores de riesgo son: déficit neurológico, alteración de la deglución y del reflejo tusígeno. El tratamiento descrito en la literatura es el retiro de la sonda, el uso de antibióticos y el drenaje torácico.

Abstract: Enteral tube placement is a routine invasive procedure that can present serious complications. We present the case of a 54-year-old man who presented with cardiorespiratory arrest secondary to myocardial infarction and who, after placement of a nasojejunal tube, developed pneumothorax that required removal of the tube, placement of a chest tube and administration of antibiotics. The patient presented adequate lung expansion, which allowed removal of the chest tube six days after its installation, extubation and finally discharge due to improvement. Pneumothorax associated with enteral tube placement occurs in 1.2% of patients. Risk factors are neurological deficit, impaired swallowing and cough reflex. Treatment described in the literature is removal of the tube, use of antibiotics and chest drainage.

Resumo: A colocação de sonda enteral é um procedimento invasivo de rotina que pode apresentar complicações graves. Apresentamos o caso de um homem de 54 anos que apresentou parada cardiorrespiratória secundária a infarto do miocárdio e que, após colocação de sonda nasojejunal, desenvolveu pneumotórax que exigiu sua retirada, colocação de sonda endopleural e administração de antibióticos.O paciente apresentou expansão pulmonar adequada, o que permitiu a retirada do tubo endopleural 6 dias após sua instalação, a extubação do paciente e por fim sua alta por melhora. O pneumotórax associado à colocação de sonda enteral ocorre em 1.2% dos pacientes. Os fatores de risco são: déficit neurológico, deglutição prejudicada e reflexo da tosse. O tratamento descrito na literatura é a retirada da sonda, uso de antibióticos e drenagem torácica.

Desenvolvimento de protótipo de aplicativo móvel sobre cuidados de enfermagem para paciente cirúrgico oncológico com sonda enteral / Development of a mobile application prototype on nursing care for surgical oncology patients with enteral tubes

Objetivo: descrever a etapa de criação do protótipo de um aplicativo móvel, baseado em evidências, com informações sobre os cuidados de enfermagem para utilização de sonda enteral em pacientes cirúrgicos oncológicos. Método: estudo metodológico com uso do design instrucional fixo, que percorreu as fases de análise, desenho e desenvolvimento. Foram realizados storyboards com base nas evidências dos principais conteúdos sobre a administração de dietas e de medicamentos via sondas enterais nos seguintes guidelines: Diretrizes Brasileiras de Práticas de Enfermagem e Diretriz Americana de Práticas Seguras para Terapia de Nutrição Enteral. Resultados: na etapa de desenho, foram mapeados os conteúdos que entrariam no aplicativo e elaborados dois roteiros, denominados storyboards, sendo um para o cuidado durante a Administração de Dietas e outro para o cuidado na etapa de Administração de Medicamentos. Nos storyboards, foram descritas as sequências das telas, o conteúdo que seria apresentado em cada uma delas sob forma de texto e de imagem e como esse conteúdo deveria ser organizado no layout da tela. Os storyboards foram submetidos à validação de conteúdo por seis enfermeiros especialistas da área. Em seguida, foram realizados ajustes nos conteúdos e forma de apresentação descritos nos storyboards. Conclusão: o protótipo de aplicativo baseado em evidências científicas atuais é uma ferramenta tecnológica que poderá ser consultada pela equipe de enfermagem durante o cuidado à beira do leito, aumentando a segurança do paciente. O embasamento científico e metodológico para o desenvolvimento do storyboard viabiliza a confiabilidade do produto educativo. Ademais, a validação de conteúdo e aparência por especialistas na área torna tal dispositivo seguro para o público-alvo e uma importante ferramenta profissional, passível de ser utilizada como atividade de educação em saúde

Objective: describe the step of creating the prototype of a mobile application, based on evidence, with information about nursing care for the use of enteral tubes in surgical oncology patients. Method: methodological study using fixed instructional design, which went through the phases of analysis, design, and development. Storyboards were made based on the evidence of the main contents about the administration of diets and medications via enteral tubes in the following guidelines: Brazilian Guidelines for Nursing Practice and American Guideline for Safe Practices for Enteral Nutrition Therapy. Results: in the design stage, the contents that would enter the application were mapped and two scripts were developed, called storyboards, one for the care during Diet Administration and the other for the care in the Medication Administration stage. The storyboards described the screen sequences, the content that would be presented on each screen in text and image form, and how this content should be organized in the screen layout. The storyboards were submitted for content validation by five specialist nurses. Then, adjustments were made to the content and presentation form described in the storyboards. Conclusion: the prototype application based on current scientific evidence is a technological tool that can be consulted by the nursing team during bedside care, increasing patient safety. The scientific and methodological basis for the storyboard development enables the reliability of the educational product. Moreover, the validation of content and appearance by experts in the field makes this device safe for the target audience and an important professional tool, which can be used as a health education activity

Does enteral nutrition through a percutaneous endoscopic gastrostomy, attenuate Helicobacter pylori colonization?: is it worth mentioning?

SUMMARY OBJECTIVE: In patients who experience difficulties in oral feeding, alimentary intake can be supported by creating direct access into the stomach through a percutaneous endoscopic gastrostomy. The present study purposed to compare naïve and exchanged percutaneous endoscopic gastrostomy tubes in terms of Helicobacter pylori infection and other clinical characteristics. METHODS: A total of 96 cases who underwent naïve or exchanged percutaneous endoscopic gastrostomy procedures with various indications were incorporated into the study. The patients' demographic data, such as age and gender, etiology of percutaneous endoscopic gastrostomy, anti-HBs status, Helicobacter pylori status, the presence of atrophy and intestinal metaplasia, biochemical parameters, and lipid profiles, had been analyzed. In addition, the anti-HCV and anti-HIV statuses had also been evaluated. RESULTS: The most common indication for percutaneous endoscopic gastrostomy placement was dementia in 26 (27.08%) cases (p=0.033). The presence of Helicobacter pylori positivity was significantly lower in the exchange group compared to the naïve group (p=0.022). Total protein, albumin, and lymphocyte levels were significantly higher in the exchange group compared to the naïve group (both p=0.001), and the mean calcium, hemoglobin, and hematocrit levels were statistically significantly higher in the exchange group (p<0.001). CONCLUSION: Preliminary outcomes of the present study revealed that enteral nutrition attenuates the incidence of Helicobacter pylori infection. Considering the acute-phase reactant, the significantly lower ferritin values in the exchange group suggest that there is no active inflammatory process in the patients and that immunity is sufficient.

Alimentação por sonda e gastrostomia no câncer avançado: indicação, vivências, sentidos e significados / Tube feeding and gastrostomy in advanced cancer: indication, experiences, senses and meanings

Introdução: Pacientes com câncer avançado apresentam sintomas e distúrbios metabólicos que podem impossibilitar a alimentação oral adequada e levar à perda de peso, com implicações na capacidade funcional e na qualidade de vida, sendo indicadas sondas/ostomias para alimentação. Objetivos: Compreender os sentidos e significados da alimentação por sondas/ostomias para pacientes com câncer avançado em cuidados paliativos exclusivos e cuidadores. Métodos: Trata-se de uma pesquisa qualitativa, exploratório-descritiva, realizada em hospital do Rio de Janeiro, através de entrevistas semiestruturadas com 12 pacientes e 12 cuidadores, no ano de 2021. Após transcrições, utilizou-se a análise de conteúdo de Laurence Bardin. Como referenciais teóricos, as ideias de Elizabeth Kübler-Ross e perspectivas da Psicologia Social. Resultados: Três dimensões temáticas foram identificadas sobre indicação, vivências e sentidos e significados da alimentação por sonda/ostomias, com respectivas categorias. A maioria dos pacientes e cuidadores abordou a evolução da doença e a participação na decisão da via alimentar alternativa. Como sentidos da alimentação: qualidade de vida, conforto, vida e esperança. Conclusões: Dessa forma, a nutrição artificial é ressignificada como a nova alimentação possível, apresentando também aspectos simbólicos, além da função biológica.

Introduction: Patients with advanced cancer show symptoms and metabolic disorders that can make appropriate oral feeding impossible causing weight loss, with implications regarding functional capacity and quality of life; feeding tubes/ostomies are indicated in such cases. Objectives: To understand the senses and meanings of tube feeding/ostomies for patients with advanced cancer in exclusive palliative care and for caregivers. Methods: This is a qualitative, exploratory-descriptive investigation, carried out in a hospital in Rio de Janeiro, through semi-structured interviews with 12 patients and 12 caregivers, in the year 2021. After transcriptions, Laurence Bardin's content analysis was used. As theoretical references, the ideas of Elizabeth Kübler-Ross and perspectives of Social Psychology were used. Results: Three thematic dimensions were identified on indication, experiences and senses and meanings of tube feeding/ostomy, with respective categories. Most patients and caregivers addressed the evolution of the disease and their decision on the alternative food route. As meanings of food: quality of life, comfort, life and hope. Conclusions: In this way, artificial nutrition is resignified as the new possible feeding method; artificial nutrition also presents symbolic aspects besides the biological function.

Effects of early standardized enteral nutrition on preventing acute muscle loss in the acute exacerbation of chronic obstructive pulmonary disease patients with mechanical ventilation / 世界急诊医学杂志（英文）

@#BACKGROUND: To investigate the effects of early standardized enteral nutrition (EN) on the cross-sectional area of erector spine muscle (ESMcsa), plasma growth differentiation factor-15 (GDF-15), and 28-day mortality of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients with invasive mechanical ventilation (MV). METHODS: A total of 97 AECOPD patients with invasive MV were screened in the ICUs of the First People's Hospital of Lianyungang. The conventional EN group (stage I) and early standardized EN group (stage II) included 46 and 51 patients, respectively. ESMcsa loss and GDF-15 levels on days 1 and 7 of ICU admission and 28-day survival rates were analyzed. RESULTS: On day 7, the ESMcsa of the early standardized EN group was significantly higher than that of the conventional EN group, while the plasma GDF-15 levels were significantly lower than those in the conventional EN group (ESMcsa: 28.426±6.130 cm2 vs. 25.205±6.127 cm2; GDF-15: 1661.608±558.820 pg/mL vs. 2541.000±634.845 pg/mL; all P<0.001]. The 28-day survival rates of the patients in the early standardized EN group and conventional EN group were 80.40% and 73.90%, respectively (P=0.406). CONCLUSION: ESMcsa loss in AECOPD patients with MV was correlated with GDF-15 levels, both of which indicated acute muscular atrophy and skeletal muscle dysfunction. Early standardized EN may prevent acute muscle loss and intensive care unit-acquired weakness (ICU-AW) in AECOPD patients.

Multiple portions enteral nutrition and chyme reinfusion of a blunt bowel injury patient with hyperbilirubinemia undergoing open abdomen: A case report / 中华创伤杂志(英文版)

Blunt bowel injury (BBI) is relatively rare but life-threatening when delayed in surgical repair or anastomosis. Providing enteral nutrition (EN) in BBI patients with open abdomen after damage control surgery is challenging, especially for those with discontinuity of the bowel. Here, we report a 47-year-old male driver who was involved in a motor vehicle collision and developed ascites on post-trauma day 3. Emergency exploratory laparotomy at a local hospital revealed a complete rupture of the jejunum and then primary anastomosis was performed. Postoperatively, the patient was transferred to our trauma center for septic shock and hyperbilirubinemia. Following salvage resuscitation, damage control laparotomy with open abdomen was performed for abdominal sepsis, and a temporary double enterostomy (TDE) was created where the anastomosis was ruptured. Given the TDE and high risk of malnutrition, multiple portions EN were performed, including a proximal portion EN support through a nasogastric tube and a distal portion EN via a jejunal feeding tube. Besides, chyme delivered from the proximal portion of TDE was injected into the distal portion of TDE via a jejunal feeding tube. Hyperbilirubinemia was alleviated with the increase in chyme reinfusion. After 6 months of home EN and chyme reinfusion, the patient finally underwent TDE reversal and abdominal wall reconstruction and was discharged with a regular diet. For BBI patients with postoperative hyperbilirubinemia who underwent open abdomen, the combination of multiple portions EN and chyme reinfusion may be a feasible and safe option.

Motivos de interrupção da nutrição enteral em unidades de terapia intensiva / Reasons of interruption in enteral nutrition in intensive care units

Esta pesquisa busca identificar as causas de interrupção da administração da nutrição enteral em pacientes internados em unidades de terapia intensiva do Hospital de Urgências da cidade de Goiânia. Objetivo: Chegar às causas de interrupção da administração da nutrição enteral em pacientes internados em Unidades de Terapia Intensiva (UTIs). Método: Estudo transversal, prospectivo, realizado com pacientes internados nas UTIs do Hospital de Urgências de Goiás, no período de maio e junho de 2022. Foram coletadas as seguintes variáveis: sexo, idade, peso, altura, IMC, diagnóstico de internação, data de internação, desfecho clínico do paciente, causas de interrupção da dieta enteral, volume prescrito e volume infundido no prontuário. Os dados foram coletados até o sétimo dia de internação e acompanhados até o desfecho clínico (alta, óbito ou transferência). Resultados: Foram obtidos dados de 45 pacientes. As principais causas de interrupção da NE foram instabilidade hemodinâmica (28,2%), jejum para exames (19%) e intolerância gastrointestinal (19%). A adequação de volume prescrito comparado com o infundido foi de 86,4%. Conclusão: Quando agrupadas as causas evitáveis representam 71,4%, enquanto a causa não evitável representa 28,6%. O tempo de retenção é controlável e, portanto, os esforços devem ser direcionados a estratégias eficientes com a equipe multiprofissional, como capacitações quanto às causas das interrupções e soluções para minimizar o tempo da retenção da dieta

This research seeks to identify the causes of interruption in the administration of enteral nutrition in patients hospitalized in intensive care units at Hospital de Urgências in the city of Goiânia. Objective: Get to the causes of interruption of the administration of enteral nutrition in patients hospitalized in Intensive Care Units (ICUs). Method: A cross-sectional, prospective study carried out with patients admitted to the ICUs of the Hospital de Urgências de Goiás, between May and June 2022. The following variables were collected: sex, age, weight, height, BMI, hospitalization diagnosis, date length of stay, clinical outcome of the patient, causes of enteral diet interruption, volume prescribed and volume infused in the medical record. Data were collected up to the seventh day of hospitalization and followed up until the clinical outcome (discharge, death or transfer). Results: Data from 45 patients were obtained. The main causes of EN interruption were hemodynamic instability (28.2%), fasting for exams (19%) and gastrointestinal intolerance (19%). The adequacy of prescribed volume compared to infused volume was 86.4%. Conclusion: The three main causes of diet interruption were hemodynamic instability, gastrointestinal intolerance due to emesis and fasting for exams. The retention time is controllable and, therefore, efforts should be directed towards efficient strategies with the multidisciplinary team, such as training on the causes of interruptions and solutions to minimize the time of diet retention

Progress on nutritional assessment and nutritional support for liver transplant recipients / 器官移植

Patients with end-stage liver disease after liver transplantation constantly suffer from malnutrition due to primary diseases and transplantation-related factors. Malnutrition will worsen clinical condition of the patients, increase the incidence of complication, length of hospital stay and medical expense after transplantation, and lower the survival rate. Sufficient nutritional support at all stages of liver transplantation is of significance. Accurate assessment of nutritional status and timely intervention are prerequisites for perioperative nutritional treatment in liver transplantation. In this article, the latest nutritional risk screening indexes and evaluation tools, nutritional support methods and other perioperative nutritional intervention measures for liver transplantation were reviewed, aiming to deepen the understanding and cognition of perioperative nutritional therapy for liver transplantation and provide reference for improving nutritional status and clinical prognosis of liver transplant recipients.

Efficacy and safety of enteral nutrition with jejunostomy tube versus nasojejunal tube after radical resection of esophageal cancer: A systematic review and meta-analysis / 中国胸心血管外科临床杂志

@#Objective    To systematically evaluate the efficacy and safety of jejunostomy tube versus nasojejunal tube for enteral nutrition after radical resection of esophageal cancer. Methods    PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, Wanfang, VIP and CBM databases were searched to collect the clinical effects of jejunostomy tube versus nasojejunal nutrition tube after radical resection of esophageal cancer from inception to October 2021. Meta-analysis was performed using RevMan 5.4 software. Results    Twenty-six articles were included, including 17 randomized controlled studies and 9 cohort studies, with a total of 35 808 patients. Meta-analysis results showed that: in the jejunostomy tube group, the postoperative exhaust time (MD=–4.27, 95%CI –5.87 to –2.66, P=0.001), the incidence of pulmonary infection (OR=1.39, 95%CI 1.06 to 1.82, P=0.02), incidence of tube removal (OR=0.11, 95%CI 0.04 to 0.30, P=0.001), incidence of tube blockage (OR=0.47, 95%CI 0.23 to 0.97, P=0.04), incidence of nasopharyngeal discomfort (OR=0.04, 95%CI 0.01 to 0.13, P=0.001), the incidence of nasopharyngeal mucosal damage (OR=0.13, 95%CI 0.04 to 0.42, P=0.008), the incidence of nausea and vomiting (OR=0.20, 95%CI 0.08 to 0.47, P=0.003) were significantly shorter or lower than those of the nasojejunal tube group. The postoperative serum albumin level (MD=5.75, 95%CI 5.34 to 6.16, P=0.001) was significantly better than that of the nasojejunal tube group. However, the intraoperative operation time of the jejunostomy tube group (MD=13.65, 95%CI 2.32 to 24.98, P=0.02) and the indent time of the postoperative nutrition tube (MD=17.81, 95%CI 12.71 to 22.91, P=0.001) were longer than those of the nasojejunal nutrition tube. At the same time, the incidence of postoperative intestinal obstruction (OR=6.08, 95%CI 2.55 to 14.50, P=0.001) was significantly higher than that of the nasojejunal tube group. There were no statistical differences in the length of postoperative hospital stay or the occurrence of anastomotic fistula between the two groups (P>0.05). Conclusion    In the process of enteral nutrition after radical resection of esophageal cancer, jejunostomy tube has better clinical treatment effect and is more comfortable during catheterization, but the incidence of intestinal obstruction is higher than that of traditional nasojejunal tube.

Aspiration risk of preventive placement of nasal jejunum nutrition tube in advanced esophageal cancer patients receiving radiotherapy and the influencing factors / 肿瘤研究与临床

Objective:To investigate the aspiration risk of preventive placement of nasal jejunum nutrition tube in advanced esophageal cancer patients receiving radiotherapy and the influencing factors.Methods:The clinical data of 220 patients with advanced esophageal cancer who received radiotherapy and preventive placement of nasal jejunum nutrition tube feeding from November 2020 to November 2021 in Cancer Hospital, Chinese Academy of Medical Sciences were retrospectively analyzed. The level of aspiration risk was measured according to the standard swallowing function assessment scale (SSA). The questionnaire collected the following data: (1) the general data including gender, age, educational level, history of smoking, history of alcoholism, knowledge of aspiration; (2) the disease factors including tumor staging, tumor site, swallowing function, abdominal distention; (3) the nosocomial factors including history of esophageal cancer surgery, sedation and analgesia treatment, combination of chemotherapy or not, cumulative radiotherapy dose, grade of radiation esophagitis, the position, time and tube feeding method of enteral nutrition. The standard swallowing function of patients was measured and repeated saliva swallowing test (RSST) was used to screen the patients with the difficulty in the esophageal function swallowing. Multiple linear regression was used to analyze the factors affecting aspiration risk.Results:A total of 220 patients with advanced esophageal cancer were enrolled in the investigation. Finally, 70 patients (31.8%) had grade 0 aspiration risk, and SSA score was 19; 23 patients (10.5%) had grade I aspiration risk, and SSA score was (23.4±1.3); 103 patients (46.8%) had grade Ⅱ aspiration risk, and SSA score was (27.5±1.1); 24 patients (10.9%) had grade Ⅲ aspiration risk, and SSA score was (33.2±1.5); 136 patients (61.8%) in total had aspiration risk. There were 32.7% (72/220) patients knowing the knowledge of aspiration. Multifactor analysis showed that esophageal tumor site ( t = -2.869, P = 0.005), cumulative radiotherapy dose ( t = 5.558, P < 0.001), grade of radiation esophagitis ( t = 11.405, P < 0.001), the duration time of enteral nutrition ( t = 4.050, P < 0.001) were independent factors affecting the aspiration risk. Conclusions:The aspiration risk of preventive placement of nasal jejunum nutrition tube in advanced esophageal cancer patients receiving radiotherapy is high, which is related to esophageal tumor site, grade of radiation esophagitis, cumulative radiotherapy dose and the duration time of enteral nutrition.