Nutrition Management: Parenteral and Enteral Nutrition and Oral Intake

AbstractBackgroundThe long-term outcomes of artificial nutrition and hydration (ANH) in the elderly with dysphagia remain uncertain. Enteral nutrition via percutaneous endoscopic gastrostomy (PEG) and total parenteral nutrition (TPN) are major methods of ANH. Although both can be a life-prolonging treatments, Japan has recently come to view PEG as representative of unnecessary life-prolonging treatment. Consequently, TPN is often chosen for ANH instead. This study aimed to compare the long-term outcomes between PEG and TPN in the elderly.MethodsThis single-center retrospective cohort study identified 253 elderly patients with dysphagia who received enteral nutrition via PEG (n=180) or TPN (n=73) between January 2014 and January 2017. The primary outcome was survival time. Secondary outcomes were oral intake recovery, discharge to home, and the incidence of severe pneumonia and sepsis. We performed one-to-one propensity score matching using a 0.05 caliper. The Kaplan–Meier method, log-rank test, and Cox proportional hazards model were used to analyze the survival time between groups.ResultsOlder patients with lower nutritional states, and severe dementia were more likely to receive TPN. Propensity score matching created 55 pairs. Survival time was significantly longer in the PEG group (median, 317 vs 195 days; P=0.017). The hazard ratio for PEG relative to TPN was 0.60 (95% confidence interval: 0.39–0.92; P=0.019). There were no significant differences between the groups in oral intake recovery and discharge to home. The incidence of severe pneumonia was significantly higher in the PEG group (50.9% vs 25.5%, P=0.010), whereas sepsis was significantly higher in the TPN group (10.9% vs 30.9%, P=0.018).ConclusionsPEG was associated with a significantly longer survival time, a higher incidence of severe pneumonia, and a lower incidence of sepsis compared with TPN. These results can be used in the decision-making process before initiating ANH.

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Overview of Enteral Nutrition

10.2310/tywc.9053 ◽

2018 ◽

Author(s):

Rebecca Lynch ◽

Erin Sisk

Keyword(s):

Gastrointestinal Tract ◽

Enteral Nutrition ◽

Medical Condition ◽

Functional Limitation ◽

Tube Feeding ◽

Oral Intake ◽

Nutrition Therapy ◽

Nutrition Support ◽

Medical Nutrition Therapy ◽

Medical Nutrition

Enteral nutrition (EN) is recognized as a medical nutrition therapy for patients with a functional gastrointestinal tract who are unable to maintain their weight and health by oral intake alone either due to a highly catabolic medical condition or a functional limitation. EN support provides calories and protein to help improve or maintain adequate weight, lean body mass, and overall nutritional status. EN also provides nonnutritive benefits such as maintaining intestinal integrity, supporting the immune system, and preventing infection. EN support can be tailored to a patient’s nutrient needs, and there are various formulas that vary in composition of macronutrients, concentration, and electrolytes for specific disease processes or conditions that may help with tolerance and absorption. EN support complications include issues with access, diarrhea, constipation, electrolyte abnormalities, hyperglycemia, and dehydration/overhydration. Generally, EN is well tolerated. While a patient is on this type of nutrition support, it is important to closely monitor tolerance, weight, laboratory values if indicated, and overall clinical progress, with adjustment to the regimen as needed. This review contains 1 figure, 4 tables, and 48 references. Key words: enteral access, enteral formula, enteral nutrition support, gastric residuals, gastrointestinal tract, immunonutrition, malnutrition, medical nutrition therapy, tube feed formula, tube feed tolerance, tube feeding, volume-based feeding

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Overview of Enteral Nutrition

10.2310/fm.9053 ◽

2017 ◽

Author(s):

Rebecca Lynch ◽

Erin Sisk

Keyword(s):

Gastrointestinal Tract ◽

Enteral Nutrition ◽

Medical Condition ◽

Functional Limitation ◽

Tube Feeding ◽

Oral Intake ◽

Nutrition Therapy ◽

Nutrition Support ◽

Medical Nutrition Therapy ◽

Medical Nutrition

Enteral nutrition (EN) is recognized as a medical nutrition therapy for patients with a functional gastrointestinal tract who are unable to maintain their weight and health by oral intake alone either due to a highly catabolic medical condition or a functional limitation. EN support provides calories and protein to help improve or maintain adequate weight, lean body mass, and overall nutritional status. EN also provides nonnutritive benefits such as maintaining intestinal integrity, supporting the immune system, and preventing infection. EN support can be tailored to a patient’s nutrient needs, and there are various formulas that vary in composition of macronutrients, concentration, and electrolytes for specific disease processes or conditions that may help with tolerance and absorption. EN support complications include issues with access, diarrhea, constipation, electrolyte abnormalities, hyperglycemia, and dehydration/overhydration. Generally, EN is well tolerated. While a patient is on this type of nutrition support, it is important to closely monitor tolerance, weight, laboratory values if indicated, and overall clinical progress, with adjustment to the regimen as needed. This review contains 1 figure, 4 tables, and 48 references. Key words: enteral access, enteral formula, enteral nutrition support, gastric residuals, gastrointestinal tract, immunonutrition, malnutrition, medical nutrition therapy, tube feed formula, tube feed tolerance, tube feeding, volume-based feeding

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Patients Discharged with Home Enteral Nutrition from a Third-Level Hospital in 2018

Nutrients ◽

10.3390/nu11112570 ◽

2019 ◽

Vol 11 (11) ◽

pp. 2570

Author(s):

Cristina Campos-Martín ◽

María Dolores García-Torres ◽

Cristina Castillo-Martín ◽

Rocío Domínguez-Rabadán ◽

Juana María Rabat-Restrepo

Keyword(s):

Enteral Nutrition ◽

Descriptive Analysis ◽

Maxillofacial Surgery ◽

Oral Intake ◽

Term Treatment ◽

Endoscopic Gastrostomy ◽

Care And Support ◽

Long Term Treatment ◽

Neurological Patients

Patients who, during admission, begin to use enteral nutrition (EN) and do not recover adequate oral intake need proper planning prior to discharge. The present study is a descriptive analysis of patients discharged with EN from our hospital in 2018. In all, the study included 141 patients (50.3% male) with an average age of 76.18 ± 14 years with the most frequent reasons for enteral support being neurological disease (71.3%) and ear, nose, and throat (ENT) and maxillofacial surgery (17.02%) (others accounted for 11.68%). In these two groups, differences were observed in both the average age (77 vs. 70.5 years) and sex of patients—mostly women (58%) in the first group and men (70%) in the second. Overall, the access routes used were nasogastric tube (76.4%), and percutaneous endoscopic gastrostomy (18.4%); 67.1% of the episodes ended by 30 June, 60.6% of patients died (47% of neurological patients), and 39.3% patients recovered function of the oral passage (85% of surgical/head and neck tumor). The duration of support was as follows: 1–3 months, 32%; 6–12 months, 26.9%; more than 12 months, 18.5%. This indicated some frequent and clearly differentiated profiles in the patients studied, which may contribute to better care and support in order to maintain long-term treatment.

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13 Macronutrient Intake and Wound Healing in Critically Ill Burn Patients

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.017 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S11-S12

Author(s):

Sarah S Rupert ◽

Beth A Shields ◽

Brenda D Bustillos ◽

Leopoldo C Cancio

Keyword(s):

Wound Healing ◽

Logistic Regression ◽

Enteral Nutrition ◽

Critically Ill ◽

Univariate Analysis ◽

Total Body Surface Area ◽

Oral Intake ◽

Nutrition Support ◽

Burn Patients ◽

Macronutrient Intake

Abstract Introduction Nutrition support is an important component of the care of the critically ill burn patient. The European Society for Parenteral and Enteral Nutrition recommends less than 35% of calories from fat and less than 60% from carbohydrate (CHO); however, favorable clinical outcomes have been found in randomized controlled trials when burn patients were given 12–27% fat and 46–65% CHO. These benefits include lower rates of pneumonia and mortality. The purpose of this research was to examine macronutrient intake of critically ill burn patients and the association with wound healing. Methods A retrospective study was approved by the Institutional Review Board and included patients admitted to our burn intensive care unit over an 11 year period who were ≥18 years of age, had ≥20% total body surface area burns. Subjects who required hospitalization for ≥8 days and required nutrition support were included in this analysis. Subjects who were admitted over a week after injury and those who underwent limb amputations were excluded. Caloric intake from CHO, fat, and protein was obtained from enteral nutrition, parenteral nutrition, and oral intake for the first eight days following hospitalization. Wound healing was defined as achieving < 10% TBSA open wound. Univariate analysis was used to identify factors significantly associated with wound healing. Variables found to be significant (p< 0.05) were subjected to logistic regression. Results A total of 309 patients (89% male) were included. Patients were 37 ± 17 years old and had 46 ± 18% TBSA burns. Wound healing was achieved by 77% of patients, with 26% mortality. Those who healed were significantly younger (34 ± 15 vs. 47 ± 19 years, p< 0.001), were taller (70 ± 3 vs. 68 ± 4 inches, p< 0.001), with smaller burns (44 ± 16% vs. 54 ± 20% TBSA, p< 0.001), predominantly male (92% vs. 77%, p< 0.001), received a higher amount of CHO (1166 ± 465 vs. 902 ± 494 kcals, p< 0.001), and received a higher amount of fat (455 ± 234 vs. 360 ± 220 kcals, p=0.003). After logistic regression, factors negatively associated with wound healing included increased age (p< 0.001), female gender (p=0.032), and larger burn size (p< 0.001); a positive association was seen with 8-day average calories from CHO (p=0.027). Conclusions This study identified several factors significantly associated with healing in burn patients; however, higher CHO intake was the only modifiable factor. Further research is needed to determine the optimal CHO intake to improve patient outcomes. Applicability of Research to Practice Consideration should be made for high-CHO enteral nutrition in critically ill burn patients.

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