Advertisement

Early Enteral Nutrition in the Intensive Care Unit

  • F. M. P. van Haren
  • J. G. van der Hoeven

Abstract

Nutritional support for critically ill patients independently influences outcome and should be considered an integral component of critical care. Decisive factors are route of feeding, timing, composition, and amount of different nutrients delivered. A recent survey among European intensivists showed that the preferred modality was enteral nutrition, instituted before the 48th hour after admission [1].

Keywords

Parenteral Nutrition Enteral Nutrition Severe Acute Pancreatitis Enteral Feeding Intestinal Permeability 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Preiser JC, Berre J, Carpentier Y, et al (1999) Management of nutrition in European intensive care units: results of a questionnaire. Working Group on Metabolism and Nutrition of the European Society of Intensive Care Medicine. Intensive Care Med 25: 95–101PubMedCrossRefGoogle Scholar
  2. 2.
    Brathwaite CE, Ross SE, Nagele R, Mure AJ, O’Malley KF, Garcia-Perez FA (1993) Bacterial translocation occurs in humans after traumatic injury: evidence using immunofluorescence. J Trauma 34: 586–589PubMedCrossRefGoogle Scholar
  3. 3.
    Landow L, Andersen LW (1994) Splanchnic ischaemia and its role in multiple organ failure. Acta Anaesthesiol Scand 38: 626–639PubMedCrossRefGoogle Scholar
  4. 4.
    Pape HC, Dwenger A, Regel G, et al (1994) Increased gut permeability after multiple trauma. Br J Surg 81: 850–852PubMedCrossRefGoogle Scholar
  5. 5.
    Roumen RM, van d V Wevers RA, Goris RJ (1993) Intestinal permeability is increased after major vascular surgery. J Vasc Surg 17: 734–737Google Scholar
  6. 6.
    Roumen RM, Hendriks T, Wevers RA, Goris JA (1993) Intestinal permeability after severe trauma and hemorrhagic shock is increased without relation to septic complications. Arch Surg 128: 453–457PubMedCrossRefGoogle Scholar
  7. 7.
    LeVoyer T, Cioffi WGJ, Pratt L, et al (1992) Alterations in intestinal permeability after thermal injury. Arch Surg 127: 26–29PubMedCrossRefGoogle Scholar
  8. 8.
    Harris CE, Griffiths RD, Freestone N, Billington D, Atherton ST, Macmillan RR (1992) Intestinal permeability in the critically ill. Intensive Care Med 18: 38–41PubMedCrossRefGoogle Scholar
  9. 9.
    Sinclair DG, Haslam PL, Quinlan GJ, Pepper JR, Evans TW (1995) The effect of cardiopulmonary bypass on intestinal and pulmonary endothelial permeability. Chest 108: 718–724PubMedCrossRefGoogle Scholar
  10. 10.
    Deitch EA (1990) Intestinal permeability is increased in burn patients shortly after injury. Surgery 107: 411–416PubMedGoogle Scholar
  11. 11.
    van der Hulst RR, von Meyenfeldt MF, van Kreel BK, et al (1998) Gut permeability, intestinal morphology, and nutritional depletion. Nutrition 14: 1–6PubMedCrossRefGoogle Scholar
  12. 12.
    Hadfield RJ, Sinclair DG, Houldsworth PE, Evans TW (1995) Effects of enteral and parenteral nutrition on gut mucosal permeability in the critically ill. Am J Respir Crit Care Med 152: 1545–1548PubMedCrossRefGoogle Scholar
  13. 13.
    Adams CAJ, Magnotti LJ, Xu DZ, Lu Q, Deitch EA (2000) Acute lung injury after hemorrhagic shock is dependent on gut injury and sex. Am Surg 66: 905–912PubMedGoogle Scholar
  14. 14.
    Magnotti LJ, Upperman JS, Xu DZ, Lu Q, Deitch EA (1998) Gut-derived mesenteric lymph but not portal blood increases endothelial cell permeability and promotes lung injury after hemorrhagic shock. Ann Surg 228: 518–527PubMedCrossRefGoogle Scholar
  15. 15.
    Magnotti LJ, Xu DZ, Lu Q, Deitch EA (1999) Gut-derived mesenteric lymph: a link between burn and lung injury. Arch Surg 134: 1333–1340PubMedCrossRefGoogle Scholar
  16. 16.
    Adams CAJ, Sambol JT, Xu DZ, Lu Q, Granger DN, Deitch EA (2001) Hemorrhagic shock induced up-regulation of P-selectin expression is mediated by factors in mesenteric lymph and blunted by mesenteric lymph duct interruption. J Trauma 51: 625–631PubMedCrossRefGoogle Scholar
  17. 17.
    Sambol JT, Xu DZ, Adams CA, Magnotti LJ, Deitch EA (2000) Mesenteric lymph duct ligation provides long term protection against hemorrhagic shock-induced lung injury. Shock 14: 416–419PubMedCrossRefGoogle Scholar
  18. 18.
    Mochizuki H, Trocki 0, Dominioni L, Brackett KA, Joffe SN, Alexander JW (1984) Mechanism of prevention of postburn hypermetabolism and catabolism by early enteral feeding. Ann Surg 200: 297–310PubMedCrossRefGoogle Scholar
  19. 19.
    Gianotti L, Nelson JL, Alexander JW, Chalk CL, Pyles T (1994) Post injury hypermetabolic response and magnitude of translocation: prevention by early enteral nutrition. Nutrition 10: 225–231PubMedGoogle Scholar
  20. 20.
    Gianotti L, Alexander JW, Nelson JL, Fukushima R, Pyles T, Chalk CL (1994) Role of early enteral feeding and acute starvation on postburn bacterial translocation and host defense: prospective, randomized trials. Crit Care Med 22: 265–272PubMedCrossRefGoogle Scholar
  21. 21.
    Langkamp-Henken B, Donovan TB, Pate LM, Maull CD, Kudsk KA (1995) Increased intestinal permeability following blunt and penetrating trauma. Crit Care Med 23: 660–664PubMedCrossRefGoogle Scholar
  22. 22.
    Kompan L, Kremzar B, Gadzijev E, Prosek M (1999) Effects of early enteral nutrition on intestinal permeability and the development of multiple organ failure after multiple injury. Intensive Care Med 25: 157–161PubMedCrossRefGoogle Scholar
  23. 23.
    Oudemans-van Straaten HM, Van der Voort PHJ, Hoek FJ, Bosman RJ, Van der Spoel JI, Zandstra DF (2002) Pitfalls in gastrointestinal permeability measurement in ICU patients with multiple organ failure using differential sugar absorption. Intensive Care Med (In Press)Google Scholar
  24. 24.
    Takagi K, Yamamori H, Toyoda Y, Nakajima N, Tashiro T (2000) Modulating effects of the feeding route on stress response and endotoxin translocation in severely stressed patients receiving thoracic esophagectomy. Nutrition 16: 355–360PubMedCrossRefGoogle Scholar
  25. 25.
    Engel JM, Menges T, Neuhauser C, Schaefer B, Hempelmann G (1997) Effects of various feeding regimens in multiple trauma patients on septic complications and immune parameters]. Anasthesiol Intensivmed Notfallmed Schmerzther 32: 234–239Google Scholar
  26. 26.
    Fukatsu K, Lundberg AH, Hanna MK, et al (2000) Increased expression of intestinal P-selectin and pulmonary E-selectin during intravenous total parenteral nutrition. Arch Surg 135: 1177–1182PubMedCrossRefGoogle Scholar
  27. 27.
    Alscher KT, Phang PT, McDonald TE, Walley KR (2001) Enteral feeding decreases gut apoptosis, permeability, and lung inflammation during murine endotoxemia. Am J Physiol 281: G569 - G576Google Scholar
  28. 28.
    Kudsk KA, Li J, Renegar KB (1996) Loss of upper respiratory tract immunity with parenteral feeding. Ann Surg 223: 629–635PubMedCrossRefGoogle Scholar
  29. 29.
    Renegar KB, Kudsk KA, Dewitt RC, Wu Y, King BK (2001) Impairment of mucosal immunity by parenteral nutrition: depressed nasotracheal influenza-specific secretory IgA levels and transport in parenterally fed mice. Ann Surg 233: 134–138PubMedCrossRefGoogle Scholar
  30. 30.
    Wu Y, Kudsk KA, Dewitt RC, Tolley EA, Li J (1999) Route and type of nutrition influence IgA-mediating intestinal cytokines. Ann Surg 229: 662–667PubMedCrossRefGoogle Scholar
  31. 31.
    Fukatsu K, Kudsk KA, Zarzaur BL, Wu Y, Hanna MK, Dewitt RC (2001) TPN decreases IL-4 and IL-10 mRNA expression in lipopolysaccharide stimulated intestinal lamina propria cells but glutamine supplementation preserves the expression. Shock 15: 318–322PubMedCrossRefGoogle Scholar
  32. 32.
    Chiarelli A, Enzi G, Casadei A, Baggio B, Valerio A, Mazzoleni F (1990) Very early nutrition supplementation in burned patients. Am J Clin Nutr 51: 1035–1039PubMedGoogle Scholar
  33. 33.
    Wang S, Li A (1997) [A clinical study of early enteral feeding to protect the gut function in burned patients]. Chung Hua Cheng Hsing Shao Shang Wai Ko Tsa Chih 13: 267–271Google Scholar
  34. 34.
    Wang S, You Z (1997) [Clinical study of the effect of early enteral feeding on reducing hypermetabolism after severe burns]. Chung Hua Wai Ko Tsa Chih 35: 44–47Google Scholar
  35. 35.
    Raff T, Hartmann B, Germann G (1997) Early intragastric feeding of seriously burned and long-term ventilated patients: a review of 55 patients. Burns 23: 19–25PubMedCrossRefGoogle Scholar
  36. 36.
    Raff T, Germann G, Hartmann B (1997) The value of early enteral nutrition in the prophylaxis of stress ulceration in the severely burned patient. Burns 23: 313–318PubMedCrossRefGoogle Scholar
  37. 37.
    Peng YZ, Yuan ZQ, Xiao GX (2001) Effects of early enteral feeding on the prevention of enterogenic infection in severely burned patients. Burns 27: 145–149PubMedCrossRefGoogle Scholar
  38. 38.
    Kiyama T, Efron DT, Tantry U, Barbul A (1999) Effect of nutritional route on colonic anastomotic healing in the rat. J Gastrointest Surg 3: 441–446PubMedCrossRefGoogle Scholar
  39. 39.
    Velez JP, Lince LF, Restrepo JI (1997) Early enteral nutrition in gastrointestinal surgery: a pilot study. Nutrition 13: 442–445PubMedCrossRefGoogle Scholar
  40. 40.
    Singh G, Ram RP, Khanna SK (1998) Early postoperative enteral feeding in patients with nontraumatic intestinal perforation and peritonitis. J Am Coll Surg 187: 142–146PubMedCrossRefGoogle Scholar
  41. 41.
    Pupelis G, Selga G, Austrums E, Kaminski A (2001) Jejunal feeding, even when instituted late, improves outcomes in patients with severe pancreatitis and peritonitis. Nutrition 17: 91–94PubMedCrossRefGoogle Scholar
  42. 42.
    Beier-Holgersen R, Boesby S (1996) Influence of postoperative enteral nutrition on postsurgical infections. Gut 39: 833–835PubMedCrossRefGoogle Scholar
  43. 43.
    Braga M, Vignali A, Gianotti L, Cestari A, Profili M, Carlo VD (1996) Immune and nutritional effects of early enteral nutrition after major abdominal operations. Eur J Surg 162: 105–112PubMedGoogle Scholar
  44. 44.
    Braga M, Vignali A, Gianotti L, Cestari A, Profili M, Di CV (1995) Benefits of early postoperative enteral feeding in cancer patients. Infusionsther Transfusionsmed 22: 280–284PubMedGoogle Scholar
  45. 45.
    Hasse JM, Blue LS, Liepa GU, et al (1995) Early enteral nutrition support in patients undergoing liver transplantation. J Parenter Enteral Nutr 19: 437–443CrossRefGoogle Scholar
  46. 46.
    Bozzetti F, Braga M, Gianotti L, Gavazzi C, Mariani L (2001) Postoperative enteral versus parenteral nutrition in malnourished patients with gastrointestinal cancer: a randomised multicentre trial. Lancet 358: 1487–1492PubMedCrossRefGoogle Scholar
  47. 47.
    Schilder JM, Hurteau JA, Look KY, et al (1997) A prospective controlled trial of early postoperative oral intake following major abdominal gynecologic surgery. Gynecol Oncol 67: 235–240PubMedCrossRefGoogle Scholar
  48. 48.
    Reissman P, Teoh TA, Cohen SM, Weiss EG, Nogueras JJ, Wexner SD (1995) Is early oral feeding safe after elective colorectal surgery? A prospective randomized trial. Ann Surg 222: 73–77PubMedCrossRefGoogle Scholar
  49. 49.
    Choi J, O’Connell TX (1996) Safe and effective early postoperative feeding and hospital discharge after open colon resection. Am Surg 62: 853–856PubMedGoogle Scholar
  50. 50.
    Stewart BT, Woods RJ, Collopy BT, Fink RJ, Mackay JR, Keck JO (1998) Early feeding after elective open colorectal resections: a prospective randomized trial. Aust NZJ Surg 68: 125128Google Scholar
  51. 51.
    Detry R, Ciccarelli O, Komlan A, Claeys N (1999) Early feeding after colorectal surgery. Preliminary results. Acta Chir Be1g 99: 292–294Google Scholar
  52. 52.
    Hochwald SN, Harrison LE, Heslin MJ, Burt ME, Brennan MF (1997) Early postoperative enteral feeding improves whole body protein kinetics in upper gastrointestinal cancer patients. Am J Surg 174: 325–330PubMedCrossRefGoogle Scholar
  53. 53.
    Heslin MJ, Latkany L, Leung D, et al (1997) A prospective, randomized trial of early enteral feeding after resection of upper gastrointestinal malignancy. Ann Surg 226: 567–577PubMedCrossRefGoogle Scholar
  54. 54.
    Harrison LE, Hochwald SN, Heslin MJ, Berman R, Burt M, Brennan MF (1997) Early postoperative enteral nutrition improves peripheral protein kinetics in upper gastrointestinal cancer patients undergoing complete resection: a randomized trial. J Parenter Enteral Nutr 21: 202–207CrossRefGoogle Scholar
  55. 55.
    Carr CS, Ling KD, Boulos P, Singer M (1996) Randomised trial of safety and efficacy of immediate postoperative enteral feeding in patients undergoing gastrointestinal resection. Br Med J 312: 869–871CrossRefGoogle Scholar
  56. 56.
    Shirabe K, Matsumata T, Shimada M, et al (1997) A comparison of parenteral hyperalimentation and early enteral feeding regarding systemic immunity after major hepatic resection–the results of a randomized prospective study. Hepatogastroenterology 44: 205–209PubMedGoogle Scholar
  57. 57.
    Wicks C, Somasundaram S, Bjarnason I, et al (1994) Comparison of enteral feeding and total parenteral nutrition after liver transplantation. Lancet 344: 837–840PubMedCrossRefGoogle Scholar
  58. 58.
    Hedberg AM, Lairson DR, Aday LA, et al (1999) Economic implications of an early postoperative enteral feeding protocol. J Am Diet Assoc 99: 802–807PubMedCrossRefGoogle Scholar
  59. 59.
    Moore FA, Feliciano DV, Andrassy RJ, et al (1992) Early enteral feeding, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis. Ann Surg 216: 172–183Google Scholar
  60. 60.
    Bastian L, Weimann A, Regel G, Trautwein C, Tscherne H (1996) [Feasibility and complications in early enteral nutrition of severely injured polytrauma patients via duodenal tubes.] Unfallchirurg 99: 642–649Google Scholar
  61. 61.
    Moore EE, Moore FA (1991) Immediate enteral nutrition following multisystem trauma: a decade perspective. J Am Coll Nutr 10: 633–648PubMedGoogle Scholar
  62. 62.
    Chuntrasakul C, Siltharm S, Chinswangwatanakul V, Pongprasobchai T, Chockvivatanavanit S, Bunnak A (1996) Early nutritional support in severe traumatic patients. J Med Assoc Thai 79: 21–26PubMedGoogle Scholar
  63. 63.
    Yanagawa T, Bunn F, Roberts I, Wentz R, Pierro A (2000) Nutritional support for head-injured patients. Cochrane Database Syst Rev 2:CD001530Google Scholar
  64. 64.
    Bower RH, Cerra FB, Bershadsky B, et al (1995) Early enteral administration of a formula (Impact) supplemented with arginine, nucleotides, and fish oil in intensive care unit patients: results of a multicenter, prospective, randomized, clinical trial. Crit Care Med 23: 436–449PubMedCrossRefGoogle Scholar
  65. 65.
    Vincent JL, Preiser JC (1999) Management of the critically ill patient with severe sepsis. J Chemother 11: 524–529PubMedGoogle Scholar
  66. 66.
    McClave SA, Greene LM, Snider HL, et al (1997) Comparison of the safety of early enteral vs parenteral nutrition in mild acute pancreatitis. J Parenter Enteral Nutr 21: 14–20CrossRefGoogle Scholar
  67. 67.
    Kalfarentzos F, Kehagias J, Mead N, Kokkinis K, Gogos CA (1997) Enteral nutrition is superior to parenteral nutrition in severe acute pancreatitis: results of a randomized prospective trial. Br J Surg 84: 1665–1669PubMedCrossRefGoogle Scholar
  68. 68.
    Nakad A, Piessevaux H, Marot JC, et al (1998) Is early enteral nutrition in acute pancreatitis dangerous? About 20 patients fed by an endoscopically placed nasogastrojejunal tube. Pancreas 17: 187–193PubMedCrossRefGoogle Scholar
  69. 69.
    Windsor AC, Kanwar S, Li AG, et al (1998) Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis. Gut 42: 431–435PubMedCrossRefGoogle Scholar
  70. 70.
    Lehocky P, Sarr MG (2000) Early enteral feeding in severe acute pancreatitis: can it prevent secondary pancreatic (super) infection? Dig Surg 17: 571–577PubMedCrossRefGoogle Scholar
  71. 71.
    Heyland DK (1998) Nutritional support in the critically ill patient. A critical review of the evidence. Crit Care Clin 14: 423–440PubMedCrossRefGoogle Scholar
  72. 72.
    Heyland DK (2000) Enteral and parenteral nutrition in the seriously ill, hospitalized patient: a critical review of the evidence. J Nutr Health Aging 4: 31–41PubMedGoogle Scholar
  73. 73.
    Revelly JP, Tappy L, Berger MM, Gersbach P, Cayeux C, Chiolero R (2001) Early metabolic and splanchnic responses to enteral nutrition in postoperative cardiac surgery patients with circulatory compromise. Intensive Care Med 27: 540–547PubMedCrossRefGoogle Scholar
  74. 74.
    Mentec H, Dupont H, Bocchetti M, Cani P, Ponche F, Bleichner G (2001) Upper digestive intolerance during enteral nutrition in critically ill patients: frequency, risk factors, and complications. Crit Care Med 29: 1955–1961PubMedCrossRefGoogle Scholar
  75. 75.
    Marvin RG, McKinley BA, McQuiggan M, Cocanour CS, Moore FA (2000) Nonocclusive bowel necrosis occurring in critically ill trauma patients receiving enteral nutrition manifests no reliable clinical signs for early detection. Am J Surg 179: 7–12PubMedCrossRefGoogle Scholar
  76. 76.
    Frey C, Takala J, Krahenbuhl L (2001) Non-occlusive small bowel necrosis during gastric tube feeding: a case report. Intensive Care Med 27: 1422–1425PubMedCrossRefGoogle Scholar
  77. 77.
    Scaife CL, Saffle JR, Morris SE (1999) Intestinal obstruction secondary to enteral feedings in burn trauma patients. J Trauma 47: 859–863PubMedCrossRefGoogle Scholar
  78. 78.
    Heyland DK, Tougas G, King D, Cook DJ (1996) Impaired gastric emptying in mechanically ventilated, critically ill patients. Intensive Care Med 22: 1339–1344PubMedCrossRefGoogle Scholar
  79. 79.
    Biffi R, Lotti M, Cenciarelli S, et al (2000) Complications and long-term outcome of 80 oncology patients undergoing needle catheter jejunostomy placement for early postoperative enteral feeding. Clin Nutr 19: 277–279PubMedCrossRefGoogle Scholar
  80. 80.
    Pinilla JC, Samphire J, Arnold C, Liu L, Thiessen B (2001) Comparison of gastrointestinal tolerance to two enteral feeding protocols in critically ill patients: a prospective, randomized controlled trial. J Parenter Enteral Nutr 25: 81–86CrossRefGoogle Scholar
  81. 81.
    Spapen HD, Duinslaeger L, Diltoer M, Gillet R, Bossuyt A, Huyghens LP (1995) Gastric emptying in critically ill patients is accelerated by adding cisapride to a standard enteral feeding protocol: results of a prospective, randomized, controlled trial. Crit Care Med 23: 481–485PubMedCrossRefGoogle Scholar
  82. 82.
    Jooste CA, Mustoe J, Collee G (1999) Metoclopramide improves gastric motility in critically ill patients. Intensive Care Med 25: 464–468PubMedCrossRefGoogle Scholar
  83. 83.
    Boivin MA, Levy H (2001) Gastric feeding with erythromycin is equivalent to transpyloric feeding in the critically ill. Crit Care Med 29: 1916–1919PubMedCrossRefGoogle Scholar
  84. 84.
    MacLaren R, Kuhl DA, Gervasio JM, et al (2000) Sequential single doses of cisapride, erythromycin, and metoclopramide in critically ill patients intolerant to enteral nutrition: a randomized, placebo-controlled, crossover study. Crit Care Med 28: 438–444PubMedCrossRefGoogle Scholar
  85. 85.
    Dranoff JA, Angood PJ, Topazian M (1999) Transnasal endoscopy for enteral feeding tube placement in critically ill patients. Am J Gastroenterol 94: 2902–2904PubMedCrossRefGoogle Scholar
  86. 86.
    Ott L, Annis K, Hatton J, McClain M, Young B (1999) Postpyloric enteral feeding costs for patients with severe head injury: blind placement, endoscopy, and PEG/J versus TPN. J Neurotrauma 16: 233–242PubMedCrossRefGoogle Scholar
  87. 87.
    Reed RL, Eachempati SR, Russell MK, Fahkry C (1998) Endoscopic placement of jejunal feeding catheters in critically ill patients by a “push” technique. J Trauma 45: 388–393PubMedCrossRefGoogle Scholar
  88. 88.
    Hernandez-Socorro CR, Marin J, Ruiz-Santana S, Santana L, Manzano JL (1996) Bedside sonographic-guided versus blind nasoenteric feeding tube placement in critically ill patients. Crit Care Med 24: 1690–1694PubMedCrossRefGoogle Scholar
  89. 89.
    Komenaka IK, Giffard K, Miller J, Schein M (2000) Erythromycin and position facilitated placement of postpyloric feeding tubes in burned patients. Dig Surg 17: 578–580PubMedCrossRefGoogle Scholar
  90. 90.
    Ugo PJ, Mohler PA, Wilson GL (1992) Bedside postpyloric placement of weighted feeding tubes. Nutr Clin Pract 7: 284–287PubMedCrossRefGoogle Scholar
  91. 91.
    Bauer P, Charpentier C, Bouchet C, Nace L, Raffy F, Gaconnet N (2000) Parenteral with enteral nutrition in the critically ill. Intensive Care Med 26: 893–900PubMedCrossRefGoogle Scholar
  92. 92.
    Baskin WN (1992) Advances in enteral nutrition techniques. Am J Gastroenterol 87: 1547–1553PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

  • F. M. P. van Haren
  • J. G. van der Hoeven

There are no affiliations available

Personalised recommendations