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Enteral Nutrition

  • Susan E. Schaefer

Abstract

Nutritional support for patients in the critical care setting is intended to prevent malnutrition and its comorbid consequences, which include rapid loss of protein stores, impairment of vital organ function, wound failure, and immune compromise.

Keywords

Enteral Nutrition Total Parenteral Nutrition Tube Feeding Enteral Feeding Bacterial Translocation 
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.

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References

  1. 1.
    Bistrian BR, Blackburn GL, Vitale J, Cochran D, Naylor J. Prevalence of malnutrition in general medical patients. JAMA 1976; 235: 1567–70.PubMedCrossRefGoogle Scholar
  2. 2.
    Chandra RK. Nutrition, immunity, and infection: present knowledge and future direction. Lancet 1983; 1: 688–91.PubMedGoogle Scholar
  3. 3.
    Bassili HR, Deitel M. Effect of nutrition support on weaning patients off mechanical ventilators. WEN J Parenter Enteral Nutr 1981; 5: 161–3.CrossRefGoogle Scholar
  4. 4.
    Barton RG. Nutrition support in critical illness. Nutr Clin Pract. 1994; 9: 127–39.PubMedCrossRefGoogle Scholar
  5. 5.
    Perioperative total parenteral nutrition in surgical patients. The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group. N Engl J Med 1991; 325: 525–32.Google Scholar
  6. 6.
    Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. American Society for Parenteral and Enteral Nutrition. WEN J Parenter Enteral Nutr 1993;17:1SA–52SA.Google Scholar
  7. 7.
    McMahon M, Bistrian BR. Anthropometric assessment of nutritional status in hospitalized patients. In: Himes JH, ed. Anthropometric assessment of nutritional status. New York: Wiley-Liss, 1991: 365–81.Google Scholar
  8. 8.
    Trice S, Melnik G, Page C. Complications and costs of early postoperative parenteral versus enteral nutrition in trauma patients. Nutri Clin Pract 1997; 12: 114–9.CrossRefGoogle Scholar
  9. 9.
    Bower RH, Talamini MA, Sax HC, Hamilton F, Fischer E. Postoperative enteral vs parenteral nutrition. A randomized controlled trial. Arch Surg 1986; 121: 1040–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Kudsk KA, Croce MA, Fabian TC, Minard G, Tolley EA, Poret HA, Kuhl MR, Brown RO. Enteral versus parenteral feeding. Effects on septic morbidity after blunt and penetrating abdominal trauma. Ann Surg 1992; 215: 503–13.PubMedCrossRefGoogle Scholar
  11. 11.
    Moore FA, Moore EE, Jones TN, McCroskey BL, Peterson VM. TEN versus TPN following major abdominal trauma: reduced septic morbidity. J Trauma 1989; 29: 916–23.PubMedCrossRefGoogle Scholar
  12. 12.
    Moore FA, Feliciano DV, Andrassy RL, McArdle AH, Booth FV, Morgenstein-Wagner TB, Kellum JM Jr, Welling RE, Moore EE. Early enteral feeding, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis. Ann Surg 1992: 216; 172–83.Google Scholar
  13. 13.
    Swank GM, Deitch AE. Role of the gut in multiple organ failure: bacterial translocation and permeability changes. World J Surg 1996; 20: 411–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Sedman PC, Macfie J, Sagar P, Mitchell CJ, May J, Mancey-Jones B, Johnstone D. The prevalence of gut translocation in humans. Gastroenterology 1994; 107: 643–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Alverdy JC, Aoys E, Moss GS. Total parenteral nutrition promotes bacterial translocation from the gut. Surgery 1988; 104: 185–90.PubMedGoogle Scholar
  16. 16.
    Alverdy J, Chi HS, Sheldon GF. The effect of parenteral nutrition on gastrointestinal immunity. The importance of enteral stimulation. Ann Surg 1985; 202: 681–4.PubMedCrossRefGoogle Scholar
  17. 17.
    Buchman AL, Moukarzel AA, Bhuta S, Belle M, Ament ME, Eckhert CD, Hollander D, Gornbein J, Kopple JD, Vijayaroghavan SR. Parenteral nutrition is associated with intestinal morphologic and functional changes in humans. WEN J Parenter Enteral Nutr 1995; 19: 45360.Google Scholar
  18. 18.
    Souba WW, Smith RI, Wilmore DW. Glutamine metabolism by the intestinal tract. WEN J Parenter Enteral Nutr 1985; 9: 608–17.CrossRefGoogle Scholar
  19. 19.
    van der Hulst RR, van Kreel BK, von Meyenfeldt MF, Brummer RI, Arends JW, Deutz NE, Soeters PB. Glutamine and the preservation of gut integrity. Lancet 1993; 341: 1363–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Barbul A, Rettura G, Levenson SM, Seifter E. Arginine: a thymotrophic and wound-healing promoting agent. Surg Forum 1977; 28: 101–3.PubMedGoogle Scholar
  21. 21.
    Barbul A, Lazarou SA, Efron DT, Wasserkrug HL, Efron G. Arginine enhances wound healing and lymphocyte immune response in humans. Surgery 1990; 108: 331–7.PubMedGoogle Scholar
  22. 22.
    Kirk SJ, Barbul A. Role of arginine in trauma, sepsis, and immunity. WEN J Parenter Enteral Nutr 1990; 14: 226S - 29S.CrossRefGoogle Scholar
  23. 23.
    Evans MA, Shronts EP. Intestinal fuels: glutamine, short chain fatty acids, and dietary fiber. J Am Diet Assoc 1992; 92: 1239–46, 1249.Google Scholar
  24. 24.
    Kapadia SA, Raimundo AH, Grimble GK, Aimer P, Silk DB. Influence of three different fiber-supplemented enteral diets on bowel function and short-chain fatty acid production. WEN J Parenter Enteral Nutr 1995; 19: 63–8.CrossRefGoogle Scholar
  25. 25.
    Tappenden KA, Marvin R, Harris LL, Moore FA. Early enteral nutrition may have detrimental effects in patients with gastrointestinal hypoperfusion. American Society for Parenteral and Enteral Nutrition. 22nd Clinical Congress Program Book. Jan-Feb 1998; p42.Google Scholar
  26. 26.
    Martindale RG. Enteral feeding during states of marginal visceral blood flow. IN:Current issues in enteral nutrition support. Report of the first Ross enteral device conference. Columbus, OH: Ross Products Division, Abbott Laboratories, 1996; 59–61.Google Scholar
  27. 27.
    Marvin RG, McKinley BA, McQuiggan M, Cocanour CS, Moore FA. Nonocclusive bowel necrosis occurring in critically ill trauma patients receiving enteral nutrition manifests no reliable clinical signs for early detection. Am J Surg 2000; 179: 7–12.PubMedCrossRefGoogle Scholar
  28. 28.
    Schunn CO, Daly JM. Small bowel necrosis associated with postoperative jejunal tube feeding. J Am Coll Surg 1995; 180: 410–6.PubMedGoogle Scholar
  29. 29.
    Smith-Choban P, Max MH. Feeding jejunostomy: a small bowel stress test? Am J Surg 1988; 155: 112–7.PubMedCrossRefGoogle Scholar
  30. 30.
    Sax HC, Illig KA, Ryan CK, Hardy DJ. Low-dose enteral feeding is beneficial during total parenteral nutrition. Am J Surg 1996; 171: 587–90.PubMedCrossRefGoogle Scholar
  31. 31.
    Chang RW, Jacobs S, Lee B. Gastrointestinal dysfunction among intensive care unit patients. Crit Care Med 1987; 15: 909–14.PubMedCrossRefGoogle Scholar
  32. 32.
    American Gastroenterological Association technical review on tube feeding for enteral nutrition. Gastroenterology 1995; 108: 1282–301.Google Scholar
  33. 33.
    Elpem EH. Pulmonary aspiration in hospitalized adults. Nutr Clin Pract 1997; 12: 5–13.CrossRefGoogle Scholar
  34. 34.
    Lord LM, Weiser-Maimone A, Pulhamus M, Sax HC. Comparison of weighted vs unweighted enteral feeding tubes for efficacy of transpyloric intubation. WEN J Parneter Enteral Nutr 1993; 17: 271–3.CrossRefGoogle Scholar
  35. 35.
    Jenson GL, Sporay G, Whitmire S, Taraszewski R, Reed MJ. Intraoperative placement of the nasoenteric feeding tube: a practical alternative? WEN J Parenter Enteral Nutr 1995; 19; 244–7.CrossRefGoogle Scholar
  36. 36.
    Nachlas MM, Younis MT, Roda CP, Wityk JJ, Gastrointestinal motility studies as a guide to postoperative management. Ann Surg 1972; 175: 510–22.PubMedCrossRefGoogle Scholar
  37. 37.
    Glucksman DL, Kaiser MH, Warren WD. Small intestinal adsorption in the immediate postoperative period. Surgery 1966; 60: 1020–25.PubMedGoogle Scholar
  38. 38.
    Montecalvo MA, Steger KA, Farber HW, Smith BF, Dennis RC, Fitzpatrick GF, Pollack SD, Korsberg TZ, Birkett DH, Hirsch EF, Craven DE. Nutritional outcome and pneumonia in critical care patients randomized to gastric versus jejunal tube feedings. The Critical Care Research Team. Crit Care Med 1992; 20: 1377–87.PubMedCrossRefGoogle Scholar
  39. 39.
    Mochizuki H, Trocki O, Dominion L, Brackett KA, Joffe SN, Alexander JW. Mechanism of prevention of postbum hypennetabolism and catabolism by early enteral feeding. Ann Sung 1984; 200: 297–310.CrossRefGoogle Scholar
  40. 40.
    Klein CJ, Stanek GS, Wiles CE 3rd. Overfeeding macronutrients to critically ill adults: metabolic complications. J Am Diet Assoc 1998; 98: 795–806.PubMedCrossRefGoogle Scholar
  41. 41.
    McClave SA, Snider HL. Use of indirect calorimetry in clinical nutrition. Nutr Clin Pract 1992; 7: 207–21.PubMedCrossRefGoogle Scholar
  42. 42.
    Hunter DC, Jaksic T, Lewis D, Benotti PN, Blackburn GL, Bistrian BR. Resting energy expenditure in the critically ill: estimate versus measurement. Br J Surg 1988; 75: 875–8.PubMedCrossRefGoogle Scholar
  43. 43.
    McClave SA, Sexton LK, Spain DA, Adams JL, Owens NA, Sullins MB, Blandford BS, Snider HL. Enteral tube feeding in the intensive care unit: factors impeding adequate delivery. Crit Care Med 1999; 27: 1252–6.PubMedCrossRefGoogle Scholar
  44. 44.
    Spain DA, McClave SA, Sexton LK, Adams JL, Blandford BS, Sullins ME, Owens NA, Snider HL. Infusion protocol improves delivery of enteral tube feeding in the critical care unit. WEN J Parenter Enteral Nutr 1999; 23: 288–92.CrossRefGoogle Scholar
  45. 45.
    Sawicky CP, Nippo J, Feitelson-Winkler MF, Albina JE. Adequate energy intake and improved prealbumin concentration as indicators of the response to total parenteral nutrition. J Am Diet Assoc 1992; 92: 1266–8.PubMedGoogle Scholar
  46. 46.
    Konstantinides FN. Nitrogen balance studies in clinical nutrition. Nutr Clin Pract 1992; 7: 231–8.PubMedCrossRefGoogle Scholar
  47. 47.
    Stack JA, Babineau TJ, Bistrian BB. Assessment of nutritional status in clinical practice. Gastroenterologist 1996; 4 (suppl 1): S8 - S15.Google Scholar
  48. 48.
    Frankel EH, Enow NB, Jackson KC, Kloiber LL. Methods of restoring patency to occluded feeding tubes. Nutrition in Clinical Practice 1998; 13: 129–32.CrossRefGoogle Scholar
  49. 49.
    Marcuard SP, Stegall KS. Unclogging feeding tubes with pancreatic enzymes. WEN J Parenter Enteral Nutr 1990; 14: 198–200.CrossRefGoogle Scholar
  50. 50.
    Williams MS, Harper R, Magnuson B, Loan T, Kearney P. Diarrhea in enterally fed patients. Nutri Clini Pract 1998; 13: 225–9.CrossRefGoogle Scholar
  51. 51.
    Keohane PP, Attrill H, Love M, Frost P, Silk DB. Relation between osmolality of diet and gastrointestinal side effects in enteral nutrition. Br Med J (Clin Res Ed) 1984; 288: 678–80.CrossRefGoogle Scholar
  52. 52.
    Keohane PP, Attrill H, Love M, Frost P, Silk DBA. The roles of lactose and clostridium difficile in the pathogenesis of enteral feeding diarrhea. Clin Nutr 1983; 1: 259–64.PubMedCrossRefGoogle Scholar
  53. 53.
    Eisenberg, PG. Causes of diarrhea in tube fed patients: a comprehensive approach to diagnosis and management. Nutr Clin Pract 1993; 8: 119–23.PubMedCrossRefGoogle Scholar
  54. 54.
    Edes TE, Walk BE, Austin JL. Diarrhea in tube-fed patients: feeding formula not necessarily the cause. Am J Med 1990; 88: 91–3.PubMedCrossRefGoogle Scholar
  55. 55.
    Miller S, Oliver AD. Sorbitol content of selected sugar-free liquid medications. Hosp Pharm 1993; 28: 741–55.Google Scholar
  56. 56.
    Mullan H, Roubenoff RA, Roubenoff R. Risk of pulmonary aspiration among patients receiving enteral nutrition support. WEN J Parenter Enteral Nutr 1992; 16: 160–4.CrossRefGoogle Scholar
  57. 57.
    Ibanez J, Penafiel A, Raurich JM, Marse P, Jorda R, Mata F. Gastroesophageal reflux in intubated patients receiving enteral nutrition: effect of supine and semirecumbent positions. WEN J Parenter Enteral Nutr 1992; 16: 419–22.CrossRefGoogle Scholar
  58. 58.
    McClave SA, Snider HL, Lowen CC, McLaughlin AJ, Greene LM, McCombs LR, Rodgers L, Wright RA, Roy TM, Schumer MP, Pfeifer MA. Use of residual volume as a marker for enteral feeding intolerance: prospective blinded comparison with physical examination and radiographic fmdings. WEN J Parenter Enteral Nutr 1992; 16: 99–105.CrossRefGoogle Scholar
  59. 59.
    Kalliafas S, Choban PS, Ziegler D, Drago S, Flancbaum L. Erythromycin facilitates postpyloric placement of nasoduodenal feeding tubes in intensive care unit patients: randomized, double-blinded, placebo-controlled trial. WEN J Parenter Enteral Nutr 1996; 20: 385–8.CrossRefGoogle Scholar
  60. 60.
    Klein CJ, Stanek GS, Wiles CE 3rd. Overfeeding macronutrients to critically ill adults: metabolic complications. J Am Diet Assoc 1998; 98: 795–806.PubMedCrossRefGoogle Scholar
  61. 61.
    Beyer PL. Complications of enteral nutrition. IN: Contemporary nutrition support practice: a clinical guide. s Mataresse LE, Gottschlich MM., editors. Philadelphia: WB Saunders, 1998 p 216–26.Google Scholar
  62. 62.
    Storm HM, Lin P. Forms of carbohydrate in enteral nutrition formulas. Support Line 1996; 18: 7–9.Google Scholar
  63. 63.
    Speigel JE, Rose R, Karabell P. Safety and benefits of fructooligosaccharides as food ingredients. Food Technol 1994; 48: 85–9.Google Scholar
  64. 64.
    Kalfarentzos F, Kehagias J, Mead N, Kokkins K, Gogos CA. Enteral nutrition is superior to parenterai nutrition in severe acute pancreatitis: results of a randomized prospective trial. Br J Surg 1997; 84: 1665–9.PubMedCrossRefGoogle Scholar
  65. 65.
    Serizawa H, Miura S, Tashiro H, Imaeda H, Shiozaki H, Ohkubo N, Kimura H, Tanaka S, Tsuchiya M. Alteration of mucosal immunity after long term ingestion of an elemental diet in rats. WEN J Parenter Enteral Nutr 1994; 18: 141–7.CrossRefGoogle Scholar
  66. 66.
    Alexander JW, Gottschlich MM. Nutritional immunomodulation in bum patients. Crit Care Med 1990; 18: S149–53.PubMedCrossRefGoogle Scholar
  67. 67.
    Daly JM, Lieberman MD, Goldfine J, Shou J, Weintraub FW, Rosato EF, Lavin PL. Enteral nutrition with supplemental arginine, RNA and omega-3 fatty acids in patients after operation: immunologic, metabolic and clinical outcome. Surgery 1992; 112: 56–67.PubMedGoogle Scholar
  68. 68.
    Moore FA, Moore EE, Kudsk KA, Brown RO, Bower RH, Koruda MJ, Baker CC, Barbul A. Clinical benefits of an immune-enhancing diet for early postinjury enteral feeding. J Trauma 1994; 37: 607–15.PubMedCrossRefGoogle Scholar
  69. 69.
    Bower RH, Cerra FB, Bershadsky B, Licari JJ, Hoyt DB, Jenson GL, Van Buren CT, Rothkopf MM, Daly JM, Adelsberg BR. 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 1995; 23: 436–49.PubMedCrossRefGoogle Scholar
  70. 70.
    Kudsk KA, Minard G, Croce MA, Brown RO, Lowrey TS, Pritchard FE, Dickerson RN, Fabian TC. A randomized trial of isonitrogenous enteral diets after severe trauma. An immune enhancing diet reduces septic complications. Ann Surg 1996; 224: 531–43.PubMedCrossRefGoogle Scholar
  71. 71.
    Braga M, Gianotti L, Vignali A, Cestari A, Bisagni P, DiCarlo V. Artificial nutrition after major abdominal surgery: impact of route of administration and composition of the diet. Crit Care Med 1998; 26: 24–30.PubMedCrossRefGoogle Scholar
  72. 72.
    Galban C, Montejo JC, Mesejo A, Marco P, Celaya S, Sanchez-Segura JM, Farre M, Bryg DJ. An immune enhancing enteral diet reduces mortality rate and episodes of bacteremia in septic intensive care unit patients. Crit Care Med 2000; 28: 643–8.PubMedCrossRefGoogle Scholar
  73. 73.
    Beale RJ, Bryg DJ, Bihari DJ. Immunonutrition in the critically ill: a systemic review of clinical outcome. Crit Care Med 1999; 27: 2799–805.PubMedCrossRefGoogle Scholar
  74. 74.
    Lacy JM, Wilmore DW. Is glutamine a conditionally essential amino acid? Nutr Rev 1990; 48: 297309.Google Scholar
  75. 75.
    Savy G. Enteral glutamine supplementation: Clinical review and practical guidelines. Nutr Clin Pract 1997; 12: 259–63.CrossRefGoogle Scholar
  76. 76.
    Ziegler TR, Benfell K, Smith RJ, Young LS, Brown E, Ferrari-Baliviera E, Lowe DK, Wilmore DW. Safety and metabolic effects of L-glutamine administration in humans. WEN J Parenter Enteral Nutr 1990: 14; 137S - 146S.CrossRefGoogle Scholar
  77. 77.
    Daly JM, Reynolds J, Thom A, Kinsley L, Dietrick-Gallagher M, Shou J, Ruggieri B. Immune and metabolic effects of arginine in the surgical patient. Ann Surg 1988; 208: 512–23.PubMedCrossRefGoogle Scholar
  78. 78.
    Lieberman MD, Shou J, Torres AS, Weintraub F, Goldfine J, Sigal R, Daly JM. Effects of nutrient substrates on immune function. Nutrition 1990; 6: 88–98.PubMedGoogle Scholar
  79. 79.
    Tappenden KA. Nutritional regulation of intestinal adaptation. Support Line 1998; 20: 8–23.Google Scholar
  80. 80.
    Cummings JH. Colonic absorption: The importance of short-chain fatty acids in man. Scand J Gastroenterol Supp11984; 93: 89–99.Google Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Susan E. Schaefer
    • 1
  1. 1.Lahey Clinic Medical CenterBurlingtonUSA

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