Search

The presence of oral or naso-enteral probes during non-invasive mechanical ventilation (NIMV) increases the risk of leakage and patient discomfort. The objective of this study was to evaluate the effectiveness of a novel tube adapter for NIMV (TA-NIMV) in relation to leakage and comfort level.A non-randomized quasi-experimental design was performed in an adult intensive care unit of a highly complex hospital, in which patients were their own controls. We included adult patients who required NIV with oronasal mask and who simultaneously had oral or naso-enteric tubes. The interventions were as follows: every participant received two therapies, one with the TA-NIMV and one conventional therapy of NIMV (CT-NIMV). Comfort could be evaluated in 99 patients with a Glasgow Coma Scale of 15. The outcomes of interest was the average percentage of air leak and patient comfort during each intervention.196 patients were included in the study during a 16-month period. The mean air leak percentage was 9.2% [standard deviation (SD), 7.7] during TA-NIMV and 32.5% (SD, 12.5) during CT-NIMV (p0.001). 84.9% reported being comfortable or very comfortable during TA-VMNI. 66.7% Uncomfortable or Very uncomfortable during CT-NIMV (p0.001).Higher comfort levels and lower air leakage volume percentages were achieved using the TA-NIMV than those achieved by CT-NIMV.

Background: Dietary protein is required to attenuate the loss of muscle mass and to support recovery during a period of hospitalization. Jejunal feeding is preferred over gastric feeding in patients who are intolerant of gastric feeding. However, the impact of gastric vs. jejunal feeding on postprandial dietary protein digestion and absorption kinetics in vivo in humans remains largely unexplored. Objective: We compared the impact of gastric vs. jejunal feeding on subsequent dietary protein digestion and amino acid (AA) absorption in vivo in healthy young men. Methods: In a randomized crossover study design, 11 healthy young men (aged 21 +/- 2 y) were administered 25 g specifically produced intrinsically L-[1-C-13] phenylalanine-labeled intact casein via a nasogastric and a nasojejunal tube placed similar to 30 cm distal to the ligament of Treitz. Protein was provided in a 240-mL solution administered over a 65-min period in both feeding regimens. Blood samples were collected during the 7-h postprandial period to assess the increase in plasma AA concentrations and dietary protein-derived plasma L-[1-C-13] phenylalanine enrichment. Results: Jejunal feeding compared with gastric feeding resulted in higher peak plasma phenylalanine, leucine, total essential AA (EAA), and total AA concentrations (all P

Consumption of excess calories results in obesity and insulin resistance and has been intensively studied in mice and humans. The objective of this study was to determine the specific contribution of dietary fat rather than total caloric intake to the development of obesity-associated insulin resistance. We used an intragastric feeding method to overfeed excess calories from a low-fat diet (and an isocalorically matched high-fat diet) through a surgically implanted gastric feeding tube to generate obesity in wild-type mice followed by hyperinsulinemic-euglycemic clamp studies to assess the development of insulin resistance. We show that overfeeding a low-fat diet results in levels of obesity similar to high-fat diet feeding in mice. However, despite a similar body weight, obese high-fat diet-fed mice are more insulin resistant than mice fed an isocaloric low-fat diet. Therefore, increased proportion of calories from dietary fat further potentiates insulin resistance in the obese state. Furthermore, crossover diet studies revealed that reduction in dietary fat composition improves glucose tolerance in obesity. In the context of the current obesity and diabetes epidemic, it is particularly important to fully understand the role of dietary macronutrients in the potentiation and amelioration of disease.

Summary Background Malpositioned feeding tubes carry the risk of serious complications. However, common bedside methods of differentiating tracheal from gastric feeding tube placement are neither accurate nor practical. Therefore, we conducted an animal study to verify feeding tube placement by syringe aspiration test. Methods A total of 26 pigs were anesthetized and intubated with tracheal tubes in the trachea and the esophagus. The animals were divided into two groups. The animals in the mechanical ventilation group were paralysed and received mechanical ventilation. The animals in the spontaneous breathing group maintained spontaneous breathing. The feeding tubes were then inserted through the tracheal tubes, into the trachea and esophagus, so that the anterior openings of the feeding tubes were located in the trachea and esophagus. A feeding syringe was then attached and 30 ml of air was aspirated into the syringe. The ability to aspirate air without resistance was defined as a positive syringe aspiration test. If there was resistance as air was aspirated, it was defined as a negative syringe aspiration test. In the next step, 20 esophageal ventilations were given to create a distended stomach in the experimental animals, and the syringe aspiration test was repeated in the same manner described above. Results The syringe aspiration test was positive for feeding tubes placed in the trachea and was negative for feeding tubes located in the esophagus in both the mechanical ventilation group and the spontaneous breathing group. Conclusion The syringe aspiration test is an effective method of differentiating tracheal from esophageal feeding tube placement.

Objective: Enteral nutrition (EN) has well-established benefits in critically ill children. Optimally, full nutritional support should be achieved expeditiously. The authors hypothesized that a protocolized continuous gastric EN (GEN) approach would decrease time to goal feeding rate and calories (TTG). Design: 96 patients were enrolled, divided equally into control (pre) and treatment (post) groups. Patients were monitored every 4 hours for 5 signs of feeding intolerance. Significance was defined as P < .05. Setting: 23-bed multidisciplinary pediatric intensive care unit (PICU). Subjects: PICU patients

BACKGROUND: Jejunal feeding is preferred instead of gastric feeding in patients who are intolerant to gastric feeding or at risk of aspiration. However, the impact of gastric feeding compared with that of jejunal feeding on postprandial circulating plasma glucose and amino acid concentrations and the associated endocrine response in vivo in humans remains largely unexplored. OBJECTIVE: We compared the impact of administering enteral nutrition as either gastric feeding or jejunal feeding on endocrine responses in vivo in humans. DESIGN: In a randomized, crossover study design, 12 healthy young men (mean +/- SD age: 21 +/- 2 y) received continuous enteral nutrition that contained noncoagulating proteins for 12 h via a nasogastric tube or a nasojejunal tube placed 30-40 cm distal to the ligament of Treitz. Blood samples were collected during the 12-h postprandial period to assess the rise in plasma glucose, amino acid, and gastrointestinal hormone concentrations. RESULTS: No differences were observed in the postprandial rise in circulating plasma amino acid and glucose concentrations between regimens. Jejunal feeding resulted in higher peak plasma insulin concentrations than did gastric feeding (392 +/- 53 compared with 326 +/- 54 pmol/L, respectively; P < 0.05). The postprandial rise in plasma cholecystokinin, peptide YY (PYY), glucagon-like peptide 1 (GLP-1), and glucagon-like peptide 2 (GLP-2) concentrations was greater after jejunal feeding than after gastric feeding, with higher peak concentrations and a greater postprandial incremental AUC for GLP-1 and cholecystokinin (all P < 0.05). Plasma ghrelin concentrations did not differ between regimens. CONCLUSIONS: Enteral nutrition with gastric or jejunal feeding in healthy young men results in similar postprandial plasma amino acid and glucose concentrations. However, the endocrine response differs substantially, with higher peak plasma cholecystokinin, PYY, GLP-1, and GLP-2 concentrations being attained after jejunal feeding. This effect may result in an improved anabolic response, greater insulin sensitivity, and an improved intestinotropic effect. Nevertheless, it may also lead to delayed gastric emptying. This trial was registered at trialregister.nl as NTR2801.

Background and Aims: Intolerance of gastric enteral feeding (GEN) commonly occurs in surgical Intensive Care Unit (SICU). A liquid containing sugar could prolong gastric emptying time. This study was to propose a method for prediction of nonsuccess GEN using gastric volume after loading (GVAL) following gradual sucrose gastric loading. Materials and Methods: Mechanical ventilator supported and hemodynamically stable patients in SICU were enrolled. About 180-240 min before the GEN starting, a sucrose solution (12.5%; 450 mosmole/kg, 800 mL) was administered via gastric feeding tube over 30 min with 45° head upright position. GVAL was measured at 30, 60, 90, and 120 min after loading. GEN success status using clinical criteria was assessed at 72 h after the starting GEN protocol. The receiving operating characteristic (ROC) and c statistic were used for discrimination at each time point of GVAL. Results: A total of 32 patients were enrolled and completed the protocol. 14 patients (43.7%) were nonsuccessful GEN. The nonsuccess group was found to have significantly more GVAL than the other group at all-time points during the test (P < 0.05). The most discriminating point of GVAL for the prediction of nonsuccess was 150 mL at 120 min after loading with a sensitivity of 92.3%, specificity of 88.9%, positive predictive value of 85.7%, negative predictive value of 94.1%, and ROC area 0.97 (95% confidence interval 0.91–1.00). Conclusion: A high GVAL following sucrose gastric loading test might be a method to predict nonsuccess GEN in critically ill surgical patients.

The trafficking of dietary fat was assessed in obesity-prone (OP) and obesity-resistant (OR) male and female rats. Test meals containing [1-14C]palmitate were delivered through gastric feeding tubes while rats consumed a high-carbohydrate diet (HCD) or after 5 days of a high-fat diet (HFD). Over the subsequent 24 h, the appearance of14C was followed in the GI tract, skeletal muscles (SM), liver, adipose tissues (AT), and expired CO2. There was no difference in the production of14CO2between OP and OR rats consuming a HCD. However, after 5 days on HFD, OR rats produced significantly more14CO2after the test meal than OP rats ( P < 0.001 females, P = 0.03 males). The differential oxidation of dietary fat between OP and OR rats on HFD was not due to differences in absorption but rather was associated with preferential disposition of tracer to AT in OP rats. Measurements of lipoprotein lipase in part explained increased tracer uptake by AT in OP rats but were not consistent with increased SM tracer uptake in OR rats. Surprisingly, female rats oxidized more tracer than male rats irrespective of phenotype or diet. These results are consistent with the notion that differences in the partitioning of dietary fat between storage in AT and oxidation in SM and liver that develop shortly after the introduction of a HFD may in part underlie the differential tendency for OR and OP rats to gain weight on this diet.

While percutaneous endoscopic gastrostomy (PEG) is a well-known approach for achieving enteral feeding, direct percutaneous endoscopic jejunostomy (DPEJ) is a technique that allows endoscopic placement of percutaneous/transabdominal feeding tube directly into the jejunum. It offers a non-surgical alternative for postpyloric enteral feeding for long-term nutritional support when gastric feeding is not technically possible or is inappriopriate. Conventionally DPEJ is done with pediatric colonoscope or small bowel enteroscope. Here, we report a case where DPEJ was accomplished with gastroscope.

The purpose of this study was to evaluate the patient with a stroke in home treatment, investigating physical capacity, mental status and anthropometric analysis. This was a cross-sectional study conducted in Fortaleza/CE, from January to April of 2010. Sixty-one individuals monitored by a home care program of three tertiary hospitals were investigated, through interviews and the application of scales. The majority of individuals encountered were female (59%), elderly, bedridden, with a low educational level, a history of other stroke, a high degree of dependence for basic (73.8%) and instrumental (80.3 %) activities of daily living, and a low cognitive level (95.1%). Individuals also presented with tracheostomy, gastric feeding and urinary catheter, difficulty hearing, speaking, chewing, swallowing, and those making daily use of various medications. It was concluded that home care by nurses is an alternative for care of those individuals with a stroke. La propuesta del estudio fue evaluar al paciente con accidente cerebro vascular en tratamiento domiciliario, se investigó la capacidad funcional, el estado mental y el análisis antropométrico. Estudio transversal desarrollado en Fortaleza/CE, de enero a abril del 2010. Se investigaron 61 personas acompañadas por el programa de atención domiciliaria de tres hospitales de nivel terciario a través de entrevistas y aplicación de escalas. Se encontró en la mayoría: mujeres (59%), adultos mayores, postrados en cama, con bajo nivel de educación, con historia de otros accidentes cerebro vasculares, alto grado de dependencia para las actividades básicas (73,8%) e instrumentales (80,3%) de la vida diaria y bajo nivel cognitivo (95,1%). También tenían traqueotomía, sonda nasogástrica y vesical, dificultad para oír, hablar, masticar, tragar y usaban varios medicamentos diarios. Se concluye que la atención domiciliaria de enfermería se consolida como alternativa de cuidado a las personas con accidente cerebro vascular. A proposta do estudo foi avaliar o paciente com acidente vascular cerebral em tratamento domiciliário, investigando capacidade funcional, estado mental e análise antropométrica. Estudo transversal realizado em Fortaleza/CE, de janeiro a abril de 2010. Foram investigados 61 indivíduos acompanhados pelo programa de assistência domiciliar de três hospitais terciários, mediante entrevista e aplicação de escalas. Encontrou-se maioria do sexo feminino (59%), idosos, acamados, com baixa escolaridade, com história de outros eventos de acidente vascular cerebral, elevado grau de dependência para as atividades básicas (73,8%) e instrumentais (80,3%) da vida diária e baixo nível cognitivo (95,1%). Também apresentavam traqueostomia, sondagem gástrica e vesical, dificuldades para ouvir, falar, mastigar, engolir e faziam uso diário de vários medicamentos. Concluiu-se que o atendimento domiciliário de enfermagem consolida-se como alternativa de assistência aos indivíduos com acidente vascular cerebral.

OBJETIVO: Caracterizar a transição da alimentação gástrica por via oral quanto à maturidade e peso do prematuro, vias e técnicas de administração e duração da transição até a alimentação oral exclusiva. MÉTODOS: Estudo retrospectivo com dados levantados em prontuários de 116 prematuros assistidos nas unidades de cuidados intensivos e intermediários neonatais de um hospital universitário do município de Ribeirão Preto - SP. RESULTADOS: A idade gestacional corrigida média foi de 36 semanas ao início da alimentação oral e de 37 semanas quando a alimentação ocorreu total por via oral. O peso médio foi de 1.743 gramas ao início da alimentação oral e peso médio de 1.934 gramas quando a alimentação ocorreu total por via oral. Durante o período de transição foram utilizadas uma ou mais técnicas de administração do leite. O uso da gavagem em conjunto com outras técnicas (89,5%) predominou em especial, complementada pelo seio materno e copo (56,9%) e a duração da transição alimentar variou de menos de 1 a 47 dias. CONCLUSÃO: A maturidade e o peso ao nascer, além das condições clínicas decorrentes dessas variáveis, podem interferir no processo de transição da alimentação láctea do prematuro. Considerando as vantagens da amamentação materna, sua prática deve ser iniciada o mais precocemente possível neste segmento populacional de risco. OBJECTIVE: To characterize the transition from oral gastric feeding related to: maturity and weight of premature babies, methods and techniques of administration and, duration of the transition to only oral feeding. METHODS: This is a retrospective study of data gathered in records of 116 infants attended in intensive care units and neonatal intermediate in a university hospital in Ribeirao Preto-SP. RESULTS: The mean-corrected of gestational age was 36 weeks at the start of oral feeding and 37 weeks when the supply came entirely by the oral route. The average weight was 1,743 grams at the start of oral feeding and 1,934 grams when the food came entirely by the oral route. During the transition period were used one or more means of milk administration. The use of forced feeding in conjunction with other techniques (89.5%) predominated, this was complemented by breast feeding and milk bottle (56.9%); the duration of feeding transition ranged from less than 1 day to 47 days. CONCLUSION: The maturity and birth weight, in addition to the clinical conditions from these variables, can interfere in the process of milk feeding transition in preterm babies. Considering the advantages of breastfeeding, the practice should be initiated as early as possible in this risk population segment. OBJETIVO: Caracterizar la transición de la alimentación gástrica por vía oral en lo que se refiere a: madurez y peso del prematuro, vías y técnicas de administración y, duración de la transición hasta la alimentación oral exclusiva. MÉTODOS: Es un estudio retrospectivo con datos levantados en fichas de 116 prematuros asistidos en las unidades de cuidados intensivos e intermedios neonatales de un hospital universitario del municipio de Ribeirao Preto- SP. RESULTADOS: La edad de gestación corregida promedio fue de 36 semanas en el inicio de la alimentación oral y de 37 semanas cuando la alimentación ocurrió totalmente por la vía oral. El peso promedio fue de 1.743 gramos en el inicio de la alimentación oral y el peso promedio de 1.934 gramos cuando la alimentación ocurrió totalmente por la vía oral. Durante el período de transición fueron utilizadas una o más técnicas de administración de leche. El uso de alimentación forzada en conjunto con otras técnicas (89,5%) predominó, complementada por el seno materno y mamadera (56,9%); la duración de la transición alimentar varió de menos de 1 día a 47 días. CONCLUSIÓN: La madurez y el peso al nascer, además de las condiciones clínicas provenientes de esas variables, pueden interferir en el proceso de transición de la alimentación láctea del prematuro. Considerando las ventajas del amamantamiento materno, su práctica debe ser iniciada lo más precozmente posible en este segmento poblacional de riesgo.

An important area concerning morbidity among infants with congenital heart defects (CHD) is related to feeding problems. Our objectives were to characterize the evolution of feeding milestones related to transition to per oral feeding among infants with CHD, and to identify associated variables impacting the feeding abilities. Specifically, we differentiated the feeding characteristics in neonates with acyanotic vs cyanotic CHD. Feeding progress was tracked during the first hospitalization in a retrospective chart review study involving 76 infants (29 acyanotic, 47 cyanotic CHD). The ages at which the following milestones attained were recorded: first feeds, maximum gavage feeds, first nipple feeds and maximum nipple feeds, in addition to the length of hospital stay. Effects of perinatal factors, duration of respiratory support, vasopressor and narcotic use and use of cardiopulmonary bypass on the feeding milestones were also evaluated. ANOVA, t-test, and stepwise linear regression analysis were applied as appropriate. Data stated as mean±s.e.m., or %; P

The effects of gastric feeding on intestinal motility are still under debate. In order to better define the character of the contractile activity in fed and fasting states, we used the impedance technique to investigate the duodenal time periods of the migrating motor complex (MMC) and the interdigestive phases I-III. During general anaesthesia, pigs (32-40 kg) were instrumented with a luminal impedance catheter into the proximal duodenum in fasting (n = 6) and fed states (n = 6, Muskator®, 400 g, Muskator-Werk, Dusseldorf, Germany). Duodenal motility was recorded continuously for 4 h, which made it possible to determine the length of interdigestive phases I-III and the MMC cycle. Differences between the groups were compared by using the Wilcoxon Rank-Sum Test. Feeding patterns were only found in pigs in the fed state. The subsequent MMC cycle length was shortened by 34% (p = 0.007) which was due to a shortened phase I of the MMC cycle (p = 0.014). While phase II seemed to be unaffected, phase III was prolonged by 31% after feeding had occurred (p = 0.012). The present study suggests that a standard maintenance diet disrupts the spontaneous MMC cycles by turning into fed pattern with the subsequent MMC cycle length being shortened. This was mainly due to a shortened phase I.

Enteral feedings through gastroenteric (GE) tubes are commonly utilised in patients with feeding difficulties and intolerance to gastric feeding. A variety of complications related to GE tubes have been described which rarely include small bowel intussusception. The case of a 23-year-old man with proximal small bowel intussusception related to an endoscopically placed low profile GE tube is described. The patient presented with abdominal pain and bilious vomiting. Symptoms resolved with tube shortening. This report includes a short review aimed at raising awareness about this complication with a discussion on diagnosis and management.

To compare outcomes from early post-pyloric to gastric feeding in ventilated, critically ill patients in a medical intensive care unit (ICU).Prospective randomized study. Ventilated patients were randomly assigned to receive enteral feed via a nasogastric or a post-pyloric tube. Post-pyloric tubes were inserted by the bedside nurse and placement was confirmed radiographically.A total of 104 patients were enrolled, 54 in the gastric group and 50 in the post-pyloric group. Bedside post-pyloric tube insertion was successful in 80% of patients. Patients who failed post-pyloric insertion were fed via the nasogastric route, but were analysed on an intent-to treat basis. A per protocol analysis was also performed. Baseline characteristics were similar for all except Acute Physiology and Chronic Health Evaluation II (APACHE II) score, which was higher in the post-pyloric group. There was no difference in length of stay or ventilator days. The gastric group was quicker to initiate feed 4.3 hours (2.9 - 6.5 hours) as compared to post-pyloric group 6.6 hours (4.5 - 13.0 hours) (P = 0.0002). The time to reach target feeds from admission was also faster in gastric group: 8.7 hours (7.6 - 13.0 hours) compared to 12.3 hours (8.9 - 17.5 hours). The average daily energy and protein deficit were lower in gastric group 73 Kcal (2 - 288 Kcal) and 3.5 g (0 - 15 g) compared to 167 Kcal (70 - 411 Kcal) and 6.5 g (2.8 - 17.3 g) respectively but was only statistically significant for the average energy deficit (P = 0.035). This difference disappeared in the per protocol analysis. Complication rates were similar.Early post-pyloric feeding offers no advantage over early gastric feeding in terms of overall nutrition received and complicationsanzctr.org.au:ACTRN12606000367549.

In a review of 125 percutaneous endoscopic gastrostomies (PEG) and 88 Stamm gastrostomies performed at Duke University Medical Center since 1978, the average operating room time for PEG (50 +/- 20 min) was shorter than for Stamm (96 +/- 26 min) (p less than 0.0001). General anesthesia was administered in only 13% of PEG placements compared with 64% of Stamm gastrostomies. The cost of PEG was about $1000 less than for Stamm gastrostomies. The average time after surgery until use of the feeding tube was 1.8 days for PEG compared with 3.4 days for Stamm (p less than 0.0001). The overall complication rate after PEG was 8.8% (4.0% major) compared with 23.9% for Stamm gastrostomies (10.2% major) (p less than 0.005). PEG reduces operative time, necessity for general anesthesia, expense of insertion, incidence of complications, and requires less recovery time before use. PEG is the procedure of choice for gastric feeding access.

A rise in the fat concentration of human milk within the syringe was noted towards the end of continuous infusion but not with intermittent bolus gastric feeding. The rise in the former was reduced most simply and effectively by using an eccentric nozzle syringe and tilting the pump up at an angle of between 25 degrees and 40 degrees.