Nutritional support: Difference between revisions
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==Classification== | ==Classification== | ||
===Enteral nutrition=== | |||
[[Enteral nutrition]], which is defined as "nutritional support given via the alimentary canal or any route connected to the gastrointestinal system (i.e., the enteral route). This includes oral feeding, sip feeding, and tube feeding using nasogastric, gastrostomy, and jejunostomy tubes."<ref>{{cite web |url=http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?field=uid&term=D004750 |title=Enteral nutrition|author=National Library of Medicine |accessdate=2007-11-13 |format= |work=}}</ref> | |||
Duodenal feeding may be more effective than gastric feeding.<ref name="pmid19384225">{{cite journal |author=Hsu CW, Sun SF, Lin SL, ''et al.'' |title=Duodenal versus gastric feeding in medical intensive care unit patients: a prospective, randomized, clinical study |journal=Crit. Care Med. |volume=37 |issue=6 |pages=1866–72 |year=2009 |month=June |pmid=19384225 |doi=10.1097/CCM.0b013e31819ffcda |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0090-3493&volume=37&issue=6&spage=1866 |issn=}}</ref> | Duodenal feeding may be more effective than gastric feeding.<ref name="pmid19384225">{{cite journal |author=Hsu CW, Sun SF, Lin SL, ''et al.'' |title=Duodenal versus gastric feeding in medical intensive care unit patients: a prospective, randomized, clinical study |journal=Crit. Care Med. |volume=37 |issue=6 |pages=1866–72 |year=2009 |month=June |pmid=19384225 |doi=10.1097/CCM.0b013e31819ffcda |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0090-3493&volume=37&issue=6&spage=1866 |issn=}}</ref> | ||
For critically ill patients who are intolerant of tube feeding, combining two prokinetic drugs, 200 mg of intravenous erythromycin twice daily with 10 mg of intravenous metoclopramide four times daily may be more effective than using either drug alone.<ref name="pmid17828038">{{cite journal |author=Nguyen NQ, Chapman M, Fraser RJ, Bryant LK, Burgstad C, Holloway RH |title=Prokinetic therapy for feed intolerance in critical illness: One drug or two? |journal= |volume= |issue= |pages= |year=2007 |pmid=17828038 |doi=10.1097/01.CCM.0000286397.04815.B1}}</ref> | For critically ill patients who are intolerant of tube feeding, combining two prokinetic drugs, 200 mg of intravenous erythromycin twice daily with 10 mg of intravenous metoclopramide four times daily may be more effective than using either drug alone.<ref name="pmid17828038">{{cite journal |author=Nguyen NQ, Chapman M, Fraser RJ, Bryant LK, Burgstad C, Holloway RH |title=Prokinetic therapy for feed intolerance in critical illness: One drug or two? |journal= |volume= |issue= |pages= |year=2007 |pmid=17828038 |doi=10.1097/01.CCM.0000286397.04815.B1}}</ref> | ||
==Parenteral nutrition== | ===Parenteral nutrition=== | ||
Parenteral nutrition is usually administered via a [[central venous catheter]]. | [[Parenteral nutrition]], which is defined as "the administering of nutrients for assimilation and utilization by a patient who cannot maintain adequate nutrition by enteral feeding alone. Nutrients are administered by a route other than the alimentary canal (e.g., intravenously, subcutaneously)."<ref>{{cite web |url=http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?field=uid&term=D010288 |title=Parenteral nutrition|author=National Library of Medicine |accessdate=2007-11-13 |format= |work=}}</ref> Parenteral nutrition is usually administered via a [[central venous catheter]]. | ||
==Nutrition assessment== | |||
[[Nutrition assessment]] is "valuation and measurement of nutritional variables in order to assess the level of nutrition or the nutritional status of the individual. Nutrition surveys may be used in making the assessment."<ref>{{MeSH|Nutrition assessment}}</ref> Prealbumin, which includes transthyretin, alpha-1-antitrypsin, transthyretin and orosomucoid, can help assessment. | |||
==Effectiveness== | ==Effectiveness== | ||
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A [[randomized controlled trial]] found no difference between the NG tube and PEG tube in stroke patients.<ref name="pmid15733717">{{cite journal |author=Dennis MS, Lewis SC, Warlow C |title=Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial |journal=Lancet |volume=365 |issue=9461 |pages=764-72 |year=2005 |pmid=15733717 |doi=10.1016/S0140-6736(05)17983-5}} [http://www.acpjc.org/Content/143/2/issue/ACPJC-2005-143-2-037.htm ACP Journal Club synopses]</ref> | A [[randomized controlled trial]] found no difference between the NG tube and PEG tube in stroke patients.<ref name="pmid15733717">{{cite journal |author=Dennis MS, Lewis SC, Warlow C |title=Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial |journal=Lancet |volume=365 |issue=9461 |pages=764-72 |year=2005 |pmid=15733717 |doi=10.1016/S0140-6736(05)17983-5}} [http://www.acpjc.org/Content/143/2/issue/ACPJC-2005-143-2-037.htm ACP Journal Club synopses]</ref> | ||
==Ethical issues== | ==Ethical issues== | ||
Revision as of 22:29, 9 September 2009
Nutritional support is defined as "the administration of nutrients for assimilation and utilization by a patient by means other than normal eating."[1]
Classification
Enteral nutrition
Enteral nutrition, which is defined as "nutritional support given via the alimentary canal or any route connected to the gastrointestinal system (i.e., the enteral route). This includes oral feeding, sip feeding, and tube feeding using nasogastric, gastrostomy, and jejunostomy tubes."[2]
Duodenal feeding may be more effective than gastric feeding.[3]
For critically ill patients who are intolerant of tube feeding, combining two prokinetic drugs, 200 mg of intravenous erythromycin twice daily with 10 mg of intravenous metoclopramide four times daily may be more effective than using either drug alone.[4]
Parenteral nutrition
Parenteral nutrition, which is defined as "the administering of nutrients for assimilation and utilization by a patient who cannot maintain adequate nutrition by enteral feeding alone. Nutrients are administered by a route other than the alimentary canal (e.g., intravenously, subcutaneously)."[5] Parenteral nutrition is usually administered via a central venous catheter.
Nutrition assessment
Nutrition assessment is "valuation and measurement of nutritional variables in order to assess the level of nutrition or the nutritional status of the individual. Nutrition surveys may be used in making the assessment."[6] Prealbumin, which includes transthyretin, alpha-1-antitrypsin, transthyretin and orosomucoid, can help assessment.
Effectiveness
In the absence of metabolic diseases such as medium-chain acyl-coenzyme A dehydrogenase deficiency, nutritional supplementation is not necessary if the patient is not eating for four days or less[7] and maybe also if duration is seven days or less.[8]
A randomized controlled trial found no difference between the NG tube and PEG tube in stroke patients.[8]
Ethical issues
References
- ↑ National Library of Medicine. Nutritional Support. Retrieved on 2007-11-13.
- ↑ National Library of Medicine. Enteral nutrition. Retrieved on 2007-11-13.
- ↑ Hsu CW, Sun SF, Lin SL, et al. (June 2009). "Duodenal versus gastric feeding in medical intensive care unit patients: a prospective, randomized, clinical study". Crit. Care Med. 37 (6): 1866–72. DOI:10.1097/CCM.0b013e31819ffcda. PMID 19384225. Research Blogging.
- ↑ Nguyen NQ, Chapman M, Fraser RJ, Bryant LK, Burgstad C, Holloway RH (2007). "Prokinetic therapy for feed intolerance in critical illness: One drug or two?". DOI:10.1097/01.CCM.0000286397.04815.B1. PMID 17828038. Research Blogging.
- ↑ National Library of Medicine. Parenteral nutrition. Retrieved on 2007-11-13.
- ↑ Anonymous (2024), Nutrition assessment (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ de Lédinghen V, Beau P, Mannant PR, et al (1997). "Early feeding or enteral nutrition in patients with cirrhosis after bleeding from esophageal varices? A randomized controlled study". Dig. Dis. Sci. 42 (3): 536-41. PMID 9073135. [e]
- ↑ 8.0 8.1 Dennis MS, Lewis SC, Warlow C (2005). "Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial". Lancet 365 (9461): 764-72. DOI:10.1016/S0140-6736(05)17983-5. PMID 15733717. Research Blogging.
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