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Nutritional support

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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]

For profit hospitals are more likely to use PEG tubes in nursing home patients.[5]

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)."[6] 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."[7] Prealbumin, which includes transthyretin, alpha-1-antitrypsin, transthyretin and orosomucoid, can help assessment because if its short half-life of 2 days.[8]

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[9] and maybe also if duration is seven days or less.[10]

A randomized controlled trial found no difference between the NG tube and PEG tube in stroke patients.[10]

A randomized controlled trial found that among patients receiving enteral nutritional support in intensive care, adding parenteral nutritional support at day 8 was equivalent to starting within 48 hours.[11]

Ethical issues

References

  1. National Library of Medicine. Nutritional Support. Retrieved on 2007-11-13.
  2. National Library of Medicine. Enteral nutrition. Retrieved on 2007-11-13.
  3. 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.
  4. 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.
  5. Teno JM, Mitchell SL, Gozalo PL, Dosa D, Hsu A, Intrator O et al. (2010). "Hospital characteristics associated with feeding tube placement in nursing home residents with advanced cognitive impairment.". JAMA 303 (6): 544-50. DOI:10.1001/jama.2010.79. PMID 20145231. Research Blogging.
  6. National Library of Medicine. Parenteral nutrition. Retrieved on 2007-11-13.
  7. Anonymous (2020), Nutrition assessment (English). Medical Subject Headings. U.S. National Library of Medicine.
  8. Shenkin A (2006). "Serum prealbumin: Is it a marker of nutritional status or of risk of malnutrition?". Clin Chem 52 (12): 2177-9. DOI:10.1373/clinchem.2006.077412. PMID 17138848. Research Blogging.
  9. 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]
  10. 10.0 10.1 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.
  11. Casaer, Michael P.; Dieter Mesotten, Greet Hermans, Pieter J. Wouters, Miet Schetz, Geert Meyfroidt, Sophie Van Cromphaut, Catherine Ingels, Philippe Meersseman, Jan Muller, Dirk Vlasselaers, Yves Debaveye, Lars Desmet, Jasperina Dubois, Aime Van Assche, Simon Vanderheyden, Alexander Wilmer, Greet Van den Berghe (2011-08). "Early versus Late Parenteral Nutrition in Critically Ill Adults". New England Journal of Medicine 365 (6): 506-517. DOI:10.1056/NEJMoa1102662. ISSN 0028-4793. Retrieved on 2011-08-11. Research Blogging.