Effects of rhubarb and different routes of nutrition support on invasive fungal infection
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OBJECTIVE To study the effects of rhubarb and the different routes of nutrition support on invasive fungal infection. METHODS One thousand and ninety patients, who suffered from sepsis subsequent to trauma, shock and infection were enrolled in this study. The patients were randomly divided into two groups, 637 cases in rhubarb preventive treatment group and 453 cases in non-preventive rhubarb treatment group. They were again divided into four subgroups: enteral nutrition support, and no nutrition support group. The incidence of invasive fungal infection was observed in those groups. RESULTS The incidence of invasive fungal infection in rhubarb preventive treatment group (3.0%) was much lower than that in non-preventive rhubarb treatment group (11.5%). There was significant difference between two groups (P<0.05). Furthermore, fewer patients developed invasive fungal infection in enteral nutrition support and enteral combined parenteral nutrition support subgroups after preventive rhubarb treatment (0.9% and 2.1%), compared with parenteral nutrition support and no nutrition support subgroups (30.4% and 61.3%) and corresponding subgroups with non-preventive treatment of rhubarb (3.9% and 7.1%, P<0.05 or P<0.01). In addition, the route of nutrition support also affected the incidence of invasive fungal infection. Patients in enteral nutrition support and enteral combined parenteral nutrition support subgroups had lower incidence of invasive fungal infection than in parenteral nutrition support and no nutrition support subgroups (all P<0.05), and the incidence was the highest in no nutrition support subgroup. There were no significant difference between parenteral nutrition support and no nutrition support subgroups. CONCLUSION Rhubarb and enteral nutrition support have preventive effects on invasive fungal infection via gut mechanism.Keywords:
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Objective To study the rationality and validity of nutrition support in treatment of pa- tients with cancerous malnutrition and the effect of nutrition support on improving the nutritional status,immune function and quality of life of cancer patient,and to establish the related nursing routine.Methods The clinical data of 125 cancer patients receiving enteral or parenteral nutrition was retrospectively analyzed.The biochemical indicators,immune function and quality of life score were determined to evaluate the nutritional status of the patients.Results Eighty-six patients re- ceived parenteral nutrition,94 patients received enteral nutrition,and 55 patients received both en- teral combined parenteral nutrition.Duration of nutritional support was 10-214 days (28.7±12.6),and the effective rate of nutritional support was 78.4% (98/125).The levels of serum al- bumin,BMI and KPS scores were significantly increased(P0.05) and the serum CRP level was significantly decreased (P0.05).Complications of parenteral nutrition and enteral nutrition were 7.0% (6/86) and 10.6% (10/94),respectively;and were treated successfully.Conclusion Nutritional support is safe and effective in treatment of cancerous malnutrition and can improve the nutrition status,quality of life and prognosis of cancer patients.
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Objective
To explore the effects of nutritional risk assessment combined with individual enteral nutrition management process among critically ill patients.
Methods
A total of 220 critically ill patients were selected in ICU at Ningbo First Hospital of Zhejiang Province from January 2016 to January 2017. They were coded according to the order of being admitted and were divided into observation group (n=110) and control group (n=110) with the method of random number table. Patients in control group received routine nutritional support following the doctor's advice involving adopting total protein enteral nutrition powder, evaluating gastric residual volume of patients by nurses at four hours interval, increasing dose of nutritive medium according to patients' conditions. Patients in observation group accepted nutritional risk screening with the evaluation standards of nutrition risk screening 2002 (NRS 2002) after being admitted to department along with gastrointestinal function assessment. And then, the individual enteral nutrition management process was carried out. In this process, doctors were responsible for establishing objectives and schemes of nutritional support including nutrition time, types of nutritive medium and nutritional goal. Besides, nurses executed enteral nutrition schemes, and evaluated the tolerance of enteral nutrition dynamically, and adjusted the velocity and quantity of enteral nutrition liquid. Finally, this research compared the indexes of nutrition and amynology, incidences of gastrointestinal dysfunction and infectious complications and time of being admitted to ICU of patients in two groups.
Results
There were no statistically significant differences in the indexes of nutrition and amynology on the first day of being admitted of patients in two groups (P>0.05) . The indexes of nutrition and amynology including total serum protein (57.06±3.31) g/L, blood albumin (32.12±1.49) g/L, hemoglobin (118.34±9.34) g/L, IgA (3.24±0.50) g/L, IgG (2.96±0.38) g/L, IgM (1.92±0.17) g/L of patients in observation group were higher than those in control group with significant differences on the seventh day (t=4.01, 3.59, 2.39, 6.06, 4.05, 6.19; P<0.05) . The incidences of gastrointestinal dysfunction and infectious complications were 21.81% and 12.72% in observation group significantly lower than those in control group (χ2=11.89, 8.91; P<0.05) . The time of being admitted to ICU was (10.01±2.28) d in observation group and (13.99±1.91) d in control group with a significant difference (t=9.91, P<0.05) .
Conclusions
The nutritional risk assessment combined with individual enteral nutrition management process can enhance the overall nutritional level, and effectively improve the nutrition of patients, and reduce the incidence of complications related to enteral nutrition, and promote the rehabilitation of patients. It is worth to be used widely in clinical application.
Key words:
Nutritional assessment; Enteral nutrition; Critically ill patients
Gastrointestinal function
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Nutrition support includes three parts: supplementation, support, and therapy. When? and how? to use nutrition support which should be related with clinical outcome of the patients. Parenteral nutrition became widely accepted in the States since the presentation at American College of Surgeons Congress 1967 by Dudrick et al. More detail study of baby growth and development receiving all nutrients exclusively by vein from Wilmore et al 1968. In China, it was Jiang et al reported the clinical applications of parenteral nutrition at Surgical Congress of Chinese Medical Association 1978. Enteral elemental diet and parenteral nutrition for intestinal fistulae illness by Jiang et al 1979 which enrolled by Medline. Although nutrition support has become a standardized technology in China, but evidences on improving the patients' outcomes were still insufficient. After Kondrup et al estsblished Nutritional Risk Screening 2002 tool, the nutrition support could use an evidence-based approaching with outcome. One prospective cohort study based on hospitals in Baltimore and Beijing, using Nutrition Risk Screening 2002 as the tool, have evaluated the impact of nutritional support (both parenteral and enteral nutrition) on the infective complications among patients at nutritional risk and demonstrated that the overall incidence of complications was significantly lower in patients who had received nutritional support, which was achieved mainly due to the decline of the incidence of infective complications. Therefore, support with appropriate nutrients being necessary for patients at nutritional risks or already with malnutrition. However, more cohort studies and randomized controlled studies with larger samples are still required.
Key words:
Nutrition support; Nutrition risk; Malnutrition; Nutrition support and outcome; Prospective cohort study
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Abstract Background The aim of this study was to systematically review effects of nutrition interventions on outcomes in patients with chronic gastrointestinal (GI) motility disorders. There is currently a lack of evidence‐based guidelines for nutrition management in this group, likely a result of the rarity of the conditions. Methods A systematic review of all study types to evaluate current evidence‐based nutrition interventions was performed using Medline, Embase, and CINAHL databases. Two independent reviewers participated in the process of this systematic review. A total of 15 studies and a total of 524 subjects were included. Results Best treatment of this population group was found to include a stepwise process, progressing from oral nutrition to jejunal nutrition and lastly to parenteral nutrition. Small particle, low‐fat diets were significantly better tolerated than the converse, with jejunal nutrition prior to consuming oral food significantly improving oral intake and motility. In more progressive cases, percutaneous endoscopic gastrostomy with jejunal extension nutrition had lower reported symptoms than other enteral routes. Exclusive long‐term parenteral nutrition is a feasible option for advanced cases, with a 68% survival rate at 15 years duration, though oral intake with parenteral nutrition is associated with higher survival rates. Conclusion Treatment of patients with GI motility disorders should first trial oral nutrition. For patients who progress to jejunal or parenteral feeds, the primary aim should be to maintain or reinstate oral intake to reduce morbidity and mortality risk. Higher‐quality studies are still required in this area, particularly in the areas of chronic intestinal pseudo‐obstruction and systemic sclerosis.
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Abstract Background Nutritional treatment is one of the most important components of multidisciplinary anti-cancer therapy. Home enteral nutrition is considered as a safe procedure, however, it may be associated with the risk of side effects, such as nausea, vomiting, abdominal pain, and diarrhoea. It is uncertain whether diarrhoea is the result of the enteral formula administration or gut dysbiosis. One of the methods which may be used to alter the composition of gut microbiota is the administration of a probiotic strain. Lactobacillus plantarum 299v ingestion was found to diminish the adverse events of irritable bowel syndrome and Clostridium difficile infection - entities that share the symptoms with enteral nutrition side effects. Therefore, the primary aim of this study is to determine the effect of Lactobacillus plantarum 299v on prevention of weight loss of cancer patients receiving home enteral nutrition. The secondary aims are to evaluate the role of this probiotic strain in the improvement of nutritional status, enteral nutrition tolerance, and patients’ quality of life. Methods Forty patients with cancer receiving home enteral nutrition will be enrolled in this clinical trial and randomized to receive one capsule of Lactobacillus plantarum 299v (Sanprobi IBS®) twice a day or placebo for 12 weeks in a double-blind manner. Laboratory tests (the level of albumin, total protein, transferrin, and total lymphocyte count), anthropometric parameters (body mass, the content of fat mass, muscle mass, and total body water), Nutritional Risk Screening (NRS 2002), enteral nutrition tolerance as well as quality of life will be measured. Measurements will be obtained at the baseline and after 4 and 12 weeks of treatment. Discussion The adverse events observed during administration of enteral nutrition have an negative impact on enteral formula tolerance and as a consequence patients’ quality of life. The previous studies have demonstrated that probiotics may reduce the gastrointestinal symptoms related to enteral nutrition. Thus, administration of Lactobacillus plantarum 299v may be effective in improvement of nutritional status, enteral nutrition tolerance, and quality of life of cancer patients receiving home enteral nutrition. Trial registration ClinicalTrials.gov Identifier: NCT03940768 .
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Objective To explore how to prevent and treat enteral nutrition related diarrhea after gastric operation with evidencebased approach.Methods Clinical problems such as best enteral nutrition injection device,injection and temperature of solution,whether with an addition of therapeutic elements in enteral nutrition or not and change of nutrition solution were identified.A retrieval was conducted in Cochrane library,Cochrane Central Register of Controlled Trials(CCRT),Database of Abstracts of Reviews of Effects(DARE),MEDLINE and Chinese Biomedical Database for quality clinical literature then nursing methods were established based on the literature.Results Eight articles were obtained and evidences in these articles were applied in the treatment of 292 patients after gastric operation.Enteral nutrition related diarrhea occurred in 19 patients(6.5%) and the incidence was lower than that in the research in the same period.Parenteral nutrition was provided for two patients while enteral nutrition was maintained among other patients.Conclusion Nutrient solution could be injected with small dose,low concentration and low speed by feeding pump and heated solution with therapeutic elements is effective for the prevention of diarrhea.
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Description of the nutritional support in an intensive care unit. REFERENCE POPULATION: Patients hospitalized in our ICU over a period of 48 months (October 1994-September 1998).The study was carried out by means of a review of the two data bases generated, one by using the clinical history management program, and the other by using the artificial nutrition program.Nutritional support is used in 31% of the non-coronary patients, predominantly medical (61%), and followed by surgical (29%) and trauma (9%) cases. These patients presented an APACHE (17.7 +/- 15), a hospitalization (15.8 +/- 14.9) and a mortality (26%) that was greater than that in non-coronary patients who did not require the nutritional support. The delay in starting the nutritional support is 2.8 +/- 1.9 days. In decreasing order, the nutritional support is most used in medical (42%), trauma (37%) and surgical (18%) patients. The access route is similar, enteral in 55% of the cases, with a predominance of medical patients, and parenteral in 45% of the cases, with a predominance of surgical patients. In 100 patients with a nutritional support in excess of 10 days, it was found that 87% at some time were given this enterally. In this group we studied the gastrointestinal complications, finding these in 61% of these patients, with the most frequent complication being an increase in the gastric residue (44%). Diarrhea was found in 14% and broncho-aspiration in 3.4%. The enteral route as the initial access failed in 25% of these cases, thus requiring parenteral nutrition.In our unit we used nutritional support in 31% of the non coronary patients, and these presented a greater severity, longer hospitalization, and higher mortality than those patients who did not require this. The beginning of the nutritional support is relatively early. The gastrointestinal complications derived from enteral nutrition are very common, with a predominance of gastric retention. In 25% of the critical patients who begin enteral nutrition, this fails, and thus they require parenteral nutrition.
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Objective:To study the effect of standardized sequential enteral parenteral nutrition support therapy and the effect of parenteral nutrition support after gastrointestinal surgery.Method:96 gastrointestinal surgery patients were divided into control group and observation group in our hospital in April 2010 to March 2013,control group patients were given conventional parenteral nutrition support therapy,observation group patients were given standardized sequential enteral parenteral nutrition support treatment.Result:Two groups of patients on the changes of the observed indicators before and after treatment there were significant differences(P0.05);Two groups in the incidence of complications in patients were no significant difference(P0.05).Conclusion:Gastrointestinal surgery for standardized sequential intestinal enteral parenteral nutrition support therapy treatment clinical curative effect is superior to parenteral nutrition support therapy alone.
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To assess the recent literature regarding parenteral nutrition to identify publications that have purported to support various beliefs about the utility of parenteral nutrition, and then to critically evaluate the data presented in those (as well as prior) publications.Artificial nutrition improves nutritional markers but not clinical outcomes, suggesting that malnutrition is not causatively associated with a poor outcome. There are no convincing data that parenteral nutrition is beneficial in severely malnourished surgical patients. Glutamine supplementation of parenteral nutrition solutions may reduce the infectious complication rate, but it is unknown if glutamine-supplemented parenteral nutrition is better than no parenteral nutrition. Most, but not all, systematic reviews have demonstrated that enteral nutrition produces fewer problems than parenteral nutrition; no data suggest that either modality is better than doing no artificial nutrition. Randomized trials have not uniformly been able to demonstrate that parenteral nutrition is efficacious in acute pancreatitis. There is some, but not convincing, data that a regimen of glutamine, growth hormone, and a specialized diet will reduce the need for parenteral nutrition in patients with short bowel syndrome.It is important for clinicians to be able to critically evaluate the medical literature.
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Nutritional depletion has been demonstrated to be a major determinant of the development of post-operative complications. Gastrointestinal surgery patients are at risk of nutritional depletion from inadequate nutritional intake, surgical stress and the subsequent increase in metabolic rate. Fears of postoperative ileus and the integrity of the newly constructed anastomosis have led to treatment typically entailing starvation with administration of intravenous fluids until the passage of flatus. However, it has since been shown that prompt postoperative enteral feeding is both effective and well tolerated. Enteral feeding is also associated with specific clinical benefits such as reduced incidence of postoperative infectious complications and an improved wound healing response. Further research is required to determine whether enteral nutrition is also associated with modulation of gut function. Studies have indicated that significant reductions in morbidity and mortality associated with perioperative Total Parenteral Nutrition (TPN) are limited to severely malnourished patients with gastrointestinal malignancy. Meta-analyses have shown that enteral nutrition is associated with fewer septic complications compared with parenteral feeding, reduced costs and a shorter hospital stay, so should be the preferred option whenever possible. Evidence to support pre-operative nutrition support is limited, but suggests that if malnourished individuals are adequately fed for at least 7-10 days preoperatively then surgical outcome can be improved. Ongoing research continues to explore the potential benefits of the action of glutamine on the gut and immune system for gastrointestinal surgery patients. To date it has been demonstrated that glutamine-enriched parenteral nutrition results in reduced length of stay and reduced costs in elective abdominal surgery patients. Further research is required to determine whether the routine supplementation of glutamine is warranted. A limitation for targeted nutritional support is the lack of a standardised, validated definition of nutritional depletion. This would enable nutrition support to be more readily targeted to those surgical patients most likely to derive significant clinical benefit in terms of improved post-operative outcome.
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