Biomedical subjects

D B Silk

Publications and source records attributed to D B Silk.

190 records · Page 11Linked to original sources

PubMedDate not supplied

Clinical evaluation of two-liter prepacked enteral diet delivery system: a controlled trial.

Following a recent study in our Unit which showed that significantly more of prescribed enteral diet was administered from 2-liter bags than 0.51 bottles, a controlled clinical trial was undertaken to investigate further the effectiveness of the 2-liter prepackaged enteral delivery system. Forty patients with normal gastrointestinal function requiring enteral nutrition were randomized to receive nasogastrically 2-liter/day of polymeric diet (2000 kcal, 12 g N) either from a presterilized 2-liter PVC bag (Express EFI Ltd, UK) or from two 1-liter rigid plastic containers filled with cans of Clinifeed 400 (Roussel Laboratories Ltd, UK). The actual volumes of feed infused were monitored in patients fed for 5 days or more. Both nursing and dietetic staff preferred the 2-liter bags which were more convenient to prepare and use. Significantly larger quantities of prescribed diet were delivered from the 2-liter bags than from the 1-liter containers (p less than 0.001). It was concluded that the 2-liter bag system was potentially more convenient and nutritionally efficacious than 1-liter containers. Although the incidence of microbial contamination associated with the 2-liter bags was low, measures to maintain the sterility of this system may need to be more stringent.

Aged↗

PubMedDate not supplied

Spontaneous transpyloric passage and performance of 'fine bore' polyurethane feeding tubes: a controlled clinical trial.

Certain groups of patients requiring enteral nutritional support are at increased risk of regurgitation and pulmonary aspiration of feed. Positioning of enteral feeding tubes distal to the pylorus has been advocated as a method of reducing such complications. Various techniques have been suggested to achieve postpyloric siting. Reports have indicated that lengthening the tube or altering the distal end tip configuration, by varying the tip profile or by the addition of a weight, may facilitate spontaneous transpyloric passage of the tube. This prospective controlled clinical study using three new polyurethane tubes demonstrates that the frequency of spontaneous transpyloric passage of the tube is not affected by tip profile or by the addition of a weight. Indeed, with all three tube designs only about one-third had passed spontaneously through the pylorus at 24 hr. Once through the pylorus the unweighted tube stayed in position significantly longer than the weighted tubes (p less than 0.005). We suggest that in those patients requiring post-pyloric feeding, endoscopic or fluoroscopic techniques should be used to position the tubes at the time of insertion, and that an unweighted tube should be used to prolong tube usage.

Clinical Trials as Topic↗

PubMedDate not supplied

Retrograde (ascending) bacterial contamination of enteral diet administration systems.

A prospective clinical study in three phases was performed to determine whether it was possible that enteral diet containers could become contaminated as a result of endogenous organisms ascending retrogradely from the enteral feeding tube via the giving set, and if this did occur whether the incidence could be altered by modifying enteral delivery systems. Each phase observed patients on enteral feeding over a 48-hour study period (phase I, n = 18; phase II, n = 17; phase III, n = 18). Each patient was prescribed an enteral diet of 2 L/24 h administered by continuous pump infusion from a closed 1-L sterile diet container. Four containers were used for each patient, and one giving set was used in the 48-hour period. Diet samples were taken at 12-hour intervals: two from the giving set before and after flushing with residual diet, and one from the diet container. Phases differed only in the design of the giving set: phase I had no drip chamber, phase II had a drip chamber, phase III had a drip chamber and an anti-reflux ball valve at the distal end. Both phase I and III had greater numbers of giving set samples colonized at 24, 36, and 48 hours. In phase I, 3 of 14 sterile diet containers were colonized with greater than 10(4) colony-forming organisms/mL of diet at 48 hours. Only phase II had no organisms contaminating the containers at 48 hours. We conclude that the retrograde spread of organisms from patient to sterile diet container does occur in clinical practice, and that a drip chamber in the giving set may prevent the problem.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacteria↗

PubMedDate not supplied

Influence of three different fiber-supplemented enteral diets on bowel function and short-chain fatty acid production.

BACKGROUND: Dietary fiber is known to influence bowel habit and gastrointestinal mucosal cell morphology and function. large-bowel function is particularly influenced by insoluble, poorly fermentable fiber sources, whereas mucosal function is affected by fiber sources that are soluble and highly fermentable. The aim of the present study was to compare bowel function during consumption of a self-selected diet, a fiber-free enteral diet, and three polymeric enteral diets, each supplemented with a fiber with different fermentation characteristics. The fiber sources used were oat, soy oligosaccharide, and soy polysaccharide. METHODS: Seven healthy subjects consumed four diets in random order for 4 to 7 days. These were a self-selected diet, a 2-L polymeric enteral diet, and a 2-L polymeric enteral diet supplemented with 15 g of total dietary fiber per liter derived from either soy oligosaccharide fiber (75 g/L) or oat fiber (15 g/L). An additional six healthy subjects were randomly assigned to three diets (4 to 7 days): a self-selected diet, a 2-L polymeric enteral diet, or the same 2-L polymeric enteral diet supplemented with 20 g of soy polysaccharide fiber per liter (15 g of total dietary fiber per liter). Bowel function was assessed by measuring whole-gut transit time, mean daily stool wet weights, and bowel movement frequency per day. Fermentation characteristics of the different fiber sources were determined quantitatively and qualitatively by measuring short-chain fatty acids produced during in vitro stool culture. RESULTS: Total short-chain fatty acid and butyric acid production with soy oligosaccharide fiber were significantly higher compared with values observed for soy polysaccharide fiber (p < .003), oat fiber (p < .005), and self-selected (control) diet (p < .003). Compared with the fiber-free diet, consumption of the soy polysaccharide, oat, and soy oligosaccharide-fiber-supplemented enteral diets did not significantly (p > .05) alter whole-gut transit time or stool wet weight. However, bowel frequency was significantly improved by consumption of the soy polysaccharide-fiber-supplemented diet but not the oat fiber or soy oligosaccharide-fiber-supplemented diets. CONCLUSION: Compared with a fiber-free polymeric enteral diet, the daily consumption of an enteral diet supplemented with 30 g of total dietary fiber per day derived from a poorly fermentable oat fiber, a highly fermentable soy oligosaccharide fiber, or a moderately fermentable soy polysaccharide fiber has little impact, if any, on bowel function.

Adult↗

PubMedDate not supplied