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At least 19 recordsLinked to original sources
PubMedDate not supplied

[Home and ambulatory artificial nutrition. Enteral nutrition. The NADYA Group].

Home enteral nutrition is, at present, a therapeutic alternative which can be applied to a great number of patients who only require hospitalization for the nutritional treatment, thus improving their quality of life and reducing costs. The experience in this field is great in other countries, and we believe its use is growing in Spain. To better understand this situation, the data of 589 patients from 25 hospitals of the entire national territory, have been evaluated. When analyzing the diseases which led to the instigation of enteral nutrition, the most frequent causes were found to be neurological afflictions and tumoral processes. At the time of establishing the indication, only 50% of the patients were undergoing curative therapy. The nasogastric tube was used in the majority of cases (69%), even during prolonged periods of time. The formula of enteral nutrition which was most used was the standard, possibly due to the difficulty of acquiring other types of formulas when this is not specifically indicated. The formula is frequently administered by syringe (44%) and by bolus (41%). The cost of the formula and the necessary infusion material, was mainly carried by the referring hospital. The complications registered were rare (0.18 episodes/patient) and of a slight character, of gastrointestinal of mechanical origin, which could be resolved in the home. The follow up of the patient was done in similar percentages by the Departments of Nutrition, by the at home hospitalization teams, and, in a coordinated way, between Nutrition and Primary Attention. 23 % of the patients finished the treatment due to improvement, 20 % died, and 15 % continued treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Older adults receiving home enteral nutrition: enteral regimen, provider involvement, and health care outcomes.

BACKGROUND: Home enteral nutrition (HEN) is most frequently prescribed for older adults. Medicare reimbursement policy limits in-home nursing visits, and in-home professional nutrition services are restricted to those patients with diabetes or predialysis kidney disease. Most older adults receiving HEN rely on informal (family) caregivers to provide HEN care. The purpose of this study was to apply care process theory to identify and investigate variables related to health care outcomes of HEN in a sample of older adults dependent on informal caregivers. We assessed relationships among patient characteristics, the HEN regimen prescription and adherence, formal provider involvement, and health care outcomes. METHODS: In-home interviews were conducted with a multiethnic (14 white, 8 Hispanic, 7 African American, 1 Asian) sample of 30 older adults (mean = 68.4 years) during their first 3 months of HEN (mean = 1.83 months). RESULTS: Daily enteral intake averaged 1596 +/- 553 kcal. Gastrointestinal complications, occurring in up to 63.3% of patients, interrupted daily infusions. Further, one-third reported tube clogging or leaking, and one-third had tube displacement. Water intake was half of calculated need and associated with decreased urination (p = .001). Average weight change was -4.35 pounds (p = .001), and 17 patients had body mass indexes (BMIs) <18.5. Women had more complications (p = .004), lower enteral intake (p = .009), and lower BMIs (p = .02). Only 6 patients saw dietitians in follow-up care. Complications and type of feeding tube were associated with unscheduled health care visits and readmissions (p < .05). CONCLUSION: The efficacy of HEN in older adults (ie, reversal of malnutrition and improvements in health, functionality and quality of life) requires more frequent monitoring, reassessment, and intervention from a highly skilled multidisciplinary team that includes dietitians.

Activities of Daily Living↗
PubMedDate not supplied

The anti-inflammatory effects of enteral nutrition.

Enteral nutrition has a positive effect on growth in children with active Crohn's disease. The question arises: is this is due only to improved nutrition? Enteral formulas may also directly reduce inflammation, lowering the expression of cytokines like interleukin (IL)-6 that inhibit growth. Four lines of evidence support the hypothesis that enteral formulas directly lessen inflammation: enteral nutrition directly affects the inflamed intestine; changes in inflammatory markers precede repletion of nutrition status; molecular pathways exist linking changes in luminal contents to the expression of class II MHC genes in intestinal epithelium in animal studies; and enteral formulas have a direct effect on cytokine expression by intestinal epithelial cells.

Child↗
PubMedDate not supplied

[Perioperative enteral nutrition].

Enteral nutrition, as demonstrated by the many published papers, is not only safer and cheaper than parenteral supply of nutrients, but modulates an exaggerated cytokine response related to surgical trauma that leads to an increase in intestinal permeability, bacterial translocation and infection. The aim of enteral nutrition is to reduce the impact of cytokines on surgical patients and the related infectious complications. Via the enteral route the nutrients can reach the bowel lumen where enterocytes draw upon their fuel, preserving the barrier effect and modulating the cytokine response. Parenteral supply does not achieve this target since the blood supply of nutrients is not as important as the luminal supply. It is only via the enteral supply route that we can preserve the barrier effect. Since the cytokine response sets in immediately after a trauma such as surgery, we implement uninterrupted enteral nutrition, which means before, during and after surgery, plus parenteral support till the full calorie intake is achieved. In a hepatic resection study, we have demonstrated that enteral nutrition modulates the interleukin-6 immunological response and shortens both the period to bowel movement resumption and the duration of hospital stay. Aggressive enteral nutrition has also been implemented in severe pancreatitis, allowing control of the disease without the onset of septic complications. The most important target is not to achieve full calorie intake rapidly, but to supply the enteric mucosa continuously with useful immuno-nutrients, such as glutamine and fibres, to preserve the barrier effect, the mucus layer, and immunological status of the mucosa. In this way we have obtained significant results in the surgical treatment of these patients, reducing the infection rate and hospital stay. New prospects may be,possible in the fight against surgical infections by adding probiotics to enteral nutrition in order to improve the microenvironment of the colon.

Enteral Nutrition↗
PubMed2006

[Enteral nutrition].

Enteral nutrition is an integrated part of the therapy in several diseases and clinical conditions. It is used to improve the clinical course and prognosis of patients with inadequate oral nutritional intake or with malnutrition. In addition, enteral nutrition may act in modulating the metabolic state of patients. Enteral diets are industrially made and have a defined composition and consistency. Enteral nutrition is provided as an oral supplement, via nasogastric/nasointestinal tubes or via gastro- or enterostomy, and requires a well functioning intestinal tract. Enteral nutrition is frequently used supplementary to oral or parenteral nutrition. In most patients standard diets can be used. Diet modifications include the energy density, the relation of carbohydrates, fat and nitrogen source and the content of specific nutrients, i. e. specific amino acids, nucleotides or fatty acids to improve the immune function. These modified diets are used for specific indications which are highlighted in this article.

Diet Therapy↗
PubMed1991

[Application and fixation systems in enteral nutrition].

Enteral nutrition is becoming more convenient because of a lot of available different techniques. Tubes can be placed nasogastrically, nasoduodenally or nasojejunally, as bedside method controlled by X-ray or with the aid of an endoscope. If there is a risk of spontaneous removal, fixing with a stabilisation system is helpful. In cases where the tube should be hidden, a specially prepared plastic olive placed in the nostril can be used. All these methods are of interest for short and medium term enteral nutrition. For long term enteral nutrition, the percutaneous endoscopic gastrostomy, especially the so-called 'thread-pass-through' method is increasingly in use. All attempts to arrange a simpler method using direct punction techniques have failed up to now. The following paper gives a survey of different technical possibilities.

Catheters, Indwelling↗
PubMed1999

[Home enteral nutrition].

Enteral nutrition in the home is applied to stabilized patients who do not require hospitalization or to chronically ill patients who can stay in their homes. However, ensuring the correct administration of this treatment requires a coordinated, expert multidisciplinary team. This article reviews the conditions for use of enteral nutrition in the home, the means of access, the nutritional formulas, the administrative technique, and the complications enteral nutrition in the home may present. Furthermore, the composition and characteristics of the multidisciplinary team which will be in charge of carrying out this treatment is discussed.

Community Health Nursing↗
PubMed1998

Cost and cost-benefit of enteral nutrition.

Enteral nutrition is a therapy provided routinely in the hospital, extended care, and home care settings for patients who are unable to maintain adequate oral nutrition yet have a functioning gastrointestinal tract. Information about the cost and effectiveness or benefits of enteral nutrition in the hospital and home care settings is important to know when making decisions about providing this therapy. This article discusses the methods used in cost analysis, explains the difference between cost and charges, and reviews the current information known about the cost-effectiveness and cost-benefits of enteral nutrition in the acute-care setting and at home.

Cost Savings↗
PubMed1994

Rationale and efficacy of specialized enteral nutrition.

Enteral nutrition, whenever feasible, is the preferred route of nutrition support. There has been a tremendous increase in the number of enteral products available on the market. Many of these are designed for use in specific disease states. This review will summarize the scientific rationale and supporting research for specialized enteral nutrition.

Enteral Nutrition↗
PubMed1988

[Digestive and respiratory complications in enteral nutrition].

Enteral nutrition is a safe technique but complications may arise. Mechanical problems can occur as a result of tube malposition: regurgitation can induce respiratory distress. Esophagitis is rare and does not seem to be related to acid gastro-oesophageal reflux. Diarrhea, the main gastro-intestinal side effect, has a complex etiology; management requires knowledge of gastro-intestinal physiology during enteral nutrition. Many of the problems encountered with enteral feeding can be avoided by using a fine bore tube, administering the feed by continuous infusion, and careful monitoring of patients for metabolic abnormalities.

Diarrhea↗
PubMed1988

[Biological hepatic abnormalities, cholestatic jaundice and hospital artificial nutrition. A comparative study in adults with cyclic total parenteral nutrition and enteral nutrition].

Two hundred and fourteen hospitalized nonsurgical, nonacutely stressed adult patients, who were receiving, either prolonged (greater than 21 days) cyclic total parenteral nutrition (n = 106) or enteral nutrition (n = 108), including lipids, for gastrointestinal disorders, and who were free of prenutrition liver function test abnormalities were prospectively investigated for hepatic dysfunction: 41 p. 100 and 17 p. 100 of parenteral and enteral nutrition patients, respectively, developed abnormalities of liver function tests after 25 +/- 5 and 21 +/- 4 days (p less than 0.01). This prevalence was unrelated to catheter sepsis, blood transfusion, caloric load, site of digestive disease or initial nutritional status, and decreased by 50 and 40 p. 100 before the end of total parenteral nutrition and enteral nutrition respectively. In the parenteral nutrition group, separate infusion of lipids, as compared with mixed infusion, was associated with a lower rate of hepatic dysfunction (29 vs 54 p. 100; p less than 0.02). Nine (8.5 p. 100) parenteral nutrition but no enteral nutrition patients developed severe cholestatic jaundice, 47 +/- 39 days after the onset of liver function test abnormalities; no identifiable cause excepting parenteral nutrition per se was found in 3 patients with diffuse obstructive small intestinal disease; jaundice led to death from noncirrhotic hepatic failure in the 2 patients who remained totally parenteral nutrition-dependent.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Our experience with ambulatory enteral nutrition].

Enteral nutrition in the home of the patient, has gained interest in recent years. In our health care area, we do not have a Unit of at Home Hospitalization, which has not prevented the implementation of this therapeutic modality in certain types of patients. 89 cases who have undergone enteral Nutrition in their home after the last hospital admission, were reviewed. According to the basic pathology, 41.6% (37 patients) correspond to neurological patients; 51.7% correspond to neoplasmic patients, and 6.7% are classified as miscellaneous. The average age is 64 years (18 months-92 years); the mean caloric ingestion is 1,520 Kcal/day (500-2,500), and the duration is a mean of 315 days (7-1,560). The complications observed through ambulatory visits of the patient and/or the family, accounted for a total of 36, of which 30 (83%) were digestive, and were corrected with the usual methods. In 8 cases (22%), it involved mechanical complications, and only 2 cases involved metabolic complications. Only 1 serious complication (massive bronchoaspiration) could have been avoided. The results indicate a good degree of acceptance, with similar results to those described by other authors, and with a low incidence of severe complications.

Adolescent↗
PubMed1998

The 1996 Nestlé International Clinical Nutrition Award for Enteral Nutrition. "Enteral versus parenteral nutrition: effects on gastrointestinal function and metabolism": background.

Nutrition therapy for the critically ill patient is today an integral part of the treatment concept in intensive care medicine. Parenteral and enteral artificial nutrition are expensive, cost-intensive treatment procedures that are certainly not risk-free. For both ethical and economic reasons, the indications and principles of artificial nutrition must always be adapted to the latest knowledge.

Awards and Prizes↗
PubMedDate not supplied

Gastrointestinal disorders caused by medication and electrolyte solution osmolality during enteral nutrition.

Enteral feeding tubes represent convenient avenues for medication administration and electrolyte replacement. The frequent association of medication therapy with gastrointestinal disorders during enteral nutrition prompted this evaluation of medication and electrolyte solution osmolality. It is concluded that the hypertonicity of electrolyte replacement solutions and various medications may cause gastrointestinal intolerance in patients. Electrolyte supplementation by parenteral means or by appropriate dilution and mixture with an enteral formula is preferable to bolus administration of undiluted solutions via the feeding tube. Routine admixture of medications such as antibiotic suspensions to enteral formulas cannot be recommended at this time pending specific study of drug compatibility and availability from enteral tube feeding systems.

Anti-Bacterial Agents↗
PubMed2004

Enteral nutrition.

Enteral nutrition is feeding the gastrointestinal tract either with food, oral supplements or via tube. It is generally safe, easy to administer and free of major complications. The most common problems relate to the tubes themselves, such as blockage and stoma infection.

Enteral Nutrition↗
PubMed2006

Clinical use of enteral nutrition.

Enteral Nutrition is among the most developed disciplines in modern Medicine. Technological advances, a better knowledge of malnutrition physiopathology and its involvement in the evolution of several clinical entities have made it possible to improve the nutritional attention paid to our patients. The use of EN has expanded as a first choice practice in patients with undernutrition or at risk of undernutrition that have a minimally functional intestine and are unable to cover their total calorie and protein requirements with natural or supplemented diets. Terms like "medical food" or "organ- or system-specific nutrition" or "pathology-specific nutrition" have revolutionized the EN field in the last 20 years with the emergence of specifically defined formulations. EN has been shown to be cost-effective in patients with malnutrition when the indication is established early. Home and Ambulatory Artificial Nutrition techniques are administratively regulated and, as they are widespread in our country, they allow some cost reductions in certain processes. Occasionally, the introduction, use or withdrawal of EN may constitute a situation of ethical dilema that should be avoided by making use of respect, companionship and shared information between the health team, patients and their substitutes.

Enteral Nutrition↗
PubMed2006

Perspectives in the design and development of new products for enteral nutrition.

Enteral nutrition is a technique that even though it was used in times immemorial, in the last 25 years has suffered a considerable development, from being considered a secondary therapeutic weapon destined only to feed the patient, to occupying an important status that goes beyond the single act of nourishing. The quantitative composition but overall the qualitative one, is object of an interesting argument in which a profile allowing the modulation of certain aspects of the organism response through the supplementation with different nutrients is searched. That includes from the keeping of the intestinal trophism and of the anti-bacteria intestinal barrier, so important to avoid the frightening multiple organ dysfunction, up to the lessening of the Systemic Response Inflammatory Syndrome (SRIS), going through the immuno-modulative feeding concepts, specific-feeding, pharmaco-nutrient or eco-nutrition. In this new dynamic not only certain nutrients such as glutamine, arginine, nucleotides, omega-3 fatty acids and many antioxidants have acquired importance, but also the manipulation of other molecules of a non- nutritional nature, such as hormones, cytokines and blockers. These aspects that imply passionate ways of investigation for the future are born from the better knowledge that is being acquired from such a severe pathophysiology processes such as sepsis and the organism response before fast and severe aggression; therefore, the modulation of that response through changes in the quantitative and qualitative formulas composition is being attempted.

Enteral Nutrition↗