Gastrointestinal tract access for enteral nutrition in critically ill and trauma patients: indications, techniques, and
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REVIEW ARTICLE
Gastrointestinal tract access for enteral nutrition in critically ill and trauma patients: indications, techniques, and complications M. Tuna • R. Latifi • A. El-Menyar H. Al Thani
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Received: 27 October 2012 / Accepted: 11 March 2013 / Published online: 22 March 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Abstract Background Enteral nutrition (EN) is a widely used, standard-of-care technique for nutrition support in critically ill and trauma patients. Objective To review the current techniques of gastrointestinal tract access for EN. Methods For this traditional narrative review, we accessed English-language articles and abstracts published from January 1988 through October 2012, using three research engines (MEDLINE, Scopus, and EMBASE) and the following key terms: ‘‘enteral nutrition,’’ ‘‘critically ill,’’ and ‘‘gut access.’’ We excluded outdated abstracts. Results For our nearly 25-year search period, 44 articles matched all three terms. The most common gut access techniques included nasoenteric tube placement (nasogastric, nasoduodenal, or nasojejunal), as well as a percutaneous endoscopic gastrostomy (PEG). Other open or laparoscopic techniques, such as a jejunostomy or a gastrojejunostomy, were also used. Early EN continues to be preferred whenever feasible. In addition, evidence is mounting that EN during the early phase of critical illness or trauma trophic feeding has an outcome comparable to that of full-strength formulas. Most patients tolerate EN
M. Tuna R. Latifi (&) A. El-Menyar H. Al Thani Department of Surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Hamad Medical Corporation, Doha, Qatar e-mail: [email protected]
through the stomach, so postpyloric tube feeding is not needed initially. Conclusion In critically ill and trauma patients, early EN through the stomach should be instituted whenever feasible. Other approaches can be used according to patient needs, available expertise, and institutional guidelines. More research is needed in order to ensure the safe use of surgical tubes in the open abdomen. Keywords Enteral nutrition Feeding tube Percutaneous endoscopic gastrostomy Gastrostomy Gastrojejunostomy Nasojejunostomy
Introduction The benefit of the early institution of adequate enteral or parenteral nutrition in the overall care of critically ill and trauma patients has been well established [1–4]. Early nutrition support has the potential to reduce disease severity, diminish complications, and decrease the intensive care unit (ICU) length of stay. In general, whenever possible, the gastrointestinal (GI) tract is the optimal route of gut access for nutrition support. But if patients cannot receive all the required nutrient substrates and calories enterally, nutrition should be provided parenterally. The enteral route should be used in patients with a normally functioning GI tract; this route is considered to be safe [5, 6], cost-effective, and practical, with clear metabolic and immune-related advantages [7, 8].
R. Latifi Department
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