Enteral Nutrition in the Early Postoperative Period: A New Semi‐Elemental Formula Versus Total Parenteral Nutrition

Abstract

Several studies have reported that gastrointestinal (GI) intolerance symptoms are the limiting factor to enteral alimentation in the immediate postoperative period and often the reason for resorting to total parenteral nutrition (TPN). We postulated that Reabilan HN (a recently developed small peptide-based formula, in part obtained by enzyme hydrolysis of proteins) might be better absorbed and better tolerated so as to avoid the need for TPN. Accordingly, 19 patients undergoing major abdominal surgery were randomly assigned to receive Reabilan HN via jejunostomy or an equicaloric isonitrogenous TPN regimen. Both were begun 6 hr postoperatively at 25 ml/hr and increased by 25 ml/hr at 12-hr intervals up to the rate providing 1.5 times the calculated REE. GI tolerance to enteral feeding was excellent during the first three postoperative days, allowing the progression of the feeding rate to 99% of goal. During the next 3 days (starting on average 1.7 days after the return of bowel sounds), GI intolerance symptoms required a reduction in feeding rate to 52% on average. Subsequently, the symptoms resolved and the feeding rate reached 96% of goal. Although overall mean daily calorie and nitrogen intakes were lower for the enteral than for the TPN group (79.6 +/- 10.2% vs 94.6 +/- 3.8% of goal; p less than 0.01), the enteral group was nevertheless in positive caloric and nitrogen balance, and maintained similar serum albumin, prealbumin, and plasma transferrin levels. Average daily cost of supplies was $44.36 for enteral vs $102.10 for parenteral nutrition (p less than 0.001). We conclude that enteral feeding using this formula is well tolerated and cost-effective in the immediate postoperative period.(ABSTRACT TRUNCATED AT 250 WORDS)

Enteral versus Parenteral Nutrition after Gastrointestinal Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials in the English Literature

“…Heylen et al 69 NR NR NR Hamaoui et al 76 Random number table NR NR Schroeder et al 39 NR NR Intention-to-treat Binderow et al 72 NR NR NR Reissman et al 37 NR NR NR Baigrie et al 70 NR NR NR Beier-Holgersen et al 12 NR Yes Intention-to-treat Braga et al 27 NR 31 NR NR Intention-to-treat Heslin et al 32 Randomization using sealed envelopes NR Intention-to-treat Reynolds et al 38 NR NR Intention-to-treat Sand et al 40 NR NR Intention-to-treat Shirabe et al 42 NR NR Intention-to-treat Watters et al 44 Randomization …”

A study of problems associated with the delivery of enteral feed in critically ill patients in five ICUs in the UK

“…Early enteral feeding appears to attenuate part of the stress response in particular groups of patients. This has been demonstrated in animal studies and a few small patient studies [4][5][6]. The ability to manipulate the patient's immune response using specific enteral nutrients (immunonutrition) has also provoked considerable interest [7][8][9][10][11].…”

Nutritional and health benefits of semi-elemental diets: A comprehensive summary of the literature

“…Studies of 100% WHP and Crohn's disease are characterized in Table 1 [5,10,11,[13][14][15][16][17][18][19][20][21][22][23][24][25] . In a one year prospective study, six Crohn's disease patients (median age, 13.6 years) were treated with an isotonic, 100% WHP semielemental diet to evaluate growth parameters and disease activity measures [11] .…”

“…As a result, studies have suggested improved growth and development patterns, fewer gastrointestinal complications, improved visceral protein levels, and decreased rates of mortality. Studies of patients with Crohn's disease, pancreatitis, and human immnodeficiency virus (HIV) among other conditions have shown improved nutrition status and clinical outcomes from supplemental semielemental formulas [9][10][11][12] . The purpose of this review is to comprehensively summarize the scientific and clinical evidence of 100% whey-hydrolyzed protein (WHP) semielemental diets and nutritional and health outcomes across various nutritionally-vulnerable populations.…”