Immediate Postoperative Enteral Feeding Results in Impaired Respiratory Mechanics and Decreased Mobility

Abstract

ObjectiveThe authors set out to determine whether immediate enteral feeding minimizes early postoperative decreases in handgrip and respiratory muscle strength. Summary Background DataMuscle strength decreases considerably after major surgical procedures. Enteral feeding has been shown to restore strength rapidly in other clinical settings. MethodsA randomized, controlled, nonblinded clinical trial was conducted in patients undergoing esophagectomy or pancreatoduodenectomy who received immediate postoperative enteral feeding via jejunostomy (fed, n = 13), or no enteral feeding during the first 6 postoperative days (unfed, n = 15). Handgrip strength, vital capacity, forced expiratory volume in one second (FEV1), and maximal inspiratory pressure (MIP) were measured before surgery and on postoperative days 2, 4, and 6. Fatigue and vigor were evaluated before surgery and on postoperative day 6. Mobility was assessed daily after surgery using a standardized descriptive scale. Postoperative urine biochemistry was evaluated in daily 24-hour collections. ResultsPostoperative vital capacity (p < 0.05) and FEV1 (p = 0.07) were consistently lower (18%-29%) in the fed group than in the unfed group, whereas grip strength and maximal inspiratory pressure were not significantly different. Postoperative mobility also was lower in the fed patients (p < 0.05) and tended to recover less rapidly (p = 0.07). Fatigue increased and vigor decreased after surgery (both p < 0.001), but changes were similar in the fed and unfed groups. Intensive care unit and postoperative hospital stay did not differ between groups. ConclusionsImmediate postoperative jejunal feeding was associated with impaired respiratory mechanics and postoperative mobility and did not influence the loss of muscle strength or 369

Routine jejunostomy tube feeding following esophagectomy

“…Previous reports also showed that severe jejunostomy-related complications requiring reoperation occur in 0-3% of all patients, which was confirmed by the present study (9,11,12,16,18,20,23). Furthermore in a randomized trial it was shown that immediate jejunostomy tube feeding may impair respiratory mechanics and may decrease mobility following esophagectomy (24).…”

Early Enteral Nutrition Versus Parenteral Nutrition After Resection of Esophageal Cancer: a Retrospective Analysis

“…Furthermore, most clinical studies did not compare enteral nutrition and total parenteral nutrition in a randomized fashion [14,22,24]. Of the studies performed in a prospective randomized fashion [9,25,26], the patients studied were not limited to esophageal cancer patients, such that the bona fide effects of EEN in esophageal surgery were not clear. Furthermore, the term Bearly^was defined as EN started within 24-48 h after admission or surgery [27]; however, EN started within 24 h had shown no advantage for the postoperative course in esophageal cancer [28].…”

“…Thus, postoperative enteral nutrition (EN) and/or parenteral nutrition (PN) have become routine management in such cases, and recent studies demonstrated that EN initiated within 24-48 h after esophagectomy reduced the length of hospital stay [5,6], postoperative morbidity, and the rate of life-threatening complications [7]. However, because some studies have not shown any clinical benefits with postoperative early enteral nutrition (EEN) after esophagectomy over PN [8,9] and indicated the importance of PN after esophagectomy as a nutrition therapy [10], so the superiority of EEN after esophagectomy has remained controversial. The aim of the present retrospective study was to clarify the superiority of EEN for postoperative course compared with PN in patients with esophageal cancer.…”

Skeletal Muscle Dysfunction in Critical Illness

“…Although patients undergoing esophagectomy or pancreaticoduodenectomy did not receive enteral nutrition during the 6 days postoperatively, there were no significant differences in grip strength, respiratory muscle strength, or recovery of walking ability, compared with nutritionally fed patients after jejunostomy [142]. In the EPaNIC study, 4640 patients were randomized to early parenteral replacement therapy (early PN group) or tolerating caloric deficiency for first week in ICU (late PN group) [143].…”