Parenteral nutrition compared with transpyloric feeding.

Glass, E J; Hume, Robert; Lang, Me; Forfar, J. O.

doi:10.1136/adc.59.2.131

Cited by 41 publications

(7 citation statements)

References 13 publications

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“…These figures are similar to those of previous studies in adults and children [36). However, the frequency of altered hepatic function and of cholestasis (2%) was low, well below that associated with parenteral nutrition in the critically ill patient, confirming that this is one of the advantages of enteral nutrition over parenteral [37,38).…”

Section: Discussionsupporting

confidence: 89%

The Use of Transpyloric Enteral Nutrition in the Critically Ill Child

Sánchez

López‐Herce

Guerra

et al. 2000

J Intensive Care Med

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To assess the use and complications of transpyloric enteral nutrition (TEN) in the critically ill child we evaluated prospectively all children who received TEN in a pediatric intensive care unit (PICU) of a tertiary university hospital. The type of nutrition used, its duration, medication administered, tolerance, gastrointestinal complications (vomiting, abdominal distension or excessive gastric residue, diarrhea, and pulmonary aspiration), nongastrointestinal complications, and mortality were assessed. A comparative analysis was made between the first 2 years of the study and the remaining period. Over a period of 4.5 years, 152 patients between the ages of 3 days and 17 years received TEN for a duration of 19 ± 32.3 days (range 1–240 days). Forty-one patients received TEN during the first 2 years; 100 patients received TEN in the postoperative period after cardiac surgery (66%). One hundred seventeen patients (77%) received sedation and 65 (43%) received muscle relaxants, presenting no extra complications. Twenty-four patients (15.8%) presented with gastrointestinal complications: abdominal distension and/or excessive gastric residue in 17 and diarrhea in 11. Gastrointestinal intolerance was associated with pulmonary infection (p < 0.05), altered hepatic function (p < 0.001), and hypokalemia or hypocalcemia (p < 0.05). Diarrhea was more frequent in patients with shock (p < 0.05), altered hepatic function (p < 0.05), excessive gastric residue (p < 0.001), and hypokalemia or hypocalcemia (p < 0.05). In the second study period, the number of patients on TEN and the doses of sedatives, muscle relaxants, and vasoactives were higher (p < 0.05), with no increase in the incidence of complications. TEN is a useful method of nutrition with few complications in the critically ill child.

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Section: Discussionsupporting

confidence: 89%

The Use of Transpyloric Enteral Nutrition in the Critically Ill Child

Sánchez

López‐Herce

Guerra

et al. 2000

J Intensive Care Med

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show abstract

“…These figures are similar to those of previous studies in adults and children [36]. However, the frequency of altered hepatic function and of cholestasis (2%) was low, well below that associated with parenteral nutrition in the critically ill patient, confirming that this is one of the advantages of enteral nutrition over parenteral [37,38].…”

Section: Discussionsupporting

confidence: 89%

The Use of Transpyloric Enteral Nutrition in the Critically Ill Child

Sánchez¹,

López‐Herce²,

Guerra³

et al. 2000

J Intensive Care Med

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To assess the use and complications of transpyloric enteral nutrition (TEN) in the critically ill child we evaluated prospectively all children who received TEN in a pediatric intensive care unit (PICU) of a tertiary university hospital. The type of nutrition used, its duration, medication administered, tolerance, gastrointestinal complications (vomiting, abdominal distension or excessive gastric residue, diarrhea, and pulmonary aspiration), nongastrointestinal complications, and mortality were assessed. A comparative analysis was made between the first 2 years of the study and the remaining period. Over a period of 4.5 years, 152 patients between the ages of 3 days and 17 years received TEN for a duration of 19 ± 32.3 days (range 1–240 days). Forty‐one patients received TEN during the first 2 years; 100 patients received TEN in the postoperative period after cardiac surgery (66%). One hundred seventeen patients (77%) received sedation and 65 (43%) received muscle relaxants, presenting no extra complications. Twenty‐four patients (15.8%) presented with gastrointestinal complications: abdominal distension and/or excessive gastric residue in 17 and diarrhea in 11. Gastrointestinal intolerance was associated with pulmonary infection (p < 0.05), altered hepatic function (p < 0.001), and hypokalemia or hypocalcemia (p < 0.05). Diarrhea was more frequent in patients with shock (p < 0.05), altered hepatic function (p < 0.05), excessive gastric residue (p < 0.001), and hypokalemia or hypocalcemia (p < 0.05). In the second study period, the number of patients on TEN and the doses of sedatives, muscle relaxants, and vasoactives were higher (p < 0.05), with no increase in the incidence of complications. TEN is a useful method of nutrition with few complications in the critically ill child.

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“…There is a natural reluctance on the part of many units to publish figures showing a high catheter sepsis rate, although some have reported experiences similar to our own. '9 20 We suspect that even collection of such data is not routine in many centres and yet our study, the first of its kind in children, emphasises how infection rates can suddenly increase. Careful prospective monitoring of catheter sepsis is essential if adverse trends are to be reliably identified at an early stage and then reversed.…”

Section: Discussionmentioning

confidence: 92%

Staff training: a key factor in reducing intravascular catheter sepsis.

Puntis

Holden

Smallman

et al. 1991

Archives of Disease in Childhood

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Catheters were used exclusively for parenteral nutrition and not for administration of drugs or blood sampling. Parenteral feed source containers were changed every 24 hours and a 0-2 micron filter used in line with the amino acid/ dextrose preparation. In the event of the catheter hub being disconnected (occlusion requiring flushing, or filter breakage), feed solutions were replaced with 10% dextrose until the next day's feed prescription became available.A diagnosis of probable catheter sepsis was made in a feverish or unwell patient without evidence of focal infection such as otitis or pneumonia, and when urine culture was negative. Primary catheter sepsis was then considered to be proved when peripheral blood cultures were positive for bacterial pathogens.

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Parenteral nutrition compared with transpyloric feeding.

Cited by 41 publications

References 13 publications

The Use of Transpyloric Enteral Nutrition in the Critically Ill Child

The Use of Transpyloric Enteral Nutrition in the Critically Ill Child

The Use of Transpyloric Enteral Nutrition in the Critically Ill Child

Staff training: a key factor in reducing intravascular catheter sepsis.

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