The Benefits of Early Jejunal Hyperalimentation in the Head-Injured Patient

Grahm, Thomas W.; Zadrozny, Donna B.; Harrington, Timothy

doi:10.1227/00006123-198911000-00007

Cited by 170 publications

(57 citation statements)

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“…To examine evidence for this nutrition strategy, we asked if early full feeding (started within the first 48 h and feeding goals to be met within 72 h of ICU admission or injury) as compared to a delayed strategy (feeds delayed for at least 48 h) improved the outcome of our critically ill patients. In our systematic review, we identified a total of 11 trials in heterogeneous critically ill patient populations (n = 412 patients) [569][570][571][572][573][574][575][576][577][578][579]. Only one trial was specifically conducted in patients with sepsis (n = 43 patients) [577].…”

Section: We Suggest the Early Initiation Of Enteral Feedingmentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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Objective: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". Design:A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. Methods:The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable.

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Section: We Suggest the Early Initiation Of Enteral Feedingmentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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“…serum albumin, cal-acid glycoprotein, or mpyema occurred in fibronectin, transferrin improved significantly trition fed group. on days 7 and 10 in the enterally fed group, rates were compar-and these values were significantly higher than the total parenteral total parenteral nutrition fed patients on days 7 sepsis, five had a and 10. Pre-albumin values remained signifia, intra-abdominal cantly below baseline on days 4 and 7 in the r all three.…”

Section: Methodsmentioning

confidence: 78%

Gut mucosal nutritional support--enteral nutrition as primary therapy after multiple system trauma.

Kudsk

1994

Gut

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“…Also, there was an indication that feeding into the small intestine increased nutrient intake, but a meta-analysis was not conducted because of the marked variation in the reporting of nutritional outcomes. 1,11,16,25 The mechanism by which small intestinal feeding may reduce pneumonia rates remains unclear. One hypothesis, which explains the unfavorable outcome of gastric feeding, is that the increased gastric residual volume leads to regurgitation and aspiration, which leads to a higher incidence of nosocomial pneumonia.…”

Section: Discussionmentioning

confidence: 99%

“…In comparison with the gastric route, the transpyloric route is well tolerated, improves the efficacy in enteral supply, and reduces the incidence of late pneumonia. 2,11,17 Using the Cochrane risk-of-bias tool, we evaluated the methodologic quality of each trial included in this study. We presume that the patients were allocated randomly, because earlier reports from the same investigators clearly described the use of random sequences.…”

Section: Discussionmentioning

confidence: 99%

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Comparisons between small intestinal and gastric feeding in severe traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials

Wang

Zheng

Chen

et al. 2015

JNS

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Severe traumatic brain injury (TBI) is a catastrophic event that often has destructive familial, economic, and societal consequences. It contributes to many deaths and cases of permanent disability, especially among patients 15-30 years old. 8,10 The average mortality rate for patients with severe TBI is 39%, and 60% of these patients have an unfavorable outcome on the Glasgow Outcome Scale. 24,26 Furthermore, those who survive tend to have significant disabilities, which also can cause a major socioeconomic burden.Patients with severe TBI have reduced immune function and higher risks of nosocomial infections as a result of decreased energy and increased protein catabolism. 4,7 By providing additional daily calories, nutrition support abbreviatioNs APACHE II = Acute Physiology and Chronic Health Evaluation II; GCS = Glasgow Coma Scale; ICU = intensive care unit; ISS = Injury Severity Score; MV = mechanical ventilation; RCT = randomized controlled trial; RR = risk ratio; TBI = traumatic brain injury; VAP = ventilator-associated pneumonia; WMD = weighted mean difference. obJect Nutritional support is highly recommended for reducing the risk of nosocomial infections, such as pneumonitis, in patients with severe traumatic brain injury (TBI). Currently, there is no consensus for the preferred route of feeding. The authors compared the risks of pneumonitis and other important outcomes associated with small intestinal and gastric feeding in patients with severe TBI. methods This systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant randomized controlled trials (up to December 16, 2013) that compared small bowel to gastric feeding in patients with severe TBI were identified from searches in the PubMed and Embase databases. The primary outcome was risk of pneumonia. Secondary outcomes included ventilatorassociated pneumonia, mortality, length of intensive care unit stay, length of hospital stay, duration of mechanical ventilation, total number of complications, aspiration, diarrhea, distention, Glasgow Coma Scale score, Injury Severity Score, and Acute Physiology and Chronic Health Evaluation II score. results Five randomized controlled trials with 325 participants in total were included in the meta-analysis. Compared with gastric feeding, small bowel feeding was associated with a significant reduction in the incidence of pneumonitis (risk ratio [RR] 0.67; 95% CI 0.52-0.87; p = 0.002; I 2 = 0.0%) and ventilator-associated pneumonia (RR 0.52; 95% CI 0.34-0.81; p = 0.003; I 2 = 0.0%). Small intestinal feeding was also associated with a decrease in the total number of complications (RR 0.43; 95% CI 0.20-0.93; p = 0.03; I 2 = 68%). However, small intestinal feeding did not seem to significantly convert any of the other end points in the meta-analysis. coNclusioNs The limited evidence suggests that small bowel feeding in patients with severe TBI is associated with a risk of pneumonia that is lower than that with gast...

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The Benefits of Early Jejunal Hyperalimentation in the Head-Injured Patient

Cited by 170 publications

References 0 publications

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Gut mucosal nutritional support--enteral nutrition as primary therapy after multiple system trauma.

Comparisons between small intestinal and gastric feeding in severe traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials

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