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A Novel Method of Nasojejunal Feeding and Gastric Decompression Using a Double Lumen Silicone Tube for Upper Gastrointestinal Obstruction.

一种使用双腔硅胶管治疗上消化道梗阻的鼻空肠喂养和胃减压的新方法。

  • 影响因子:1.21
  • DOI:10.1097/SLE.0000000000000754
  • 作者列表:"Tan JH","Sivadurai G","Tan HCL","Tan YR","Jahit S","Hans Alexander M
  • 发表时间:2020-01-07
Abstract

BACKGROUND:Provision of enteral nutrition with jejunal feeding in upper gastrointestinal obstruction is highly recommended. Access to jejunum can be obtained surgically, percutaneously, or endoscopically. Our institution routinely and preferentially utilizes a silicone nasojejunal tube that is inserted past the obstruction endoscopically. We use a custom dual channel tube that allows feeding at the distal tip and another channel 40 cm from the tip that enables decompression proximally. This is a report of our experience with this custom nasojejunal tube. METHODS:This is a prospective observational study of 201 patients who underwent endoscopic nasojejunal wire-guided feeding tube insertions for obstruction of either the esophagus or the stomach including both benign and malignant pathologies between January 2015 to June 2018 in Hospital Sungai Buloh and Hospital Sultanah Aminah, Malaysia. The indications for tube insertion, insertion technique, and tube-related problems were described. RESULTS:The nasojejunal tube was used to establish enteral feeding in patients with obstructing tumors of the distal esophagus in 65 patients (32.3%) and gastric outlet obstruction in 72 patients (35.8%). There were 54 patients (26.9%) who required reinsertion. The most common reason for reinsertion was unintentional dislodgement, where 32 patients (15.9%) followed by tube blockage 20 patients (10.0%). Using our method of advancement under direct vision, we had only 2 cases of malposition due to severely deformed anatomy. We had no incidence of aspiration in this group of patients and overall, the patients tolerated the tube well. CONCLUSIONS:The novel nasojejunal feeding tube with gastric decompression function is a safe and effective method of delivery of enteral nutrition in patients with upper gastrointestinal obstruction. These tubes if inserted properly are well tolerated with almost no risk of malposition and are tolerated well even for prolonged periods of time until definitive surgery could be performed.

摘要

背景: 强烈建议上消化道梗阻患者在空肠喂养的同时提供肠内营养。可以手术、经皮或内镜下获得空肠通路。我们机构常规优先使用经内镜插入梗阻的硅胶鼻空肠管。我们使用一个定制的双通道管,允许在远端尖端喂食,另一个通道距离尖端 40 cm,可以在近端减压。这是我们使用这种定制鼻空肠管的经验报告。 方法: 这是一项前瞻性观察性研究,201 例患者在 2015年1月至 2018年6月期间接受内镜下鼻空肠钢丝引导下食管或胃管插入术,包括良性和恶性病变。 sungai Buloh 和苏丹医院 Aminah, 马来西亚。介绍了导管插入的适应症、插入技术和导管相关问题。 结果: 65 例 (32.3%) 食管远端肿瘤梗阻和 72 例 (35.8%) 胃出口梗阻患者采用鼻空肠管建立肠内营养。有 54 例患者 (26.9%) 需要重新插入。重新插入的最常见原因是无意的移位,其中 32 例患者 (15.9%) 其次是堵管 20 例患者 (10.0%)。利用我们的直视下推进方法,我们只有 2 例由于解剖严重畸形而出现错位。本组患者无误吸发生率,总体而言,患者对管的耐受性良好。 结论: 具有胃减压功能的新型鼻空肠营养管是一种安全有效的上消化道梗阻患者肠内营养输送方法。这些管如果正确插入,耐受性良好,几乎没有错位的风险,即使在可以进行确定性手术之前的较长时间内,也耐受性良好。

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影响因子:3.31
发表时间:2020-01-06
来源期刊:Critical care medicine
DOI:10.1097/CCM.0000000000004176
作者列表:["Heyland DK","Marquis F","Lamontagne F","Albert M","Turgeon AF","Khwaja KA","Garland A","Hall R","Chapman MG","Kutsiogannis DJ","Martin C","Sessler DI","Day AG"]

METHODS:OBJECTIVES:To evaluate the effect of esophageal stimulation on nutritional adequacy in critically ill patients at risk for enteral feeding intolerance. DESIGN:A multicenter randomized sham-controlled clinical trial. SETTING:Twelve ICUs in Canada. PATIENTS:We included mechanically ventilated ICU patients who were given moderate-to-high doses of opioids and expected to remain alive and ventilated for an additional 48 hours and who were receiving enteral nutrition or expected to start imminently. INTERVENTIONS:Patients were randomly assigned 1:1 to esophageal stimulation via an esophageal stimulating catheter (E-Motion Tube; E-Motion Medical, Tel Aviv, Israel) or sham treatment. All patients were fed via these catheters using a standardized feeding protocol. MEASUREMENTS AND MAIN RESULTS:The co-primary outcomes were proportion of caloric and protein prescription received enterally over the initial 7 days following randomization. Among 159 patients randomized, the modified intention-to-treat analysis included 155 patients: 73 patients in the active treatment group and 82 in the sham treatment group. Over the 7-day study period, the percent of prescribed caloric intake (± SE) received by the enteral route was 64% ± 2 in the active group and 65% ± 2 in sham patients for calories (difference, -1; 95% CI, -8 to 6; p = 0.74). For protein, it was 57% ± 3 in the active group and 60% ± 3 in the sham group (difference, -3; 95% CI, -10 to 3; p = 0.30). Compared to the sham group, there were more serious adverse events reported in the active treatment group (13 vs 6; p = 0.053). Clinically important arrhythmias were detected by Holter monitoring in 36 out of 70 (51%) in the active group versus 22 out of 76 (29%) in the sham group (p = 0.006). CONCLUSIONS:Esophageal stimulation via a special feeding catheter did not improve nutritional adequacy and was associated with increase risk of harm in critically ill patients.

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翻译标题与摘要 下载文献
影响因子:5.24
发表时间:2020-01-06
DOI:10.1164/rccm.201909-1810OC
作者列表:["Deane AM","Little L","Bellomo R","Chapman MJ","Davies AR","Ferrie S","Horowitz M","Hurford S","Lange K","Litton E","Mackle D","O'Connor S","Parker J","Peake SL","Presneill JJ","Ridley EJ","Singh V","van Haren F","Williams P","Young P","Iwashyna TJ","TARGET Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group."]

METHODS:RATIONALE:The long-term effects of delivering approximately 100% of recommended calorie intake via the enteral route during critical illness compared to a lesser amount of calories are unknown. OBJECTIVES:Our hypotheses were that achieving approximately 100% of recommended calorie intake during critical illness would increase quality of life scores, return to work and key life activities and reduce death and disability six months later. METHODS:We conducted a multicenter, blinded, parallel group, randomized clinical trial, with 3957 mechanically ventilated critically ill adults allocated to energy-dense (1.5 kcal/ml) or routine (1.0 kcal/ml) enteral nutrition. MEASUREMENTS AND MAIN RESULTS:Participants assigned energy-dense nutrition received more calories (% recommended energy intake, mean (SD) (energy-dense: 103% (28) vs. usual: 69% (18)). Mortality at day-180 was similar (560/1895 (29.6%) vs. 539/1920 (28.1%); relative risk 1.05 (95%CI, 0.95 to 1.16)). At a median [IQR] of 185 [182, 193] days after randomization, 2492 survivors were surveyed and reported similar quality of life (EuroQol five dimensions five-level quality of life questionnaire visual analogue scale, median [IQR]: 75 [60-85]; group difference: 0 (95%CI, 0 to 0)). Similar numbers of participants returned to work with no difference in hours worked or effectiveness at work (n=818). There was no observed difference in disability (n=1208) or participation in key life activities (n=705). CONCLUSIONS:The delivery of approximately 100% compared to 70% of recommended calorie intake during critical illness does not improve quality of life, or functional outcomes, or increase the number of survivors six months later. Clinical trial registration available at www.clinicaltrials.gov, ID: NCT02306746.

翻译标题与摘要 下载文献
影响因子:1.21
发表时间:2020-01-07
DOI:10.1097/SLE.0000000000000754
作者列表:["Tan JH","Sivadurai G","Tan HCL","Tan YR","Jahit S","Hans Alexander M"]

METHODS:BACKGROUND:Provision of enteral nutrition with jejunal feeding in upper gastrointestinal obstruction is highly recommended. Access to jejunum can be obtained surgically, percutaneously, or endoscopically. Our institution routinely and preferentially utilizes a silicone nasojejunal tube that is inserted past the obstruction endoscopically. We use a custom dual channel tube that allows feeding at the distal tip and another channel 40 cm from the tip that enables decompression proximally. This is a report of our experience with this custom nasojejunal tube. METHODS:This is a prospective observational study of 201 patients who underwent endoscopic nasojejunal wire-guided feeding tube insertions for obstruction of either the esophagus or the stomach including both benign and malignant pathologies between January 2015 to June 2018 in Hospital Sungai Buloh and Hospital Sultanah Aminah, Malaysia. The indications for tube insertion, insertion technique, and tube-related problems were described. RESULTS:The nasojejunal tube was used to establish enteral feeding in patients with obstructing tumors of the distal esophagus in 65 patients (32.3%) and gastric outlet obstruction in 72 patients (35.8%). There were 54 patients (26.9%) who required reinsertion. The most common reason for reinsertion was unintentional dislodgement, where 32 patients (15.9%) followed by tube blockage 20 patients (10.0%). Using our method of advancement under direct vision, we had only 2 cases of malposition due to severely deformed anatomy. We had no incidence of aspiration in this group of patients and overall, the patients tolerated the tube well. CONCLUSIONS:The novel nasojejunal feeding tube with gastric decompression function is a safe and effective method of delivery of enteral nutrition in patients with upper gastrointestinal obstruction. These tubes if inserted properly are well tolerated with almost no risk of malposition and are tolerated well even for prolonged periods of time until definitive surgery could be performed.

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