Transcript The benefits of enteral nutrition

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報告學生 : 劉家祥
指導老師 : 賴聖如 營養師
報告日期 : 2012/12/28
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Effect of early enteral nutrition on morbidity and
mortality in children with burns.
burns 36 ( 2010 ) 1067 – 1071
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The burn can result in profound metabolic abnormalities,
and that malnourishment is associated with increased
infection risks, decreased healing rates and altered cell
function.
auto-destructive
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International nutritional support guidelines concur that enteral
feeding should occur early in critically ill patients who have a
functioning gastrointestinal tract but time frames as to what is
considered early varies from 24 to 48 h .
J Physiol 1993;119:210–23.
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30days12Y/O
2 h prior to
admission
≧10% TBSA
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LEN
enteral nutrition
after 48 h
kept open with 5 ml h-1
EEN
within 3–6 h
every 3 h by 50% (2 ml kg1), 33% (3ml kg-1),25% (4
ml kg-1),20% (5 ml kg-1)
and 17% (6 ml kg-1)
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17–20% of protein
22–28% of fat
55–58% of carbohydrate
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The LEN group lost 9% of body weight between admission and discharge
compared to 3% in the EEN group.
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Our research showed that EEN decreases
duration of hospitalisation and mortality in
children with burns.
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Nutrition 28 (2012) 864–867
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infectious
complications
mortality
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Literature search
MEDLINE
EMBASE
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Objective criteria of critical illness.
(1) The patients were recruited in an ICU or
(2) The inclusion criteria described were such that the patients would normally be
cared for in an ICU (e.g. all patients were receiving invasive mechanical
ventilatory support) or
(3) The patients were suffering from a condition that usually requires care in an ICU
(e.g. severe thermal burns of >40–50% TBSA, multi trauma that required
urgent laparotomy) or
(4) The patients had an average ICU length of stay of greater than two days or
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Fig. 1. Flow diagram
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Pneumonia
Multiple organ
dysfunction
syndrome (MODS)
EN within 24
h of injury
12/17 EN
patients
13/19 EN
patients
incidence of
pneumonia
2.5 ± 0.7
3.1 ± 0.8
（organ failures per patient）
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Although the detection of a statistically significant
reduction in mortality is promising,overall trial quality
was low and trial size was small. The results of this
meta-analysis should beconfirmed by the conduct of a
large multi-center trial.
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Factors leading to discrepancies between prescription and
intake of enteral nutrition therapy in hospitalized patients
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The prescribed amount of ENT to be provided
via feeding tube or stoma is not always actually
delivered to the patient.
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Methods and results
A total of 640 patients older than 18
Y/O,TF,gastrostomies,jejunsotomies
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excluded from discharged from
the hospital, died, oral or
parenteral nutrition.
enrolled 201 patients
Patient identification
variables
cardiac
diseases
neurologic
diseases
45 patients ENTand
4 patients data records.
cancer
ENT included
vascular
diseases
infectious
diseases.
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In this study, the major reasons for the
discrepancy between EN prescription and intake
in a general Brazilian hospital were operational
logistical problems, gastric stasis, accidental
loss of enteral feeding tube, and interference by
an external physician.
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早期腸道營養可以降低燒燙傷孩童的死亡率以及住院
時間，對於創傷的病人則是可以降低住院感染率以
及死亡率。由前兩個文得知及早的腸道營養對於病
人的重要性，但是在給予病人腸道營養時(非由口
進食)，需注意某些因子阻礙了營養的攝取。
Thank you for your attention