Kudsk KA, Stone JA, Carpenter C, Sheldon GF. Coben RM, Weintraub A, DiMarino AJ Jr, Cohen S. Gastroesophageal reflux during gastrostomy feeding. Critical Windows for the Programming Effects of Early-Life Nutrition on Skeletal Muscle Mass. Ferguson DR, Harig JM, Kozarek RA, Kelsey PB, Picha GJ. The heterogeneity in methodology and outcomes among the 5 studies did not allow for a meta-analysis. Gazzaneo MC, Suryawan . Ciocon JO, Galindo-Ciocon DJ, Tiessen C, Galindo D. Continuous compared with intermittent tube feeding in the elderly. Gastroenterology 1990;98:780-785. J Nutr. Mickschl DB, Davidson LS, Fluornoy DJ, Parker DE. It has also been suggested that high percentages of branched-chain amino acids are necessary for severely stressed or traumatized patients to enhance nitrogen balance.187 These patients show significant proteolysis and hydrolysis of skeletal muscle branched-chain amino acids for energy. Early enteral feeding, compared with parenteral, reduces postoperative septic complications: the results of a meta-analysis. If a bolus feeding regimen is required for a patient, gastric feeding is most commonly prescribed, although there are no published, prospective, randomized trials demonstrating a superior-ity of bolus versus continuous gastric feeding.8 Small Bowel Feeding Patients who are unable to tolerate gastric feed-ings, cannot receive a gastric enteral . J Okla State Med Assoc 1987;80:163-165. Recent findings indicate that bolus feeding enhances protein synthesis more than continuous feeding and promotes greater protein anabolism. The ultimate decision concerning nutritional support rests with the patient's physician. Candida-associated diarrhea in hospitalized patients. Nasointestinal tube placement with a pH sensor feeding tube. Medium-chain triglyceride-supplemented formulations have been proposed as alternatives to long-chain fatty acids in patients with fat malabsorption. McClave SA, Snider HL, Lowen CC, McLaughlin AJ, Greene LM, McCoombs RJ, Rodgers L, Wright RA, Roy TM, Schumer MP, Pfeifer MA. Bolus and continuous feeding are equally suitable feeding strategies for preterm neonates. Peters AL, Davidson MB, Isaac RM. Am J Clin Nutr 1993;57:73-80. Gonzáles-Huix F, Fernández-Bañares F, Esteve-Comas M, Abad-Lacruz A, Cabré E, Acero D, Figa M, Guilera M, Humbert P, de León R, Gassull MA. Gastrointest Endosc 1986;32:253-258. Rev Hosp Clín Fac Med S Paul. JPEN 1988; 14:34-38. The practice of bolus feeding has evolved over time in response to the preferences and needs of individual patients using enteral tube feeding, their social circumstances and the experience of the healthcare professionals caring for them. Gastrointest Endosc 1990;36:1-5. [5,6] EN can be given as intermittent (bolus tube feeding [BTF]) or continuous tube feeding (CTF). Nutr Supp Serv 1987;7:11-13. Enteral formulations containing soy fiber have been used in the acute care setting to prevent diarrhea associated with tube feedings. Hillman KM, Riordan R, O'Farrell SM, Tabaqchali S. Colonization of the gastric contents in critically ill patients. 2009 Jan;12(1):78-85. doi: 10.1097/MCO.0b013e32831cef9f. Park RHR, Allison MC, Lang J, Spence E, Morris AJ, Danesh BJZ, Russell RI, Mills PR. Feeding intolerance may be associated with increased complications and costs. Modern nutrition in health and disease. Duckworth PF Jr, Kirby DF, McHenry L, DeLegge MH, Foxx-Orenstein A. Percutaneous endoscopic gastrojejunostomy (PEG/J) made easy: a new over-the-wire technique. In: Shils ME, Young VR, eds. They are also independent of carnitine transport into the mitochondria. In: Rombeau JL, Caldwell MD, eds. JPEN 1990;14:362-365. Maintenance of small bowel mucosa with glutamine enriched parenteral nutrition. Eat the meat or feed the meat: protein turnover in remodeling muscle. Am J Surg 1985;149:102-105. Calvey H, Davis M, Williams R. Controlled trial of nutritional supplementation with and without branched chain amino acid enrichment, in treatment of alcoholic hepatitis. Percutaneous feeding gastrostomy. Hiebert JM, Brown A, Anderson RG, Halfacre S, Rodeheaver GT, Edlich GT. JPEN 1987;11:210-213. Guidelines for the scientific review of enteral food products for special medical purposes. Martindale R, Witte M, Hodges G, Kelley J, Harris S, Andersen C. Necrotizing fasciitis as a complication of percutaneous endoscopic gastrostomy. This suggests that, compared to continuous feeding, bolus feeding is associated with superior clinical outcomes among patients treated for medical NEC. Larson DE, Burton DD, Schroeder KW, DiMagno EP. It is unclear which method is better for reducing reflux of milk into the oesophagus. Gastrointest Endosc 1986;32:397-399. Saltzberg DM, Anand K, Juvan P, Joffe I. Colocutaneous fistula: an unusual complication of percutaneous endoscopic gastrostomy. Clipboard, Search History, and several other advanced features are temporarily unavailable. Am J Clin Nutr 1989;50:553-558. �|���}�_O����W�?� �oE�UF�+�O�G��#8��3�V�I췽\3���ɪ-k�/s��flU��ع�Z���5S��ϡZg��T?����k�kw0��#����ʢxY��&�� The safety of bolus vs continuous feeding in the ICU. Ponsky JL, Aszodi A. Percutaneous endoscopic jejunostomy. The force of gravity pulls the formula from the bag, through the tube. [7,8] BTFs are given at standard intervals, allow greater patient mobility and are . Bolus feedings are delivered four to eight times per day; each feeding lasting about 15 to 30 minutes. Equal aspiration rates from postpylorus and intragastric-placed small-bore nasoenteric feeding tubes: a randomized, prospective study. Feeding jejunostomy with endoscopic guidance. Philadelphia: Lea & Febiger, 1988:133-135. Gastrointest Endosc 1988;34:368-369. Medium-chain triglycerides can be an advantage to the patient who shows fat malabsorption secondary to intestinal mucosal damage, bile salt deficiency, or biliary tract dysfunction. Winterbauer RH, Durning RB, Barron E, McFadden MC. Continuous feeding is defined as delivering enteral nutrition with constant speed for 24 h via nutritional pump [2, 3]. Thus, a custom enteral solution can be devised or individual components added to a commercial formula to obtain higher levels of a particular nutrient. The foundation of this decision depends on an appropriate nutritional assessment. Enteral formulations were originally designed to have a low fiber or residue content. Percutaneous gastrostomy. American Gastroenterological Association technical review on tube feeding for enteral nutrition. Payne-James JJ, Silk DBA. Br J Surg 1979;66:727-732. Comparison of continuous vs intermittent tube feedings in the adult burn patient. 2 0 obj Ann Surg 1989;209:455-461. Kelling G. Zur verschluss der duodenal fistel nach magenresektion. Kudsk KA, Croce MA, Fabian TC, Minard G, Tolley EA, Poret A, Kuhl MR, Brown RO. Gastrointest Endosc 1990;36:311-312. More information is needed concerning their practicality and effectiveness. Am J Gastroenterol 1987;82:622-624. 300-400mL every 3-6 hours, 30-60 min infusion using gravity drip or feeding pump infusion and feeding bag. Found inside – Page 506Out of 19 prospective , controlled trials of early versus delayed enteral nutrition therapy , 16 of those studies showed improved outcome . ... Enteral nutrition can be delivered by either bolus , intermittent , or continuous feeding . <>>> The use of a branched-chain amino acid-fortified, low aromatic amino acid enteral formulation may be useful in patients with hepatic encephalopathy. Willis JS, Oglesby JT. Zachary TM, Lipman TO, Finkelstein JD. A percutaneous method for inserting a feeding gastrostomy tube. The difference in response is attributable to the pulsatile pattern of amino acid-induced and insulin-induced translation initiation induced only by bolus feeding. El-Kadi SW, Boutry C, Suryawan A, Gazzaneo MC, Orellana RA, Srivastava N, Nguyen HV, Kimball SR, Fiorotto ML, Davis TA. Powers T, Cowan GSM, Deckard M, Stark N. Prospective randomized evaluation of two regimens for converting from continuous to intermittent feedings in patients with feeding gastrostomies. Raff MH, Cho S, Dale R. A technique for positioning nasoenteral feeding tubes. Contamination of enteral feedings and diarrhea in patients in intensive care units. Disclaimer, National Library of Medicine This is a meal-sized amount of liquid food given through the tube several times a day. Zentralbl Chir 1922;49:779-780. Wolfsen HC, Kozarek RA, Ball TJ, Patterson DJ, Botoman VA. Tube dysfunction following percutaneous endoscopic gastrostomy and jejunostomy. Current concepts in nutrition: enteral tube feeding. Powers DA, Brown RO, Cowan Jr GSM, Luther RW, Sutherland DA, Drexler G. Nutrition support team vs nonteam management of enteral nutrition support in a veterans administration medical center teaching hospital. Surg Gynecol Obstet 1981;152:659-660. Fairman RP. Efficacy of metoclopramide as an adjunct to duodenal placement of small-bore feeding tubes: a randomized, placebo-controlled, double-blind study. Effects of enteral and parenteral feeding of malnourished rats on body composition. Feeding using a syringe or gravity drip can also be called bolus feeding. Whether bolus or continuous feeding is more beneficial has been controversial, largely due to limitations inherent in clinical studies, such as the presence of confounding variables and the inability to use invasive approaches. J Pediatr Gastroenterol Nutr 1990;11:45-47. Intolerance to enteral feeding in the brain-injured patient. %PDF-1.5 Borlase BC, Bell SJ, Lewis EJ, Swails W, Bistrian BR, Forse A, Blackburn GL. Effect of starvation on tissue composition of the small intestine in the rat. D��a$}Q�F-�xO���=K�`|LɢP���Χ��!�e�E��%V� ��$��|E7�s�z���d�%~��~xZ'�lR J Hepatol 1990;11:92-101. Please enable it to take advantage of the complete set of features! Cunha F. Gastrostomy: its inception and evolution. Select appropriate feeding tube: a. In a prospective, nonblinded study comparing team-managed and non-team-managed enteral nutrition support patients, Powers et al. Huxley EJ, Viroslav J, Gray WR, Pierce AK. 2006 Nov;9(6):672-6. doi: 10.1097/01.mco.0000247471.64532.7d. Ann Surg 1984;199:286-291. Marked resistance to tube-feeding-induced diarrhea: the role of magnesium. Fluoroscopically guided nasoenteric feeding tube placement: results of a 1-year study. Google Scholar | Medline Richmond, Virginia, Division of Gastroenterology leaves the ports of the feeding tube, it is mixed immediately with gastric or intestinal secretions and diluted--this inconsistency in practice is difficult to rationalize. Predictors of outcome after percutaneous endoscopic gastrostomy: a community-based study. Am J Clin Nutr. We sought to compare bolus (B) versus continuous (C) gastric feeding in brain injured patients. Ou J, Courtney CM, Steinberger AE, Tecos ME, Warner BW. Abbreviations used in this paper: NET, nasoenteric tube; NGT, nasogastric tube; OG, operative gastrostomy; PEG, percutaneous endoscopic gastrostomy; PEG/J, percutaneous endoscopic gastrojejunostomy; PEJ, percutaneous endoscopic jejunostomy; RV, residual volume. There have been reviews on advances, challenges, and prospects in enteral nutrition. This Special Issue is intended to provide information on recent advances in the area of enteral nutrition. N Engl J Med 1973;288:695-699. 2003;58(1):9-14. Gastroenterology 1995;108:1282-1301. CONCLUSION:Infants given bolus feeds reached goal feeds faster, required less time on PN, and were discharged quicker than those fed continuously. Course Objectives: • Identify the benefits of bolus feeding for patients with head & neck cancer. Continuous nasogastric milk feeding versus intermittent bolus milk feeding for premature infants less than 1500 grams. Infants in the continuous feeding group had an average shorter time to full feeds, better feeding tolerance and improved weight gain. Aspiration pneumonia in nursing home patients fed via gastrostomy tubes. Epub 2011 Oct 19. • Continuous or Intermittent • Over 30-60 minutes in some pediatric patients • Delivered up to 24 hours a day • Appropriate for JT and GT/NGT who require slower rate. Radiology 1986;158:543-545. Immune and metabolic effects of arginine in the surgical patient. Performance Indicators: 4.1.2, 8.1.5, 8.3.1, 8.3.4. The major role for fiber in enteral formulas is likely the contribution of short-chain fatty acids, which are trophic for bowel mucosa. There is often a break of several hours between feeds. JPEN 1983;7: 521-524. Session Objectives • Compare effects of enteral feeding using continuous vs bolus methods on glycemic control and other metabolic parameters • Discuss implications of using continuous vs bolus feeding delivery on circadian rhythms • Identify which is the more optimum feeding modality in the critically ill 3. Laitinen M, Hienaren E, Vainio H. Dietary fats and properties of endoplasmic reticulum: dietary lipid-induced changes of microsomal membranes in liver and gastroduodenal tissue of rat. J Hum Nutr 1981;35:123-127. Crit Care Med 1987;15:506-509. Daly JM, Lieberman MD, Goldfine J, Shou J, Weintraub F, Rosato E, Lavin P. Enteral nutrition with supplemental arginine, RNA, and omega-3 fatty acids in patients after operation: immunologic, metabolic and clinical outcome. The daily nutrients to be provided at goal, including total daily volume of formula, calories, protein, and free water. Edelman DS, Unger SW. Laparoscopic gastrostomy. Am J Gastroenterol 1990;85:448-451. See this image and copyright information in PMC. Continuous Drip vs. Bolus Feedings. Calton WC, Martindale RG, Gooden SM. Gastrointest Endosc 1984;30:296-298. Hammarqvist F, Wernerman J, Ali R, von der Decken A, Vinnars E. Addition of glutamine to parenteral nutrition after elective abdominal surgery spares free glutamine in muscle, counteracts the fall in muscle protein synthesis, and improves nitrogen balance. Scott JS, De La Torre RA, Unger SW. Surg Gynecol Obstet 1991;173:401. Babies receiving continuous feeding may reach full enteral feeding almost one day later than babies receiving intermittent feeding (mean difference (MD) 0.84 days, 95% confidence interval (CI) -0.13 to 1.81; 7 studies, 628 infants; low-certainty evidence). 2 Remove the plunger from the large syringe and attach the large syringe high volume of feed administered over a short period multiple times a day) - could Boutry C, El-Kadi SW, Suryawan A, Wheatley SM, Orellana RA, Kimball SR, Nguyen HV, Davis TA. AAMJ 10(3). Intermittent bolus feeding may be preferable. Cave DR, Robinson WR, Brotschi EA. Intermittent Bolus Compared With Continuous Feeding Enhances Insulin and Amino Acid Signaling to Translation Initiation in Skeletal Muscle of Neonatal Pigs. Brown AS, Mueller PR, Ferrucci JT Jr. Recent concepts of the insulin and amino acid signaling pathways that regulate the…, Plasma insulin (A) and branched-chain amino acid (BCAA; B) concentrations in intermittent bolus…, Protein synthesis rate (A) and eIF4E•eIF4G abundance (B) in the longissimus dorsi muscle…, Hindquarter rates of protein synthesis (A), degradation (B), and deposition (C) in neonatal…, MeSH Gutierrez ED, Balfe DM. Hogan RB, DeMarco DC, Hamilton JK, Walker CO, Polter DE. 3. J Pediatr Surg 1980;15:872-875. Serpa LF, Kimura M, Faintuch J, Ceconello I. Mathus-Vliegen EMH, Tytgat GNJ, Merkus MP. Enteral feeding in the hypoalbuminemic patient. Immediate enteral nutrition following multisystem trauma: a decade perspective. endobj Found inside – Page 46312-21 Advantages and Risks of Various Feeding Methods Not dependent on GI function No danger of aspiration Low ... The benefits of continuous versus intermittent bolus feedings are not clear.181 The enteral feeding–induced surge of gut ... Bolus feeding also led to an increase in concentrations of insulin (P = 0.0024) and peptide YY (P < 0.0001), not seen with continuous feeding. Effect of a catheter in the pharynx on the frequency of transient lower esophageal sphincter relaxations. Gastrointest Endosc 1986;32:292-293. Article Google Scholar 12. 3. �ue?��.o��� bolus and continuous enteral nutrition. J Trauma 1982;22:904-906. PubMed Google Scholar 18. Mayo Clinic Jacksonville JPEN 1992;16:525-528. Gastroenterology 1992;103:1236-1240. Edes TE, Walk BE, Austin JL. Randall HT. Accessibility Myth #3: Jejunal Feeding Causes Diarrhea This particular myth has been applied to both jejunal and gastric feedings alike, when in reality, diarrhea is a common complaint among JPEN 1991;15:277-280. Bolus Feedings Bolus feedings allow for more mobility than continuous drip feedings because there are breaks in the feedings, allowing the patient to be free from the TF apparatus for activities such as physical therapy. Cameron JL, Mitchell WH, Zuidema GD. Liquid food is dripped slowly through the tube for part or all of a day. Fisher M, Adkins W, Hall L, Seaman P, Hsi S, Marlett J. JPEN 1987;11:412-421. Found inside – Page 578Continuous or hourly bolus feeds may defined as daily increments of 15–20 mL/kg/day, and faster advancement as ... CONTINUOUS. FEEDS. VERSUS. BOLUS. INTERMITTENT. FEEDS. AND. FEED. oral cavity may interfere with sucking and swallowing.
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