Gut access in critically ill and injured patients: Where have we gone thus far?

European Surgery (Impact Factor: 0.26). 02/2011; 43(1):24-29. DOI: 10.1007/s10353-011-0590-1

ABSTRACT BACKGROUND: Nutritional support in critically ill and injured patients is crucial. It can be provided via parenteral or enteral
access, each of which has advantages and disadvantages. In this article, we review enteral support, particularly gut access.
METHODS: We conducted a literature review. RESULTS: A number of techniques enable access to the gastrointestinal tract in
critically ill and injured patients. A temporary orogastric (OG), nasogastric (NG), or nasojejunal (NJ) feeding tube can be
placed. But the prevalent technique is the more permanent percutaneous endoscopic gastrostomy (PEG), which has economic as
well as safety benefits. Other techniques include open operative gastrostomy, laparoscopic or laparoscopic-assisted gastrostomy,
and jejunostomy. CONCLUSIONS: Nutritional support should be provided enterally, via gut access whenever possible. The issue
of pre- versus post-pyloric access remains controversial. PEG is safe and economical for long-term access.

GRUNDLAGEN: Ernährung beim kritisch Kranken und Schwerverletzten ist essentiell und kann parenteral oder enteral erfolgen.
Jede Methode hat ihre Vor-und Nachteile. Hier untersuchen wir den enteralen Zugang, vor allem die Zugangswege. METHODIK: Übersicht
der Literatur. ERGEBNISSE: Folgende Zugangswege für enterale Ernährungssonden stehen uns zur Verfügung: orogastrisch, nasogastrisch,
nasojejunal. Die beliebtere Methode ist die permanente endoskopische Gastrostomie (PEG), aus ökonomischen und sicherheitstechnischen
Überlegungen. Alternativ finden sich die offene Gastrostomie, laparoskopische oder laparoskopisch assistierte Gastrostomie
und Jejunostomie. SCHLUSSFOLGERUNGEN: Wann immer ein enteraler Zugang möglich ist, sollte einer enteralen Ernährung der Vorzug
gegeben werden, ob prä- oder post-pylorisch ist derzeit nicht eindeutig zu beantworten. PEG ist sicher und ökonomisch sinnvoll.

KeywordsFeeding tube–Percutaneous endoscopic gastrostomy–Nasogastric tube–Nasojejunostomy
SchlüsselwörterErnährungssonde–Perkutane endoskopische Gastrostomie (PEG)–Nasojejunalsonde

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Available from: Bellal Joseph, Aug 16, 2015
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    ABSTRACT: Background Enteral nutrition (EN) is a widely used, standard-of-care technique for nutrition support in critically ill and trauma patients. Objective To review the current techniques of gastrointestinal tract access for EN. Methods For this traditional narrative review, we accessed English-language articles and abstracts published from January 1988 through October 2012, using three research engines (MEDLINE, Scopus, and EMBASE) and the following key terms: “enteral nutrition,” “critically ill,” and “gut access.” We excluded outdated abstracts. Results For our nearly 25-year search period, 44 articles matched all three terms. The most common gut access techniques included nasoenteric tube placement (nasogastric, nasoduodenal, or nasojejunal), as well as a percutaneous endoscopic gastrostomy (PEG). Other open or laparoscopic techniques, such as a jejunostomy or a gastrojejunostomy, were also used. Early EN continues to be preferred whenever feasible. In addition, evidence is mounting that EN during the early phase of critical illness or trauma trophic feeding has an outcome comparable to that of full-strength formulas. Most patients tolerate EN through the stomach, so postpyloric tube feeding is not needed initially. Conclusion In critically ill and trauma patients, early EN through the stomach should be instituted whenever feasible. Other approaches can be used according to patient needs, available expertise, and institutional guidelines. More research is needed in order to ensure the safe use of surgical tubes in the open abdomen.
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