The effect of route of nutrient administration on the nutritional state, catabolic hormone secretion, and gut mucosal integrity after burn injury

Abstract

So that the efficacy of route of nutrient administration in thermal injury could be determined, a comparison was made between immediate enteral vs parenteral feedings in burned guinea pigs. Thirty-five guinea pigs underwent both catheter gastrostomy and jugular vein catheterization. On postoperative day 8, burned animals [30% total body surface area (TBSA)] were divided into an intragastrically (ig) fed group (N = 14) and a parenterally (iv) fed group (N = 14). Animals in each group received 175 kcal/kg/day with a solution of identical nutrient value beginning 2 hr after burn. The body weight change until postburn day (PBD) 8 and the average nitrogen balance were significantly better in the ig group than in the iv group. Values were also higher for the iv group than for the ig group in the early postburn period for urinary vanillyl mandelic acid (VMA) (p less than 0.05), plasma cortisol (p less than 0.05), and plasma glucagon (p less than 0.05). Also, the iv group showed reduced mucosal weight and thickness compared to the ig group on PBD 1 (p less than 0.02). There were significant negative correlations between VMA excretion and body weight change, and between plasma cortisol and jejunal mucosal structure (thickness and weight). These findings suggest that immediate postburn enteral nutrition can provide better nutritional support than parenteral nutrition through the maintenance of gut mucosal integrity and the prevention of increased secretion of catabolic hormones.

A randomised clinical trial to assess the effect of total enteral and total parenteral nutritional support on metabolic, inflammatory and oxidative markers in patients with predicted severe acute pancreatitis (APACHEE II ≥ 6)

“…Among the reasons for avoiding the enteral route for nutritional support in the past have been concerns regarding stimulation of an already inflamed pancreas and the belief that successful management of haemodynamic and cardiopulmonary aspects of the patients' care took priority. However, in other conditions characterised by haemodynamic instability and a systemic inflammatory response, early enteral feeding has been shown to attenuate the hypercatabolism associated with thermal injury and sepsis in animals as well as humans [14,15]. The observed benefit in these studies was attributed to preservation of gut barrier function and reduced translocation of viable bacteria and endotoxin into the portal and systemic circulation.…”

Basis of nutritional support in pediatrics

“…Essa equação pode ser utilizada em crianças maiores ou adolescentes. A Tabela 1 relaciona os fatores de correção para situações de estresse 4,6 . Necessidades de vitaminas: a oferta basal é essencial para a manutenção das reações metabólicas.…”

“…O jejum causa atrofia da mucosa intestinal rompendo a integridade imunológica do trato gastrintestinal e aumentando o risco de translocação bacteriana 4 .…”

“…Vários estudos demonstram a relação entre desnutrição e morbidade e mortalidade em pacientes internados 3,4 . A doença de base e situações como jejum ou estresse são também fatores potenciais de risco para o aumento dessa incidência 5 .…”

Early Enteral Nutrition Versus Parenteral Nutrition After Resection of Esophageal Cancer: a Retrospective Analysis

“…In addition to these advantages, enteral nutrition during and after certain surgical insults has other benefits including inhibition of energy expenditure [17], the cytokine response [18], the secretion of stress hormones [19], and bacterial translocation [20]. A landmark meta-analysis performed by Moore et al [21] showed that the incidence of infectious and noninfectious complications in trauma patients managed with enteral nutrition was significantly lower than in patients managed with parenteral nutrition.…”