Experience of 6 years with home enteral nutrition in an area of Spain

S3-Leitlinie Heimenterale und heimparenterale Ernährung der Deutschen Gesellschaft für Ernährungsmedizin (DGEM)

Medizinische Ernährungstherapie, die enterale und parenterale Ernährung umfasst, ist ein wesentlicher Teil der Ernährungstherapie. Medizinische Ernährungstherapie beschränkt sich nicht auf die Krankenhausbehandlung, sondern kann effektiv und sicher auch zu Hause eingesetzt werden. Dadurch hat sich der Stellenwert der Medizinischen Ernährungstherapie deutlich erhöht und ist zu einem wichtigen Bestandteil der Therapie vieler chronischer Erkrankungen geworden. Für Menschen mit chronischem Darmversagen, z. B. wegen Kurzdarmsyndrom ist die Medizinische Ernährungstherapie sogar lebensrettend. In der Leitlinie wird die Evidenz für die Medizinische Ernährungstherapie in 161 Empfehlungen dargestellt. Die Leitlinie wendet sich in erster Linie an Ärzte, Ernährungsfachkräfte und Pflegekräfte, sie dient der Information für Pharmazeuten und anderes Fachpersonal, kann aber auch für den interessierten Laien hilfreich sein.

Epidemiology of home enteral and parenteral nutrition in adults: Comprehensive national data

BACKGROUND AND AIMS

Although HEN and HPN are important parts of home healthcare, lack of information about the number of patients concerned is surprising. This educational paper presents a review of literature concerning published national data on epidemiology of both HEN and HPN, for different countries. It compares these publications with an exhaustive retrospective observational study on our national adult population for the year 2019.

METHODS

Our presented retrospective observational national study was carried out on patients aged 20 and over, divided by sex and into three age groups: 20-39, 40-59, 60 years old and over. Open data from the National Health Insurance obtained the number of patients who started a HEN or HPN during 2019 (incidence), as well as those followed in HEN or HPN during this year (prevalence). Results are compared with a literature review compiling all available publications presenting national data on epidemiology of both HEN and HPN for a same country.

RESULTS

This work covered an entire national population of 50.881 948 adults. The incidence and prevalence of HEN were respectively 37.4/100 000 inhab/year and 74.0/100 000 inhab, with significant gender and age differences. The incidence and overall prevalence of HPN were respectively 22.0/100 000 inhab/year and 25.3/100 000 inhab. The prevalence of HPN during over 12 weeks was 6.2/100 000 inhab. The HEN/HPN ratio was 3:1. A total of 37 657 and 12 859 adults respectively required HEN and HPN among 50 881 948 people aged 20 and over. Published papers to compare, aggregating national data for both HEN and HPN, are only few. They do not have exhaustive data, they are often carried out on limited populations and often indiscriminately affect adults and children.

CONCLUSIONS

Epidemiology of HEN and HPN remains poorly described in the literature. We present here the first results to accurately assess the incidence and prevalence of HAN on a complete national adult population and for a same year. The completeness of our data may explain these results of incidence and prevalence significantly higher than almost all available information in the existing literature, but as close as possible to real data.

[ESPEN practical guideline: Home enteral nutrition]

Introduction

This ESPEN practical guideline will inform physicians, nurses, dieticians, pharmacists, caregivers and other home enteral nutrition (HEN) providers in a concise way about the indications and contraindications for HEN, as well as its implementation and monitoring. This guideline will also inform interested patients requiring HEN. Home parenteral nutrition is not included but will be addressed in a separate ESPEN guideline. The guideline is based on the ESPEN scientific guideline published before, which consists of 61 recommendations that have been reproduced and renumbered, along with the associated commentaries that have been shorted compared to the scientific guideline. Evidence grades and consensus levels are indicated. The guideline was commissioned and financially supported by ESPEN and the members of the guideline group were selected by ESPEN.

ESPEN practical guideline: Home enteral nutrition

This ESPEN practical guideline will inform physicians, nurses, dieticians, pharmacists, caregivers and other home enteral nutrition (HEN) providers in a concise way about the indications and contraindications for HEN, as well as its implementation and monitoring. This guideline will also inform interested patients requiring HEN. Home parenteral nutrition is not included but will be addressed in a separate ESPEN guideline. The guideline is based on the ESPEN scientific guideline published before, which consists of 61 recommendations that have been reproduced and renumbered, along with the associated commentaries that have been shorted compared to the scientific guideline. Evidence grades and consensus levels are indicated. The guideline was commissioned and financially supported by ESPEN and the members of the guideline group were selected by ESPEN.

A retrospective analysis on epidemiological characteristics of home enteral nutrition: results from a Chinese tertiary hospital in 2018

BACKGROUND

The use of home enteral nutrition (HEN) has increased enormously. HEN has been shown to decrease length of stays, improve clinical outcomes, and increase quality of life. Literature on HEN epidemiology has also sprouted recently. Nevertheless, studies on Chinese HEN users are hardly seen. The objective of this study was thus to describe the epidemiological characteristics of HEN users from a Chinese tertiary hospital in 2018.

METHODS

Data were retrospectively analyzed using the personal patient profiles we created upon each HEN initiation. In the year of 2018, 2007 patients and a cumulative total of 3375 episodes were recorded.

RESULTS

The median age was 61 (IQR 46-75) years, and 63 (IQR 49-75) for males and 55 (IQR 43-72) for females. The most frequent indication for HEN implementation was oncological diseases (35.8%), followed by digestive diseases (13.4%), and neurological diseases (9.0%). Overall, 90.0% of the episodes were prescribed for oral nutrition supplement (ONS) and 9.5% for tube feeding (TF). Majority (70.8%) of the episodes comprised standard commercial formula.

CONCLUSIONS

Our study revealed some fundamental epidemiological characteristics of Chinese HEN patients. This preliminary single-center study has multiple limitations but still possesses revelatory and referential significance for other Chinese practitioners in the field of HEN. In future, multicenter studies and qualified HEN registries are widely needed in China.

Home Enteral Nutrition in Adults-Nationwide Multicenter Survey

Home enteral nutrition (HEN) is an important part of the health care system, with a growing population of patients around the world. The aim of our study was to analyze one of the largest cohorts of HEN patients to provide the most recent data available in European literature. A multicenter, nation-wide survey in the period of 1 January 2018–1 January 2019 was performed in Poland. Data concerning adult patients on HEN in 2018 during 1 year of observation time were analyzed: demographic characteristics, primary disease, technique of enteral feeding, diet formulation and amount of energy provided. A total of 4586 HEN patients (F: 46.7%, M: 53.3%) were included in the study. The primary diseases were: 54.5% neurological (17.4%—neurovascular, 13.7%—neurodegenerative), 33.9% cancer (20.2%—head and neck, 11.7%—gastrointestinal cancer), 2.5%—gastroenterology, 1.5%—inherited diseases. Of new registrations in 2018—cancer patients 46.3%, neurological patients 45.1%. The median age overall was: 64 yr., BMI-20.2 kg/m², NRS 2002 score—4.28. A total of 65% of patients were treated with PEG, 11.6% with surgical gastrostomy, 14.3% with naso-gastric tube and 7% with jejunostomy. Boluses were the most common method of feeding (74.4%). Gravity flow was used in 17.6% and peristaltic pump was used in 8% patients. The median energy provision was 1278 kcal/day and 24 kcal/kg/day. The most commonly used diets were: isocaloric (28.1%), protein-enriched isocaloric (20%) and protein-enriched hypercaloric (12%). The median overall duration of HEN was 354 days, 615 days for neurological and 209 days for cancer patients. A number of new registrations of cancer patients was significant and long duration of HEN in this group is encouraging. A developing spectrum of enteral formulas available enables more specified nutritional interventions.

Evaluation of a Semi-Solidifying Liquid Formula for Nasogastric Tube Feeding After Oral and Maxillofacial Surgery

PURPOSE

The aim of this retrospective study was to evaluate a semi-solidifying liquid formula for nasogastric tube (NGT) feeding after oral and maxillofacial surgery.

MATERIALS AND METHODS

In total, 42 patients who underwent oral and maxillofacial surgery for malignant tumors, benign tumors, jaw reconstruction, or jaw fractures received postoperative NGT feeding for nutritional control between 2013 and 2019. Of these patients, 21 received a liquid diet (liquid group; administration rate, 100 mL/hour) and 21 received a semi-solidifying liquid formula (semisolid group [SSG]; administration rate, 400 mL/hour; Mermed Plus; Terumo, Tokyo, Japan). We retrospectively evaluated the complications of NGT feeding in both groups.

RESULTS

During the course of NGT feeding, the incidence of abdominal pain (P = .022), rate of probiotic prescription for diarrhea (P = .012), and Bristol stool form scale score (P = .014) were significantly lower in the SSG than in the liquid group. The maximum defecation frequency per day was also lower in the SSG, although the difference was not significant (P = .069).

CONCLUSIONS

Overall, the semi-solidifying formula was associated with a higher administration rate and a lower incidence of gastrointestinal complications. These findings will help oral and maxillofacial surgeons in the selection of appropriate diets for postoperative NGT feeding.

Comparison of Complications With Semisolid Versus Liquid Diet Via Nasogastric Feeding Tube After Orthognathic Surgery

PURPOSE

The aim of this retrospective study was to compare the effectiveness of nasogastric tube (NGT) feeding of a semisolid diet versus a liquid diet after orthognathic surgery.

PATIENTS AND METHODS

The orthognathic surgery patients were relatively young and generally healthy, without severe medical disease. Of the patients, 26 received liquid feeding (liquid diet group [LG], with an administration rate of 100 mL/hour), 30 received semisolid feeding at a high administration rate (semisolid diet-rapid administration group [SSRAG], 200 to 500 mL/hour), and 33 received semisolid feeding at a slower rate (semisolid diet-slow administration group [SSSAG], 100 mL/hour). We retrospectively investigated the complications of NGT feeding in each group.

RESULTS

The incidence of diarrhea was clearly lower in the SSRAG than in the LG. Among patients with lower-gastrointestinal tract symptoms, stool form scale scores and maximum defecation frequency per day were significantly lower in the SSRAG than in the LG (P = .001 for both). Rapid administration of a semisolid diet via an NGT resulted in fewer complications and shorter feeding times for orthognathic surgery patients.

CONCLUSIONS

The rapid administration of a semisolid diet via an NGT should decrease the complications of NGT feeding and improve the quality of the perioperative period for patients. The findings of this study will help clinicians select NGT diets for relatively young, healthy patients, such as orthognathic surgery patients.

Complications of Home Enteral Nutrition: Mechanical Complications and Access Issues in the Home Setting

Home enteral nutrition (HEN) is an essential component in the care of patients with an array of underlying etiologies resulting in the inability to meet caloric needs through volitional intake alone. Although some would include oral nutrition supplementation as HEN, for the purposes of this review, the term is limited to a patient's requiring an enteral access device for the delivery of exogenous nutrients. Complications related to such devices remain a difficult problem in the hospital setting, and these issues are often amplified when encountered in the home setting. Focused multidisciplinary teams and close follow-up are essential in optimizing outcomes for patients receiving HEN, but all healthcare providers should have foundational knowledge regarding commonly encountered complications of HEN access and the initial management of these issues.

Nutrition accesses among patients receiving enteral treatment in the home environment

Enteral feeding in the home environment is connected with creating access to digestive tract, and thanks to that, this kind of treatment is possible. The gold standard in enteral nutrition is PEG, other types of access are: nasogastric tube, gastronomy and jejunostomy. In the article 851 patients who were treated nutritionally in the home environment, in the nutrition clinic, Nutrimed Górny Śląsk, were analyzed. It was described how, in practice, the schedule of nutrition access looks like in the nutrition clinic at a time of qualifying patients to the treatment (PEG 47,35%, gastronomy 18,91%, nasogastric tube 17,39%,jejunostomy 16,33%) and how it changes among patients treated in the nutrition clinic during specific period of time - to the treatment there were qualified patients with at least three-month period of therapy ( second evaluation: PEG 37,01%, gastrostomy 31,13%, nasogastric tube 16,98%, jejunostomy 15,86%). The structure of changes was described, also the routine and the place in what exchanging or changing nutrition access was analyzed.

CONCLUSIONS

The biggest changes in quantity, among all groups of ill people concerned patients with PEG and gastronomy. In most cases the intervention connected with exchanging access to the digestive tract could be implemented at patient's home.

Influence of age and type of underlying disease on complications related to home enteral nutrition: a single Italian center experience

BACKGROUND

No data about the influence of age and underlying diseases on home enteral nutrition (HEN)-related complications are reported in the literature. Herein, we retrospectively investigated this issue by analyzing HEN-related complications in a cohort of consecutive patients grouped according to the underlying disease and age.

MATERIAL AND METHODS

We reviewed the medical records of 101 patients referring to our team in 2007-2010 to obtain patients' demographic data, age, nutrition status, duration of HEN treatment, and type of HEN-related complications. They were divided in cancer and neurologic patients and subgrouped on the basis of their age. HEN-related complications were expressed as complication rates.

RESULTS

Patients with neurological diseases suffered a significantly higher number of complications as compared with cancer patients (P = .04). Age did not significantly influence complication rates. The mechanical complications were the most frequent. The majority of HEN-related complications were resolved at home.

CONCLUSION

Our data strongly suggest that HEN-related complications are influenced by underlying diseases and not by age. In neurologic patients, dementia, loss of autonomy, and the different therapies administered by PEG probably play an important role in increasing the number of HEN-related complications as compared with cancer patients. The most frequent complications can be managed at home, reducing the costs of hospitalizations and discomfort for the patient.

A review of drug-induced hypernatraemia

Drug-induced electrolyte abnormalities have been increasingly reported and may be associated with considerable morbidity and/or mortality. In clinical practice, hypernatraemia (serum sodium higher than 145 mmol/L) is usually of multifactorial aetiology and drug therapy not infrequently is disregarded as a contributing factor for increased serum sodium concentration. Strategies to prevent this adverse drug effect involve careful consideration of risk factors and clinical and laboratory evaluation in the course of treatment. Herein, we review evidence-based information via PubMed and EMBASE and the relevant literature implicating pharmacologic treatment as an established cause of hypernatraemia and discuss its incidence and the underlying pathophysiologic mechanisms.