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Short-term hemofiltration is cost-effective for severe acute pancreatitis
October 15, 2007Early nasogastric enteral nutrition is a breakthrough in the management of severe acute pancreatitis. From meta-analysis based on current available clinical studies early nasogastric enteral nutrition appeared effective and safe in clinical practice.
Three randomized controlled clinical trials were eligible, and 131 participants were included. Of them, 67 were randomly assigned to the early nasogastric enteral nutrition group and 64 to the conventional nutritional route group. Conventional routes included total parenteral nutrition and nasojejunal enteral nutrition.
Nutritional management of severe acute pancreatitis is regarded as an indispensable approach. Total parenteral nutrition and gastrointestinal tract rest have been recommended in the management of severe acute pancreatitis since the mid 1990s. Enteral nutrition through jejuna route has been accepted as a safe and effective approach to the management of severe acute pancreatitis by preserving the integrity of intestinal mucosa and preventing bacterial translocation. Some studies have attempted to assess the feasibility and safety of early enteral nutrition through nasogastric route.
Early nasogastric enteral nutrition is a breakthrough in the management of severe acute pancreatitis. Previously, it was forbidden because it might potentially oppose the requirement of pancreatic rest in the acute inflammation phase. However, the present systematic review of three randomized controlled trials showed that nasogastric route does not worsen the clinical outcomes compared with the conventional total parenteral or jejunal enteral routes.
Gastrointestinal and pancreatic rest has been regarded as an important factor for management of severe acute pancreatitis. Nevertheless, nasogastric enteral nutrition disobeys this discipline. Whether the nasogastric route is able to gain similar results to gastrointestinal and pancreatic rest needs to be further investigated. If possible, serological, radiological or histological appraisal should be considered for the effectiveness and safety of early nasogastric enteral nutrition in the treatment of severe acute pancreatitis.
Nasogastric route is much more convenient in clinical practice. Moreover, it is obviously cheaper than nasojejunal tube placement. Based on the present results, nasogastric enteral nutrition can be applied in the early management of severe acute pancreatitis. However, before its application in clinical practice, further investigation is necessary to validate its effectiveness and safety.
The research group evaluated the effectiveness and safety of early nasogastric enteral nutrition for severe acute pancreatitis compared with conventional nutritional routes. Based on current studies, early nasogastric enteral nutrition appears effective and safe, but the available evidence is limited.
World Journal of Gastroenterology
Early nasogastric enteral nutrition is a breakthrough in the management of severe acute pancreatitis. Previously, it was forbidden because it might potentially oppose the requirement of pancreatic rest in the acute inflammation phase. However, the present systematic review of three randomized controlled trials showed that nasogastric route does not worsen the clinical outcomes compared with the conventional total parenteral or jejunal enteral routes.
Gastrointestinal and pancreatic rest has been regarded as an important factor for management of severe acute pancreatitis. Nevertheless, nasogastric enteral nutrition disobeys this discipline. Whether the nasogastric route is able to gain similar results to gastrointestinal and pancreatic rest needs to be further investigated. If possible, serological, radiological or histological appraisal should be considered for the effectiveness and safety of early nasogastric enteral nutrition in the treatment of severe acute pancreatitis.
Nasogastric route is much more convenient in clinical practice. Moreover, it is obviously cheaper than nasojejunal tube placement. Based on the present results, nasogastric enteral nutrition can be applied in the early management of severe acute pancreatitis. However, before its application in clinical practice, further investigation is necessary to validate its effectiveness and safety.
The research group evaluated the effectiveness and safety of early nasogastric enteral nutrition for severe acute pancreatitis compared with conventional nutritional routes. Based on current studies, early nasogastric enteral nutrition appears effective and safe, but the available evidence is limited.
World Journal of Gastroenterology
Early feeding could help reduce liver dysfunction in critically ill patients
Changing the way that critically ill patients suffering from sepsis or multiple organ failure are fed could reduce liver dysfunction.
Small-bowel obstruction
Small-bowel obstruction-Obstruction of the intestines due to adhesions resulting from previous abdominal surgery is painful, results in vomiting and dehydration and requires urgent medical and often surgical intervention.
Medical students: 'anxiety' about lack of training
A new survey of medical students will suggest they have reason to be concerned about their lack of training in key practical skills such as inserting an intravenous drip, taking blood samples or suturing a wound. The results of the survey, conducted by Mr Peter Goodfellow and colleagues at Sheffield's Royal Hallamshire Hospital, will be published in the October Journal of the Royal Society of Medicine. Are students learning practical medicine? Mr Goodfellow was inspired to carry out the study after a group of Sheffield medical students, all approaching final exams, said they were worried about their 'haphazard and random' training in many of the procedures they would need on the wards after
MAJOR TRIAL WILL LOOK AT BEST WAYS TO FEED STROKE PATIENTS
Dr Martin Dennis, Reader in Stroke Medicine and FOOD Trial Clinical Co-ordinator at the Neurosciences Trials Unit, explains: "Stroke affects approximately 15,000 people in Scotland every year and accounts for about 5% of NHS resources. Currently, there are no definitive recommendations for feeding a patient with stroke, although one of the most common and immediate problems the clinician faces is how to feed a dysphagic patient. This trial hopes to evaluate all of the currently used feeding policies: feeding via nasogastric, percutaneous endoscopic gastrostomy or parenteral routes and the use of nutritional supplements. In order to evaluate these policies most effectively, in terms of ti
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