Enteral nutrition

Long-term absence of food intake leads to atrophy of the mucous membrane of the digestive organs, a decrease in mesenteric and hepatic blood flow, and the formation of acute ulcers in the stomach. Enteral nutrition has advantages over parenteral nutrition, such as physiologicality, a lower risk of infectious complications, lower cost, and has created conditions for the widespread introduction of the latest technologies related to this type of nutritional support. For enteral nutrition, three main methods of introducing nutrients into the digestive tract are used:

• sipping (English - to sip, drink in small sips) - taking special balanced nutritional mixtures, usually with a pleasant taste, through the mouth;
• enteral tube feeding - administration of nutritional mixtures through a gastric or intestinal tube;
• enteral nutrition through a stoma - the introduction of mixtures directly into a gastrostomy or enterostomy.

The choice of access to the digestive organs is determined by a number of factors. One of them is the duration of enteral nutrition: short-term enteral nutrition (up to 3 weeks), medium (from 3 weeks to 1 year), long-term enteral nutrition (more than 1 year). For short-term enteral nutrition, nasogastric or nasojejunal intubation is used. Medium-term enteral nutrition requires endoscopic or surgical gastro- or enterostomy.

Nasogastric intubation is indicated provided that the patient is conscious and has satisfactory gastric motility. This method is simpler, fairly physiological, and is also used to decompress the digestive organs; however, there is a risk of aspiration of gastric contents during feeding. Nasojejunal intubation is indicated in cases of impaired consciousness, gastric paresis, and increased risk of aspiration.

Stomata for enteral nutrition are created by surgical and endoscopic methods. Surgical methods include gastrostomy according to Witzel or Stamm-Kader, jejunostomy according to Witzel, Mayo-Robson, Meidl or by the needle-catheter method. Combined gastrojejunostomy and percutaneous endoscopic gastrostomy are also used.

Contraindications to the application of a gastrostomy: gastric ulcer, erosion of the gastric mucosa, ascites, severe bleeding, peritonitis, sepsis, inflammatory processes in the anterior abdominal wall, defects of the anterior abdominal wall after previous surgeries.

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Characteristics of enteral nutrition media

Requirements for the mixture:

• caloric density not less than 1 kcal/ml;
• absence or small amounts of lactose;
• low viscosity;
• absence of a pronounced stimulating effect on intestinal peristalsis;
• availability of documentation.

Classification of enteral mixtures

• Standard polymers:
  • dry (Nutrizon, Nutricomp Standard, Berlamin Modular, Nutrien Standard);
  • liquid, ready to use (Nutrizon Standard, Liquid Standard, Nutrizon Energy, Liquid Energy).
• For oral use (Nutridrink, Liquid Standard, Standard Energy).
• Semi-element (Nutrilon Pepti TSC, Peptamen, Alfare).
• Specialized, used in the following pathological conditions:
  • diabetes mellitus (Diabetes, Diazon, Glucerna);
  • liver failure (Nutrien Hepa);
  • dysbacteriosis (Nutricomp Fiber);
  • respiratory failure (Pulmocare, Nutrien Pulmo);
  • renal failure (Nutricomp Renal, Nutrien Nephro).
• Modules for enriching diets based on natural products (Protein module, Energy module, MCT module).

The absorption of polymer mixtures depends on their osmolarity. According to this parameter, modern nutritional mixtures can be divided into three groups:

• low osmolar - from 194 to 257 mosm/l;
• medium osmolar - from 265 to 280 mOsm/l;
• high osmolar - from 235 to 400 mosm/l.

Highly osmolar, usually hypercaloric (1.5 kcal/ml), an exception is the hypercaloric mixture Nutricomp Liquid Energy, the osmolarity of which is 257 mosm/l.

Enteral nutrition should be prescribed:

• 12-24 hours after surgery;
• 12 hours after hemodynamic stabilization;

You should not wait for peristaltic sounds to appear before starting enteral feeding.

Early enteral nutrition promotes rapid healing of intestinal anastomoses.

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Standard Diet System

The old nomenclature of diets has been replaced by a new system. Some tables (1-3,5-7,9,10,12-15) are now designated as a single basic diet standard (SBDS).