Enteral nutrition

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

• sipping (English - to sip, drink in small sips) - the reception of special balanced nourishing mixtures, usually having a pleasant taste, through the mouth;
• probing enteral nutrition - introduction of nutrient mixtures through a gastric or intestinal probe;
• Enteral nutrition through the stoma - the introduction of mixtures directly into the gastrostoma or enterostoma.

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), an average (from 3 weeks to 1 year), and prolonged enteral nutrition (more than 1 year). With short-term enteral nutrition, nasogastric or naso-natural sounding is used. Enteral nutrition of medium duration requires endoscopic or surgical gastro- or enterostomy.

Nasogastric sounding is indicated on condition of patient's consciousness preservation and satisfactory gastric motility. This method is simpler, physiological enough, it is also used for decompression of digestive organs, however, when feeding, there is a risk of aspiration of gastric contents. Naso-natural sounding is indicated for impaired consciousness, paresis of the stomach and increased risk of aspiration.

The application of the stoma for the purpose of enteral nutrition is performed by operative and endoscopic methods. Operative methods - gastrostomy by Wittzel or Stamm-Kader, Einostomia by Wittzel, Mayo-Robson, Maidel or needle-catheter method. They also use combined gastrojejunostomy and percutaneous endoscopic gastrostomy.

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

[1], [2],

Characteristics of enteric feeding 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 motility;
• availability of documentation.

Classification of zinteral mixtures

• Standard Polymer:
  • Dry (Nutrizone, Nutrikomp Standard, Berlamin Modular, Nutrien Standard);
  • liquid, ready-to-use (Nutrizone Standard, Liquid Standard, Nutrizone Energy, Liquid Energy).
• For oral administration (Nutridrinck, Liquid Standard, Standard Energy).
• Semi-element (Nutrilon Pepti TCS, Peptamen, Alfare).
• Specialized, used in the following pathological conditions:
  • diabetes mellitus (Diabetes, Diazone, Glucerne);
  • hepatic insufficiency (Nutrien Gepa);
  • Dysbacteriosis (Nutrikomp Fiber);
  • respiratory insufficiency (Pulmocare, Nutrien Pulmo);
  • Renal failure (Nutrikomp Renal, Nutrien Nephro).
• Modules for the enrichment of diets based on natural products (Protein module, Energy module, MCT module).

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

• low osmolarity - from 194 to 257 mosm / l;
• average osmolarity - from 265 to 280 mosm / l;
• high-osmolarity - from 235 to 400 mosm / l.

High-osmolar, as a rule, hypercaloric (1.5 kcal / ml), the exception is the hypercaloric mixture Nutrikompip Liquid Energy, whose osmolarity is 257 mosm / l.

Enteral nutrition should be prescribed:

• 12-24 h after the operation;
• 12 h after hemodynamic stabilization;

To start enteral nutrition should not wait for the appearance of peristaltic noise.

Early enteral nutrition contributes to the early healing of intestinal anastomoses.

[3], [4], [5]

System of standard diets

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