Early postoperative enteral nutrition improves gut oxygenation and reduces costs compared with total parenteral nutrition

Marco Braga, Luca Gianotti, Oreste Gentilini, Valeria Parisi, Carlo Salis, Valerio Di Carlo

Research output: Contribution to journalArticle

256 Citations (Scopus)

Abstract

Objective: To evaluate the potential clinical, metabolic, and economic advantages of enteral nutrition over total parenteral nutrition. Design: Prospective, randomized clinical trial. Setting: Department of surgery in a university hospital. Patients: Two hundred and fifty-seven patients with cancer of the stomach (n = 121), pancreas (n = 110), or esophagus (n = 26) were randomized to receive postoperative total parenteral nutrition (TPN group, n = 131) or early enteral nutrition (EEN group, n = 126). The nutritional goal was 25 kcal/kg/day. The two nutritional formulas were isocaloric and isonitrogenous, and they were continued until oral intake was at least 800 kcal/day. Measurements: Morbidity, mortality, length of hospital stay, and treatment costs were evaluated in all patients. In 40 consecutive patients, selected nutritional, immunologic and inflammatory variables were studied. Moreover, intestinal oxygen tension was evaluated by micropolarographic implantable probes. Main Results: The nutritional goal was reached in 100/126 (79.3%) patients in the EEN group and in 128/131 (97.7%) patients in the TPN group (p <.001). In the EEN group, hyperglycemia (serum glucose, >200 mg/dL) was observed in 4.7% of the patients vs. 9.1% in the TPN group (p = NS). Alteration of serum electrolyte levels was 3.9% in the EEN group vs. 13.7% in the TPN group (p <.01). No significant difference was found in nutritional, immunologic, and inflammatory variables between the two groups. The overall complication rate was similar (40.4% for TPN vs. 35.7%, for EEN; p = .52). No difference was detected for either infectious or noninfectious complications, length of hospital stay, and mortality. From postoperative day 5, intestinal oxygen tension recovered faster in the EEN group than in the TPN group (43 ± 5 mm Hg vs. 31 ± 4 mm Hg at day 7; p <.001). EEN was four-fold less expensive than TPN ($25 vs. $90.60/day, respectively). Conclusion: EEN represents a rational alternative to TPN in patients who undergo upper gastrointestinal tract surgery for cancer and who clinically require postoperative artificial nutrition.

Original languageEnglish
Pages (from-to)242-248
Number of pages7
JournalCritical Care Medicine
Volume29
Issue number2
Publication statusPublished - 2001

Fingerprint

Total Parenteral Nutrition
Enteral Nutrition
Costs and Cost Analysis
Length of Stay
Oxygen
Upper Gastrointestinal Tract
Hospital Costs
Hospital Mortality
Health Care Costs
Electrolytes
Esophagus
Stomach Neoplasms
Pancreas
Randomized Controlled Trials
Economics
Morbidity
Mortality
Serum

Keywords

  • Cancer
  • Cost
  • Enteral
  • Gut
  • Metabolism
  • Nutrition
  • Outcome
  • Oxygenation
  • Parenteral
  • Surgery

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Early postoperative enteral nutrition improves gut oxygenation and reduces costs compared with total parenteral nutrition. / Braga, Marco; Gianotti, Luca; Gentilini, Oreste; Parisi, Valeria; Salis, Carlo; Di Carlo, Valerio.

In: Critical Care Medicine, Vol. 29, No. 2, 2001, p. 242-248.

Research output: Contribution to journalArticle

Braga, Marco ; Gianotti, Luca ; Gentilini, Oreste ; Parisi, Valeria ; Salis, Carlo ; Di Carlo, Valerio. / Early postoperative enteral nutrition improves gut oxygenation and reduces costs compared with total parenteral nutrition. In: Critical Care Medicine. 2001 ; Vol. 29, No. 2. pp. 242-248.
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abstract = "Objective: To evaluate the potential clinical, metabolic, and economic advantages of enteral nutrition over total parenteral nutrition. Design: Prospective, randomized clinical trial. Setting: Department of surgery in a university hospital. Patients: Two hundred and fifty-seven patients with cancer of the stomach (n = 121), pancreas (n = 110), or esophagus (n = 26) were randomized to receive postoperative total parenteral nutrition (TPN group, n = 131) or early enteral nutrition (EEN group, n = 126). The nutritional goal was 25 kcal/kg/day. The two nutritional formulas were isocaloric and isonitrogenous, and they were continued until oral intake was at least 800 kcal/day. Measurements: Morbidity, mortality, length of hospital stay, and treatment costs were evaluated in all patients. In 40 consecutive patients, selected nutritional, immunologic and inflammatory variables were studied. Moreover, intestinal oxygen tension was evaluated by micropolarographic implantable probes. Main Results: The nutritional goal was reached in 100/126 (79.3{\%}) patients in the EEN group and in 128/131 (97.7{\%}) patients in the TPN group (p <.001). In the EEN group, hyperglycemia (serum glucose, >200 mg/dL) was observed in 4.7{\%} of the patients vs. 9.1{\%} in the TPN group (p = NS). Alteration of serum electrolyte levels was 3.9{\%} in the EEN group vs. 13.7{\%} in the TPN group (p <.01). No significant difference was found in nutritional, immunologic, and inflammatory variables between the two groups. The overall complication rate was similar (40.4{\%} for TPN vs. 35.7{\%}, for EEN; p = .52). No difference was detected for either infectious or noninfectious complications, length of hospital stay, and mortality. From postoperative day 5, intestinal oxygen tension recovered faster in the EEN group than in the TPN group (43 ± 5 mm Hg vs. 31 ± 4 mm Hg at day 7; p <.001). EEN was four-fold less expensive than TPN ($25 vs. $90.60/day, respectively). Conclusion: EEN represents a rational alternative to TPN in patients who undergo upper gastrointestinal tract surgery for cancer and who clinically require postoperative artificial nutrition.",
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T1 - Early postoperative enteral nutrition improves gut oxygenation and reduces costs compared with total parenteral nutrition

AU - Braga, Marco

AU - Gianotti, Luca

AU - Gentilini, Oreste

AU - Parisi, Valeria

AU - Salis, Carlo

AU - Di Carlo, Valerio

PY - 2001

Y1 - 2001

N2 - Objective: To evaluate the potential clinical, metabolic, and economic advantages of enteral nutrition over total parenteral nutrition. Design: Prospective, randomized clinical trial. Setting: Department of surgery in a university hospital. Patients: Two hundred and fifty-seven patients with cancer of the stomach (n = 121), pancreas (n = 110), or esophagus (n = 26) were randomized to receive postoperative total parenteral nutrition (TPN group, n = 131) or early enteral nutrition (EEN group, n = 126). The nutritional goal was 25 kcal/kg/day. The two nutritional formulas were isocaloric and isonitrogenous, and they were continued until oral intake was at least 800 kcal/day. Measurements: Morbidity, mortality, length of hospital stay, and treatment costs were evaluated in all patients. In 40 consecutive patients, selected nutritional, immunologic and inflammatory variables were studied. Moreover, intestinal oxygen tension was evaluated by micropolarographic implantable probes. Main Results: The nutritional goal was reached in 100/126 (79.3%) patients in the EEN group and in 128/131 (97.7%) patients in the TPN group (p <.001). In the EEN group, hyperglycemia (serum glucose, >200 mg/dL) was observed in 4.7% of the patients vs. 9.1% in the TPN group (p = NS). Alteration of serum electrolyte levels was 3.9% in the EEN group vs. 13.7% in the TPN group (p <.01). No significant difference was found in nutritional, immunologic, and inflammatory variables between the two groups. The overall complication rate was similar (40.4% for TPN vs. 35.7%, for EEN; p = .52). No difference was detected for either infectious or noninfectious complications, length of hospital stay, and mortality. From postoperative day 5, intestinal oxygen tension recovered faster in the EEN group than in the TPN group (43 ± 5 mm Hg vs. 31 ± 4 mm Hg at day 7; p <.001). EEN was four-fold less expensive than TPN ($25 vs. $90.60/day, respectively). Conclusion: EEN represents a rational alternative to TPN in patients who undergo upper gastrointestinal tract surgery for cancer and who clinically require postoperative artificial nutrition.

AB - Objective: To evaluate the potential clinical, metabolic, and economic advantages of enteral nutrition over total parenteral nutrition. Design: Prospective, randomized clinical trial. Setting: Department of surgery in a university hospital. Patients: Two hundred and fifty-seven patients with cancer of the stomach (n = 121), pancreas (n = 110), or esophagus (n = 26) were randomized to receive postoperative total parenteral nutrition (TPN group, n = 131) or early enteral nutrition (EEN group, n = 126). The nutritional goal was 25 kcal/kg/day. The two nutritional formulas were isocaloric and isonitrogenous, and they were continued until oral intake was at least 800 kcal/day. Measurements: Morbidity, mortality, length of hospital stay, and treatment costs were evaluated in all patients. In 40 consecutive patients, selected nutritional, immunologic and inflammatory variables were studied. Moreover, intestinal oxygen tension was evaluated by micropolarographic implantable probes. Main Results: The nutritional goal was reached in 100/126 (79.3%) patients in the EEN group and in 128/131 (97.7%) patients in the TPN group (p <.001). In the EEN group, hyperglycemia (serum glucose, >200 mg/dL) was observed in 4.7% of the patients vs. 9.1% in the TPN group (p = NS). Alteration of serum electrolyte levels was 3.9% in the EEN group vs. 13.7% in the TPN group (p <.01). No significant difference was found in nutritional, immunologic, and inflammatory variables between the two groups. The overall complication rate was similar (40.4% for TPN vs. 35.7%, for EEN; p = .52). No difference was detected for either infectious or noninfectious complications, length of hospital stay, and mortality. From postoperative day 5, intestinal oxygen tension recovered faster in the EEN group than in the TPN group (43 ± 5 mm Hg vs. 31 ± 4 mm Hg at day 7; p <.001). EEN was four-fold less expensive than TPN ($25 vs. $90.60/day, respectively). Conclusion: EEN represents a rational alternative to TPN in patients who undergo upper gastrointestinal tract surgery for cancer and who clinically require postoperative artificial nutrition.

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KW - Cost

KW - Enteral

KW - Gut

KW - Metabolism

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KW - Outcome

KW - Oxygenation

KW - Parenteral

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