Enteral nutrition therapy – more than just nutrition Enteral nutrition (EN) is a nutritional support modality that provides metabolically required nutrients and various other nutrients via the gastrointestinal tract. With the in-depth research on the structure and function of the gastrointestinal tract in recent years, it is gradually recognized that the gastrointestinal tract is not only a digestive and absorption organ, but also an important immune organ, and nutritional support through the enteral route can help maintain the structural and barrier functional integrity of the intestinal mucosa. Therefore, enteral nutrition has become the first choice for most clinicians when choosing nutritional support modalities.
What conditions require enteral nutritional support?
Correction and prevention of malnutrition before and after surgery Difficulty in swallowing and chewing Impaired consciousness or coma Gastrointestinal fistula Short bowel syndrome Inflammatory bowel disease Acute pancreatitis Hypermetabolic state Chronic wasting disease Enteral nutrition when the gastrointestinal tract is functional and safe What are the routes of enteral nutrition support?
There are still many ways of EN support. At present, PUMC mainly adopts transnasal jejunal nutrition tube to give, which can better achieve adequate nutrition giving, and at the same time can reduce nausea, vomiting, gastric retention, aspiration pneumonia and other related complications, and achieve good nutrition treatment effect.
What is the relationship between enteral nutrition and intestinal bacterial translocation?
The intestinal mucosa cells have a characteristic that it needs direct contact with the chyme in order to proliferate and repair. The intestine has a barrier function, which consists of three parts: “mucosal barrier”, “immune barrier” and “biological barrier”. During tissue ischemia and hypoxia, the permeability of intestinal mucosa increases, and bacteria and endotoxins in the intestinal lumen can cross the tight junctions of intestinal mucosal cells or directly pass through the mucosal cells into the submucosal lymphatic vessels or portal microvessels, and then enter the systemic lymphatic system or blood circulation. It is also a source of secondary infection in critically ill patients in the late stage.
Enteral nutrition is considered to be the most ideal way of nutrition supply because it can conform to physiology, provide more comprehensive nutrients, promote intestinal motility, secretion and digestion, release gastrointestinal hormones, increase intestinal and portal blood flow, protect the integrity of intestinal mucosa and maintain intestinal barrier function, and support intestinal immune system. Early implementation of enteral nutrition can enable patients to receive more adequate nutritional supplementation and thus improve certain clinical outcomes, therefore, conditions should be created for early initiation.
The choice of preparation, complication prevention and control, timing of application, methods of assessing nutritional status, etc. regarding enteral nutrition support.