JPEN GUIDELINE FOR CRITICAL CARE NUTRITION SUPPORT.pptVIP

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JPEN GUIDELINE FOR CRITICAL CARE NUTRITION SUPPORT.ppt

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JPEN GUIDELINE FOR CRITICAL CARE NUTRITION SUPPORT

Out of three level II randomized studies which included patients with less disease severity (62%-81% of patients had mild to moderate acute pancreatitis), none showed significant outcome benefits with use of EN compared to PN. Provision of nutrition support therapy in these patients should be considered if a subsequent unanticipated complication develops (eg, sepsis, shock, organ failure) or the patient fails to advance to oral diet after 7 days of hospitalization. Patients with mild to moderate acute pancreatitis do not require nutrition support therapy (unless an unexpected complication develops or there is failure to advance to oral diet within 7 days). (Grade: C) Two level II prospective randomized trials comparing gastric with jejunal feeding in patients with severe acute pancreatitis showed no significant differences between the 2 levels of EN infusion within the GI tract. Patients with severe acute pancreatitis may be fed enterally by the gastric or jejunal route. (Grade: C) Eatock FC, Chong P, Menezes N, et al. A randomized study of early nasogastric versus nasojejunal feeding in severe acute pancreatitis. Am J Gastroenterol. 2005;100:432-439. Kumar A, Singh N, Prakash S, Saraya A, Joshi YK. Early enteral nutrition in severe acute pancreatitis: a prospective randomized controlled trial comparing nasojejunal and nasogastric routes. J Clin Gastroenterol. 2006;40:431-434. Tolerance to EN in patients with severe acute pancreatitis may be enhanced by the following measures: Displacing the level of infusion of EN more distally in the GI tract. (Grade: C) Minimizing the period of ileus after admission by early initiation of EN. (Grade: D) Changing the content of the EN delivered from intact protein to small peptides, and long-chain fatty acids to medium-chain triglycerides or a nearly fat-free elemental formulation. (Grade: E) Switching from bolus to continuous infusion.(Grade: C) In a later level II study by Xian-Li et al in patients with severe pancreatitis wher