I Putu Pramana Suarjaya

To describe the benefits of enteral nutrition therapy

To review indications and contraindications of enteral
nutrition
To describe access routes for enteral nutrition infusion

Appropriate enteral feeding helps maintain:

Intestinal morphology and function

Immune function
Nitrogen retention
Advantages:

Fewer medical complications

Preservation of immune response
Decreased incidence of sepsis
Lower delivery costs

If the gut works,

use it.

Patients unable or unwilling to consume adequate

nutrition to meet metabolic requirements alone or with
assistance
Complement insufficient intake or increased demand

Requires total or partial GI tract function

Anorexia
Coma
Sepsis
Trauma/surgery
Transition from parenteral nutrition

Absolute

Complete bowel obstruction

Severe small bowel ileus with abdominal distention
Complete inability to absorb nutrients through the GI
tract

Relative
Severe postprandial pain
Short bowel syndrome
Intractable vomiting
Severe diarrhea

To maintain intestinal mucosal integrity

Normal microvilli
Height and number

Normal intestinal barrier

Intestinal mucosal immunity

Provide nutrients required during metabolic stress

Maintain GI integrity
Reduce morbidity compared with parenteral nutrition
Reduce cost compared with parenteral nutrition

Early enteral feeding, compared to parenteral

nutrition, reduces postoperative septic complications

Eight prospective, randomized controlled trials

Objective: to compare efficacy of parenteral vs.
enteral nutrition
Study groups well matched
Isonitrogenous intakes

Moore F, et al. Ann Surg 1992;216:172-183

Enteral therapy reduced postoperative septic complications

Total Septic Complications

p < 0.05

Pneumonia
Others
Catheter Sepsis

Parenteral
Enteral

Intra-abdominal Abscess
Bacteremia
0

10

20

Percentage of Patients
Moore F, et al. Ann Surg 1992;216:172-183

30

40

Gastric Route Preferred

Adequate gastric motility
Minimum risk of aspiration
Gastric Route Contraindicated
Delayed gastric emptying (gastroparesis)
High risk for aspiration

Gastric Route Advantages

Normal reservoir for food
Easy access
Tolerates high osmotic loads
Tolerates intermittent feedings
Gastric acid destroys contaminants
Can be placed by nurses

Nasogastric Tube

Gastrostomy

Short term

Long term

Manual or
radiologic
placement

Endoscopic,
radiologic, or
surgical placement

Rugeles S, et al. Universitas Medica 1993;34(I):19-23

Short-term use only

Higher risk for aspiration
Difficult to confirm position
Small bore
Nasopharyngeal trauma/irritation
Accidental tube displacement

Indications for post-pyloric route

Patient at risk for bronchial aspiration, gastric reflux

Gastric feeding contraindicated
Gastric motility disorders; e.g., gastroparesis
Upper GI tract condition; e.g., carcinoma,
stricture, fistula

Enteral nutrition should always be the first option

considered
Gastric access is the first choice
Use post-pyloric route if gastric access not possible
Nasogastric route should be used for short term
feedings
Surgical or percutaneous enterostomies should be the
choice for long term cases

THANK YOU

Thank You