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01.10.2006 | Pediatric Original

Transpyloric enteral nutrition in the critically ill child with renal failure

verfasst von: Jesús López-Herce, César Sánchez, Angel Carrillo, Santiago Mencía, Maria José Santiago, Amaya Bustinza, Dolores Vigil

Erschienen in: Intensive Care Medicine | Ausgabe 10/2006

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Abstract

Objective

To study the efficacy and tolerance of transpyloric enteral nutrition (TEN) in the critically ill child with acute renal failure (ARF).

Design

Prospective observational study.

Setting

Paediatric intensive care unit.

Patients

Critically ill children with ARF who received TEN were included in the study. They were compared with the remaining 473 critically ill children receiving TEN in this period. Tolerance of nutrition and gastrointestinal complications were assessed.

Intervention

Transpyloric enteral nutrition.

Measurements and results

Fifty-three critically ill children with ARF aged between 3 days and 17 years received TEN. Children with ARF more frequently received parenteral nutrition before TEN (56.6%) than the other patients (17.5%). The incidence of shock, hepatic alterations and mortality was significantly higher in patients with ARF than in the remaining children. In children with ARF the mean duration of the TEN was 16.5 ± 27.3 days and the maximum caloric intake was 77 ± 26.7 kcal/kg/day. Thirteen patients (24.5%) presented gastrointestinal complications, 9 (17%) abdominal distension and/or excessive gastric residue, 5 (9.4%) diarrhoea, 1 necrotising enterocolitis and 1 duodenal perforation. The frequency of gastrointestinal complications was significantly higher in children with ARF. TEN was definitive suspended in five patients due to gastrointestinal complications. Four of these patients were treated with continuous renal replacement therapy. Thirty percent of patients died during TEN. In only one patient was the death related to complications of the nutrition.

Conclusions

Critically ill children with ARF tolerate TEN, although the incidence of gastrointestinal complications is higher than in other critically ill children.

Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Ronco C; Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators (2005) Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 294:813–818PubMedCrossRef

Fernández C, López-Herce J, Flores JC, Galaviz D, Rupérez M, Brandstrup KB, Bustinza A (2005) Prognosis in critically ill children requiring continuous renal replacement therapy. Pediatr Nephrol 20:1473–1477PubMedCrossRef

Goldstein SL, Somers MJ, Baum MA, Symons JM, Brophy PD, Blowey D, Bunchman TE, Baker C, Mottes T, McAfee N, Barnett J, Morrison G, Rogers K, Fortenberry JD (2005) Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy. Kidney Int 67:653–658PubMedCrossRef

Bunchman TE, McBryde KD, Mottes TE, Gardner JJ, Maxvold NJ, Brophy PD (2001) Pediatric acute renal failure: outcome by modality and disease. Pediatr Nephrol 16:1067–1071PubMedCrossRef

Fiaccadori E, Lombardi M, Leonardi S, Rotelli CF, Tortorella G, Borghetti A (1999) Prevalence and clinical outcome associated with preexisting malnutrition in acute renal failure: a prospective cohort study. J Am Soc Nephrol 10:581–593PubMed

Metnitz PG, Krenn CG, Steltzer H, Lang T, Ploder J, Lenz K, Le Gall JR, Druml W (2002) Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. Crit Care Med 30:2051–2058PubMedCrossRef

Mouser JF, Hak EB, Kuhl DA, Dickerson RN, Gaber LW, Hak LJ (1997) Recovery from ischemic acute renal failure is improved with enteral compared with parenteral nutrition. Crit Care Med 25:1748–1754PubMedCrossRef

Galbán C, Montejo JC, Mesejo A, Marco P, Celaya S, Sánchez-Segura JM, Farré M, Bryg DJ (2000) An immune-enhancing enteral diet reduces mortality rate and episodes of bacteremia in septic intensive care unit patients. Crit Care Med 28:643–648PubMedCrossRef

Briassoulis G, Filippou O, Kanariou M, Hatzis T (2005) Comparative effects of early randomized imune or non-immune-enhancing enteral nutrition on cytokine production in children with septic shock. Intensive Care Med 31:851–858PubMedCrossRef

10.

De Lucas C, Moreno M, López-Herce J, Ruiz F, Pérez-Palencia M, Carrillo A (2000) Transpyloric enteral nutrition reduces the complication rate and cost in the critically ill child. J Pediatr Gastroenterol Nutr 30:175–180PubMedCrossRef

11.

Mentec H, Dupont H, Bocchetti M, Cani P, Ponche F, Bleichner G (2001) Upper digestive intolerance during enteral nutrition in critically ill patients: frequency, risk factors and complications. Crit Care Med 29:1955–1961PubMedCrossRef

12.

Montejo JC, Grau T, Acosta J, Ruiz-Santana S, Planas M, García-De-Lorenzo A, Mesejo A, Cervera M, Sánchez-Alvarez C, Núñez-Ruiz R, López-Martínez J; Nutritional and Metabolic Working Group of the Spanish Society of Intensive Care Medicine and Coronary Units (2002) Multicenter, prospective, randomized, single-blind study comparing the efficacy and gastrointestinal complications of early jejunal feeding with early gastric feeding in critically ill patients. Crit Care Med 30:796–800PubMedCrossRef

13.

Davies AR, Froomes PR, French CJ, Bellomo R, Gutteridge GA, Nyulasi I, Walker R, Sewell RB (2002) Randomized comparison of nasojejunal and nasogastric feeding in critically ill patients. Crit Care Med 30:586–590PubMedCrossRef

14.

Sánchez C, López-Herce J, Moreno de Guerra M, Carrillo A, Moral R, Sancho L (2000) The use of transpyloric enteral nutrition in the critically ill child. J Intensive Care Med 15:247–254CrossRef

15.

Chellis MJ, Sanders SV, Webster H, Dean JM, Jackson D (1996) Early enteral feeding in the pediatric intensive care unit. JPEN 20:71–73

16.

Van Vlem B, Schoonjans R, Vanholder R, De Vos M, Vandamme W, Van Laecke S, Lameire N (2000) Delayed gastric emptying in dyspeptic chronic hemodialysis patients. Am J Kidney Dis 36:962–968PubMed

17.

Druml W (2001) Nutritional management of acute renal failure. Am J Kidney Dis 37 [Suppl 2]: S89–S94

18.

Maxvold NJ, Smoyer WE, Custer JR, Bunchman TE (2000) Amino acid loss and nitrogen balance in critically ill children with acute renal failure: a prospective comparison between classic hemofiltration and hemofiltration with dialysis. Crit Care Med 28:1161–1165PubMedCrossRef

19.

Fiaccadori E, Maggiore U, Giacosa R, Rotelli C, Picetti E, Sagripanti S, Melfa L, Meschi T, Borghi L, Cabassi A (2004) Enteral nutrition in patients with acute renal failure. Kidney Int 65:999–1008PubMedCrossRef

20.

21.

Spalding HK, Sullivan KJ, Soremi O, Gonzalez F, Goodwin SR (2000) Bedside placement of transpyloric feeding tubes in the pediatric intensive care unit using gastric insufflation. Crit Care Med 28:2041–2046PubMedCrossRef

22.

World Health Organization (1985) Energy and protein requirements. Report of a joint FAO/WHO/UNO expert consultation. WHO Tech Rep Ser Geneva 724

23.

Flores JC, López-Herce J, Sola I, Carrillo A Jr (2006) Duodenal perforation caused by a transpyloric tube in a critically ill infant. Nutrition 22:209–212PubMedCrossRef

24.

Panadero E, López-Herce J, Caro L, Sánchez A, Cueto E, Bustinza A, Moral R, Carrillo A, Sancho L (1998) Transpyloric enteral feeding in critically ill children. J Pediatr Gastroenterol Nutr 26:43–48PubMedCrossRef

25.

Briassoulis GC, Zavras NJ, Hatzis TD (2001) Effectiveness and safety of a protocol for promotion of early intragastric feeding in critically ill children. Pediatr Crit Care Med 2:113–121PubMedCrossRef

26.

Lafrance J-P, Leblanc M (2005) Metabolic, electrolytes and nutritional concerns in critical illness. Crit Care Clin 21:305–327PubMedCrossRef

27.

Scheinkestel CD, Kar L, Marshall K, Bailey M, Davies A, Nyulasi I, Tuxen DV (2003) Prospective randomized trial to assess caloric and protein needs of critically ill, anuric, ventilated patients requiring continuous renal replacement therapy. Nutrition 19:909–916PubMedCrossRef

28.

Scheinkestel CD, Adams F, Mahony L, Bailey M, Davies AR, Nyulasi I, Tuxen DV (2003) Impact of increasing parenteral protein loads on amino acid levels and balance in critically ill anuric patients on continuous renal replacement therapy. Nutrition 19:733–740PubMedCrossRef

29.

Briassoulis G, Venkataraman S, Thompson AE (2000) Energy expenditure in critically ill children. Crit Care Med 28:1166–1172PubMedCrossRef

30.

Verhoeven JJ, Hazelzet JA, van der Voort E, Joosten KF (1998) Comparison of measured and predicted energy expenditure in mechanically ventilated children. Intensive Care Med 24:464–468PubMedCrossRef

31.

Montejo JC. The Nutritional and Metabolic Working Group of the Spanish Society of Intensive Care Medicine and Coronary Units (1999) Enteral nutrition-related gastrointestinal complications in critically ill patients: a multicenter study. Crit Care Med 27:1652–1653

32.

Pérez-Navero JL, Dorao P, López-Herce J, Ibarra I, Pujol M, Hermana MT (2005) Grupo de Trabajo de Nutrición de la Sociedad Española de Cuidados Intensivos Pediátricos. Artificial nutrition in pediatric intensive care units. An Pediatr (Barc) 62:105–112CrossRef

33.

Rogers EJ, Gilbertson HR, Heine RG, Henning R (2003) Barriers to adequate nutrition in critically ill children. Nutrition 19:865–868PubMedCrossRef

34.

Sánchez Sánchez C, López-Herce Cid J, Carrillo Álvarez A, Bustinza Arriortúa A, Sancho Pérez L, Vigil Escribano D (2003) Nutrición enteral transpilórica en el niño críticamente enfermo. II. Complicaciones. An Pediatr (Barc) 59:25–30CrossRef

35.

Garner JS, Jarwis WR, Emori TG, Horan TC, Hughes JM (1988) CDC definitions for nosocomial infections. Am J Infect Control 16:128–140PubMedCrossRef

Titel: Transpyloric enteral nutrition in the critically ill child with renal failure
verfasst von: Jesús López-Herce
César Sánchez
Angel Carrillo
Santiago Mencía
Maria José Santiago
Amaya Bustinza
Dolores Vigil
Publikationsdatum: 01.10.2006
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 10/2006
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-006-0271-x

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Transpyloric enteral nutrition in the critically ill child with renal failure