Home enteral nutrition: A descriptive study.
enteral access
enteral feeding intolerance
enteral formulas
home enteral nutrition
Journal
JPEN. Journal of parenteral and enteral nutrition
ISSN: 1941-2444
Titre abrégé: JPEN J Parenter Enteral Nutr
Pays: United States
ID NLM: 7804134
Informations de publication
Date de publication:
05 2023
05 2023
Historique:
revised:
11
02
2023
received:
05
01
2023
accepted:
08
03
2023
medline:
8
5
2023
pubmed:
14
3
2023
entrez:
13
3
2023
Statut:
ppublish
Résumé
With data demonstrating benefit, the prevalence of home enteral nutrition (HEN) has increased significantly over the last few decades. Despite this increase, there remains a paucity of data regarding real-world use of HEN including clinical outcomes and complications. Descriptive analysis of prospectively maintained database of our specialized HEN program was undertaken. Patients who received care in our program with HEN initiation date between January 1, 2018, and December 31, 2020, were included in the analysis. Data regarding demographic information, anthropometrics, enteral nutrition (EN) regimen, electrolytes, and nutrition therapy history were included and tracked until July 31, 2021. During the study period, 1600 patients initiated HEN treatment under our care. Majority of the study population needed EN therapy due to malignancy and its complications, including malignant dysphagia or mechanical obstruction (60.6%) followed by neurodegenerative diseases (7.5%). By the end of the study period, a majority of the patients (82%) stopped HEN treatment. Of these, 44.2% achieved EN goals and/or oral autonomy. Patients continued HEN treatment for a median of 100 (interquartile range, 32-301) days. Overall, 53.2% of patients experienced/reported at least one HEN-related complication that was clinically managed by the HEN team. Complications included tube-related, enteral feeding intolerance (EFI), and electrolyte shifts. In our study population, HEN was most utilized to manage malignancy-related complications, including dysphagia. Unfortunately, complications, including EFI and tube-related complications, remained quite prevalent. Further evaluation regarding risk factors for complications and preventive mechanisms, such as increased education, is indicated.
Sections du résumé
BACKGROUND
With data demonstrating benefit, the prevalence of home enteral nutrition (HEN) has increased significantly over the last few decades. Despite this increase, there remains a paucity of data regarding real-world use of HEN including clinical outcomes and complications.
METHODS
Descriptive analysis of prospectively maintained database of our specialized HEN program was undertaken. Patients who received care in our program with HEN initiation date between January 1, 2018, and December 31, 2020, were included in the analysis. Data regarding demographic information, anthropometrics, enteral nutrition (EN) regimen, electrolytes, and nutrition therapy history were included and tracked until July 31, 2021.
RESULTS
During the study period, 1600 patients initiated HEN treatment under our care. Majority of the study population needed EN therapy due to malignancy and its complications, including malignant dysphagia or mechanical obstruction (60.6%) followed by neurodegenerative diseases (7.5%). By the end of the study period, a majority of the patients (82%) stopped HEN treatment. Of these, 44.2% achieved EN goals and/or oral autonomy. Patients continued HEN treatment for a median of 100 (interquartile range, 32-301) days. Overall, 53.2% of patients experienced/reported at least one HEN-related complication that was clinically managed by the HEN team. Complications included tube-related, enteral feeding intolerance (EFI), and electrolyte shifts.
CONCLUSION
In our study population, HEN was most utilized to manage malignancy-related complications, including dysphagia. Unfortunately, complications, including EFI and tube-related complications, remained quite prevalent. Further evaluation regarding risk factors for complications and preventive mechanisms, such as increased education, is indicated.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
550-562Informations de copyright
© 2023 American Society for Parenteral and Enteral Nutrition.
Références
Bischoff SC, Austin P, Boeykens K, et al. ESPEN practical guideline: home enteral nutrition. Clin Nutr. 2022;41(2):468-488. doi:10.1016/j.clnu.2021.10.018
Harkness L. The history of enteral nutrition therapy. J Am Diet Assoc. 2002;102(3):399-404. doi:10.1016/S0002-8223(02)90092-1
Gauderer MWL, Ponsky JL, Izant RJ. Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg. 1980;15(6):872-875.
Mundi MS, Pattinson A, McMahon MT, Davidson J, Hurt RT. Prevalence of home parenteral and enteral nutrition in the United States. Nutr Clin Pract. 2017;32(6):799-805. doi:10.1177/0884533617718472
Flood C, Parker EK, Kaul N, et al. A benchmarking study of home enteral nutrition services. Clin Nutr ESPEN. 2021;44:387-396. doi:10.1016/j.clnesp.2021.05.007
Yu FJ, Shih HY, Wu CY, et al. Enteral nutrition and quality of life in patients undergoing chemoradiotherapy for esophageal carcinoma: a comparison of nasogastric tube, esophageal stent, and ostomy tube feeding. Gastrointest Endosc. 2018;88(1):21-31.e4. doi:10.1016/j.gie.2017.11.030
Bozzetti F, Braga M, Gianotti L, Gavazzi C, Mariani L. Postoperative enteral versus parenteral nutrition in malnourished patients with gastrointestinal cancer: a randomised multicentre trial. Lancet. 2001;358(9292):1487-1492. doi:10.1016/S0140-6736(01)06578-3
Mohamed Elfadil O, Ewy M, Patel J, Patel I, Mundi MS. Growing use of home enteral nutrition: a great tool in nutrition practice toolbox. Curr Opin Clin Nutr Metab Care. 2021;24(5):446-452. doi:10.1097/MCO.0000000000000777
Gomes CAR, Andriolo RB, Bennett C, et al. Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances. Cochrane Database Syst Rev. 2015;2015(5):CD008096. doi:10.1002/14651858.CD008096.pub4
Wang J, Liu M, Liu C, Ye Y, Huang G. Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for patients with head and neck cancer: a systematic review. J Radiat Res. 2014;55(3):559-567. doi:10.1093/jrr/rrt144
Hull MA, Rawlings J, Field J, et al. Audit of outcome of long-term enteral nutrition by percutaneous endoscopic gastrostomy. Lancet. 1993;341(8849):869-872. doi:10.1016/0140-6736(93)93072-9
Zopf Y, Konturek P, Nuernberger A, et al. Local infection after placement of percutaneous endoscopic gastrostomy tubes: a prospective study evaluating risk factors. Can J Gastroenterol. 2008;22(12):987-991. doi:10.1155/2008/530109
Gungabissoon U, Hacquoil K, Bains C, et al. Prevalence, risk factors, clinical consequences, and treatment of enteral feed intolerance during critical illness. JPEN J Parenter Enter Nutr. 2015;39(4):441-448. doi:10.1177/0148607114526450
Wang K, McIlroy K, Plank LD, Petrov MS, Windsor JA. Prevalence, outcomes, and management of enteral tube feeding intolerance: a retrospective cohort study in a tertiary center. JPEN J Parenter Enter Nutr. 2017;41(6):959-967. doi:10.1177/0148607115627142
Kay Nelson J, Palumbo PJ, O'Brien PC. Home enteral nutrition: observations of a newly established program. Nutr Clin Pract. 1986;1(4):193-199. doi:10.1177/088453368600100405
Asiedu GB, Carroll K, Griffin JM, Hurt RT, Mundi M. Home enteral nutrition: use of photo-elicitation to capture patient and caregiver experiences. Health Sci Rep. 2018;1(8):e56. doi:10.1002/hsr2.56
Bravo JGP, Ide E, Kondo A, et al. Percutaneous endoscopic versus surgical gastrostomy in patients with benign and malignant diseases: a systematic review and meta-analysis. Clinics. 2016;71(3):169-178. doi:10.6061/clinics/2016(03)09
Odedra D, Nasirzadeh R, Menard A. Safety of outpatient vs inpatient percutaneous radiological gastrostomy tubes in patients with head and neck cancers. Can Assoc Radiol J. 2016;67(4):416-419. doi:10.1016/j.carj.2016.05.001
Silas AM, Pearce LF, Lestina LS, et al. Percutaneous radiologic gastrostomy versus percutaneous endoscopic gastrostomy: a comparison of indications, complications and outcomes in 370 patients. Eur J Radiol. 2005;56(1):84-90. doi:10.1016/j.ejrad.2005.02.007
Mohamed Elfadil O, Linch FB, Seegmiller SL, Hurt RT, Mundi MS, Neisen MJ. Safety and effectiveness of radiologic and endoscopic percutaneous gastrostomy placement: a randomized study. JPEN J Parenter Enter Nutr. 2022;46(8):1808-1817. doi:10.1002/jpen.2365
Hurt RT, Miller KR, Patel J, Codner P, Mundi MS. Universal small bore connectors (ENFit) for enteral access: implications for clinical practice. Curr Nutr Rep. 2016;5:240-244. doi:10.1007/s13668-016-0173-7
Mundi MS, Epp L, Hurt RT. Increased force required with proposed standardized enteral feed connector in blenderized tube feeding. Nutr Clin Pract. 2016;31(6):795-798. doi:10.1177/0884533616639126
Hurt RT, Epp LM, Pattinson AK, Duellman WM, Corner SM, Mundi MS. Gravity flow in proposed enteral tube small-bore connectors. Nutr Clin Pract. 2017;32(2):189-192. doi:10.1177/0884533616679141
Mundi MS, Duellman W, Epp L, Davidson J, Hurt RT. Comparison of gravity flow rates between ENFit and legacy feeding tubes. JPEN J Parenter Enter Nutr. 2018;42(3):522-528. doi:10.1177/0148607117703959
Guha S, Ravi N, Silverstein JS, Cooper J, Myers MR. In vitro performance testing of legacy and ENFit gastrostomy tube devices under gravity flow conditions. JPEN J Parenter Enteral Nutr. 2018;42(8):1334-1341. doi:10.1002/jpen.1159
Mundi MS, Duellman W, Epp L, Davidson J, Hurt RT. Comparison of syringe compression force between ENFit and legacy feeding tubes. JPEN J Parenter Enter Nutr. 2019;43(1):107-117. doi:10.1002/jpen.1174
Guha S, Bouhrira N, Antonino MJ, Silverstein JS, Cooper J, Myers MR. Impact of design changes in gastrostomy tube (G-tube) devices for patients who rely on home-based blenderized diets for enteral nutrition. J Am Coll Nutr. 2019;38(4):311-317. doi:10.1080/07315724.2018.1509247
Mundi MS, Seegmiller S, Davidson J, Schneckloth J, Saied J, Hurt RT. Prospective assessment of peristomal infections using objective criteria. JPEN J Parenter Enter Nutr. 2018;42(5):877-884. doi:10.1002/jpen.1020
Zarling EJ, Edison T, Berger S, Leya J, DeMeo M. Effect of dietary oat and soy fiber on bowel function and clinical tolerance in a tube feeding dependent population. J Am Coll Nutr. 2013;13(6):565-568. doi:10.1080/07315724.1994.10718448
Elia M, Engfer MB, Green CJ, Silk DBA. Systematic review and meta-analysis: the clinical and physiological effects of fibre-containing enteral formulae. Aliment Pharmacol Ther. 2008;27(2):120-145. doi:10.1111/j.1365-2036.2007.03544.x
Hurt RT, Edakkanambeth Varayil J, Epp LM, et al. Blenderized tube feeding use in adult home enteral nutrition patients a cross-sectional study. Nutr Clin Pract. 2015;30(6):824-829. doi:10.1177/0884533615591602
Epp LM, Salonen BR, Hurt RT, Mundi MS. Cross-sectional evaluation of home enteral nutrition practice in the United States in the context of the new enteral connectors. JPEN J Parenter Enteral Nutr. 2019;43(8):1020-1027. doi:10.1002/jpen.1510
Johnson TW, Milton DL, Johnson K, et al. Comparison of microbial growth between commercial formula and blenderized food for tube feeding. Nutr Clin Pract. 2019;34(2):257-263. doi:10.1002/ncp.10226
Milton DL, Johnson TW, Johnson K, et al. Accepted safe food-handling procedures minimizes microbial contamination of home-prepared blenderized tube-feeding. Nutr Clin Pract. 2020;35(3):479-486. doi:10.1002/ncp.10450
Mohamed Elfadil O, Steien DB, Narasimhan R, et al. Transition to peptide-based diet improved enteral nutrition tolerance and decreased healthcare utilization in pediatric home enteral nutrition. JPEN J Parenter Enteral Nutr. 2022;46(3):626-634. doi:10.1002/jpen.2202
Mundi MS, Velapati S, Kuchkuntla AR, Hurt RT. Reduction in healthcare utilization with transition to peptide-based diets in intolerant home enteral nutrition patients. Nutr Clin Pract. 2020;35(3):487-494. doi:10.1002/ncp.10477
LaVallee C, Seelam P, Balakrishnan S, et al. Real-world evidence of treatment, tolerance, healthcare utilization, and costs among postacute care adult patients receiving enteral peptide-based diets in the United States. JPEN J Parenter Enteral Nutr. 2021;45(8):1729-1735. doi:10.1002/jpen.2074