Frankel and Horowitz 1989117
This paper differs from several other papers here | RCT | 1+/1−? | 69 patients
(19 excluded) 50 randomised | Patients with chronic or acute cholecystitis undergoing op for cholecystectomy
Nasoduodenal group (ND) Age (mean, range) 43.4 yrs (18–74)
No nasoduodenal group (NIL) Age (mean, range) 40.4 yrs (18–61) | Nasoduodenal tube with esophagastric decompression Timing of intervention: Enteral feedings were initiated in the recovery room with an elemental feed (Viivonex T.E.N.) full strength, 40kcals per kg for 24 hours then stopped and then a clear liquid diet begun
n=25 | No nasoduodenal tube but NG tube inserted for gastric decompression this was removed in recovery. No enteral feeding allowed but sips of clear liquid diet on first post op night.
n=25 | Until discharge from hospital | Post op diarrhoea | Post op diarrhoea ND: 1 NIL: 0 | The methods of randomisation, blinding are not clear and the sample size is small.
This study differs from the many other studies included in this review – since it is cholecystectomy patients and enteral feeding only lasted for 1 day.
However and ITT was done and it would seem that although probably not significant patients randomised to the not fed group, no intervention did better than those randomised to ND feeding. |
Post op ileus | Post op ileus ND: 1 NIL: 0 |
Post op length of stay | Post op length of stay days, (mean, sd) ND: 2.0 +/−0.2 NIL: 1.7+/−0.1 |
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Hasse et al 1995145 | RCT | 1− | 50 patients | Liver transplant | Immediate post op naso jejunal feeding full-strength Reabilan HN (n=25) Timing of intervention: Patients began to receive a continuous pump infusion of full- strength Reabilan HN 12 hrs after surgery. Infusion rate started at 20 mL/h and was increased to 40 mL/h 24 hrs after the initiation of the tube feeding. If the patient tolerated 40 mL/h, the tube feeding (TF) rate was increased to 60 mL/h 12 hrs after the previous rate increase. If patients required more than 60 mL/h, the TF rates were adjusted individually on the basis of measured energy and protein needs. NG placed. Blue food colouring was added to TF formula. If the NG aspirate became blue or if patients showed other signs of intolerance the tube feeding was withheld for a few hours and then restarted. The NG tube was removed and diets were initiated when patient had bowel sounds. Diet progression followed the same pattern as for the control group. NJ tube remained in place until the patients were able to meet at least 66 % of nutritional needs by oral intake. | IV electrolyte fluid until oral feeding established (NG tubes placed but not used. NG tube removed when patients had bowel sounds. Clear liquid diets were initiated within 24 hrs of removal of the NG tube, and the diet was advanced to a general diet as tolerated) (n=25) | 12 days for some measures and until discharge | Length of stay after transplant: | Length of stay after transplant mean +/− SD: Int: 16 (17.3 +/− 5.4) (n=14) Cont: 18 (27.1 +/37.1) (n=17) [not significant] | 31 patients completed the study Int:(n=14) Con (n=17) An intention to treat analysis was not done.
The figures for the mean nitrogen balance figures were read from the graphs in the papers and should not be taken as exact values. However, the paper does report that there was a significant difference on day 4.
The figures for the mean daily total calorie intake at day 4 and day 12 were read from the graphs in the papers and should not be taken as exact values.
Funding: Nutrition Support Practice Group Member Research Award, Elan Pharma, Dallas Transplant Surgeons Associates |
Mean nitrogen balance at 4 and 12 days post transplant | Approximate mean nitrogen balance Day 4: Int: −5 grams (n=14) Cont: −10 grams (n=17) [p<0.03] Day 12: Int: −6.5 grams (n=14) Cont: −2.5 grams (n=17) (not significant) |
Overall infection rate in the first 21 days after transplantation | Overall infections in the first 21 days after transplantation Int: 3 (21.4%) (n=14) Cont: 8 (47.1%) (n=17) (not significant) |
Mean daily total calorie intake | Approximate mean daily total calorie intake Day 4 Int: 2,500 kcal (n=14) Cont: 1,300 kcal (n=17) Day 12 Int: 1,300 kcal (n=14) Cont: 1,600kcal (n=17) ([p<0.05] days 1–6) |
Cumulative mean total calorie intake at day 12 | Cumulative mean total calorie intake at day 12 (mean +/− range) Int: 22,464 +/− 3,554 kcal (n=14) Cont: 15,474 +/− 5,265 kcal (n=17) [p=0.0006] |
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Hwang et al 1991163 | RCT | 1+ | 24 patients | Post-op biliary surgery (common bile duct or intrahepatic duct stones, treated by choledocholithotomy); uncomplicated surgeries sepsis, jaundice, or other complications excluded.
Nasoduodenal tubes inserted during the operation.
Mean age 52. | Nasodudonal tube feeding within 1 day of operation.
Blenderised diet (17% protein, 33% fat and 50% carbohydrate) | Nasodudonal feeding in day 4th of operation | 8 days
outcomes measured post-surgery days 1 and 8 | No intended clinical outcome? | Early vs late | Not all relevant outcomes are reported. Quality of life should have been considered.
Allocation procedure and also the total number of eligible patients unclear |
Wound infection | 0/12 vs 1/12 |
Nutritional status | Increase pre-albumin rate and lymphocyte count for early group. All others no difference |
A range of outcomes | |