Intestinal failure (IF) is a condition, in which the intestinal function or length remaining is below the minimum amount required for the absorption of sufficient nutrients and fluid to maintain normal life. The nutritional supply of IF depends on the anatomical site, length, and function of the remaining bowel. The goals of nutritional therapy for patients with IF are to achieve bowel adaptation to absorb nutrients sufficiently to live a healthy life with the current intestinal condition, and to promote the enteral autonomy to control nutrient digestion, absorption, excretion, and bowel movement. To stabilize and recover the patient’s nutrition condition after a huge bowel resection, the intestinal rehabilitation team (IRT) for individual nutritional therapy should be established. IRT carefully monitors the changes in body weight, medication use, patient’s symptoms, nutrient deficiency, hydration status, function of the remaining bowel, degree of bowel adaptation, adverse effects due to nutritional therapy, and enteral balance. To achieve intestinal adaptation and enteral autonomy through complicated and difficult nutritional intensive therapy in IF patients, it is essential to manage the patients through multidisciplinary collaboration involving physicians, pharmacists, dietitians, and nurses.
Enteral feeding remains controversial in patients receiving extracorporeal membrane oxygenation (ECMO), particularly in those treated with a high-dose vasopressor. This study examined the safety and feasibility of enteral nutritional support for patients undergoing ECMO in a cardiac care unit (CCU).
Adult patients admitted to the CCU undergoing ECMO from January 2014 to May 2015 were included. Patients with <48 hours of support, undergoing ECMO at another hospital, and inaccurate medical records were excluded.
Among the 14 patients undergoing ECMO in the CCU, 2 patients were diagnosed with malnutrition and the others were in the normal state in the initial assessment. On the other hand, they had the malnutrition risk factors (anorexia, weight loss, fluid retention, and hypermetabolic state). Thirteen patients received enteral nutrition and 1 patient had possible oral intake. The average initiation day of enteral nutrition was 2.0±1.6 days on ECMO. The mean duration of enteral nutrition was 5.2±4.9 days and the target goal was achieved within 3 days. There were no serious adverse effects for enteral nutrition but 3 patients had gastrointestinal problems (diarrhea and anorexia), and gastrointestinal bleeding occurred in 1 patient. In 1 case, enteral nutrition had to be stopped due to the prone position. Overall, 5 patients were cured, 3 patients recovered through heart transplantation, and 6 patients died.
Most CCU patients receiving ECMO were well nourished but had the malnutrition risk factors in progress. These results suggest that enteral feeding might be safe and feasible in patients treated with ECMO but there were minor side effects.