Percutaneous endoscopic gastrostomy (PEG) is currently a popular method of administering enteral feeding. Most of these patients are elderly, debilitated, and chronically ill. They are on a number of medications and have multiple diseases. With impaired consciousness and swallowing disability, these patients are prone to develop pneumonia. In order to identify possible risk factors, we followed 24 men who underwent PEG for the occurrence of pneumonia or until they died. We then analyzed the medical records of these patients for potential risk factors for pneumonia. The presence of esophagitis during PEG placement endoscopy and history of pneumonia prior to PEG were significant risk factors. Advanced age and cerebrovascular accident (CVA) tended to indicate a higher risk of pneumonia. Taking these risk factors into consideration may be beneficial in the management of such patients.

No intuito de simplificar a gastrostomia endoscópica percutânea (GEP) suprimindo- se a utilização de um endoscópio ou métodos de imagem, a gastrostomia magnética percutânea (GMP) foi concebida como nova opção técnica. Objetivo: investigar factibilidade de nova técnica para GMP por estudo experimental controlado, comparada à técnica GEP. Método: quatorze porcos foram submetidos a GEP (grupo ENDO, 7 animais) ou a GMP (grupo MAG), e submetidos a eutanásia 7 dias após o procedimento. Foram avaliados sucesso técnico, peso, tempo de procedimento e número de ocorrências/complicações (complicação menor – sem necessidade de nova intervenção). Para análise estatística foram aplicados o teste não paramétrico de Mann-Whitney e o teste exato de Fisher. Valores de p<0.05 indicaram significância estatística. Resultados: Todos os procedimentos realizados foram tecnicamente bem-sucedidos. Doze animais apresentaram evolução pós-operatória favorável. Dois animais (um de cada grupo) foram a óbito precocemente, não atribuível ao acesso gástrico. Houve no total 5 ocorrências/ complicações menores (4 no grupo MAG), sendo 3 dessas relacionadas ao tubo de gastrostomia. Houve maior perda de peso no grupo MAG comparado ao grupo ENDO, com significância estatística (peso médio em gramas 115±131(desvio-padrão) e -83±128, respectivamente, p=0,04). O tempo de procedimento foi maior para o grupo MAG comparado ao grupo ENDO, com significância estatística (tempo médio em segundos 471±140 e 882±239, respectivamente, p=0,001). Conclusão: a gastrostomia percutânea magnética é tecnicamente factível, porém necessita de melhorias no dispositivo devido a complicações relacionadas ao tubo de gastrostomia. Comparado ao método tradicional endoscópico, a gastrostomia magnética apresentou maior tempo de procedimento e maior perda de peso. / In order to simplify a Percutaneus Endoscopic Gastrostomy (PEG) procedure and obviate the need of imaging methods, a Percutaneous Magneticallyguided Gastrostomy (PMG) has been conceived. OBJECTIVE to investigate preclinical application of a novel magnetic device for PMG through an experimental controlled trial compared to PEG. METHODS fourteen domestic pigs were assigned for ENDO group (undergoing PEG, 7 animals), and MAG group (undergoing PMG). All animals were euthanized 7 days after procedure. Aspects related to technical success, procedure duration and clinical outcome (weight changes, event/complication rate) were evaluated. These were statisctically evaluated using Mann-Whitney (non-parametric) and Fisher’s exact test. Values of p<0.05 were considered statistically significant. RESULTS technical success was achieved for all animals undergoing the procedures. Of these, 12 had a favorable clinical outcome. Two animals died in less than 24 hours (one from each group), not directly related to gastric access. There were 4 minor complications (4 of them for group MAG), and 3 of these were tube-related. Weight loss was statistically significantly higher for group MAG (mean weight in grams 115±131(standard-deviation) e - 83±128, respectively, p=0.04). The procedural time was statistically significant higher for group MAG compared to ENDO (mean time in seconds 471±140 e 882±239, respectively, p=0.001). CONCLUSION a magnetically-guided percutaneous gastrostomy without imaging is technically feasible, however a device improvement is needed because of tube-related complications. Compared to percutaneous endoscopic gastrostomy, the magnetically-guided percutaneous gastrostomy technique is more time-consuming and had more weight loss.

A retrospective chart review was conducted on pediatric patients at the Intermountain Cystic Fibrosis Center who had a percutaneous endoscopic gastrostomy (PEG) placed between 1993 and 1999. Height velocity improved significantly in the group of patients with a PEG placed; however, pulmonary function declined more significantly over time. Questionnaires regarding attitude toward PEG placement were sent to patients enrolled in accredited cystic fibrosis centers in the mountain west region and to their parents. The overall response rate was 54.25% for the PEG questionnaire and 24% for the non-PEG questionnaire. Ninety-six percent of the patients with a PEG reported that weight was a problem at time of placement, and 91% reported weight gain after PEG ill placement. Sixty-four percent of the patients with a PEG reported that they would have a PEG placed if they made the decision again. Of the patients without a PEG, 60.7% thought a PEG looked bad, and 59.2% would be embarrassed to have a PEG. Forty-nine percent of patients without a PEG expressed a lack of knowledge of the pros and cons of PEG placement and 35.4% had no opinion about their knowledge of PEGs. PEG placement can be beneficial in improving nutritional status. Optimal time for PEG placement may be earlier rather than after pulmonary function has declined. People with a PEG have felt positive toward placement, and those without a PEG seem to lack knowledge about the pros and cons of PEG placement.

Percutaneous endoscopic placement of feeding gastrostomies (PEG) was pioneered by Gauderer et. al, in 1980. Since then, it has become the preferred method of providing enteral nutritional support in children and adults because of advantages in morbidity and cost. Pneumonia is a known sequel of this procedure, occurring at different rates, depending on the length of follow-up. Some series have shown an incidence of 10% at 30 days and others 56% at 11 months. It does not appear that PEG feeding offers an advantage over the more traditional naso-enteric tube feeding methods in this respect. To study the prevalence of gastroesophageal reflux (GER) in PEG-fed patients, we quantitated GER by 24-hour intraesophageal pH monitoring in a group of patients who developed post-PEG pneumonia and compared it with a control group. Our study demonstrates an increased prevalence of GER in the pneumonia group compared with the control group. However, the exact contribution of this observed increased GER to the development of pneumonia needs to be determined.

Background: Enteral nutrition is artificial nutrition, which is delivered via a tube to the gastrointestinal tract when the ability to eat is reduced. Previous research shows that both relatives and nurses think that enteral nutrition can enable continued life, but they also emphasize that it can limit everyday life. According to nurses, good knowledge about enteral nutrition and how it should be administered is needed to provide adequate care to patients. Relatives can get bad conscience if they go to social events by themselves when the family member refrain because the events often include meals. Enteral nutrition can take up the relatives everyday life and it can lead to that their previous lifestyle change and less time for themselves and their own hobbies. Aim: To describe women's experiences of being dependent on enteral nutrition. Method: A qualitative, manifest content analysis with an inductive approach. Result: It was found that well-being could be experienced and that support and good relationships were important in everyday life. The women´s relationship to food could change and they could experience limitations in everyday life and suffering. Conclusion: It was found that a joy of life could be experienced, simultaneously it was a challenge to live with enteral nutrition. / Bakgrund: Enteral nutrition är konstgjord näring som tillförs via en sond till mag-tarmkanalen när förmågan att äta blivit nedsatt. Tidigare forskning visar att både anhöriga och sjuksköterskor anser att enteral nutrition kan möjliggöra fortsatt liv, dock framhäver de att den kan begränsa vardagen. Enligt sjuksköterskor kan det behövas goda kunskaper om enteral nutrition och hur den ska administreras för att kunna ge patienter adekvat vård. Anhöriga kan få dåligt samvete om de går själva till sociala evenemang när familjemedlemmen avstår på grund av att de ofta innefattar måltider. De anhörigas tidigare livsstil kan förändras och det kan leda till mindre tid till sig själva och sina fritidsintressen, då dagarna planeras utefter enterala nutritionen. Syfte: Att beskriva kvinnors erfarenheter av att vara beroende av enteral nutrition. Metod: En kvalitativ manifest innehållsanalys. Resultat: Det framkom i resultatet att ett välbefinnande kunde upplevas och att stöd och goda relationer var viktiga i vardagen för kvinnorna. Kvinnorna fick en förändrad relation till mat och de kunde uppleva begränsningar i vardagen och ett lidande. Slutsats: Det konstaterades att livsglädje kunde upplevas, samtidigt som det var en prövning att leva med enteral nutrition.

0BABSTRACT This thesis is focused on enteral nutrition. This issue is an integral part of intensive and resuscitation care, but it is also a part of standard and follow-up care. There are more and more new resources and the products for enteral nutrition are improving. The theoretical part deals with malnutrition, discusses the different components of nutrition. Much of the thesis forms ways of application of nutrition. The issue is a nasogastric tube, a nasojejunal tube, percutaneous endoscopic gastrostomy, percutaneous endoscopic jejunostomy, feeding button or sipping. There are further expanded the introductions, nursing care, indications and contraindications of these options. The following chapters analyse the modes of enteral feeding, advantages and disadvantages of enteral nutrition compared to parenteral. The practical part is focused on research using anonymous questionnaires in the area of enteral nutrition. The survey was conducted in four departments of three teaching hospitals in Prague. It was focused on nurses and paramedics in medical intensive metabolic care units. The survey had 73 respondents. The aim was to identify the mode of feeding that nurses prefer and how they apply it, analyze the extent to which the nurses actively involve themselves in this, how they are oriented in...

Made available in DSpace on 2015-07-22T20:50:46Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-05-25 / Stanich P. Relevância dos aspectos nutricionais na sobrevida de pacientes com Doença do Neurônio Motor. São Paulo; 2001. [Tese de Doutorado- Escola Paulista de Medicina – Universidade Federal de São Paulo]. Objetivos. Avaliar o efeito dos aspectos nutricionais na sobrevida de pacientes com Doença do Neurônio Motor (DNM) e apresentar as variáveis preditivas para a indicação de terapia nutricional enteral, por gastrostomia endoscópica percutânea (GEP). Material e Métodos. Foi um estudo longitudinal tipo coorte retrospectiva, de 2000 a 2008, e a casuística constituída por 128 pacientes com DNM. Variáveis clínicas, nutricionais e respiratórias foram analisadas. As análises foram conduzidas adotando-se a sobrevida como variável dependente. A sobrevida foi avaliada pela Curva de Kaplain - Meier. As variáveis que apresentaram nível de significância de 20% (p< 0,20) foram selecionadas para o modelo de regressão proporcional de Cox. Resultados. Cento e onze pacientes realizaram a gastrostomia, sendo 59 com a forma apendicular (ELA) e 52 com a forma bulbar (PBP). A desnutrição estava presente em 32% da população antes da GEP, com maior frequência nos pacientes com ELA. O tempo de sobrevida após a GEP foi de 11 meses para os pacientes com PBP e 16 meses para ELA (p< 0,05). As variáveis associadas à sobrevida foram: precocidade na indicação da GEP; redução de CVF %, idade e IMC antes da GEP (hazard ratio de 0, 254 e p = 0, 007) para os pacientes com ELA e exclusão da alimentação por via oral e traqueostomia (hazard ratio de 0, 345 e p= 0, 014) para os pacientes com PBP. Ao final do modelo as variáveis mais associadas com a sobrevida foram precocidade na indicação de GEP, exclusão da alimentação por via oral, para os pacientes com PBP e estado nutricional antes da GEP para os pacientes com ELA. Conclusões. A inserção precoce de gastrostomia endoscópica percutânea, a partir do momento diagnóstico, foi fator protetor para a sobrevida dos pacientes. A desnutrição foi fator prognóstico ruim, especialmente para os pacientes com ELA. Vigilância nutricional durante a evolução da doença pode melhorar os resultados quando o objetivo é aumentar a sobrevida de pacientes com DNM/ELA. / Aims. To evaluate the effect of nutrition on survival of patients with Motor Neurone Disease (MND) and present the predictor variables for indications of nutritional therapy, percutaneous endoscopic gastrostomy (PEG). Methods. It was a retrospective longitudinal cohort study, from 2000 to 2008, and the sample consisted of 128 patients with MND. The variables investigated were clinical, nutritional and respiratory were analysed. Analyses were conducted by adopting the survival as the dependent variable. The survival curve was evaluated by Kaplain - Meier. The variables that had a significance level of 20% (p <0.20) were selected for the proportional regression model of Cox. Results. One hundred and eleven patients underwent gastrostomy, and 59 limb onset (ALS) and 52 with bulbar onset (PBP). Malnutrition was present in 32% of the population before PEG, most frequently in patients with limb onset. The survival time after PEG was 10.5 months for patients with PBP and 16 months for ALS (p <0.05). Variables associated with survival were: early indication in the PEG, for ALS and PBP; reduction of FVC% and BMI before PEG (hazard ratio of 0, 254, p = 0, 007) for patients with limb onset and exclusion of oral feeding and tracheostomy (hazard ratio of 0, 345, p = 0, 014) for patients with bulbar onset. Conclusions. Early insertion of percutaneous endoscopic gastrostomy, from the time diagnosis was a protective factor for patient survival. Malnutrition was a bad prognostic factor, especially for patients with limb onset. Nutritional surveillance for disease progression may improve results when the goal is to increase the survival of patients with MND / ALS. / TEDE / BV UNIFESP: Teses e dissertações