Implementing Best Practices For Nasogastric Tube Feeding In Neurosurgical ICU Patients: An Essay.

Literature Review

Describe about the Implementation of the best practice in nasogastric tube feeding of critically ill patients in a neurosurgical intensive care unit?

In modern day health care especially for critically ill patient, nanogastric tube feeding plays a significant role. It is also closely concern for the patient who is in care of neurosurgical intensive care unit. Feeding of Nasogastric intubation is a method in which an insertion of sleek, plastic tube is occurred through the passage of nostril, down towards the esophagus, followed by the stomach. With the help of the nasogastric tube, the nurse, physician, etc. provides food, nutrition and medicine to the critically ill patient.

In neurosurgical intensive care unit, nasogastric tube are introduced to critically ill patient as they associated with swallowing problem or serious infection in the airway passage is there. There are various significant management factor related to nasogastric tube feeding especially in the case of critically ill patient.

Previous literature reviews along with meta-analyses of internal nutrition mechanism have been performed to a limited scope. The study of Langmore (2006) mainly emphasised on the comparison of using the feeding tube along with the direct method for providing some significant nutrition element towards neurosurgical intensive care unit patient. Though, findings of this study indicate that there is no significant difference between the selected control groups.

It involves characterizing the eligibility of participants such as patients associated with dysphasia or swelling disorder and obviously treated in neurosurgical critical care unit. Based on Norton in 2006 in case of the primary resultant such as Intervention abnormality which defined as any one of the event significant elements to regarding failure in introducing the tube, as well as seasonal displacement? Secondary resultants are several. These are status of nutritional metabolism and risk assessment also takes into the consideration. Here is a clarified diagram of this literature review.  With the help of developed Rankin scale, only single report is available.

Researchers could not find any remarkable difference in the function ability in the two group, Where MRS 0-3 (RR 0.58, 96% P = 0.06 and cl is 0.35 to 1.0)

In the case of critically ill adults in neurosurgical intensive care unit, often abnormal gastric motility is the cause of lack of nutritional optimum target.  Here, in this study, Comparison of nasogastric metabolism associated with the nasogastric tube feeding to nasojejunal nutrition has been performed in details.  Design involved in this study considered randomized trailing in the controlled group with concerning some specific elements with 17 closed multifaceted, neurosurgical intensive care unit of Australia.

The standard energy required is the optimum measurement as per primary result point of view.  Secondary resultant expressed incidence in neurosurgical complication, hemorrhage of intestine, and fatal rate in hospital. There are 89 to relating to nasogastric nutrition, and 92 patient are of nasojejunal nutrition group (Law, 2008). The fundamental characteristics are same.

Insertion of nasojejunal tube was occurred in 79 (87%) rapid nasojejunal nutrition subject after a span of 15hrs. The deviation result of optimum energy delivered in the form of internal nutrition was 73% in the case of nasojejunal nutritional nutrition which 72% in nutrition associated with nasogastric. (Average difference 1%, 94% confidence interval −4% to 5%, p = .66)..02).

As per a clinical trial conducted by  Dr. Teresa and colleges The internal nutrition relevance are most of the time demonstrated by aspirating stomach element by gastrointestinal tube insertion at prescribed intervals.

In this type of randomization relating to the controlling group of enrolled subjects who admitted to ICU > 48 hours, there is having insertion of the gastric tube. Subjects are analyzed on the basis of randomization to either maintain or group related to intervention. (Lunde, 2014)

Followed by Ethics Committee of Institutional, 356 patients were recruited (group under control n=180 and intervention group n=179). After the analysis, it shows for the group under intervention having aspirations of tube intervention rate is minimum per day (3.5 versus 5.5 in the group under control, p<0.001). In the case of the intervention group, vomiting is increased. (2.2% with comparison to 3.6% and p=0.02).

Frequent insertion of a nasogastric tube to grant proper intake of various essential nutrients is the main aspect of this study. Subjects may a case of long duration constituting nasogastric tubes insertion in order to gastrointestinal fluid withdrawal ileus after operation. (Cook and Stawicki, 2012)

In subjects, the occurrence of sinusitis relating to nosocomial after intubation associated with naso-enteric is influenced by diagnosis methodology, as well as aspiration. Here the rate of overwrapped sinuses is (10% to 12%), separately radiography (22%) where computed tomography is remarkable (100%).

A clinical study performed by Daniel and his colleges on the comparison of a nasogastric tube and nasoenteric tube insertion. Where application of nasoenteric tubes (NETs) is universal and, physicians are most of the time take placement as well as activity, and maintenance for approval. Tube relating to nasogastric systems is applied for decompression nasogastric, feeding to enteral, drug administration, nasal drainage, and other abnormal condition like bleeding of gastrointestinal. The study shows that in compare to nasoenteric tube insertion, fatality rate is lower for insertion of the nasogastric tube in critically ill patient. It has been evidenced especially when they are in neurosurgical intensive care unit, where nasoenteric tube insertion is stable as per protocols relating to patient safety (Lanas, 2009).

Gastrointestinal tube insertion is preferable over internal nutrition for critically ill patients. In the context of neurosurgical intensive care unit where an intense study is done by Mcclave, where previous is thought to retain the consistency of stomach and reason of some complications relating to infection. After various researchers study is suggested by researchers that among the other therapy of tube nasogastric tube insertion are much effective at least in the morbidity concern. But certainly there is always some associated with physiological risk.

McClave and his colleges have shown that 25 of 35 gastric-fed for very complex condition patient in neurosurgical intensive care unit. It has one aspiration of micro during advance feeding time. After the analysis of the resultant getting from the study, it is suggested that various strategies by nasogastric intubation to prevent pneumonia relating to aspiration (Thompson, 2010).

A clinical study of the subject is urgently requiring airway therapy from 01.01.2000 to 31.01.2006.where 2,343 subjects having advanced airway therapy.  The main diagnoses were various heart related abnormality. The vital reasons of abnormal airways are calculated by percentage wise. Such as related to the larynx (40.9%), immobility of neck (23.7%) and blood related (15.1%). The average attempts for nasogastric tube intubation are 4.6 versus 2.2 for all circumstances. The fatality rate of 41.5% within the subjects associated with difficult airways compare to who had airway management (41%). So the researchers suggest that there are no such remarkable differences in between nasogastric tube feeding and other related therapy. Out of all participants, only 0.3% is failed in airway management (van der Star, 2012).

To measure the amount of food elements, nutrients which are prescribed, and passes through the nasogastric tube in neurosurgical intensive care unit for critically ill patients by a nutritionist Collins in 2006. It is suggested that with the nasogastric tube patient has received 63.5% more nutrition element compare to other intubation therapy. Researchers conducted the study for 484 days of nutrition (Wang, Liu, and Huang, 2014).

A combined clinical review on nasogastric tube feeding associating its advantages and risk factor by Williams and his colleges' internal nutrition was taken up by 375 participants. Nutrition days which is a significant factor is analyzed which reflects 63.5% caloric intake. It was supplied enter ally. However 78% of the average caloric required was noted, and among these 71% was delivered. The proper amount calories which are delivered versus the amount which significantly prescribed as lower in parenteral -intake (86.7% vs. 112.3% where p < .001). (Williams, Davies, Dobb 2013)

Depending upon the tolerance of the digestive system Wong and his colleges performed a clinical trial on 240 no of participants. This study is mainly concerning about the various interruptions in order to get maximum outcomes of the nasogastric tube feeding in neurosurgical intensive care unit. After the analysis of the trial result, researchers focused on some vital factor and categorized them percentage wise. These are as follows tolerance in digestion (27.6%, daily waste average 640mL), management of the airway is about (30.7%, volume of waste 744 mL).

Conclusions:

As per suggestion of researcher's consistent delivery of some vital nutrition relating to the insertion of the nasogastric tube for patient in neurosurgical intensive care unit. The researchers observed a unique pattern related to the administration of nutrients. According to the findings, nutrients are supplied in relatively small amount then almost whole the part is applied as effectively but when nutrients are delivered in the large amount then wastage of huge percentage of nutrients is there. Wong and Ng, 2008)

Conclusion

Depending upon all the above literature review, it is acknowledged that among all the therapy related to intubation especially for patient in neurosurgical intensive care unit, nasogastric tube feeding is much more effective. Depending upon the base of various clinical study and research article, there are some fundamental characteristics of critical patient who are given nasogastric tube.

References:

Davies, A., Morrison, S., Bailey, M., Bellomo, R., Cooper, D., Doig, G., Finfer, S. and Heyland, D. (2012). A multicenter, randomized controlled trial comparing early nasojejunal with nasogastric nutrition in critical illness*. Critical Care Medicine, 40(8), pp.2342-2348.

Lanas, A. (2009). Education-based approach to addressing non-evidence-based practice in preventing NSAID-associated gastrointestinal complications. WJG, 15(47), p.5953.

Law, R. (2008). Problematic fine bore nasogastric intubation: A radiographer led service development. Radiography, 14, pp.e82-e84.

Lunde, D. (2014). Extrauterine Growth Restriction: What is the Evidence for Better Nutritional Practices in the Neonatal Intensive Care Unit?. Newborn and Infant Nursing Reviews, 14(3), pp.92-98.

Prabhakaran, S., Doraiswamy, V., Nagaraja, V., Cipolla, J., Ofurum, U., Evans, D., Lindsey, D., Seamon, M., Kavuturu, S., Gerlach, A., Jaik, N., Eiferman, D., Papadimos, T., Adolph, M., Cook, C. and Stawicki, S. (2012). Nasoenteric Tube Complications. Scandinavian Journal of Surgery, 101(3), pp.147-155.

Thompson, R. (2010). Endoscopy: Acoustic lubrication reduces pain and discomfort associated with nasogastric intubation. Nat Rev Gastroenterol Hepatol, 7(12), pp.654-654.

van der Star, M. (2012). Continuous versus bolus nasogastric tube feeding in premature neonates: Randomized controlled trial. OJPed, 02(03), pp.214-218.

Wang, J., Liu, M., Liu, C., Ye, Y. and Huang, G. (2014). Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for patients with head and neck cancer: a systematic review. Journal of Radiation Research, 55(3), pp.559-567.

Williams, T., Leslie, G., Mills, L., Leen, T., Davies, H., Hendron, D. and Dobb, G. (2013). Frequency of Aspirating Gastric Tubes for Patients Receiving Enteral Nutrition in the ICU: A Randomized Controlled Trial. Journal of Parenteral and Enteral Nutrition, 38(7), pp.809-816.

Wong, E. and Ng, Y. (2008). The difficult airway in the emergency department. Int J Emerg Med, 1(2), pp.107-111.