A comparative Study between Tube Feeding versus Parenteral Nutrition in GIT Cancer Patients in ICU
Authors: Abdellatif Ahmad Antr , Shams Manal Mohammed Kamal , Helmy Amr Fouad Hafez 
Published: October 2021

Abstract

Objectives
Our study is designed to determine whether providing nutrition via parenteral route or enteral route is better in patients with GIT cancer after surgery in ICU.

Background
Patients with gastrointestinal malignancy have a higher risk of postoperative complications and alterations resulting from their pre and postadmission nutritional status. Malnutrition and subsequent weight loss have long been among the leading causes of morbidity and mortality, as well as increased costs with other organs dysfunction associated to cancer patients undergoing surgery.

Methods
A prospective randomized clinical trial conducted in critical care units in Ain Shams University Hospitals from August 2017 to February 2019.Eighty patients with GIT cancer were included. Half of them received enteral nutrition and the other half received parenteral nutrition. All patients were compared regarding demographic data, hemodynamic parameters, complications (Infection, GIT symptoms, and central venous line insertion), signs of malnutrition (weight loss and hypoalbuminaemia), time to pass flatus, ICU stay and mortality. An informed written consent was obtained from patients and/or their relatives.

Results
Postoperative complications occurred in 20 (50%) patients fed enterally versus 23 (57.5%) patients fed parenterally with p = 0.501.Infectious complications happened in 5 (12.5%) patients fed enterally versus 9 (22.5%) patients fed parenterally with p = 0.239.Surgical complications occurred in 3(7.5%) patients fed enterally versus 4(10%) patients fed parenterally with p = 0.905.GIT complications occurred in 9 (22.5%) patients fed enterally versus 6 (15%) patients fed parenterally with p = 0.872.Respiratory complications occurred in 4 (10%) patients fed enterally versus 2(5%) patients fed parenterally with p = 0.708. Time to flatus (days) was 2.90 ±1.0 in enteral group versus 3.78 ±0.8 in parentral group with p = 0.003. ICU stay (days) was 5.50 ±1.8 in enteral group versus 9.83 ±3.40 in parentral group with p = 0.003. Mortality n (%) was 1 (2.5%) in enteral group versus 2 (5.0%) in parentral group with p = 1.000. Albumin after 7 days and albumin after 14 days were increased statistically significantly in patients of enteral nutrition than parenteral nutrition group (p = 0.021) and (p = 0.003) respectively. There was a statistically significance improvement of albumin level within the same group (P = 0.003). There was a statistically significant improvement of weight in patients who had received enteral nutrition (p = 0.003) while There was a statistically significant decrease in weight in patients who had received parenteral nutrition (p = 0.003).

Conclusion
Enteral nutrition showed better results in comparison to parenteral nutrition regarding time to pass flatus, ICU stay, albumin after 7 days and albumin after 14 days. Both types of nutrition are equal statistically regarding complications and infection, mortality rate, post-operative weight after 7 days (kg) and weight after 14 days (kg).