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Address correspondence to: J. S. W. Lee. Fax: (q852) 246 85800. Email: jleesw@hotmail.com
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Feeding methods for older tube-fed patients
tube feeding for various reasons, especially neuro- spurious diarrhoea or with a history of frequent self-
dysphagia after stroke or in late stage dementia. Most extubation. The study was approved by the ethics
clinical trials in tube-feeding have involved patients committee of the hospital and subjects or their next
in an intensive care unit (ICU) setting and frequently in of kin gave informed consent.
post-operative conditions. Subjects were randomised into two groups. Block
There have been two randomised trials which com- randomisation in groups of 6 (3 for intermittent bolus
pared intermittent and continuous tube feeding in terms feeding and 3 for continuous infusion feeding) was used
of the incidence of complications including diarrhoea, to avoid high discrepancy between the subject number in
aspiration pneumonia, clogged tubes, and the time to each group. The first subject was assigned by drawing a
achieve the required caloric goal. Hiebert et al. [12] studied sealed envelope out of six. The second subject was
76 adult burn patients in a burn centre and randomised assigned by drawing a second envelope out of the
them to receive either mode of feeding. Among the 62 remaining five, and so on. When all the six envelopes had
patients (age 12–81 years) who completed the study been drawn the cycle was repeated again.
period of 1 week, those fed continuously had signi- In the intermittent bolus group (I) the patients
ficantly less frequent stools than intermittently fed continued to receive the same mode of feeding. In
patients. The volume and consistency of stools were the continuous infusion group (C) the patients were
not studied. switched to continuous infusion of the same daily
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J. S. W. Lee, T. W. Auyeung
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Feeding methods for older tube-fed patients
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J. S. W. Lee, T. W. Auyeung
This study was conducted in a hospital setting and 3. Bliss DZ, Guenter PA, Settle RG. Defining and reporting
the results may therefore not be applicable to nursing diarrhoea in tube-fed patients – what a mess! Am J Clin Nutr
home residents. Our results may not be applicable to 1992; 55: 753–9.
younger patients in other settings, such as in intensive 4. Guenter PA, Settle RG, Perlmutter S, Marino PL,
care or burns units, or in post-operative states. DeSimone GA, Rolandelli RH. Tube feeding-related diarrhoea
in acutely ill patients. J Parenter Enteral Nutr 1991; 15: 277–80.
5. Edes TE, Walk BE, Austin JL. Diarrhoea in tube-fed
Conclusions patients: feeding formula not necessarily the cause. Am J Med
1990; 88: 91–3.
Contrary to common belief and recommendations, we 6. Homann KK, Kemen M, Fuessenich C, Senkal M,
could not find evidence that a change to the continuous Zumtobel V. Reduction in diarrhoea incidence by soluble
mode of feeding can result in any additional reduction in fibre in patients receiving total or supplemental enteral
diarrhoea in elderly tube-fed patients, as compared with nutrition. J Parenter Enteral Nutr 1994; 18: 486–90.
those who continued with intermittent feeding. CD 7. Shankardass K, Chuchmach S, Chelswick K et al. Bowel
cytotoxin has been found to be a cause of diarrhoea in function of long-term tube-fed patients consuming formulae
a significant proportion of patients in our study, and with and without dietary fiber. J Parenter Enteral Nutr 1990;
routine stool assay of the toxin is recommended in these 14: 508–12.
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Feeding methods for older tube-fed patients
20. Stuart S, Stuart M, Unger LD. Enteral and parenteral nutrition 23. Heimburger DC, Sockwell DG, Geels WJ. Diarrhoea with
support. In Morrison G, Hark L eds. Medical Nutrition and enteral feeding: Prospective reappraisal of putative causes.
Disease. New York: Blackwell Science, 1996: 339–47. Nutrition 1994; 10: 392–6.
21. Bliss DZ, Johnson S, Savik K, Clabots CR, Willard K, 24. Weinsier RL, Heimgurger DC, Butterworth CE Jr.
Gerding DN. Acquisition of Clostridium difficile and Handbook of Clinical Nutrition: Clinician’s Manual for the
Clostridium difficile-associated diarrhoea in hospitalized Prevention, Diagnosis, and Management of Nutritional
patients receiving tube feeding. Ann Int Med 1998; Problems. 2nd Edition. St Louis: The CV Mosby Company,
129: 1012–19. 1989: 209–20.
22. Woolfson AMJ, Saour JN, Ricketts CR, Pollard BJ,
Hardy SM, Allison SP. Prolonged nasogastric tube feeding in criti- Received 12 March 2002; accepted in revised form 27 January
cally ill and surgical patients. Postgrad Med J 1976; 52: 678–82. 2003
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