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تغذیۀ انترال
Several converging factors align to contribute to this catabolic state, including decreased oral intake because of NPO states, anorexia secondary to injury and inflam- mation, and anatomic obstacles to enteral nutrition such as intes- tinal surgery.
Patients who are not intubated and who are unable to eat because of an altered sensorium, sedatives, narcotics, or anorexia should have a small-bore nasogastric tube placed as well. ftese tubes are readily tolerated and are not as prone to clogging as pure feeding tubes; they also allow for gastric suctioning and decompression should that be required. fte nutritional plan should never be "the patient will start eating tomorrow" because more often than not tomor- row never comes, and the patient's nutritional deficits become even greater. fte advantages of enteral nutrition continue to accrue in the literature and include maintaining gut integrity, trophic effects on the liver, increased intestinal immunoglobulin production, decreased infection rates, and more stable glycemic profiles.
In some patients, such as patients with burn injuries and patients with TBI, enteral nutrition has been shown not only to reduce the rates of ileus and gastroparesis but also to reduce septic complications and promote better neurologic outcomes.
Several barriers to the effective delivery of enteral nutrition exist, but one of the most common and troubling reasons that patient's needs are not met is frequent interruptions for various reasons, such as turning the patient for care, washing or bedding changes, diagnostic imaging studies, bedside procedures, and ill- conceived NPO orders.
Lastly, patients on moderate to high doses of vasopressors should not receive enteral nutrition because of the rare complication of bowel necrosis from the increased intestinal oxygen demand induced by feeding in the setting of splanchnic ischemia.
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