IMMEDIATE POSTOPERATIVE ENTERAL FEEDING RESULTS IN IMPAIRED RESPIRATORY MECHANICS AND DECREASED MOBILITY

Objective The authors set out to determine whether immediate enteral f eeding minimizes early postoperative decreases in handgrip and respira tory muscle strength. Summary Background Data Muscle strength decrease s considerably after major surgical procedures. Enteral feeding has be en shown to restore strength rapidly in other clinical settings. Metho ds A randomized, controlled, nonblinded clinical trial was conducted i n patients undergoing esophagectomy or pancreatoduodenectomy who recei ved immediate postoperative enteral feeding via jejunostomy (fed, n = 13), or no enteral feeding during the first 6 postoperative days (unfe d, n = 15). Handgrip strength, vital capacity, forced expiratory volum e in one second (FEV1), and maximal inspiratory pressure (MIP) were me asured before surgery and on postoperative days 2, 4, and 6. Fatigue a nd vigor were evaluated before surgery and on postoperative day 6. Mob ility was assessed daily after surgery using a standardized descriptiv e scale. Postoperative urine biochemistry was evaluated in daily 24-ho ur collections. Results Postoperative vital capacity (p < 0.05) and FE V1 (p = 0.07) were consistently lower (18%-29%) in the fed group than in the unfed group, whereas grip strength and maximal inspiratory pres sure were not significantly different. Postoperative mobility also was lower in the fed patients (p < 0.05) and tended to recover less rapid ly (p = 0.07). Fatigue increased and vigor decreased after surgery (bo th p less than or equal to 0.001), but changes were similar in the fed and unfed groups. Intensive care unit and postoperative hospital stay did not differ between groups. Conclusions Immediate postoperative je junal feeding was associated with impaired respiratory mechanics and p ostoperative mobility and did not influence the loss of muscle strengt h or the increase in fatigue, which occurred after major surgery, Imme diate postoperative enteral feeding should not be routine in well-nour ished patients at low risk of nutrition-related complications.