Overnight nasogastric tube feeding

Overnight nasogastric tube feeding allows the patient freedom for normal daytime activities and exercise, essential components of rehabilitation. In order to avoid disturbed nights through frequent micturition we have kept the volume of feed to a minimum. Two types of feed have been used: 1. A supplementary isosmolar feed containing 1000 kCals in 1 litre. 2. A concentrated low volume (404 mosm/kg) feed supplying 1800 kCals including 60 g of nitrogen in 1 litre. Both were delivered via a fine bore tube (internal diameter 1 mm) by continuous infusion from a 1-1.5 litre reservoir using a rotary pump. Feed 1 was given to 64 undernourished elderly female patients (group 1) with fractured neck of femur, the tube being tolerated by 78%; 47 patients in this group were fed for more than 5 days. Feed 2 was given to 10 patients in hospital (group 2) and 8 patients at home (group 3). Few side effects were encountered, the hyperosmolar feed causing no diarrhoea, nausea or hyperglycaemia, emphasising the importance of osmoles per unit time rather than per unit volume. Voluntary oral intake was neither impaired nor increased during the period of tube feeding in group 1, in whom anorexia and thinness were longstanding. In group 2, with recent onset of anorexia and weight loss, tube feeding disinhibited appetite, resulting in a doubling of voluntary oral intake. Improvement in anthropometric and biochemical nutritional parameters was seen in all patients. Clinical improvements e.g. closure of fistulae were also observed. This paper describes the results of our trial of both these options in patients treated in hospital or at home.