title: Immediate postoperative enteral feeding results in impaired respiratory mechanics and decreased mobility.
abstract: OBJECTIVE
  The authors set out to determine whether immediate enteral feeding minimizes early postoperative decreases in handgrip and respiratory muscle strength.
  
  
  BACKGROUND
  Muscle strength decreases considerably after major surgical procedures. Enteral feeding has been shown to restore strength rapidly in other clinical settings.
  
  
  METHODS
  A randomized, controlled, nonblinded clinical trial was conducted in patients undergoing esophagectomy or pancreatoduodenectomy who received immediate postoperative enteral feeding via jejunostomy (fed, n = 13), or no enteral feeding during the first 6 postoperative days (unfed, n = 15). Handgrip strength, vital capacity, forced expiratory volume in one second (FEV1), and maximal inspiratory pressure (MIP) were measured before surgery and on postoperative days 2, 4, and 6. Fatigue and vigor were evaluated before surgery and on postoperative day 6. Mobility was assessed daily after surgery using a standardized descriptive scale. Postoperative urine biochemistry was evaluated in daily 24-hour collections.
  
  
  RESULTS
  Postoperative vital capacity (p < 0.05) and FEV1 (p = 0.07) were consistently lower (18%-29%) in the fed group than in the unfed group, whereas grip strength and maximal inspiratory pressure were not significantly different. Postoperative mobility also was lower in the fed patients (p < 0.05) and tended to recover less rapidly (p = 0.07). Fatigue increased and vigor decreased after surgery (both p < or = 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 jejunal feeding was associated with impaired respiratory mechanics and postoperative mobility and did not influence the loss of muscle strength or the increase in fatigue, which occurred after major surgery. Immediate postoperative enteral feeding should not be routine in well-nourished patients at low risk of nutrition-related complications.
authors.affiliation: Department of Surgery, University of Ottawa, and Ottawa Civic Hospital, Ontario, Canada.
authors.forename: J M
authors.initials: JM
authors.lastname: Watters
authors.forename: S M
authors.initials: SM
authors.lastname: Kirkpatrick
authors.forename: S B
authors.initials: SB
authors.lastname: Norris
authors.forename: F M
authors.initials: FM
authors.lastname: Shamji
authors.forename: G A
authors.initials: GA
authors.lastname: Wells
mesh_terms: D000367:Age Factors; D000368:Aged; D004750:Enteral Nutrition / Q000009:adverse effects*; D016629:Esophagectomy; D005260:Female; D005541:Forced Expiratory Volume; D018737:Hand Strength / Q000502:physiology*; D006801:Humans; D007582:Jejunostomy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D016577:Pancreaticoduodenectomy; D011182:Postoperative Care / Q000009:adverse effects*; D012129:Respiratory Function Tests; D012132:Respiratory Muscles / Q000503:physiopathology*; D012307:Risk Factors; D012737:Sex Factors; D014797:Vital Capacity