Comparison of the Initiation Time of Enteral Nutrition for Critically Ill Patients: At Admission vs. 24 to 48 Hours after Admission

Objective. To investigate the better time of initiation of enteral nutrition for critically ill patients, such as at admission or 24 to 48 hours after admission. Methods. This was a prospective, randomized, parallel-controlled, single-blind, interventional clinical trial. A total of 100 patients admitted to the intensive care unit (ICU) of our hospital between January 2017 and December 2018 were recruited in this study. These patients had been divided into the control group or intervention group by a computer-generated random number table, and each group had 50 patients. For the control group, a gastric tube was inserted to start enteral nutrition at 24 to 48 hours after admission. For the intervention group, a nasojejunal tube was placed to start enteral nutrition at admission. The main endpoints included serum albumin and prealbumin at admission and on days 3, 7, and 14 after admission, length of ICU stay, ventilator time, and complications such as diarrhea, gastric retention, esophageal reflux, and pulmonary infection. Results. The results showed that serum albumin and prealbumin were significantly higher in the intervention group than in the control group ( P < 0.05). The length of ICU stay ( P < 0.05) and ventilator time ( P < 0.05) were both significantly shorter in the intervention group than in the control group. The incidences of gastric retention, esophageal reflux, and pulmonary infection were significantly lower in the intervention group than those in the control group ( P < 0.05). Conclusion. In the absence of contraindications, enteral nutrition can be initiated immediately after admission to the ICU (within 6 hours), and feeding nasojejunal tube is recommended. It can improve the nutritional status and prognosis of critical patients, improve the feeding effect, shorten the length of stay in the ICU and the use of the ventilator, and reduce the incidence of complications.

Raft Forming Systems: A Novel Approach to Gastric Retention

Oral delivery of drug is the most preferable drug delivery due to the ease of administration, patient compliance and flexibility in the formulations. In recent era various technologies have been made in research and development of oral controlled release drug delivery system to overcome various physiological difficulties such as variation in gastric retention and emptying time. Conventional oral dosage forms pose low bioavailability problems due to their rapid gastric transition from stomach, especially in case of drugs which are less soluble at alkaline pH of intestine and locally acting drugs in stomach get rapidly emptied. So, frequency of dose administration in such cases is increased. Gastro retentive drug delivery system (GRDDS) is facing many challenges which can be overcome by upcoming newly emerging approach, raft forming systems (RFS). The present study provides valuable information and highlights advances in this raft forming system. Different types of smart polymers used for their formulation have also been summarized. The current review focuses on the mechanism, formulation development and evaluation aspects of the raft forming systems and also highlights parameters which may lead to response variations in altered physiological conditions are discussed as well.

Floating micro particles of Stavudine: An Exceptional approach for Gastric retention and Sustainable drug action

Stavudine is synthetic analog of reverse transcriptase inhibitor possessing a short half-life of 0.8 to 1.5 hours. Therefore frequent administration of the medication is required which results in poor patient acceptability The following research work aims to prepare the floating microparticles of stavudine with an intention to increase the gastric retention time. Microparticles were prepared via emulsion solvent diffusion method utilizing Eudragit S 100 and Eudragit L 100 as the rate controlling polymers. The influence of these polymers and its compositions on various formulation parameters in addition to the in vitro release characteristics of the microspheres was investigated. The particle size of the prepared microparticles were found to be in the range of 108.25µm to 152.41µm. Free flowing particles which are spherical free flowing with a buoyancy ≥12 hour in the simulated gastric fluid were obtained. The drug content of the selected micro particles (F12) showed an encapsulation efficiency of up to 85.28±0.18%. In vitro release profiles of floating microspheres indicated a sustained drug release up to 14 hours. Thus, the present formulations could be a superior alternative to conventional oral therapy due to the sustained drug action.

A Review on Floating Multi-particulate Drug Delivery System

The objective of writing this review on Floating Drug Delivery Systems (FDDS) was to accumulate new work with a special focus on the primary floatation mechanism for gastric retention. Drug delivery systems are those that instantly float on contact with gastric fluids and present promising approaches to improve the bioavailability of drugs with absorption windows in the stomach or upper small intestine, imbalanced in the intestinal or colonic environment, and exhibit low solubility at high pH standards. It is a novel drug delivery system that takes full advantage of effectiveness and compliance. Physical problems such as short gastric residence time and unpredictable gastric emptying time were overcome with the use of floating dosage forms that provide the possibility of local and systemic effects. The floating drug delivery system allows prolonged and continuous entry of the drug into the upper part of the gastric retention pathway and increases the bioavailability of the medication characterized by a narrow absorption window. This review provides detailed information on the pharmaceutical basis of its Introduction, Advantages, Disadvantages, Factors Affecting Gastric Emptying, and Criteria for Suitable Drug Products for Floating Gastric-Retention, Classification of Floating Multiparticulate Drug Delivery System, and Characterization of Floating Multiparticulate Drug Delivery System. These systems are beneficial for various difficulties encountered during the development of a pharmaceutical dosage form and the future potential of FDDS. This review article has attempted to announce to readers about the floating drug delivery system.

Formulation development and characterization of eplerenone insitu oralgels

Gastro retentive drug delivery systems have been widely used to prolong the retention of dosage forms in the stomach. Among the various approaches, the floating in-situ gelling formulation offers sustained drug release as well as prolonged gastric retention, along with the added advantage of the liquid oral dosage form. The present study was an attempt to formulate and evaluate floating in situ gel of Eplerenone by using various polymers like Xanthan gum, Carbopol, HPMC K100M, and Karaya gum which undergoes pH dependant sol-gel transition at gastric pH, thereby prolonging the retention of the system in the stomach. Sodium alginate a natural polymer was employed as a gelling agent where Gelation is triggered by the source of calcium ions in the form of calcium carbonate. Drug and polymers were subjected for compatibility study using FTIR studies, which revealed that there was no interaction between drugs and polymers. The evaluation was carried out for invitro parameters such as gelling nature, Total floating time, drug content, viscosity, & in vitro dissolution studies. Among all the formulations, the F12 formulation containing HPMC K100M was chosen as an optimized formulation that shows maximum drug release by the end of 12hrs and has excellent floating characteristics and gastric retention. From kinetic studies, the optimized formulation shows zero-order release with super case II transport mechanism.

A Novel Approaches - Gastroretentive Microballoons Drug Delivery System

Due to its potential to stay in the gastric region for a longer period of time, the gastro-retentive is one of the most promising oral drug delivery systems. This increases the solubility of the drug, which improves bioavailability and reduces drug waste. To achieve the gastro-retentive property, numerous methods have been proposed. Microballoons are the most common form among them. Microballoons (hollow microspheres) have the ability to be a viable option for gastric retention. The microballoons drug delivery system is based on a non-effervescent system that comprises hollow spherical particles with no center and a size of less than 200 micrometres. The microballoons drug delivery system has been shown to be more effective in regulating the rate of release of drugs with site-specific absorption. The floating Microballoons demonstrated gastro-retentive mediated release delivery with effective methods for increasing bioavailability, and they could be a promising solution for gastric retention. Optimized hollow microspheres could play a key role in novel drug delivery, especially in secure, targeted, and efficient in vivo delivery. They may be a promising approach for gastric retention, which would minimize variability in plasma drug concentrations. The review presents an insight in to recent advance methods of formulation, evaluation, polymers used in microballoons, applications of microballoons as gastroretentive drug delivery system which provide controlled release properties.

A124 GASTRIC RETENTION IN CAPSULE STUDIES – IS AN ENDOSCOPY ALWAYS REQUIRED?

Background Capsule endoscopy (CE) is a non-invasive procedure for evaluating small bowel (SB) disorders but is limited by the completion rate. Gastric retention (GR), whereby the capsule remains in the stomach for the duration of the recording, can contribute to incomplete examinations given CE’s finite battery life. Although this may be mitigated by using real-time imaging and/or endoscopic placement of capsule into the SB, such strategies require additional resource allocation. While other risk factors associated with incomplete examinations are well known, GR is not often discussed in the literature. Aims To describe the management and outcomes of patients with GR. We hypothesize that most patients with previous gastric retention of the capsule, without known obstruction, will pass the capsule normally through the stomach with a second attempt without requiring endoscopic placement into the duodenum. Methods Case series of patients with GR at a tertiary care centre in Vancouver, Canada. Prior to CE, all patients had undergone appropriate investigations to exclude obstructive pathology. All patients ingested 2L of polyethylene glycol-based bowel preparation the evening prior to the procedure and were fasting after midnight. Ingestion of the capsule occurred at 0700h. In patients who required repeat CE due to previous GR, capsule progress was assessed via real-time imaging at 1–2 hrs. If the capsule had not entered the SB by three hours, an attempt at endoscopic advancement of the capsule into the duodenum was made and/or endoscopic placement of capsule was arranged for a later date. Results GR was found in 21 (2%) of 1024 patients between 09/2015 - 09/2020. The mean age of patients with GR was 58 ± 20.9 years (48% female). The most common indication for CE in this group was obscure gastrointestinal bleeding (n = 12, 57%). The mean Charlson Comorbidity Index was 2.9 ± 3.5. Thirteen patients (62%) had a history of abdominal/pelvic surgery. Fourteen patients (67%) had repeat CE, nine (64%) of which passed into the SB without endoscopic assistance. Of those requiring endoscopic assistance (n = 5), two had successful endoscopic placement, one required dilation of pyloric stenosis prior to successful placement, one failed endoscopic placement due to stenotic gastroplasty orifice, and another required upper endoscopy for further evaluation. None experienced delayed adverse events related to GR. Conclusions CE can be safely repeated in patients with previous GR; most capsules will pass through the stomach spontaneously when repeated and do not require endoscopic assistance. Funding Agencies None