Life Jacket

It saves people who cannot eat

Brown-haired, blue-eyed Jason White looks like any sturdy, active, eight-year-old boy. But Jason is different; he cannot eat a bite of food. Ever since doctors removed his diseased stomach and part of his intestines five years ago, he has been fed almost entirely by vein, and seemed destined to spend his remaining years in hospitals. Now, outfitted with a newly designed life-giving vest, Jason is living at home and thriving.

The polyester mesh vest, developed by Dr. Stanley Dudrick and his team at the University of Texas, has two breast pockets that hold plastic bags filled with Jason's food--a solution of amino acids, water, sugar, salt, potassium, magnesium, calcium, phosphorus, vitamins and trace elements. A battery-powered miniature pump zippered into another vest pocket propels the solution through a tube implanted in Jason's skin midway between his rib cage and navel. The tube runs up his chest to the base of his neck, where it threads into a vein leading to the superior vena cava, the large vessel that finally returns blood from the head and neck to the heart.

Only Jason and 18 other patients are so far enjoying the relative freedom and mobility afforded by Dudrick's new vest. But thousands of people across the country who cannot digest or absorb their food are benefiting, though less conveniently from the feeding technique on which the vest is based: intravenous hyperalimentation. By using this technique, which involves pumping nutrients directly into the bloodstream, doctors are able to keep alive patients with shortened guts, inflamed bowels, and immunological defects that prevent proper digestion of food. It is also used for burn victims and people receiving drug or radiation treatment following cancer surgery. Without intravenous feeding many of these patients would die, not of their diseases, but because they were unable to eat or absorb enough food to sustain life; they would literally starve to death. In fact, doctors estimate that at least 10% of all hospital deaths are attributable to malnutrition and another 30% are due in part to insufficient nourishment.

As recently as the early 1960s, medicine had little to offer patients with impaired gastrointestinal tracts besides the standard intravenous feeding of sugar water. Even if fortified with vitamins and minerals and supplemented with predigested protein, the sugar solution provides only 500 to 600 calories a day, and not enough nutrients to meet the body's needs. Dr. Dudrick came face to face with the nutrition problem one weekend in 1961 when, as a young surgical intern in Philadelphia, he helped perform successful operations on three patients only to have them die from what the chief surgeon diagnosed as malnutrition. Recalls Dudrick: "He told me, 'Nothing we can do with knives can overcome that.' "

Dudrick set out to overcome the problem in another way. He reasoned that if he could put all the needed nutrients directly into the blood, he could bypass the entire gastrointestinal tract, including the mouth, esophagus, stomach, duodenum, jejunum, ileum and colon. But what combination and concentration of chemicals to use? And how to deliver the chemical soup? Dudrick knew he needed a concentrated mixture of sugar for energy and amino acids for growth and development, as well as fats, vitamins, minerals and trace elements. But he was also aware that the necessarily high concentration of substances introduced at one point in the circulatory system could damage blood vessels or cause blood clots. His solution: infusing the nutrients into the superior vena cava because the vessel's large blood flow dilutes the mixture rapidly. In 1966 Dudrick tried the technique on six "terminally ill" patients. All survived their immediate illnesses and four are still alive.

Since that initial success, Dudrick has treated more than 6,000 patients. Most required only temporary hyperalimentation while they recovered from illness, surgery, the effects of cancer therapy or severe burns. In some cases of severe inflammatory bowel disease, intravenous feeding has given the bowel a rest and a chance to heal itself, thus eliminating the need for surgery. All of Dudrick's patients receive solutions tailor-made to their individual needs; some contain as many as 60 substances. An adult generally receives three liters a day, each liter supplying about 1,000 calories.

Despite widespread awareness of intravenous hyperalimentation, only 5% to 10% of hospitals actually use the technique regularly. Still, Dudrick is encouraged. Says he: "Physicians are less and less resistant to hyperalimentation, and any hospital today can muster people capable of doing this. It's so simple it's almost embarrassing."

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