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Comparison of the Initiation Time of Enteral Nutrition for Critically Ill Patients: At Admission vs. 24 to 48 Hours after Admission. Emerg Med Int 2021; 2021:3047732. [PMID: 34580613 PMCID: PMC8464429 DOI: 10.1155/2021/3047732] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/06/2021] [Indexed: 01/03/2023] Open
Abstract
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.
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Cara KC, Beauchesne AR, Wallace TC, Chung M. Safety of Using Enteral Nutrition Formulations Containing Dietary Fiber in Hospitalized Critical Care Patients: A Systematic Review and Meta-Analysis. JPEN J Parenter Enteral Nutr 2021; 45:882-906. [PMID: 34165812 DOI: 10.1002/jpen.2210] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/01/2021] [Accepted: 06/17/2021] [Indexed: 12/27/2022]
Abstract
Enteral nutrition (EN) is the preferred route of nutrition support for patients with critical illness undergoing intensive care. Experts in the field caution against using fiber during EN because of perceived adverse patient outcomes; however, a comprehensive assessment of this topic is not evident to date. In this systematic review and meta-analysis, we searched four databases from inception to April 20, 2020, for studies on adverse events or health outcomes associated with using EN formulations containing fiber in hospitalized adults with critical illness. Nineteen articles were included. Random-effects meta-analysis models showed significantly lower diarrhea scores for fiber groups compared with nonfiber groups (pooled mean difference: -2.78; 95% CI, -4.10 to -1.47) but mixed results for risk of diarrhea between groups, depending on measures used for diarrhea (Hart and Dobb scale, pooled risk ratio [RR]: 0.68; 95% CI, 0.45-1.02; other diarrhea scales, pooled RR: 0.42; 95% CI, 0.20-0.89). Models showed 39% lower risk of gastrointestinal (GI) complications overall for fiber compared with nonfiber groups (pooled RR: 0.61; 95% CI, 0.47-0.79) but no group differences for individual GI complications, mortality, and intensive care unit or hospital length of stay. Analyses stratified by soluble- or mixed-fiber interventions reduced heterogeneity in models but showed identical conclusions. EN formulas with fiber may help reduce incidence and severity of diarrhea and GI complications overall in critically ill patients, without increased risk of other adverse events. Bias among specific GI measures indicates more high-quality studies are needed to verify these conclusions.
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Affiliation(s)
- Kelly Copeland Cara
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts, USA.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | | | - Taylor C Wallace
- Think Healthy Group, Inc, Washington, DC, USA.,Department of Nutrition and Food Studies, George Mason University, Fairfax, Virginia, USA
| | - Mei Chung
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts, USA.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
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Gastrointestinal Tolerance and Protein Absorption Markers with a New Peptide Enteral Formula Compared to a Standard Intact Protein Enteral Formula in Critically Ill Patients. Nutrients 2021; 13:nu13072362. [PMID: 34371872 PMCID: PMC8308653 DOI: 10.3390/nu13072362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/04/2021] [Accepted: 07/08/2021] [Indexed: 11/18/2022] Open
Abstract
The aim of this exploratory study was to investigate gastrointestinal tolerance and protein absorption markers with a new enteral peptide formula (PF) compared to an isocaloric enteral intact protein standard formula (SF) containing the same amount of protein in ICU patients. Patients admitted to a cardio-thoracic intensive care unit expected to receive tube feeding for ≥5 days were randomized to receive either PF (1.5 kcal/mL) or SF in a double-blind manner for ≤14 days. Twenty-six patients were randomized (13 SF and 13 PF) and 23 (12 SF and 11 PF) completed at least 5 days of product administration. There were no statistically significant differences between the feeds during the first 5 days of intervention for diarrhea (SF:3 (23%); PF:5 (39%), p = 0.388), vomiting (SF:1 (8%); PF:2 (15%), p = 0.549), constipation (SF:7 (54%), PF:3 (23%), p = 0.115), and high gastric residual volume (>500 mL: SF:1 (8%); PF: 2 (15%), p = 0.535). There were no differences in plasma amino acids or urinary markers of protein absorption and metabolism. In conclusion, no major differences were found in tolerability and protein absorption markers between the standard intact protein formula and the peptide formula.
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54
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Hanson LM, Bettencourt AP. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Guide for Nurses. AACN Adv Crit Care 2021; 31:281-295. [PMID: 32866260 DOI: 10.4037/aacnacc2020634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Nurses are central to the care of patients with Stevens-Johnson syndrome and toxic epidermal necrolysis. Patients with these conditions present with nuanced symptoms and have complex nursing care needs. Although much of the exact pathophysiology of these diseases is not known, all nurses benefit from a fundamental understanding of the genesis of skin manifestations, associated pharmacology, and prognosis. The care of patients hospitalized with Stevens-Johnson syndrome and toxic epidermal necrolysis consists of wound care, infection prevention, comfort management, hydration and nutrition, psychosocial support, and the prevention of long-term complications. This article provides an overview of these diseases, including clinical diagnosis, history and physical assessment, related pharmacology, and nursing care priorities. A description of the current state of the science in clinical management for nurses at all levels is provided, with an emphasis on nursing's contribution to the best possible patient outcomes.
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Affiliation(s)
- Leah M Hanson
- Leah M. Hanson is Decentralized Nurse Educator, Burn Center, Regions Hospital, St Paul, Minnesota
| | - Amanda P Bettencourt
- Amanda P Bettencourt is Research Fellow, NCSP, and TACTICAL Scholar, Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, North Campus Research Center, 2800 Plymouth Rd, B14, Suite G-100, Ann Arbor, MI 48109
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Validity and Reliability of the Home Enteral Nutrition Caregiver Task Checklist. TOP CLIN NUTR 2021. [DOI: 10.1097/tin.0000000000000248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gundogan K, Emur Gunay Y, Ozer NT, Gunes Sahin G, Alptekinoglu Mendil NO, Sahin S, Temel S, Guven M, Sungur M. Serum trace elements levels in patients transferred from the intensive care unit to wards. Clin Nutr ESPEN 2021; 44:218-223. [PMID: 34330469 DOI: 10.1016/j.clnesp.2021.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND & AIMS Trace elements act as co-factors and/or in co-enzymes in many metabolic pathways and its deficiency contributes to metabolic and infectious complications. The aim of this study was to determine serum zinc, selenium, cobalt, chromium, copper and ceruloplasmin levels for identify the need for post intensive care unit (ICU) nutritional follow-up. METHODS This study was prospectively conducted in medical ICU. Adult patients (≥18 years) who stayed in ICU more than 48 h and transferred to ward were included in the study. Blood samples of trace element levels were sampled at discharge. RESULTS We enrolled 100 patients. The median age was 60 (40-70) years with Acute Physiology and Chronic Health Evaluation II (APACHE II) score 15 (11-21) . The median C-Reactive Protein (CRP) level was 53.9 (24.8-116.0) mg/L at discharge. Median serum zinc (24.4 mcg/dl:14.2-38.7) and chromium (0.22 mcg/dl:0.17-0.34) levels were below reference values, while median copper (111.9 (73.0-152.5) mcg/dl) and selenium (54.8 (36.4-95.25) mcg/L) values were within ranges. Serum concentrations of chromium, zinc, and selenium were lower than the normal values in 98, 90, and 36% of patients, respectively. The 28-day ICU mortality were correlated with low serum selenium levels (p = 0.03). CONCLUSION Serum chromium and zinc levels were below reference values at discharge, but this finding was in context of inflammation. Low serum selenium level observed in 36% was associated to 28-day ICU mortality.
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Affiliation(s)
- Kursat Gundogan
- Division of Medical Intensive Care, Department of Medicine, Erciyes University School of Medicine, Kayseri, Turkey; Division of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkey.
| | - Yasemin Emur Gunay
- Department of Medicine, Erciyes University School of Medicine, Kayseri, Turkey
| | - Nurhayat Tugra Ozer
- Division of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkey
| | - Gulsah Gunes Sahin
- Division of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkey
| | | | - Serap Sahin
- Division of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkey
| | - Sahin Temel
- Division of Medical Intensive Care, Department of Medicine, Erciyes University School of Medicine, Kayseri, Turkey
| | - Muhammet Guven
- Division of Medical Intensive Care, Department of Medicine, Erciyes University School of Medicine, Kayseri, Turkey; Department of Medicine, Lokman Hekim University School of Medicine, Ankara, Turkey
| | - Murat Sungur
- Division of Medical Intensive Care, Department of Medicine, Erciyes University School of Medicine, Kayseri, Turkey; Division of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkey
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The clinical impacts of early using glutamine/arginine enriched high protein density formula at trophic dose in intolerant enteral nutrition cachectic hypoalbuminemic hospitalized patients. ACTA ACUST UNITED AC 2021; 58:153-160. [PMID: 32449700 DOI: 10.2478/rjim-2020-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND We sought to evaluate the clinical impacts of the early administration of trophic doses of a glutamine/arginine enriched enteral nutrition formula (ENF) with a high protein density to cachectic hypoalbuminemic hospitalized patients intolerant to enteral nutrition. METHODS A retrospective analysis was conducted using the nutritional and non-nutritional data of patients admitted to our institution from April 2017 through August 2019. Patients who died or were discharged before completing ≥1 weeks of hospital admission, or those whose data could not be obtained were excluded. Among other variables, percent changes in serum albumin levels (%∆ALB), C - reactive protein (CRP) and their ratios were expressed as Mean ± SD using the Independent Samples T-test, while categorical variables were expressed as numbers with percentages by using χ2 test. Two tested groups were determined based on the use of ENF: Group I received trophic doses of ENF, while Group II received no enteral nutrition. RESULTS The overall hospital length of stay (LOS) and overall 28-day hospital mortality were significantly lower in Group I when compared with Group II with Means ± SDs of (11.32 ± 2.19 days vs 23.49 ± 4.33 days) and (13.13% vs. 28.16%), respectively. Also, significantly higher (%∆ALB) for Group I compared with group II (43.48% ± 7.89% vs. 33.45% ± 6.18%), respectively was observed. CONCLUSION In malnourished hypoalbuminemic patients suffering from feeding intolerance, early trophic administration of glutamine/arginine enriched high protein density ENF was well tolerated and may be associated with increased plasma albumin levels, reduced LOS, and overall 28-day mortality, and hence may be considered in such patients.
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Dixit SB, Tiwari NR, Zirpe KG, Tolat AG, Khatib KI, Kulkarni AP, Mehta Y, Mishra RC, Govil D, Chaudhry D, Ahsina Jahan L. How Have Nutrition Practices in the ICU Changed in the Last Decade (2011-2020): A Scoping Review. Cureus 2021; 13:e15422. [PMID: 34249568 PMCID: PMC8253490 DOI: 10.7759/cureus.15422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 01/03/2023] Open
Abstract
Malnutrition is more prevalent in the critically ill than ambulatory patients due to a variety of factors. Strategies employed in the optimization of nutrition practices rely largely on the review of published literature and guidelines. While the last decade was marked by some landmark large randomized controlled trials taking place and some high-quality systematic reviews, it still has left us with many unanswered questions. The evidence generated by these trials can, to a good extent, extrapolate to the developed countries. However, its implementation in developing and third-world countries needs further elaboration and logistical considerations. With this scoping review, we attempt to provide insights into the landmark developments in the decade 2011-2020. Solutions to employ and implement the results of these developments and ways for their corroboration into a larger population are also discussed.
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Affiliation(s)
| | - Nishant R Tiwari
- Internal Medicine, Byramjee Jeejeebhoy Medical College, Pune, IND
| | - Kapil G Zirpe
- Neurocritical Care, Ruby Hall Clinic, Grant Medical Foundation, Pune, IND
| | - Aditya G Tolat
- General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Khalid I Khatib
- Critical Care Medicine, Smt Kashibai Navale Medical College and General Hospital, Pune, IND
| | - Atul P Kulkarni
- Anaesthesiology and Critical Care Medicine, Tata Memorial Hospital, Mumbai, IND
| | - Yatin Mehta
- Anaesthesiology and Critical Care Medicine, Medanta-The Medicity, Gurugram, IND
| | - Rajesh C Mishra
- Critical Care Medicine, Sanjivani Super Speciality Hospital, Ahmedabad, IND
| | - Deepak Govil
- Anaesthesiology and Critical Care Medicine, Medanta-The Medicity, Gurugram, IND
| | - Dhruva Chaudhry
- Pulmonary and Critical Care Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Lopa Ahsina Jahan
- Critical Care Medicine, MH Samorita Hospital and Medical College, Dhaka, BGD
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Cheung K, Rathbone A, Melanson M, Trier J, Ritsma BR, Allen MD. Pathophysiology and management of critical illness polyneuropathy and myopathy. J Appl Physiol (1985) 2021; 130:1479-1489. [PMID: 33734888 PMCID: PMC8143786 DOI: 10.1152/japplphysiol.00019.2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 12/19/2022] Open
Abstract
Critical illness-associated weakness (CIAW) is an umbrella term used to describe a group of neuromuscular disorders caused by severe illness. It can be subdivided into three major classifications based on the component of the neuromuscular system (i.e. peripheral nerves or skeletal muscle or both) that are affected. This includes critical illness polyneuropathy (CIP), critical illness myopathy (CIM), and an overlap syndrome, critical illness polyneuromyopathy (CIPNM). It is a common complication observed in people with critical illness requiring intensive care unit (ICU) admission. Given CIAW is found in individuals experiencing grave illness, it can be challenging to study from a practical standpoint. However, over the past 2 decades, many insights into the pathophysiology of this condition have been made. Results from studies in both humans and animal models have found that a profound systemic inflammatory response and factors related to bioenergetic failure as well as microvascular, metabolic, and electrophysiological alterations underlie the development of CIAW. Current management strategies focus on early mobilization, achieving euglycemia, and nutritional optimization. Other interventions lack sufficient evidence, mainly due to a dearth of large trials. The goal of this Physiology in Medicine article is to highlight important aspects of the pathophysiology of these enigmatic conditions. It is hoped that improved understanding of the mechanisms underlying these disorders will lead to further study and new investigations for novel pharmacologic, nutritional, and exercise-based interventions to optimize patient outcomes.
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Affiliation(s)
- Kevin Cheung
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Alasdair Rathbone
- Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, Ontario, Canada
| | - Michel Melanson
- Division of Neurology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Jessica Trier
- Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, Ontario, Canada
| | - Benjamin R Ritsma
- Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, Ontario, Canada
| | - Matti D Allen
- Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, Ontario, Canada
- School of Kinesiology, Faculty of Arts and Sciences, Queen's University, Kingston, Ontario, Canada
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Kaneko H, Itoh H, Morita K, Sugimoto T, Konishi M, Kamiya K, Kiriyama H, Kamon T, Fujiu K, Michihata N, Jo T, Takeda N, Morita H, Yasunaga H, Komuro I. Early Initiation of Feeding and In-Hospital Outcomes in Patients Hospitalized for Acute Heart Failure. Am J Cardiol 2021; 145:85-90. [PMID: 33454342 DOI: 10.1016/j.amjcard.2020.12.082] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 11/28/2022]
Abstract
Extensive data on early nutrition support for patients requiring critical care are available. However, whether early initiation of feeding could be beneficial for patients hospitalized for acute heart failure (HF) remains unclear. We sought to compare outcomes of early and delayed initiation of feeding for hospitalized patients with acute HF using a nationwide inpatient database. We retrospectively analyzed data from the Diagnosis Procedure Combination database. We included patients hospitalized for HF between January 2010 and March 2018. We excluded patients with length of hospital stay ≤2 days, those patients who underwent major procedures under general anesthesia, and those requiring advanced mechanical supports within 2 days after admission including intubation, intra-aortic balloon pumping, and extracorporeal membrane oxygenation. Propensity score matching and instrumental variable analyses were conducted to compare in-hospital mortality, complications and length of stay between the early and delayed feeding groups. Among 432,620 eligible patients, 403,442 patients (93%) received early initiation of feeding (within 2 days after admission) and 29,178 patients (7%) received delayed initiation of feeding. Propensity score matching created 29,153 pairs and delayed initiation of feeding was associated with higher in-hospital mortality (odds ratio 1.32; 95% confidence interval 1.26 to 1.39), longer hospital stay and higher incidence of pneumonia and sepsis. The instrumental variable analysis also showed patients with delayed initiation of feeding had higher in-hospital mortality (odds ratio 1.34; 95% confidence interval 1.28 to 1.40). In conclusion, our analysis suggested a potential benefit of early initiation of feeding for in-hospital outcomes in hospitalized patients hospitalized for acute HF. Further investigations are required to confirm our results and to clarify the underlying mechanisms.
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Affiliation(s)
- Hidehiro Kaneko
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan; The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan.
| | - Hidetaka Itoh
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Kojiro Morita
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; The Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tadafumi Sugimoto
- Department of Clinical Laboratory, Mie University Hospital, Mie, Japan
| | - Masaaki Konishi
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kentaro Kamiya
- The Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Hiroyuki Kiriyama
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Kamon
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuhito Fujiu
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan; The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Norifumi Takeda
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
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Lee J, Lee EY, Yeo YJ, Oh YS, Hong SS, Lee JM. Pharmacological Interventions on Surgical Intensive Care Units Initiated by Pharmacists. JOURNAL OF ACUTE CARE SURGERY 2021. [DOI: 10.17479/jacs.2021.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Hatakeyama J, Aso S. Bacterial Contamination during Continuous Administration of Liquid Enteral Nutrition Formula in a Sterile Sealed Bag: A Prospective Interventional Study. ANNALS OF NUTRITION AND METABOLISM 2021; 77:56-60. [PMID: 33789263 DOI: 10.1159/000515061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/29/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In nutrition therapy for critically ill patients, it is recommended that enteral nutrition (EN) formula be changed every 8 h to avoid bacterial contamination. However, it remains unknown whether long-term administration of EN formula from a sterile sealed bag without changing the formula can cause bacterial contamination. This study investigates the association between bacterial contamination and administration of liquid EN formula from a sterile sealed bag without changing the formula for 24 h. METHODS This single-center, prospective, interventional study included patients aged ≥20 years who were admitted to an intensive care unit and received 24-h continuous liquid EN formula from a sterile sealed bag. A 3-mL sample of the formula was collected from each bag every 4 h for bacterial culture. The primary outcome was the detection of bacterial colonies. RESULTS A total of 630 specimens from 30 patients were cultured. No bacterial colonies were detected. CONCLUSION There was no association between bacterial contamination and continuous administration of liquid EN formula from a sterile sealed bag for 24 h. Therefore, this study recommends continuous administration of EN from a sterile sealed bag for 24 h without changing the EN formula under those limited conditions.
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Affiliation(s)
- Junji Hatakeyama
- Department of Emergency and Critical Care Medicine, Yokohama City Minato Red Cross Hospital, Yokohama, Japan.,Department of Emergency and Critical Care Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Shotaro Aso
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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McClave SA, Omer E. Point-Counterpoint: Indirect Calorimetry Is not Necessary for Optimal Nutrition Therapy in Critical Illness. Nutr Clin Pract 2021; 36:268-274. [PMID: 33769598 DOI: 10.1002/ncp.10657] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Clinicians have widely recognized that indirect calorimetry (IC) is the "gold standard" for measuring energy expenditure (EE) and thus would intuitively anticipate that its use would be needed to provide optimal nutrition support in critical illness. Recent studies in the literature as well as dramatic changes in clinical practice over the past decade, though, would suggest that such a precise measure by IC to set energy goals is not required to maximize clinical benefit from early feeding in the intensive care unit (ICU). Results from randomized controlled trials evaluating permissive underfeeding, use of supplemental parenteral nutrition to achieve tight calorie control, and caloric density of formulas to increase energy delivery have provided an important perspective on 3 pertinent issues. First, a simple weight-based predictive equation (25 kcal/kg/day) provides a clinically useful approximation of EE. Second, a precise measure of EE by IC does not appear to improve outcomes compared with use of this less accurate estimation of energy requirements. And third, providing some percentage of requirements (50%-80%), achieves similar clinical benefit to full feeding (100%) in the early phases of critical illness. The value from IC use lies in the determination of caloric requirements in conditions for which weight-based equations are rendered inaccurate (anasarca, amputation, severe obesity) or the clinical state is markedly altered (such as the prolonged hyperinflammatory state of coronavirus disease 2019 [COVID-19]). In most other circumstances, routine use of IC would not be expected to change clinical outcomes from early nutrition therapy in the ICU.
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Affiliation(s)
- Stephen A McClave
- Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Endashaw Omer
- Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville School of Medicine, Louisville, Kentucky, USA
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Mezzomo TR, Fiori LS, de Oliveira Reis L, Schieferdecker MEM. Nutritional composition and cost of home-prepared enteral tube feeding. Clin Nutr ESPEN 2021; 42:393-399. [PMID: 33745611 DOI: 10.1016/j.clnesp.2020.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/28/2020] [Accepted: 12/18/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS To aid in dietary prescription and contribute to the promotion of food and nutritional safety of individuals, this study's objective was to compare the nutritional composition and cost of homemade preparations, blended preparations, and commercial enteral formula prescribed for adults and elderly people at hospital discharge. METHODS All hospitals in a Brazilian city that prescribed the three types of enteral formulations provide information about enteral formulations prescribed for home use. Enteral formulations were estimated in relation to energy content, macronutrients, micronutrients, and cost. RESULTS Homemade diets, blended and commercial enteral formulations showed, on average, normoproteic, normoglicidic and normolipidic features, with average daily costs (US$/2000 kcal) of US$ 29.77, 50.56 and 154.44, respectively. The cost was higher in the commercial enteral formulas (P < .001); vitamin and mineral content were poorer in homemade preparations. CONCLUSIONS The homemade and blended enteral preparations cost less, but were generally lower in micronutrients, calling for more adequate dietary prescription.
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Affiliation(s)
- Thais Regina Mezzomo
- Nutrition Course, International University Center UNINTER, Treze de Maio St, 538, 80510-030, São Francisco, Curitiba, Brazil; Master´s and Doctoral Graduate Program in Child and Adolescent Health, Federal University of Parana (UFPR), General Carneiro St., 181, Alto da Gloria, 80.060-900, Curitiba, Parana, Brazil.
| | - Lize Stangarlin Fiori
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Parana (UFPR), Lothario Meissner Ave., 632, Jardim Botanico Campus, 80.210-170, Curitiba, Parana, Brazil
| | - Letícia de Oliveira Reis
- Nutrition Course, Positivo University, Prof. Pedro Viriato Parigot de Souza St, 5300, Campo Comprido, 81280-330, Curitiba, Brazil
| | - Maria Eliana Madalozzo Schieferdecker
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Parana (UFPR), Lothario Meissner Ave., 632, Jardim Botanico Campus, 80.210-170, Curitiba, Parana, Brazil
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Comprehensive metabolic amino acid flux analysis in critically ill patients. Clin Nutr 2021; 40:2876-2897. [PMID: 33946038 DOI: 10.1016/j.clnu.2021.03.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/04/2021] [Accepted: 03/12/2021] [Indexed: 01/16/2023]
Abstract
Amino acid (AA) metabolism is severely disturbed in critically ill ICU patients. To be able to make a more scientifically based decision on the type of protein or AA nutrition to deliver in ICU patients, comprehensive AA phenotyping with measurements of plasma concentrations and whole body production (WBP) is needed. Therefore, we studied ICU patients and matched control subjects using a novel pulse isotope method to obtain in-depth metabolic analysis. In 51 critically ill ICU patients (SOFA~6.6) and 49 healthy controls, we measured REE and body composition/phase-angle using BIA. In the postabsorptive state, we collected arterial (ized) blood for CRP and AA. Then, we administered an 8 mL solution containing 18 stable AA tracers as a pulse and calculated WBP. Enrichments: LC-MS/MS and statistics: t-test, ANCOVA. Compared to healthy, critically ill ICU patients had lower phase-angle (p < 0.00001), and higher CRP (p < 0.0001). Most AA concentrations were lower in ICU patients (p < 0.0001), except tau-methylhistidine and phenylalanine. WBP of most AA were significantly (p < 0.0001) higher with increases in glutamate (160%), glutamine (46%), and essential AA. Remarkably, net protein breakdown was lower. There were only weak relationships between AA concentrations and WBP. Critically ill ICU patients (SOFA 8-16) had lower values for phase angle (p = 0.0005) and small reductions of most plasma AA concentrations, but higher tau-methylhistidine (p = 0.0223) and hydroxyproline (p = 0.0028). Remarkably, the WBP of glutamate and glutamine were lower (p < 0.05), as was their clearance, but WBP of tau-methylhistidine (p = 0.0215) and hydroxyproline (p = 0.0028) were higher. Our study in critically ill ICU patients shows that comprehensive metabolic phenotyping was able to reveal severe disturbances in specific AA pathways, in a disease severity dependent way. This information may guide improving nutritional compositions to improve the health of the critically ill patient. CLINICAL TRIAL REGISTRY: Data are from the baseline measurements of study NCT02770092 (URL: https://clinicaltrials.gov/ct2/show/NCT02770092) and NCT03628365 (URL: https://clinicaltrials.gov/ct2/show/NCT03628365).
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Crovesy L, El-Bacha T, Rosado EL. Modulation of the gut microbiota by probiotics and symbiotics is associated with changes in serum metabolite profile related to a decrease in inflammation and overall benefits to metabolic health: a double-blind randomized controlled clinical trial in women with obesity. Food Funct 2021; 12:2161-2170. [PMID: 33565558 DOI: 10.1039/d0fo02748k] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Modulation of the gut microbiota may help in treating obesity by improving host metabolic health. We aimed to evaluate the effects of probiotics or symbiotics on body weight and serum metabolite profile in women with obesity. A double-blind, parallel, randomized, controlled clinical trial was conducted with 32 adult women with body mass index ranging from 30 to 34.9 kg m-2. Volunteers followed a low-energy diet and were subjected to 8 weeks intervention: probiotic group (PG - Bifidobacterium lactis UBBLa-70, n = 10), symbiotic group (SG - Bifidobacterium lactis UBBLa-70 and fructooligosaccharide, n = 11), or control group (CG - placebo, n = 11). Analyses of anthropometric variables, gut microbiota and serum metabolites by 1H nuclear magnetic resonance (NMR) were performed at baseline and after the intervention. Multivariate statistics showed that all groups presented a decrease in glycerol and increase in arginine, glutamine and 2-oxoisovalerate. Therefore, a low-energy diet per se promoted changes in the metabolite profile related to decreased inflammation and positive effects on body weight. SG presented unique changes in metabolites (increase in pyruvate and alanine and decrease in citrate and BCAA). Negative correlations between arginine and glutamine with fat mass were observed in the SG. PG presented a decrease in 1H NMR lipid signals and negative correlation between Verrucomicrobia and Firmicutes with (CH2)n lipids. Both probiotics and symbiotics promoted changes in metabolites related to improved metabolic health. Specific metabolite changes following symbiotic intervention might suggest some advantage in providing Bifidobacterium lactis in combination with fructooligosaccharide in a low-energy diet, rather than probiotics or diet alone. Clinical trial: NCT02505854.
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Affiliation(s)
- Louise Crovesy
- Department of Nutrition and Dietetics (DND), Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro - RJ, Brazil.
| | - Tatiana El-Bacha
- Lebiome - Núcleo de estudos com bioativos, Mitocôndria e metabolismo da placenta, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro - RJ, Brazil
| | - Eliane Lopes Rosado
- Department of Nutrition and Dietetics (DND), Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro - RJ, Brazil.
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Cinotti R, Lascarrou JB, Azais MA, Colin G, Quenot JP, Mahé PJ, Roquilly A, Gaultier A, Asehnoune K, Reignier J. Diuretics decrease fluid balance in patients on invasive mechanical ventilation: the randomized-controlled single blind, IRIHS study. Crit Care 2021; 25:98. [PMID: 33691730 PMCID: PMC7943707 DOI: 10.1186/s13054-021-03509-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/16/2021] [Indexed: 01/09/2023] Open
Abstract
Background Fluid overload has been associated with increased morbidity and mortality in critically ill patients. The goal of this study was to assess the efficacy and safety of a diuretic strategy to overcome positive fluid balance in patients on invasive mechanical ventilation.
Methods Design: Multicenter, single-blind, randomized-controlled study. Patients were randomized into a diuretic (furosemide) or a control group. Patients were eligible in case of fluid overload defined as in-ICU weight increase ≥ 3%, invasive mechanical ventilation (FiO2 ≤ 60% and PEEP ≤ 10 cm H2O on inclusion) and hemodynamic stabilization. The primary outcome was fluid balance, defined as weight variation from reference weight to successful extubation. The main secondary outcome was the safety of diuretic. Results 171 patients were randomized. After 5 exclusions, 166 patients were included in the analysis: 77 in the diuretic and 89 in the control group. Fluid balance was 1.4 [− 2.5 to 4.5] kg in the diuretic and 6.4 [0.5–11.2] kg in the control group (p < 0.001). In the multiple imputation analysis, fluid balance was significantly decreased in the diuretic group (mean difference = − 4.8 95% CI [− 7.3 to − 2.5], p < 0.001). Eleven (14%) patients died in the diuretic group and 16 (18%) patients in the control group (p = 0.5). There was a worsening of Acute Kidney Injury in 67 (75.3%) patients of the control group versus 46 (59.7%) patients in the diuretic group (p = 0.03). Conclusions In this multicenter randomized-controlled study, protocolized diuretic therapy reduced fluid accumulation in patients receiving mechanical ventilation and was well tolerated with a favorable safety profile. Trial registration NCT 02345681, Registered January 26 2015, Prospectively registered, https://clinicaltrials.gov/ct2/show/NCT02345681?term=02345681&draw=2&rank=1. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03509-5.
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Affiliation(s)
- Raphaël Cinotti
- CHU Nantes, Pôle Anesthésie-Réanimation, Service d'Anesthésie Réanimation Chirurgicale, Hôpital Guillaume et René Laennec, Université de Nantes, 44800, Saint-Herblain, France
| | - Jean-Baptiste Lascarrou
- Médecine Intensive et Réanimation, Hôtel Dieu, University Hospital of Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France
| | - Marie-Ange Azais
- Médecine Intensive et Réanimation, Centre Hospitalier Départemental de la Vendée, La Roche-sur-Yon, France
| | - Gwenhaël Colin
- Médecine Intensive et Réanimation, Centre Hospitalier Départemental de la Vendée, La Roche-sur-Yon, France
| | - Jean-Pierre Quenot
- Service de Médecine Intensive-Réanimation, CHU Dijon-Bourgogne, Dijon, France.,Equipe Lipness, Centre de Recherche INSERM UMR1231 et LabEx LipSTIC, Université de Bourgogne-Franche Comté, Dijon, France.,INSERM, CIC 1432, Module Épidémiologie Clinique, Université de Bourgogne-Franche Comté, Dijon, France
| | - Pierre-Joachim Mahé
- CHU Nantes, Pôle Anesthésie-Réanimation, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Université de Nantes, 44093, Nantes, France
| | - Antoine Roquilly
- CHU Nantes, Pôle Anesthésie-Réanimation, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Université de Nantes, 44093, Nantes, France.,Laboratoire UPRES EA 3826 «Thérapeutiques cliniques et expérimentales des infections», University Hospital of Nantes, 1 rue Gaston Veil, 44035, Nantes Cedex 1, France
| | - Aurélie Gaultier
- Direction de la recherche, Plateforme de Méthodologie et Biostatistique, CHU de Nantes, Nantes, France
| | - Karim Asehnoune
- CHU Nantes, Pôle Anesthésie-Réanimation, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Université de Nantes, 44093, Nantes, France. .,Laboratoire UPRES EA 3826 «Thérapeutiques cliniques et expérimentales des infections», University Hospital of Nantes, 1 rue Gaston Veil, 44035, Nantes Cedex 1, France.
| | - Jean Reignier
- Médecine Intensive et Réanimation, Hôtel Dieu, University Hospital of Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France.
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Abu Hdaib N, Albsoul-Younes A, Wazaify M. Oral medications administration through enteral feeding tube: Clinical pharmacist-led educational intervention to improve knowledge of Intensive care units' nurses at Jordan University Hospital. Saudi Pharm J 2021; 29:134-142. [PMID: 33679176 PMCID: PMC7910138 DOI: 10.1016/j.jsps.2020.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/31/2020] [Indexed: 01/10/2023] Open
Abstract
Introduction Medication administration through enteral feeding tubes is a practice that is commonly encountered in hospital settings, particularly in critically ill patients. This study aims to evaluate the knowledge of intensive care unit nurses regarding enteral medication administration and evaluate the effect of an educational intervention led by a clinical pharmacist that would improve nurses’ knowledge regarding the subject. Methods A pre/post interventional study was conducted. Improvement in nurses’ knowledge regarding medication administration through an enteral feeding tube was assessed using a validated questionnaire. Results Data were coded, entered, and analyzed using the Statistical Package for Social Sciences (IBM SPSS statistics 22). Independent samples t-test and paired t-test were used to detect any statistically significant differences in the mean total knowledge scores both between and within each group respectively. A P-value of <0.05 was considered statistically significant. The mean total knowledge score for nurses in the intervention and control group at the pre-interventional phase of the study was inadequate. There was a statistically significant improvement in the mean total knowledge score for the interventional group at the post-interventional phase of the study, while that of the control group remained inadequate (Intervention group total mean knowledge score at baseline 12.11 ± 3.75, post-intervention 21.50 ± 2.36, p-value <0.001; Control group total mean knowledge score at baseline 12.05 ± 3.12, post-intervention 12.60 ± 3.76, p-value 0.96). Conclusion Incorrect drug preparation and administration for patients with feeding tubes can affect patients. The knowledge of nurses regarding the subject can be improved significantly via an educational intervention. The activation of clinical pharmacists’ role and collaboration between pharmacists, physicians, and nurses is highly recommended in this clinical setting.
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Affiliation(s)
- N. Abu Hdaib
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Jordan
- Department of Pharmacy, Faculty of Pharmacy, Middle East University, Amman, Jordan
| | - A. Albsoul-Younes
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Jordan
| | - M. Wazaify
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Jordan
- Corresponding author at: Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman 11942, Jordan.
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Percutaneous Endoscopic Gastrostomy Enhances Interstage Growth in Infants With Hypoplastic Left Heart Syndrome. Pediatr Crit Care Med 2021; 22:e213-e223. [PMID: 33055529 DOI: 10.1097/pcc.0000000000002596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Infants with hypoplastic left heart syndrome undergoing staged palliation commonly experience chronic growth failure and malnutrition. Greater patient weight at stage 2 palliation (Glenn) is thought to be associated with improved perioperative outcomes. We aimed to compare weight for age z score and interstage growth velocity in children with and without a percutaneous endoscopic gastrostomy prior to Glenn and hypothesize that those with a percutaneous endoscopic gastrostomy experience-enhanced interstage growth and reduced malnutrition rates. DESIGN Single-center, retrospective cohort study. SETTING A total of 259-bed, quaternary, pediatric referral center. PATIENTS Infants with hypoplastic left heart syndrome from 2007 to 2016 with and without percutaneous endoscopic gastrostomy insertion after initial palliation (Norwood). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Primary outcomes were weight for age z score (at birth, Norwood, Norwood discharge, and Glenn), interstage growth velocity, and moderate-to-severe malnutrition (weight for age z score<-2) rates. Secondary outcomes were lengths of stay, mechanical ventilation rates after Glenn, and mortality. Statistical analyses included chi-square, Wilcoxon rank-sum, student's t, paired testing, and exploratory logistic regression. Of the 69 infants studied, 47 (68%) had percutaneous endoscopic gastrostomy insertion at a median of 156 (interquartile range, 115-158) days prior to Glenn. Among children with and without percutaneous endoscopic gastrostomy, we observed no differences in demographics, comorbidities, cardiothoracic surgical times, postoperative Glenn outcomes (length of stay, mechanical ventilation rate, peak 24-hr lactate, nitric oxide use, extracorporeal life support rate, or mortality), weight for age z score at birth, and weight for age z score at Norwood. At the time of percutaneous endoscopic gastrostomy insertion, weight for age z score was -2.5 ± 1.3 and subsequent growth velocity increased from 8 ± 7 to 40 ± 59 g/d (p < 0.01). From Norwood discharge to the date of Glenn, weight for age z score increased in infants with percutaneous endoscopic gastrostomy (-2.5 ± 1.1 to -1.5 ± 1.4 [p < 0.01]) with a large reduction in moderate-to-severe malnutrition rates (76-36%; p < 0.01). In general, weight for age z score at the time of Glenn was associated with reduced postoperative mortality (odds ratio, 0.3; 95% CI, 0.09-0.95; p = 0.04). CONCLUSIONS Infants undergoing palliation for hypoplastic left heart syndrome with percutaneous endoscopic gastrostomy insertion prior to Glenn had improved growth velocity and dramatically reduced rates of moderate-to-severe malnutrition rates (40% reduction). In addition, we noted weight for age z score at when Glenn was associated with improved postoperative Glenn survival. No complications from percutaneous endoscopic gastrostomy were noted. Placement of a percutaneous endoscopic gastrostomy improved weight for age z score, enhanced interstage growth, and reduced malnutrition rates for this at-risk population of malnourished children.
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Bing X, Yinshan T, Ying J, Yingchuan S. Efficacy and safety of a modified method for blind bedside placement of post-pyloric feeding tube: a prospective preliminary clinical trial. J Int Med Res 2021; 49:300060521992183. [PMID: 33622069 PMCID: PMC7907950 DOI: 10.1177/0300060521992183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective To compare the efficacy and safety of a new modified method of bedside
post-pyloric feeding tube catheterization with the Corpak protocol versus
electromagnetic-guided catheterization. Materials and Methods We conducted a single-center, single-blinded, prospective clinical trial.
Sixty-three patients were treated with a non-gravity type gastrointestinal
feeding tube using different procedures: modified bedside post-pyloric
feeding tube placement (M group), the conventional Corpak protocol (C
group), and standard electromagnetic-guided tube placement (EM group). Results The success rate in the M group, C group, and EM group was 82.9% (34/41),
70.7% (29/41), and 88.2% (15/17), respectively, with significant differences
among the groups. The time required to pass the pylorus was significantly
shorter in the M group (26.9 minutes) than in the C group (31.9 minutes) and
EM group (42.1 minutes). The proportion of pylorus-passing operations
completed within 30 minutes was significantly higher in the M group than in
the C group and EM group. No severe complications occurred. Conclusion This modified method of bedside post-pyloric feeding tube catheterization
significantly shortened the time required to pass the pylorus with no severe
adverse reactions. This method is effective and safe for enteral nutrition
catheterization of patients with dysphagia and a high risk of aspiration
pneumonia.
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Affiliation(s)
- Xiong Bing
- Department of Rehabilitation, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR China
| | - Tang Yinshan
- Department of Rehabilitation, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR China
| | - Jin Ying
- Department of Rehabilitation, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR China
| | - Shen Yingchuan
- Department of Radiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR China
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71
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Guo W, Zheng R, Xue S, Lv B, Zhang H. Factors associated with fluoroscopy-guided placement of nasoenteral feeding tubes. Nutr Clin Pract 2021; 36:884-890. [PMID: 33624347 DOI: 10.1002/ncp.10636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Feeding by nasoenteral tube (NET) is safe and effective for supporting the nutrition needs of patients with inadequate oral intake. However, during insertion of the NET with fluoroscopic guidance, both the professional staff and patients are exposed to radiation. To improve the success rate of NET placement and minimize radiation exposure, this retrospective study evaluated potential factors associated with successful fluoroscopy-guided NET placement and short total fluoroscopy time (TFT) among Chinese patients. METHODS An assessment was conducted among patients (n = 348) who received NET placement by physicians under fluoroscopic guidance. Multivariate logistic regression models and linear models were used to validate factors that affected the success of placement and TFT. RESULTS NET was placed successfully in 319 patients (91.7%), with a median TFT of 6.1 (interquartile range [IQR], 4.9-9.9) minutes. The median TFT of patients with unsuccessful placement was 15.4 (IQR, 12.7-20.9) minutes. Factors associated with successful placement included lack of upper gastrointestinal (GI) surgery history and normal peristalsis of the upper GI tract (P ≤ .015). The TFT was significantly influenced by upper GI surgery history and characteristics of the upper GI tract (P ≤ .025). The professional title or experience of the operators had no association with successful NET placement or TFT. CONCLUSIONS NET placement under fluoroscopic guidance had a high success rate. Factors that are crucial for planning the approach include a history of upper GI surgery, the dynamic status of the upper GI tract, and features of the upper GI tract.
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Affiliation(s)
- Weiying Guo
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Ruipeng Zheng
- Department of Interventional Therapy, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Suyang Xue
- Department of Interventional Therapy, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Bin Lv
- Department of Interventional Therapy, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Haifeng Zhang
- Department of Interventional Therapy, The First Hospital of Jilin University, Changchun, Jilin, China
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Özdemir U, Yıldız Ş, Aygencel G, Türkoğlu M. Ultrasonography-guided post-pyloric feeding tube insertion in medical intensive care unit patients. J Clin Monit Comput 2021; 36:451-459. [PMID: 33599881 DOI: 10.1007/s10877-021-00672-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 02/05/2021] [Indexed: 11/26/2022]
Abstract
In this study, we investigated placement rate, complication rate and time spent of successful post-pyloric enteral feeding (PPEF) tube insertion procedure guided by ultrasonography (USG). The patients who required enteral nutrition and who admitted to medical intensive care unit (MICU) of Gazi University Hospital were included to this single-center, prospective, cohort study. It was aimed to insert the enteral feeding tube into the proximal duodenum as the post-pyloric area by ultrasonography guidance. During the PPEF tube insertion procedure, the linear probe was used to display the proximal esophagus and the convex probe was used to display the post-pyloric area, antrum and pyloric channel. 33 patients were included in this study. The median age was 68 [IQR 52-79] years. There were 17 (51.5%) woman and 22 (66.7%) intubated patients. The enteral feeding tube was successfully passed into the post-pyloric area in 29 (87.9%) patients with this technique. The median time of successful feeding tube insertion was 14 [IQR 10-25] min. The median level of the enteral feeding tube was 74 [IQR 70-76] cm. in successful placement. There was no significant difference in insertion time according to gender (female vs male; 10 [IQR 8-20] min. vs 17 [IQR 12-25] min., p = 0.052) and endotracheal intubation status (intubated vs non-intubated; 14 [IQR 10-25] min. vs 12 [IQR 10-25] min., p = 0.985). Only one complication was seen during study (self-limiting epistaxis in one patient). PPEF tube insertion under USG guidance could ensure the initiation of enteral feeding safely and rapidly without exposure to radiation in ICU patients.
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Affiliation(s)
- Uğur Özdemir
- Division of Critical Care Medicine, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey.
| | - Şeyma Yıldız
- Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Gulbin Aygencel
- Division of Critical Care Medicine, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Melda Türkoğlu
- Division of Critical Care Medicine, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
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Hiesmayr M, Csomos A, Dams K, Elke G, Hartl W, Huet O, Krzych LJ, Kuechenhoff H, Matejovic M, Puthucheary ZA, Rooyackers O, Tetamo R, Tjäder I, Vaquerizo C. Protocol for a prospective cohort study on the use of clinical nutrition and assessment of long-term clinical and functional outcomes in critically ill adult patients. Clin Nutr ESPEN 2021; 43:104-110. [PMID: 34024501 DOI: 10.1016/j.clnesp.2021.01.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/20/2020] [Accepted: 01/15/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS Limited data are available on the impact of clinical nutrition over the course of critical illness and post-discharge outcomes. The present study aims to characterize the use of nutrition support in patients admitted to European intensive care units (ICUs), and its impact on clinical outcomes. Here we present the procedures of data collection and evaluation. METHODS Around 100 medical, surgical, or trauma ICUs in 11 countries (Austria, Belgium, Czech Republic, Germany, France, Hungary, Italy, Poland, Spain, Sweden, United Kingdom) participate in the study. In defined months between November 2019 and April 2020, approximately 1250 patients are enrolled if staying in ICU for at least five consecutive days. Data from ICU day 1-4 are collected retrospectively, followed by a prospective observation period from day 5-90 after ICU admission. Data collection includes patient characteristics, nutrition parameters, complications, ICU and hospital length of stay, discharge status, and functional outcomes. For data analysis, the target is 1000 patients with complete data. Statistical analyses will be descriptive, with multivariate analyses adjusted for potential confounders to explore associations between nutritional balance and change in functional status, time-to-weaning from invasive mechanical ventilation, time to first clinical complication, and overall 15, 30 and 90-day survival. ETHICS AND DISSEMINATION This non-interventional study was reviewed and approved by the ethics committee of the Medical University Vienna, Vienna, Austria (approval number 1678/2019), and the respective ethical committees from participating sites at country and/or local level, as required. Results will be shared with investigators on a country level, and a publication and results presentation at the 2021 ESPEN Congress is planned. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT04143503.
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Affiliation(s)
- M Hiesmayr
- Division of Cardiac, Thoracic, Vascular Anesthesia and Intensive Care, and Center for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Spitalgasse 23, Vienna, Austria.
| | - A Csomos
- MH EK Honvedkorhaz, Budapest, Hungary.
| | - K Dams
- Department of Critical Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem, Belgium.
| | - G Elke
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany.
| | - W Hartl
- Klinik Fuer Allgemeine, Viszeral-, und Transplantationschirurgie, Klinikum der Universitaet, Campus Grosshadern, Ludwig-Maximilians-Universität Muenchen, Munich, Germany.
| | - O Huet
- CHRU la Cavale Blanche, Brest, France.
| | - L J Krzych
- Medical University of Silesia, Katowice, Poland.
| | - H Kuechenhoff
- Statistisches Beratungslabor, Institut Fuer Statistik Ludwig-Maximilians-Universitaet Muenchen, Germany.
| | - M Matejovic
- First Medical Department, Faculty of Medicine in Pilsen, Charles University and University Hospital in Pilsen, Czech Republic.
| | - Z A Puthucheary
- Barts Health (Royal London) & Queen Mary University of London, London, England, UK.
| | - O Rooyackers
- Klinisk Vetenskap, Intervention Och Teknik, Anestesi, Karolinska Institut, Stockholm, Sweden.
| | - R Tetamo
- Ospedale Civile di Guastalla (Reggio Emilia), Italy.
| | - I Tjäder
- Karolinska University Hospital, PMI Huddinge, Stockholm, Sweden.
| | - C Vaquerizo
- Department of Intensive Care Medicine, Fuenlabrada University Hospital (Hospital Universitario de Fuenlabrada), Madrid, Spain.
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Kim SH, Bu SY. Effect of the Timing of Nutritional Support Team Intervention on Nutritional Status on Patients Receiving Enteral Nutrition. Clin Nutr Res 2021; 10:1-13. [PMID: 33564648 PMCID: PMC7850813 DOI: 10.7762/cnr.2021.10.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/09/2021] [Accepted: 01/11/2021] [Indexed: 12/03/2022] Open
Abstract
Many hospitalized patients usually have a high risk of malnutrition, which delays the therapy process and can lead to severe complications. Despite of the potential benefits, the effects of timely intervention by nutrition support team (NST) on the nutritional status of admitted patients are not well established. This study aimed to compare the nutritional status between patients with early and delayed NST supports and to assess the effect of the timing of NST support initiation on the nutritional status of enteral nutrition patients. In a simple comparison between the two groups, the early NST intervention group had shorter hospital stays and fewer tube feeding periods than the delayed NST intervention group. The increase in the amount of energy intake from first to last NST intervention was 182.3 kcal in patients in the early NST intervention group, higher than that in patients in the delayed intervention group (p = 0.042). The extent of reduction in serum albumin and hemoglobin levels between the initial and last NST intervention tended to be lower in the early NST intervention group than in the delayed NST intervention group. The mean odds ratio for the patients who were severely malnourished in the early NST intervention group was 0.142 (95% confidence interval, 0.045–0.450) after adjusting for hospital stay and age. The results of this study indicate that early NST intervention can improve patients' overall nutritional status.
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Affiliation(s)
- Su Hyun Kim
- Department of Food and Nutrition, Daegu University, Gyeongsan 38453, Korea.,Dietary Team, Daegu Fatima Hospital, Daegu 41199, Korea
| | - So Young Bu
- Department of Food and Nutrition, Daegu University, Gyeongsan 38453, Korea
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75
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Neuromuscular Electrical Stimulation Improves Energy Substrate Metabolism and Survival in Mice With Acute Endotoxic Shock. Shock 2021; 53:236-241. [PMID: 31935202 PMCID: PMC6964866 DOI: 10.1097/shk.0000000000001354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study investigated the therapeutic benefits of neuromuscular electrical stimulation (NMES). C57BL/6 mice were administered lipopolysaccharide (LPS; 20 mg/kg body weight) by intraperitoneal injection and divided into control (C) and NMES groups (n = 10–12 each). The latter received NMES to the bilateral gastrocnemius muscle for 1 h at low or high frequency (LF = 2 Hz and HF = 50 Hz, respectively) and low or high voltage (LV = 10 V and HV = 50 V, respectively). In LF–LV and LF–HV groups, NMES was performed twice and the results were compared with those for mice that received one round of NMES. Changes in energy metabolism were measured by indirect calorimetry up to 24 h; survival was evaluated up to 72 h after LPS administration; peroxisome proliferator-activated receptor gamma coactivator (PGC)-1α expression in the liver and gastrocnemius muscle was evaluated by quantitative PCR; and plasma concentration of interleukin (IL)-6 was determined by enzyme-linked immunosorbent assay. Survival was improved only in the LF–LV group with one round of NMES (P < 0.01) and the LF–HV group with two rounds of NMES (P < 0.05). Fatty acid oxidation (FAO) was slightly increased in these two groups, whereas carbohydrate oxidation (CHO) was decreased or not changed. Significant upregulation of PGC-1α in muscle as well as a decrease in plasma IL-6 level were also observed in these two groups (P < 0.05). Thus, NMES exerts therapeutic effects under conditions that induce a mild switch in energy metabolism from glucose to lipid predominant metabolism through PGC-1α upregulation and suppression of inflammation, and may be an effective early intervention even in hemodynamically unstable patients.
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76
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Carteron L, Samain E, Winiszewski H, Blasco G, Balon AS, Gilli C, Piton G, Capellier G, Pili-Floury S, Besch G. Semi-elemental versus polymeric formula for enteral nutrition in brain-injured critically ill patients: a randomized trial. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:31. [PMID: 33472680 PMCID: PMC7818740 DOI: 10.1186/s13054-020-03456-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/29/2020] [Indexed: 12/14/2022]
Abstract
Background The properties of semi-elemental enteral nutrition might theoretically improve gastrointestinal tolerance in brain-injured patients, known to suffer gastroparesis. The purpose of this study was to compare the efficacy and tolerance of a semi-elemental versus a polymeric formula for enteral nutrition (EN) in brain-injured critically ill patients. Methods Prospective, randomized study including brain-injured adult patients [Glasgow Coma Scale (GCS) ≤ 8] with an expected duration of mechanical ventilation > 48 h. Intervention: an enteral semi-elemental (SE group) or polymeric (P group) formula. EN was started within 36 h after admission to the intensive care unit and was delivered according to a standardized nurse-driven protocol. The primary endpoint was the percentage of patients who received both 60% of the daily energy goal at 3 days and 100% of the daily energy goal at 5 days after inclusion. Tolerance of EN was assessed by the rate of gastroparesis, vomiting and diarrhea. Results Respectively, 100 and 95 patients were analyzed in the SE and P groups: Age (57[44–65] versus 55[40–65] years) and GCS (6[3–7] versus 5[3–7]) did not differ between groups. The percentage of patients achieving the primary endpoint was similar (46% and 48%, respectively; relative risk (RR) [95% confidence interval (CI)] = 1.05 (0.78–1.42); p = 0.73). The mean daily energy intake was, respectively, 20.2 ± 6.3 versus 21.0 ± 6.5 kcal/kg/day (p = 0.42). Protein intakes were 1.3 ± 0.4 versus 1.1 ± 0.3 g/kg/day (p < 0.0001). Respectively, 18% versus 12% patients presented gastroparesis (p = 0.21), and 16% versus 8% patients suffered from diarrhea (p = 0.11). No patient presented vomiting in either group. Conclusion Semi-elemental compared to polymeric formula did not improve daily energy intake or gastrointestinal tolerance of enteral nutrition. Trial registration EudraCT/ID-RCB 2012-A00078-35 (registered January 17, 2012).
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Affiliation(s)
- Laurent Carteron
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, 3 bvd Alexander Fleming, 25000, Besancon, France. .,EA3920, University of Franche Comté, Besancon, France.
| | - Emmanuel Samain
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, 3 bvd Alexander Fleming, 25000, Besancon, France.,EA3920, University of Franche Comté, Besancon, France
| | - Hadrien Winiszewski
- EA3920, University of Franche Comté, Besancon, France.,Medical Intensive Care Unit, University Hospital of Besancon, Besancon, France
| | - Gilles Blasco
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, 3 bvd Alexander Fleming, 25000, Besancon, France
| | - Anne-Sophie Balon
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, 3 bvd Alexander Fleming, 25000, Besancon, France
| | - Camille Gilli
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, 3 bvd Alexander Fleming, 25000, Besancon, France
| | - Gael Piton
- EA3920, University of Franche Comté, Besancon, France.,Medical Intensive Care Unit, University Hospital of Besancon, Besancon, France
| | - Gilles Capellier
- EA3920, University of Franche Comté, Besancon, France.,Medical Intensive Care Unit, University Hospital of Besancon, Besancon, France
| | - Sebastien Pili-Floury
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, 3 bvd Alexander Fleming, 25000, Besancon, France.,EA3920, University of Franche Comté, Besancon, France
| | - Guillaume Besch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, 3 bvd Alexander Fleming, 25000, Besancon, France.,EA3920, University of Franche Comté, Besancon, France
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Yoon J, Kym D, Hur J, Won JH, Yim H, Cho YS, Chun W. Time-varying discrimination accuracy of longitudinal biomarkers for the prediction of mortality compared to assessment at fixed time point in severe burns patients. BMC Emerg Med 2021; 21:1. [PMID: 33407163 PMCID: PMC7786914 DOI: 10.1186/s12873-020-00394-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The progression of biomarkers over time is considered an indicator of disease progression and helps in the early detection of disease, thereby reducing disease-related mortality. Their ability to predict outcomes has been evaluated using conventional cross-sectional methods. This study investigated the prognostic performance of biomarkers over time. METHODS Patients aged > 18 years admitted to the burn intensive care unit within 24 h of a burn incident were enrolled. Information regarding longitudinal biomarkers, including white blood cells; platelet count; lactate, creatinine, and total bilirubin levels; and prothrombin time (PT), were retrieved from a clinical database. Time-dependent receiver operating characteristic curves using cumulative/dynamic and incident/dynamic (ID) approaches were used to evaluate prognostic performance. RESULTS Overall, 2259 patients were included and divided into survival and non-survival groups. By determining the area under the curve using the ID approach, platelets showed the highest c-index [0.930 (0.919-0.941)] across all time points. Conversely, the c-index of PT and creatinine levels were 0.862 (0.843-0.881) and 0.828 (0.809-0.848), respectively. CONCLUSIONS Platelet count was the best prognostic marker, followed by PT. Total bilirubin and creatinine levels also showed good prognostic ability. Although lactate was a strong predictor, it showed relatively poor prognostic performance in burns patients.
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Affiliation(s)
- Jaechul Yoon
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, College of Medicine, Hallym University Medical Center, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul, 07247, South Korea
- Graduate School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Dohern Kym
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, College of Medicine, Hallym University Medical Center, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul, 07247, South Korea
| | - Jun Hur
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, College of Medicine, Hallym University Medical Center, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul, 07247, South Korea.
| | - Jae Hee Won
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, College of Medicine, Hallym University Medical Center, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul, 07247, South Korea
| | - Haejun Yim
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, College of Medicine, Hallym University Medical Center, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul, 07247, South Korea
| | - Yong Suk Cho
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, College of Medicine, Hallym University Medical Center, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul, 07247, South Korea
| | - Wook Chun
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, College of Medicine, Hallym University Medical Center, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul, 07247, South Korea
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Al-Wadees AAN, Al-Khayyat AN, Yaqoob QA. The Outcome of Sepsis Patients Admitted to the Intensive Care Unit: Experience of 100 Cases. Med Arch 2021; 75:35-40. [PMID: 34012197 PMCID: PMC8116088 DOI: 10.5455/medarh.2021.75.35-40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: The term sepsis has a deep root all over medical history. It defined by a many physician and myth such as Homer’s Iliad. Sepsis defined as a clinical syndrome as an outcome from both systemic inflammatory response syndrome and infection. It can complicate by disturb the function of the organ (severe sepsis) and shock (septic shock). Aim: Our study aims to recognize sepsis cases in Al-Sader Medical city during 2019 and evaluate the management’s management and the weak point in this management. Methods: It is a cross-sectional study done in Al-Sader Medical city; data collected from the archived files in the hospital during 2019, 100 cases reported in this period diagnosed and admitted as sepsis or admitted with other diagnosis evolved sepsis. Results: We found that one-third of the patients diagnosed as sepsis admitted to the intensive care unit, the mean duration of management 15.8 days. Many investigations did for these patients, the treatment which given to the patients was iv. fluids and antibiotics for entire patients, we also noted that death occurs in more than half of the patients in our study and death were prevalent among patient with a negative result in blood culture also the male patient was more predominant than the female patient and Najaf residency is more than three-quarters of them. Finally, we found that admission to the intensive care unit from units other than emergency or intensive care unit itself found is nearly one-third of the patient diagnosed as sepsis and the respiratory system was commonly involved and presented as pneumonia. Conclusion: More than half of the diagnosed cases died. The maximum common source of admission was from other hospital units, the severe sepsis and no growth of blood culture closely associated with death.
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Affiliation(s)
| | - Ali Najeh Al-Khayyat
- Department of Surgery, Faculty of Medicine, Jabir Ibn Hayyan Medical University, Iraq
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79
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Does nutritional treatment in patients with dysphagia affect malnutrition and anxiety? NUTR HOSP 2021; 38:533-539. [PMID: 33657826 DOI: 10.20960/nh.03430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Introduction: dysphagia is common in patients with cerebrovascular disease (CVD), with an incidence reported to be 35 %-50 %. Dysphagia can result in malnutrition, dehydration, and death, and negatively affects anxiety levels. Objectives: this study aimed to evaluate the effects of recommended nutritional treatment (NT) on nutritional status and anxiety levels in patients with dysphagia based on clinical and fiber-optic endoscopic evaluation of swallowing (FEES) tests. Methods: seventy-five patients over the age of 50 who were diagnosed with CVD, hospitalized at the Mersin City Research and Training Hospital, Neurology Clinic, from October 2019 to January 2020 were followed up for the study. The FEES test was performed to diagnose dysphagia in CVD patients. Anthropometric measurements of the patients were taken to calculate their body mass index (BMI) values. To determine a patient's daily energy and food intake, 24-h food recalls were taken, and the Nutritional Risk Screening 2002 (NRS 2002) test was used to identify patients at risk of malnutrition. State (SAI)-Trait Anxiety Inventories (TAI) were used to determine instant and general anxiety levels. After patient evaluations NT was provided. All evaluations were repeated 8 weeks after NT. Our study was carried out based on a longitudinal design since we worked with the same units at two different time points. Results: post-NT SAI scores were significantly lower than pre-NT scores (p < 0.05). A moderate correlation was found between pre- and post-NT SAI scores and daily energy and fluid intake status, and between TAI scores and daily energy, fat, and fluid intake amounts (p < 0.05). Post-NT SAI scores significantly decreased with both NRS 2002 and BMI values (p < 0.05). Conclusions: this study highlights the importance of NT in improving rehabilitation outcomes of patients with dysphagia. Since exercises such as postural techniques or maneuvers, and muscle strengthening to reduce swallowing difficulties are an important part of NT for dysphagia, a multidisciplinary study is required for the management of dysphagia, and further studies are needed on this subject.
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80
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Energy and protein intake in critically ill people with respiratory failure treated by high-flow nasal-cannula oxygenation: An observational study. Nutrition 2020; 84:111117. [PMID: 33486298 DOI: 10.1016/j.nut.2020.111117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES High-flow nasal-cannula (HFNC) oxygen therapy is increasingly used in the management of respiratory distress. Since this treatment may be required for many days and may impair nutritional intake, this study planned to observe the energy and protein intake of individuals receiving this therapy. METHODS Forty consecutive patients requiring HFNC oxygenation after extubation or to prevent intubation from November 2017 to June 2018 were included in the study. Demographics, route of nutrition (oral, enteral, or parenteral), calories and protein prescribed and administered, and complications were noted until discharge. Statistical analysis used χ2 or Kruskal-Wallis H test. RESULTS HFNC oxygen therapy was applied for 42 d in the 40 participants. Overall, individuals with HFNC oxygenation therapy received 449.5 (interquartile range [IQR], 312-850) kcal/d and 19.25 (IQR, 13.9-33.3) g/d protein. Twenty-one participants treated with enteral nutrition received 387 (IQR, 273-931) kcal/d and 18.5 (IQR, 13.9-33.3) g/d protein, whereas those with oral feeding (n = 13) received higher totals of calories, 600 (IQR, 459-850) kcal/d (P = 0.056), and protein, 22 (IQR, 20-45) g/d (P = 0.005). Four participants received parenteral nutrition alone, providing 543 (IQR, 375-886.5) kcal/d and 8.7 (IQR, 0-20) g/d protein. When parenteral nutrition was administered with enteral nutrition, it provided only 324 (IQR, 290-358) kcal/d. Two participants did not receive any nutritional support. The overall length of stay in the intensive care unit was 8 (IQR, 5-17.5) d. Participants receiving enteral nutrition had a longer stay (14 d; IQR, 8-20) than the oral-diet group (4 d; IQR, 2-10; P < 0.03). The rate of intubation after HFNC therapy was not significantly different between the groups (P = 0.586). CONCLUSIONS Administration of HFNC oxygen therapy was associated with significant underfeeding. In order to reach optimal caloric and protein intake, parenteral nutrition may be considered.
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81
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Pearcy J, Agarwal E, Isenring E, Somani A, Wright C, Shankar B. Ward-based nutrition care practices and a snapshot of patient care: Results from nutritionDay in the ICU. Clin Nutr ESPEN 2020; 41:340-345. [PMID: 33487287 DOI: 10.1016/j.clnesp.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Poor adherence to intensive care unit (ICU) guidelines is common, leading to suboptimal nutritional care. This study determined current ward-based nutrition care practices in the Indian ICU setting, comparing them to international best-practice guidelines and provided patient demographic, clinical and nutritional information to serve as baseline data for future benchmarking. METHODS This multi-site cross-sectional retrospective study analysed data collected from nutritionDay worldwide audits (2012-2016) across ICUs from a chain of urban private hospitals in India. Additional guideline-specific data were collected through questionnaires and phone interviews with the Head of Dietetics Departments in the participating hospitals. RESULTS Overall, 10 ICUs and 457 participants were included. It was common practice to use modified versions of the Mini Nutritional Assessment-Short Form (MNA-SF) and Subjective Global Assessment (SGA) for nutrition screening and assessment. Nearly half the participants (n = 222, 49%) received nutrition orally. A majority of the remaining participants received enteral nutrition (n = 163, 36%) or no nutrition (n = 60, 13%) at the time of data collection. The calories prescribed for most participants were between 1500 and 1999 kilocalories per day (n = 207, 45%), with no nutrition planned for 115 (25%) participants. Three-quarters (n = 129, 74%) of participants on EN received the planned calories, while 24% (n = 42) were given less than planned. CONCLUSION Overall, most participants received the calories planned for enteral nutrition. The use of modified screening and assessment tools and suboptimal delivery of EN remains a global problem for critical care, possibly requiring a more pragmatic approach to nutritional therapy.
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Affiliation(s)
- Joshua Pearcy
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, 4229, Australia.
| | - Ekta Agarwal
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, 4229, Australia
| | - Elizabeth Isenring
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, 4229, Australia
| | - Ananya Somani
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, 4229, Australia
| | - Charlene Wright
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, 4229, Australia
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Salciute-Simene E, Stasiunaitis R, Ambrasas E, Tutkus J, Milkevicius I, Sostakaite G, Klimasauskas A, Kekstas G. Impact of enteral nutrition interruptions on underfeeding in intensive care unit. Clin Nutr 2020; 40:1310-1317. [PMID: 32896448 DOI: 10.1016/j.clnu.2020.08.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/06/2020] [Accepted: 08/15/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Malnutrition leads to poor outcomes for critically ill patients; however, underfeeding remains a prevalent issue in the intensive care unit (ICU). One of the reasons for underfeeding is enteral nutrition interruption (ENI). Our aim was to investigate the causes, frequency, and duration of ENIs and their association with underfeeding in critical care. METHODS This was a prospective observational study conducted at the Vilnius University Hospital Santaros Clinics, Lithuania, between December 2017 and February 2018. It included adult medical and surgical ICU patients who received enteral nutrition (EN). Data on ENIs and caloric, as well as protein intake were collected during the entire ICU stay. Nutritional goals were assessed using indirect calorimetry, where available. RESULTS In total 73 patients were enrolled in the study. Data from 1023 trial days and 131 ENI episodes were collected; 68% of the patients experienced ENI during the ICU stay, and EN was interrupted during 35% of the trial days. The main reasons for ENIs were haemodynamic instability (20%), high gastric residual volume (GRV) (17%), tracheostomy (16%), or other surgical interventions (16%). The median duration of ENI was 12 [6-24] h, and the longest ENIs were due to patient-related factors (22 [12-42] h). The rate of underfeeding was 54% vs. 15% in the trial days with and without ENI (p < 0.001), respectively. Feeding goal was achieved in 26% of the days with ENI vs. 45% of days without ENI (p < 0.001). The daily average caloric provision was 77 ± 36% vs. 106 ± 29% in the trial days with and without ENI (p < 0.001) and protein provision was 0.96 ± 0.5 vs. 1.3 ± 0.5 g/kg, respectively (p < 0.001). CONCLUSIONS The episodes of ENI in critically ill patients are frequent and prolonged, often leading to underfeeding. Similar observations have been reported by other studies; however, the causes and duration of ENI vary, mainly because of different practices worldwide. Hence, safe and internationally recognised reduced-fasting guidelines and protocols for critically ill patients are needed in order to minimise ENI-related underfeeding and malnutrition.
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Affiliation(s)
- Erika Salciute-Simene
- Centre of Anaesthesiology, Intensive Therapy and Pain Management, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
| | - Raimundas Stasiunaitis
- Centre of Anaesthesiology, Intensive Therapy and Pain Management, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania; Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Eduardas Ambrasas
- Centre of Anaesthesiology, Intensive Therapy and Pain Management, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Jonas Tutkus
- Centre of Anaesthesiology, Intensive Therapy and Pain Management, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania; Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Gintare Sostakaite
- Centre of Anaesthesiology, Intensive Therapy and Pain Management, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Andrius Klimasauskas
- Centre of Anaesthesiology, Intensive Therapy and Pain Management, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Gintautas Kekstas
- Centre of Anaesthesiology, Intensive Therapy and Pain Management, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
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Nakahori Y, Shimizu K, Ogura H, Asahara T, Osuka A, Yamano S, Tasaki O, Kuwagata Y, Shimazu T. Impact of fecal short-chain fatty acids on prognosis in critically ill patients. Acute Med Surg 2020; 7:e558. [PMID: 32864147 PMCID: PMC7447560 DOI: 10.1002/ams2.558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 11/24/2022] Open
Abstract
Aim This study aimed to evaluate the relationship between fecal organic acids and mortality in critically ill patients. Methods This retrospective study included 128 patients who fulfilled the criteria of systemic inflammatory response syndrome and had a serum C‐reactive protein level of greater than 10 mg/dL. Patients were treated in the intensive care unit for more than 2 days. Patients were divided into two groups: survivors and non‐survivors. We measured and compared eight kinds of fecal organic acids between the two groups. We focused on the minimum and maximum value of each fecal organic acid and evaluated prognostic factors by using classification and regression tree (CART) and multivariate logistic regression analyses. Results We included 90 patients as survivors and 38 as non‐survivors. The CART analysis revealed that the dominant factors for mortality were the minimum values of propionate and acetate and the maximum values of lactate and formic acid. In the evaluation of the minimum values of fecal organic acids, propionate was significantly associated with increased mortality (odds ratio, 0.11 [95% confidence interval, 0.024–0.51]; P = 0.005), acetate (0.047 [0.005–0.49]; P = 0.01), and age (1.048 [1.015–1.083]; P = 0.004). In the evaluation of the maximum values, lactate was significantly associated with increased mortality (5.21 [2.024–13.42], P = 0.001) and age (1.050 [1.017–1.084]; P = 0.003). Conclusion An altered balance of fecal organic acids was significantly associated with mortality in critically ill patients.
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Affiliation(s)
- Yasutaka Nakahori
- Division of Trauma and Surgical Critical Care Osaka General Medical Center Osaka Japan.,Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Kentaro Shimizu
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Osaka Japan
| | | | - Akinori Osuka
- Department of Trauma Critical Care Medicine and Burn Center Chukyo Hospital Aichi Japan
| | - Shuhei Yamano
- Acute and Critical Care Center Nagasaki University Hospital Nagasaki Japan
| | - Osamu Tasaki
- Acute and Critical Care Center Nagasaki University Hospital Nagasaki Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Osaka Japan
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Mesenteric ischemia with pneumatosis intestinalis and portal vein gas associated with enteral nutrition: a series of three patients. Clin J Gastroenterol 2020; 13:1160-1164. [PMID: 32794155 DOI: 10.1007/s12328-020-01206-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/05/2020] [Indexed: 01/16/2023]
Abstract
Enteral nutrition is usually associated with a low risk of intestinal complications. We report three non-critically ill patients who received enteral nutrition and developed mesenteric ischemia with pneumatosis intestinalis and hepatic portal vein gas. These findings are often considered to be indications for emergency surgery. In these three patients, prompt cessation of enteral nutrition avoided progression to intestinal necrosis obviating the need for intestinal resection, although one patient underwent surgical exploration. Follow-up computed tomography scan showed resolution of the radiologic findings, and all patients started enteral nutrition again without complications. All patients had comorbidities associated with atherosclerosis, which may have led to a mismatch between oxygen delivery and demand in the bowel, resulting in ischemia. To the best of our knowledge, this is the first report of successful management of mesenteric ischemia related to enteral nutrition in non-critically ill patients without resection. If the cause of mesenteric ischemia such as enteral nutrition, can be eliminated quickly, non-resectional and possibly nonoperative management can be a reasonable management option, with close follow-up and readiness for resection.
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85
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Xu E, Tejada S, Solé-Lleonart C, Campogiani L, Valenzuela-Sanchez F, Koulenti D, Rello J. Evaluation of the quality of evidence supporting guideline recommendations for the nutritional management of critically ill adults. Clin Nutr ESPEN 2020; 39:144-149. [PMID: 32859308 DOI: 10.1016/j.clnesp.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/14/2020] [Accepted: 07/02/2020] [Indexed: 12/29/2022]
Abstract
AIMS The primary aim of this study was to evaluate the quality of evidence supporting the 2019 European Society for Clinical Nutrition and Metabolism (ESPEN) and 2016 American Society for Parenteral and Enteral Nutrition (ASPEN) recommendations for medical nutrition therapy in critically ill patients. Secondary objectives are to assess the differences between 2019 ESPEN and 2016 ASPEN recommendations and to inform relevant stakeholders of areas requiring improvement in the research. METHODS The 2019 ESPEN and 2016 ASPEN guidelines were identified and downloaded from the official websites. The level of evidence and strength of recommendations from the guidelines were standardised to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Level of evidence was classified as high-quality (randomised controlled trials (RCTs) without important limitations), moderate-quality (downgraded RCTs or upgraded observational studies) or low-quality (observational studies without specific strengths or important limitations, case series, case reports). In addition, good practice points (GPP; recommendations based on the clinical experience of the guideline development group) were considered. Strength of recommendation was reported as strong or weak. RESULTS From 152 total recommendations, only five (3.3%) were supported by high-quality evidence, with 14 being strong recommendations. A total of 79 (52.0%) recommendations were GPPs. Overall, the proportion of recommendations supported by high-quality (7% [ESPEN] vs. 1.1% [ASPEN], p < 0.05) and moderate-quality evidence (33.3% [ESPEN] vs. 8.4% [ASPEN], p < 0.01) was significantly higher in ESPEN guidelines. On the other hand, ASPEN guidelines reported a greater proportion of recommendations supported by GPPs (58.9% [ASPEN] vs. 40.4% [ESPEN], p = 0.03). In enteral and parenteral nutrition, the proportion of recommendations supported by moderate-quality evidence (50% [ESPEN] vs. 15.8% [ASPEN], p < 0.01) was significantly higher in ESPEN guidelines. CONCLUSION Published guideline recommendations for the nutritional management of critically ill adults remain largely supported by expert opinion and only a minority by high-quality evidence. An urgent unmet clinical need for high-quality clinical trials is warranted.
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Affiliation(s)
- Elena Xu
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Sofia Tejada
- Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institut of Research (VHIR), Barcelona, Spain; CIBER de Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Barcelona, Spain
| | | | - Laura Campogiani
- Clinical Infectious Diseases, Department of System Medicine, Tor Vergata University, Rome, Italy
| | | | - Despoina Koulenti
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4072, Australia; 2nd Critical Care Department, Attikon University Hospital, 12462, Athens, Greece.
| | - Jordi Rello
- Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institut of Research (VHIR), Barcelona, Spain; CIBER de Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Barcelona, Spain
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86
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Arabi SM, Sedaghat A, Ehsaei MR, Safarian M, Ranjbar G, Rezaee H, Rezvani R, Tabesh H, Norouzy A. Efficacy of high-dose versus low-dose vitamin D supplementation on serum levels of inflammatory factors and mortality rate in severe traumatic brain injury patients: study protocol for a randomized placebo-controlled trial. Trials 2020; 21:685. [PMID: 32727558 PMCID: PMC7388115 DOI: 10.1186/s13063-020-04622-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 07/18/2020] [Indexed: 11/25/2022] Open
Abstract
Background Traumatic brain injury (TBI) is the most common trauma worldwide and is a leading cause of injury-related death and disability. Inflammation is initiated as a result of the TBI, which is in association with severity of illness and mortality in brain trauma patients, especially in subdural hemorrhage and epidural hemorrhage cases. A high percentage of adults admitted to the intensive care unit with TBI are diagnosed with vitamin D deficiency; this deficiency may induce impaired immune responses and increase the risk of infections. Vitamin D intervention has been shown to modulate pro- and anti-inflammatory cytokines in non-critically ill patients, but to date, there is no substantial data on the effectiveness of vitamin D for the improvement of immune function in traumatic brain injury patients. Methods/design A randomized clinical trial (RCT) will be performed on 74 Iranian adults 18–65 years old with brain trauma and will be treated daily with vitamin D supplements (100,000 IU oral drop) or a similar placebo (1000 IU) for 5 days. Discussion If this randomized clinical trial demonstrates reductions in inflammatory cytokines, it would provide evidence for a multicenter clinical trial to evaluate the efficacy of vitamin D supplementation in neurocritically ill patients. Since vitamin D supplements are inexpensive and safe, this clinical trial could have the potential to improve clinical outcomes in traumatic brain injury patients through reduction of inflammation and infection-associated morbidity and mortality rates. Trial registration Iranian Registry of Clinical Trials, IRCT20180619040151N3. Registered on 10 August 2019.
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Affiliation(s)
- Seyed Mostafa Arabi
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Sedaghat
- Cardiac Anesthesia Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Reza Ehsaei
- Department of Neurosurgery, Shahid Kamiab Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Safarian
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Golnaz Ranjbar
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Rezaee
- Department of Neurosurgery, Shahid Kamiab Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Rezvani
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamed Tabesh
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abdolreza Norouzy
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Launey Y, Painvin B, Roquilly A, Dahyot-Fizelier C, Lasocki S, Rousseau C, Frasca D, Gacouin A, Seguin P. Factors associated with time to defecate and outcomes in critically ill patients: a prospective, multicentre, observational study. Anaesthesia 2020; 76:218-224. [PMID: 32662524 DOI: 10.1111/anae.15178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2020] [Indexed: 12/20/2022]
Abstract
Delayed defecation is common in patients on intensive care. We aimed to determine factors associated with time to defecation after admission to intensive care and in turn its association with length of stay and mortality. We studied 396 adults admitted to one of five intensive care units in whom at least 2 days' invasive ventilation was anticipated during an expected stay of at least 3 days. The median (IQR [range]) time to defecate by the 336 out of 396 (84%) patients who did so before intensive care discharge was 6 (4-8 [1-18]) days. Defecation was independently associated with five factors, hazard ratio (95%CI), higher values indicating more rapid defecation: alcoholism, 1.32 (1.05-1.66), p = 0.02; laxatives before admission, 2.35 (1.79-3.07), p < 0.001; non-invasive ventilation, 0.54 (0.36-0.82), p = 0.004; duration of ventilation, 0.78 (0.74-0.82), p < 0.001; laxatives after admission, 1.67 (1.23-2.26), p < 0.001; and enteral nutrition within 48 h of admission, 1.43 (1.07-1.90), p = 0.01. Delayed defecation was associated with prolonged intensive care stay but not mortality.
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Affiliation(s)
- Y Launey
- Department of Anaesthesia and Critical Care, University Hospital, Rennes, France
| | - B Painvin
- Department of Anaesthesia and Critical Care, University Hospital, Rennes, France
| | - A Roquilly
- Department of Anaesthesia and Critical Care, University Hospital, Nantes, France
| | - C Dahyot-Fizelier
- Department of Anaesthesia and Critical Care, University Hospital, Poitiers, France
| | - S Lasocki
- Department of Anaesthesia and Critical Care, University Hospital, Angers, France
| | - C Rousseau
- Department of Clinical Investigation, University Hospital, Rennes, France
| | - D Frasca
- Department of Anaesthesia and Critical Care, University Hospital, Poitiers, France
| | - A Gacouin
- Medical Intensive Care and Infectious Diseases, University Hospital, Rennes, France
| | - P Seguin
- Department of Anaesthesia and Critical Care, University Hospital, Rennes, France
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Rapid Advancement in Enteral Nutrition Does Not Affect Systemic Inflammation and Insulin Homeostasis Following Pediatric Cardiopulmonary Bypass Surgery. Pediatr Crit Care Med 2020; 21:e441-e448. [PMID: 32195897 DOI: 10.1097/pcc.0000000000002314] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To determine impact of enteral nutrition delivery on the relationship among inflammation, insulin resistance, and outcomes following pediatric cardiopulmonary bypass surgery. DESIGN Pilot, randomized study analyzed according to intention-to-treat analysis. SETTING Pediatric cardiac ICU. PATIENTS Infants (≤ 6 mo) undergoing cardiopulmonary bypass. INTERVENTIONS Patients randomly assigned to receive rapid escalation to enteral nutrition reaching goal feeds by 27 hours or standard feeding practice reaching goal feeds by 63 hours. Feeds were initiated on the first postoperative day. MEASUREMENTS AND MAIN RESULTS Fifty patients were randomized equally to study arms. Patients were a median (interquartile range) of 16 days old (7-110 d old), undergoing biventricular surgery (88%) with a median cardiopulmonary bypass time of 125 minutes (105-159 min). Serial blood samples were drawn before and after cardiopulmonary bypass, cardiac ICU admission, and every 12 hours (up to 96 hr) for glucose, insulin, and cytokines (interleukin-1α, interleukin-6, interleukin-8, interleukin-10, and tumor necrosis factor-α) levels. Glucose-insulin ratio was calculated to quantify insulin resistance. Patient characteristics, time to enteral nutrition initiation, enteral nutrition interruptions, and insulin administration were similar across intervention arms. FF reached goal feeds at similar intervals as standard feeding (39 hr [30-60 hr] vs 60 hr [21-78 hr]; p = 0.75). No difference in cytokine, insulin, or glucose-insulin ratio was noted between groups. Higher inflammation was associated with increased glucose-insulin ratio and higher risk of adverse events. In multivariable models of interleukin-8, FF was associated with increased glucose-insulin ratio (estimate of effect [95% CI], 0.152 [0.033-0.272]; p = 0.013). Although higher interleukin-8 was associated with an elevated risk of adverse event, this relationship was possibly mitigated by FF (odds ratio [95% CI], 0.086 [0.002-1.638]; p = 0.13). CONCLUSIONS A FF strategy was not associated with changes to early enteral nutrition delivery. Inflammation, insulin resistance, and morbidity were similar, but FF may modify the relationship between inflammation and adverse event. Multicenter nutrition studies are possible and necessary in this vulnerable population.
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Ong CS, Yesantharao P, Brown PM, Canner JK, Brown TA, Sussman MS, Whitman GJR. Nutrition Support After Cardiac Surgery: Lessons Learned From a Prospective Study. Semin Thorac Cardiovasc Surg 2020; 33:109-115. [PMID: 32610197 DOI: 10.1053/j.semtcvs.2020.06.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/27/2020] [Indexed: 01/15/2023]
Abstract
The importance of postoperative nutrition support (NS) has been poorly recognized in cardiac surgery. In this population, we aim to describe the delivery of NS, factors affecting calorie/protein delivery and NS-associated morbidity. From January 2015 to January 2017, we prospectively observed all cardiac surgery patients at a single institution who could not take nutrition orally, requiring postoperative NS, either enteral or parenteral, for the duration of NS up to 14 days. We compared outcomes to patients without NS and examined NS indications, factors affecting its delivery and its associated complications. Nine percent of patients (232/2603) required NS for a total of 1938 NS-days. The most common indication was mechanical ventilation. NS met 69% of daily caloric needs. On days when tube feeds (TFs) were held (mean of 13 hours), this decreased to 43%, compared to 96% when TFs were not held (P < 0.001). The most common reason for holding TFs was procedures. When TFs were supplemented with parenteral nutrition (TFs + PN), 86% of daily caloric needs were met. Even on days when TFs were held, this only dropped to 77% (TFs + PN), compared to 36% (TFs-only). By multivariable logistic regression, elemental and semielemental formulas, TF volume, and postpyloric feeds increased the risk of diarrhea, occurring in 28% of patients and 18% of TF-days. In cardiac surgery patients given postoperative NS, mortality and morbidity were an order of magnitude higher than those able to be fed orally. Enteral feeding delivered approximately two-thirds of needs, but PN supplementation dramatically improved this. Diarrhea was common, associated with the postpyloric route, increasing TF volume, and nonintact formula.
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Affiliation(s)
- Chin Siang Ong
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Pooja Yesantharao
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Patricia M Brown
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Joseph K Canner
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - T Andrew Brown
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Marc S Sussman
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Glenn J R Whitman
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
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90
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Castanon L, Asmar S, Bible L, Chehab M, Ditillo M, Khurrum M, Hanna K, Douglas M, Joseph B. Early Enteral Nutrition in Geriatric Burn Patients: Is There a Benefit? J Burn Care Res 2020; 41:986-991. [PMID: 32598455 DOI: 10.1093/jbcr/iraa109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Nutrition is a critical component of acute burn care and wound healing. There is no consensus over the appropriate timing of initiating enteral nutrition in geriatric burn patients. This study aimed to assess the impact of early enteral nutrition on outcomes in this patient population. We performed a 1-year (2017) analysis of the American College of Surgeons Trauma Quality Improvement Program and included all older adult (age ≥65 years) isolated thermal burn patients who were admitted for more than 24 hr and received enteral nutrition. Patients were stratified into two groups based on the timing of initiation of feeding: early (≤24 hr) vs late (>24 hr). Multivariate logistic regression was performed to control for potential confounding factors. Outcome measures were hospital and intensive care unit lengths of stay, in-hospital complications, and mortality. A total of 1,004,440 trauma patients were analyzed, of which 324 patients were included (early: 90 vs late: 234). The mean age was 73.9 years and mean TBSA burnt was 31%. Patients in the early enteral nutrition group had significantly lower rates of in-hospital complications and mortality (15.6% vs 26.1%; P = 0.044), and a shorter hospital length of stay (17 [11,23] days vs 20 [14,24] days; P = 0.042) and intensive care unit length of stay (13 [8,15] days vs 17 [9,21] days; P = 0.042). In our regression model of geriatric burn patients, early enteral nutrition was associated with improved outcomes. The cumulative benefits observed may warrant incorporating early enteral nutrition as part of intensive care protocols.
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Affiliation(s)
- Lourdes Castanon
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
| | - Samer Asmar
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
| | - Letitia Bible
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
| | - Mohamad Chehab
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
| | - Michael Ditillo
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
| | - Muhammad Khurrum
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
| | - Kamil Hanna
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
| | - Molly Douglas
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
| | - Bellal Joseph
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
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Gündoğan K, Doğan E, Özer NT, Güneş Şahin G, Şahin S, Sungur M, Akbudak IH, Muhtaroğlu S, Güven M, Ziegler TR. The association between the route of nutrition and serum levels of adipokines in critical illness: a pilot study. Turk J Med Sci 2020; 50:877-884. [PMID: 32336076 PMCID: PMC7379413 DOI: 10.3906/sag-1911-165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 04/24/2020] [Indexed: 12/27/2022] Open
Abstract
Background/aim Adipokines play an important role in the regulation of metabolism. In critical illness, they alter serum levels and are suspected to worsen clinical outcomes. But the effect of the route of nutrition on adipokines is not known. The purpose of this study was to evaluate the association between the route of nutrition and adipokine levels in critically ill patients. Materials and methods This prospective study was performed in an intensive care unit (ICU). Patients admitted to the ICU for least 72 h and receiving either enteral nutrition (EN) via tube feeding or parenteral nutrition (PN) were enrolled. Serum was obtained at baseline, 24 h, and 72 h for concentrations of leptin, adiponectin, resistin, glucagon–like peptide 1 (GLP–1), insulin–like growth factors 1 (IGF–1), and ghrelin. Results A total of 26 patients were included in the study. Thirteen patients received EN and 13 patients received PN. In the PN group, leptin level significantly increased (P = 0.037), adiponectin and ghrelin significantly decreased during follow up (P = 0.037, P = 0.008, respectively). There was no significant change between all adipokines in the EN group and resistin, IGF–1 and GLP–1 in the PN group during follow up. Resistin levels were markedly lower in the EN group at both 24 h (P = 0.015) and 72 h (P = 0.006) while GLP–1 levels were higher in the EN group at baseline, 24 h, and 72 h (P = 0.018, P = 0.005, and P = 0.003, respectively). There were no differences in leptin, adiponectin, IGF–1, and ghrelin levels over time. Conclusion The delivery of EN in critical illness was associated with decreased resistin levels and increased GLP–1 levels. Thus, the route of nutrition may impact the clinical outcome in critical illness due to adipokines.
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Affiliation(s)
- Kürşat Gündoğan
- Division of Medical Intensive Care, Department of Medicine, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Ender Doğan
- Department of Medicine, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Nurhayat Tuğra Özer
- Department of Clinical Nutrition, Institute of Health Sciences, Erciyes University, Kayseri, Turkey
| | - Gülşah Güneş Şahin
- Department of Clinical Nutrition, Institute of Health Sciences, Erciyes University, Kayseri, Turkey
| | - Serap Şahin
- Department of Clinical Nutrition, Institute of Health Sciences, Erciyes University, Kayseri, Turkey
| | - Murat Sungur
- Division of Medical Intensive Care, Department of Medicine, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Ismail Hakki Akbudak
- Division of Medical Intensive Care, Department of Medicine, School of Medicine, Erciyes University, Kayseri, Turkey
| | | | - Muhammet Güven
- Division of Medical Intensive Care, Department of Medicine, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Thomas R Ziegler
- Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, Georgia, USA,Division of Endocrinology, Metabolism and Lipids, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
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92
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GÜNDOĞAN K, KARAKOÇ E, TEKE T, ZERMAN A, ESMAOĞLU A, TEMEL Ş, GÜVEN M, SUNGUR M. Effects of oral/enteral nutrition alone versus plus pantoprazole on gastrointestinal bleeding in critically ill patients with low risk factor: a multicenter, randomized controlled trial. Turk J Med Sci 2020; 50:776-783. [PMID: 32151119 PMCID: PMC7379460 DOI: 10.3906/sag-1911-42] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 03/05/2020] [Indexed: 01/14/2023] Open
Abstract
Background/aim Critically ill patients are at risk of developing gastrointestinal (GI) bleeding due to stress causing mucosal damage. Aim of the study was to determine the effect of oral/enteral nutrition with or without concomitant pantoprazole on upper GI bleeding in low risk critically ill patients. Materials and methods This was a prospective, randomized, open-label, multicenter study conducted with intensive care unit (ICU) patients receiving oral/enteral nutritional support. Patients were randomly assigned into two groups including intervention group (received oral/EN plus pantoprazole) and control group (received only oral/EN). Results A total of 300 patients (intervention group: 152, control group: 148) participated in the study. Overall, 226 (75%) patients were fed by orally and 74 (25%) patients fed by enteral tube feeding. Median duration of nutritional support 4 (range: 2–33) days. Overt upper GI bleeding was noted only in one patient (0.65%) who was in the intervention group. The overall length of ICU stay of 4 (2–105) days, while ICU stay was significantly longer in the intervention group than in the control group (P = 0.006). Conclusions Our findings seems to indicate that in patients who are at low risk for GI bleeding and under oral/enteral nutritional support, the use of PPIs may not reduce the risk of bleeding, however these results are imprecise because of low event (GI bleeding) rate and limited power.
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Affiliation(s)
- Kürşat GÜNDOĞAN
- Division of Intensive Care, Department of Internal Medicine, Faculty of Medicine, Erciyes University, KayseriTurkey
| | - Emre KARAKOÇ
- Division of Intensive Care, Department of Internal Medicine, Faculty of Medicine, Çukurova University, AdanaTurkey
| | - Turgut TEKE
- Division of Intensive Care, Department of Pulmonary Disease, Faculty of Medicine, Necmettin Erbakan University, KonyaTurkey
| | - Avşar ZERMAN
- Intensive Care Unit, Department of Internal Medicine, Ministry of Health Adana Numune Training and Educational Hospital, AdanaTurkey
| | - Aliye ESMAOĞLU
- Division of Intensive Care, Department of Anesthesiology and Reanimation, Faculty of Medicine, Erciyes University, KayseriTurkey
| | - Şahin TEMEL
- Division of Intensive Care, Department of Internal Medicine, Faculty of Medicine, Erciyes University, KayseriTurkey
| | - Muhammet GÜVEN
- Division of Intensive Care, Department of Internal Medicine, Faculty of Medicine, Erciyes University, KayseriTurkey
| | - Murat SUNGUR
- Division of Intensive Care, Department of Internal Medicine, Faculty of Medicine, Erciyes University, KayseriTurkey
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Silva NCD, Cardoso LO, Muniz CK, Prestes IV, Pena GDG. Failure to achieve proteic goals in non-critical patients increases risk for death: Old discussion, ongoing problem. Nutrition 2020; 77:110894. [PMID: 32736297 DOI: 10.1016/j.nut.2020.110894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/30/2020] [Accepted: 05/30/2020] [Indexed: 12/07/2022]
Abstract
OBJECTIVES Providing adequate nutritional support for hospitalized patients continues to be a challenge. The aim of this study was to evaluate the association of energy and protein provision with in-hospital mortality in non-critically ill patients. METHODS A retrospective study (2014-2016) was performed with all patients >18 y of age who were admitted to medical and surgical clinic wards and given exclusive enteral therapy. The mean of energy and protein was estimated per day and per kilogram of body mass from the enteral prescription data, over the entire period of hospitalization. A prescription mean was considered hypocaloric or hypoproteic at <20 kcal · kg · d-1 or <0.8 g · kg · d-1, respectively. RESULTS Of the 240 patients, 58.3% were >60 y of age and 60% were men. The frequencies of in-hospital mortality (19.2%) and malnutrition (78.8%) were high. The means of protein (0.75 g· kg· d-1) and energy (17.60 kcal · kg · d-1) were below the general recommendations and 37.8% did not reach a mean of 20 kcal · kg · d-1 during the entire hospitalization period. Hypocaloric (hazard ratio [HR], 5.78; 95% confidence interval [CI], 1.59-21.04) and hypoproteic nutrition (HR, 3.69; 95% CI, 1.25-10.93) were predictors of all-cause in-hospital mortality in adjusted multivariate models. However, when we adjusted the hypoprotein nutrition by energy (non-protein calories to nitrogen ratio), hypoprotein nutrition seems to maintain the increased risk for death (HR, 3.15; 95% CI, 1.04-9.53). CONCLUSIONS Hypoproteic nutrition appears to be more significant than hypocaloric nutrition in predicting all-cause in-hospital mortality. Protocols should be implemented to ensure that target caloric and protein levels are reached as quickly as possible to optimize patient survival.
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Affiliation(s)
- Nayara Cristina da Silva
- Graduate Program in Health Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | | | - Cinara Knychala Muniz
- Food and Nutrition Service of Hospital of the Federal University of Uberlandia, Brazil
| | | | - Geórgia das Graças Pena
- Graduate Program in Health Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil.
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The modified NUTRIC score can be used for nutritional risk assessment as well as prognosis prediction in critically ill COVID-19 patients. Clin Nutr 2020; 40:534-541. [PMID: 32527576 PMCID: PMC7273137 DOI: 10.1016/j.clnu.2020.05.051] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/19/2020] [Accepted: 05/27/2020] [Indexed: 02/06/2023]
Abstract
Background & aims In the newly emerged Coronavirus Disease 2019 (COVID-19) disaster, little is known about the nutritional risks for critically ill patients. It is also unknown whether the modified Nutrition Risk in the Critically ill (mNUTRIC) score is applicable for nutritional risk assessment in intensive care unit (ICU) COVID-19 patients. We set out to investigate the applicability of the mNUTRIC score for assessing nutritional risks and predicting outcomes for these critically ill COVID-19 patients. Methods This retrospective observational study was conducted in three ICUs which had been specially established and equipped for COVID-19 in Wuhan, China. The study population was critically ill COVID-19 patients who had been admitted to these ICUs between January 28 and February 21, 2020. Exclusion criteria were as follows: 1) patients of <18 years; 2) patients who were pregnant; 3) length of ICU stay of <24 h; 4) insufficient medical information available. Patients' characteristics and clinical information were obtained from electronic medical and nursing records. The nutritional risk for each patient was assessed at their ICU admission using the mNUTRIC score. A score of ≥5 indicated high nutritional risk. Mortality was calculated according to patients’ outcomes following 28 days of hospitalization in ICU. Results A total of 136 critically ill COVID-19 patients with a median age of 69 years (IQR: 57–77), 86 (63%) males and 50 (37%) females, were included in the study. Based on the mNUTRIC score at ICU admission, a high nutritional risk (≥5 points) was observed in 61% of the critically ill COVID-19 patients, while a low nutritional risk (<5 points) was observed in 39%. The mortality of ICU 28-day was significantly higher in the high nutritional risk group than in the low nutritional risk group (87% vs 49%, P <0.001). Patients in the high nutritional risk group exhibited significantly higher incidences of acute respiratory distress syndrome, acute myocardial injury, secondary infection, shock and use of vasopressors. Additionally, use of a multivariate Cox analysis showed that patients with high nutritional risk had a higher probability of death at ICU 28-day than those with low nutritional risk (adjusted HR = 2.01, 95% CI: 1.22–3.32, P = 0.006). Conclusions A large proportion of critically ill COVID-19 patients had a high nutritional risk, as revealed by their mNUTRIC score. Patients with high nutritional risk at ICU admission exhibited significantly higher mortality of ICU 28-day, as well as twice the probability of death at ICU 28-day than those with low nutritional risk. Therefore, the mNUTRIC score may be an appropriate tool for nutritional risk assessment and prognosis prediction for critically ill COVID-19 patients.
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95
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Ohman K, Zhu H, Maizlin I, Williams RF, Guner YS, Russell RT, Harting MT, Vogel AM, Starr JP, Johnson D, Ramirez R, Manning L. A Multicenter Study of Nutritional Adequacy in Neonatal and Pediatric Extracorporeal Life Support. J Surg Res 2020; 249:67-73. [DOI: 10.1016/j.jss.2019.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 09/16/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
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96
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Zaragoza-García I, Arrogante O. Post-pyloric versus gastric tube feeding for preventing pneumonia and improving nutritional outcomes in critically ill adults. ENFERMERIA INTENSIVA 2020; 31:96-98. [PMID: 32336618 DOI: 10.1016/j.enfi.2020.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/28/2020] [Indexed: 10/24/2022]
Affiliation(s)
- I Zaragoza-García
- Departamento de Enfermería, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid; Instituto de Investigación Sanitaria del Hospital 12 de Octubre «imas12», Madrid, España.
| | - O Arrogante
- Departamento de Enfermería, Centro Universitario de Ciencias de la Salud San Rafael, Fundación San Juan de Dios, Universidad Nebrija, Madrid, España
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97
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Jin M, Wang Y, Wang Y, Li Y, Wang G, Liu X, Xue Y, Liu Z, Li C. Protective Effects Oncorneal Endothelium During Intracameral Irrigation Using N-(2)-l-alanyl-l-Glutamine. Front Pharmacol 2020; 11:369. [PMID: 32292346 PMCID: PMC7118711 DOI: 10.3389/fphar.2020.00369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/10/2020] [Indexed: 12/21/2022] Open
Abstract
Corneal endothelial disease is a global sight-threatening disease, and corneal transplantation using donor corneas remains the sole therapeutic option. A previous work demonstrated that N (2)-alanyl-glutamine (Ala-Gln) protected against apoptosis and cellular stress, and maintained intestinal tissue integrity. In this pursuit, the present study aimed to examine the effect of Ala-Gln in the protection of the corneal endothelium and expand its range of potential clinical applications. Mice in the control group were intracamerally irrigated with Ringers lactate injection, whereas those in the experimental group were irrigated with Ringers lactate injection containing Ala-Gln. The mean intraocular pressure increased to 44 ± 3.5 mm Hg during intracameral irrigation (normal range 10.2 ± 0.4 mmHg). In vivo confocal microscopy results showed that the addition of Ala-Gln protected the morphology, structure, and density of the corneal endothelial cells. Optical Coherence Tomography (OCT) measurements showed that corneal thickness was not significantly different between the two groups, because of the immediate corneal edema after irrigation, but the addition of Ala-Gln obviously promoted the recovery of the corneal edema. Scanning electron microscopy indicated that the corneal endothelial cells were severely ruptured and exfoliated in the Ringer’s group accompanied with cellular edema, when compared with the Ala-Gln group. The intracameral irrigation using Ala-Gln protected the structure and expression of cytoskeleton and Na-K-ATPase, which exhibited a regular distribution and significantly increased expression in comparison to Ringer’s group. Furthermore, Ala-Gln maintained the mitochondrial morphology and increased the activity of mitochondria. Moreover, transmission electron microscopy showed that intracameral irrigation of Ala-Gln reversed the ultrastructural changes induced by the acute ocular hypertension in mice. Our study demonstrates that the intracameral irrigation of Ala-Gln effectively maintained the corneal endothelial pump function and barrier function by protecting the mitochondrial function and preventing the rearrangement of cytoskeleton in acute ocular hypertension in mice.
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Affiliation(s)
- Mengyi Jin
- Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, China.,Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, China
| | - Yanzi Wang
- Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, China.,Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, China
| | - Yixin Wang
- Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, China.,Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, China
| | - Yunpeng Li
- Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, China.,Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, China
| | - Guoliang Wang
- Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, China.,School of Pharmaceutical Sciences, Xiamen University, Xiamen, China
| | - Xuezhi Liu
- Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, China.,Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, China
| | - Yuhua Xue
- School of Pharmaceutical Sciences, Xiamen University, Xiamen, China
| | - Zuguo Liu
- Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, China.,Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, China
| | - Cheng Li
- Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, China.,Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, China
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98
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Mundi MS, Velapati S, Kuchkuntla AR, Hurt RT. Reduction in Healthcare Utilization With Transition to Peptide-Based Diets in Intolerant Home Enteral Nutrition Patients. Nutr Clin Pract 2020; 35:487-494. [PMID: 32149433 DOI: 10.1002/ncp.10477] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Since the introduction of percutaneous endoscopic gastrostomy in the 1980s, the prevalence of home enteral nutrition (HEN) support has increased significantly. Despite these increases, many patients are unable to tolerate standard polymeric formulas (SPFs), resulting in significant healthcare resource utilization. Peptide-based diets (PBDs) have emerged as a viable option in SPF-intolerant patients; however, data in the HEN population are lacking. METHODS Retrospective review of our prospectively maintained HEN database was conducted to assess tolerance, efficacy, and impact on healthcare utilization in patients on PBDs. RESULTS From January 1, 2016, to May 1, 2018, 95 patients were placed on PBDs, with 53 patients being started directly and 42 patients being transitioned from SPFs. In patients transitioned to PBDs, symptoms of nausea and vomiting, diarrhea, abdominal pain, and distention improved significantly. Healthcare utilization also declined significantly, including mean number of phone calls (1.8 ± 1.6 to 1.1 ± 0.9, P = 0.006), mean number of emergency room visits (0.3 ± 0.6 to 0.09 ± 0.3, P = 0.015), and mean number of provider visits (1.3 ± 1.3 to 0.3 ± 0.5, P < 0.0001). CONCLUSIONS Overall, PBDs were well tolerated and resulted in significant improvements in symptoms of gastrointestinal distress and healthcare utilization in patients intolerant to SPFs.
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Affiliation(s)
- Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Saketh Velapati
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Aravind R Kuchkuntla
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan T Hurt
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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99
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Ewy M, Aqeel M, Kozeniecki M, Patel K, Banerjee A, Heyland DK, Patel JJ. Impact of Enteral Feeding on Vasoactive Support in Septic Shock: A Retrospective Observational Study. Nutr Clin Pract 2020; 35:540-547. [PMID: 32134146 DOI: 10.1002/ncp.10480] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Introducing enteral nutrition (EN) during hemodynamic instability may induce the splanchnic steal phenomenon, which may worsen systemic oxygen delivery and increase vasopressor dose. We aimed to determine the change in vasopressor dose in septic shock patients who received concomitant EN. We hypothesize that EN delivery is not associated with worsening hemodynamic instability, as defined by an increase in vasopressor dose ≥50% at 24 hours. METHODS This is a retrospective observational cohort study of adult patients with septic shock who were admitted to the intensive care unit from January 2015 to June 2015 and received EN. Vasopressor and EN parameters were collected at 6-hour intervals for the first 24 hours. RESULTS Data were available for 28 consecutive patients. The mean age was 60 years (SD = 18), and 54% were females. Norepinephrine (NE) was used in 100%. EN and vasopressor overlap totaled 36 hours (interquartile range [IQR], 27-69). Median NE dose when starting EN was 5.9 μg/min (IQR, 3.88). Median change in dose from 0 to 6 hours was 0.85 μg/min (95% CI, 0.681.06; P = 0.136), corresponding to a median increase of 14.5%. Total NE duration was 60.5 hours (IQR, 47.5-75.5). No serious complications occurred. CONCLUSION The median vasopressor dose did not increase by ≥50% during the first 24 hours of EN. This suggests early EN delivered during septic shock is not associated with worsening hemodynamic instability. Limitations include a small sample size and residual confounding. Prospective data are needed.
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Affiliation(s)
- Matthew Ewy
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Masooma Aqeel
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Aga Khan University, Karachi, Sindh, Pakistan
| | - Michelle Kozeniecki
- Nutrition Services Department, Froedtert Hospital, Milwaukee, Wisconsin, USA
| | - Kadam Patel
- Institute for Health & Equity, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anjishnu Banerjee
- Institute for Health & Equity, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Daren K Heyland
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Jayshil J Patel
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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100
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Wiese AN, Rogers MJM, Way M, Ballard E. The impact of removing gastric residual volume monitoring and enteral nutrition rate titration in adults receiving mechanical ventilation. Aust Crit Care 2020; 33:155-161. [DOI: 10.1016/j.aucc.2018.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 12/06/2018] [Accepted: 12/06/2018] [Indexed: 11/16/2022] Open
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