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Zhang G, Zhang K, Cui W, Hong Y, Zhang Z. The effect of enteral versus parenteral nutrition for critically ill patients: A systematic review and meta-analysis. J Clin Anesth 2018; 51:62-92. [PMID: 30098572 DOI: 10.1016/j.jclinane.2018.08.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/25/2018] [Accepted: 08/03/2018] [Indexed: 02/07/2023]
Abstract
STUDY OBJECTIVE To analyze the effect of enteral nutrition compared with parenteral nutrition in critically ill patients. DESIGN Systematic review and meta-analysis of randomized controlled trials. SETTING Intensive care unit. PATIENTS 23 trials containing 6478 patients met our inclusion criteria. INTERVENTION A systematical literature search was conducted to identify eligible trials in electronic databases including PubMed, Embase, Scopus, EBSCO and Cochrane Library. The primary outcome was mortality, the secondary outcomes were gastrointestinal complications, bloodstream infections, organ failures, length of stay in ICU and hospital. We performed a predefined subgroup analyses to explore the treatment effect by mean age, publication date and disease types. MAIN RESULTS The result showed no significant effect on overall mortality rate (OR 0.98, 95%CI 0.81 to 1.18, P = 0.83, I2 = 19%) and organ failure rate (OR 0.87, 95%CI 0.75 to 1.01, P = 0.06, I2 = 16%). The use of EN had more beneficial effects with fewer bloodstream infections when compared to PN (OR 0.59, 95%CI 0.43 to 0.82, P = 0.001, I2 = 27%) and this was more noteworthy in the subgroup analysis for critical surgical patients (OR 0.36, 95%CI 0.22 to 0.59, P < 0.0001, I2 = 0%). EN was associated with reduction in hospital LOS (MD -0.90, 95%CI -1.63 to -0.17, P = 0.21, I2 = 0%) but had an increase incidence of gastrointestinal complications (OR 2.00, 95%CI 1.76 to 2.27, P < 0.00001, I2 = 0%). CONCLUSION For critically ill patients, the two routes of nutrition support had no different effect on mortality rate. The use of EN could decrease the incidence of bloodstream infections and reduce hospital LOS but was associated with increased risk of gastrointestinal complications.
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Affiliation(s)
- Gensheng Zhang
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Kai Zhang
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Wei Cui
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Yucai Hong
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Zhongheng Zhang
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
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Association of Inadequate Caloric Supplementation with 30-Day Mortality in Critically Ill Postoperative Patients with High Modified NUTRIC Score. Nutrients 2018; 10:nu10111589. [PMID: 30380680 PMCID: PMC6266175 DOI: 10.3390/nu10111589] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 10/23/2018] [Accepted: 10/26/2018] [Indexed: 02/05/2023] Open
Abstract
Modified NUTRIC (mNUTRIC) score is a useful assessment tool to determine the risk of malnutrition in patients on mechanical ventilation (MV). We identified associations between postoperative calorie adequacy, 30-day mortality, and surgical outcomes in patients with high mNUTRIC scores. Medical records of 272 patients in the intensive care unit who required MV support for >24 h after emergency gastro-intestinal (GI) surgery between January 2007 and December 2017 were reviewed. Calorie adequacy in percentage (Calorie intake in 5 days ÷ Calorie requirement for 5 days × 100) was assessed in patients with high (5–9) and low (0–4) mNUTRIC scores. In the high mNUTRIC score group, patients with inadequate calorie supplementation (calorie adequacy <70%) had higher 30-day mortality than those with adequate supplementation (31.5% vs. 11.1%; p = 0.010); this was not observed in patients with low mNUTRIC scores. This result was also confirmed through Kaplan–Meier survival curve (p = 0.022). Inadequate calorie supplementation in the high mNUTRIC score group was not associated with Intra-abdominal infection (p = 1.000), pulmonary complication (p = 0.695), wound complication (p = 0.407), postoperative leakage (p = 1.000), or infections (p = 0.847). Inadequate calorie supplementation after GI surgery was associated with higher 30-day mortality in patients with high mNUTRIC scores. Therefore, adequate calorie supplementation could contribute to improved survival of critically ill postoperative patients with high risk of malnutrition.
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Ramirez AVG, de Almeida Soriano E, Ribas Filho D, Zotarelli Filho IJ. Major Predictors of Incidence of Congestive Heart Failure and the Responsive Character of Enteral Nutrition: Meta-Analysis. Cardiol Res 2018; 9:273-278. [PMID: 30344824 PMCID: PMC6188049 DOI: 10.14740/cr746w] [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: 06/18/2018] [Accepted: 08/08/2018] [Indexed: 11/29/2022] Open
Abstract
Background Statistical data from the USA estimate that 5.7 million Americans over 20 years of age have congestive heart failure (CHF) and this number is expected to increase approximately 46.0% between 2012 and 2030. In Brazil, there are no epidemiological studies involving the incidence of heart failure; however, according to other countries, it can be estimated that up to 6.4 million Brazilians suffer from this syndrome. Randomized and controlled clinical studies on the efficacy of enteral nutrition (EN) in patients with CHF are lacking. The aim of the present study was to perform a systematic review of the main predictors of CHF that promote EN, as well as to find if the literary findings were conclusive in the efficacy of EN for treatment and prophylaxis of CHF. Methods A total of 105 papers were submitted to the eligibility analysis, after which 28 studies were selected, following the rules of the systematic review - PRISMA. The search strategy was followed in MEDLINE/Pubmed, Web of Science, ScienceDirect Journals (Elsevier), Scopus (Elsevier) and ONEFile (Gale), with the following steps: search for mesh terms and use of bouleanos “and” between terms and “or” between historical findings. Results The present study listed the major predictors of CHF with indication for EN. After testing the normality of each group of variables of causes of decompensation in CHF, it was analyzed that all the variables did not present normal distribution, with P < 0.10. Thus, a non-parametric Kruskal-Wallis analysis was performed, obtaining P > 0.05 in all analyses, that is, in all groups of causes of decompensation in CHF, there was no statistical difference in each group studied. Conclusion There is still no known influence of the efficacy of EN on increasing survival and reducing the morbidity of patients with CHF because there are few clinical trials that have evaluated this question; however, EN is very indicated in the attempt to mitigate the weight loss in these patients.
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Affiliation(s)
- Ana Valeria Garcia Ramirez
- Associacao Brasileira de Nutrologia (ABRAN)/Brazilian Association of Nutrology, Catanduva/SP, Rua Belo Horizonte, 909 - Centro, Catanduva SP 15801-150, Brazil
| | - Eline de Almeida Soriano
- Associacao Brasileira de Nutrologia (ABRAN)/Brazilian Association of Nutrology, Catanduva/SP, Rua Belo Horizonte, 909 - Centro, Catanduva SP 15801-150, Brazil
| | - Durval Ribas Filho
- Associacao Brasileira de Nutrologia (ABRAN)/Brazilian Association of Nutrology, Catanduva/SP, Rua Belo Horizonte, 909 - Centro, Catanduva SP 15801-150, Brazil
| | - Idiberto Jose Zotarelli Filho
- Post Graduate and Continuing Education (Unipos), Department of Scientific Production, Street Ipiranga, 3460, Sao Jose do Rio Preto SP, Brazil
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Zamberlan P, Feferbaum R, Doria Filho U, Brunow de Carvalho W, Figueiredo Delgado A. Bioelectrical Impedance Phase Angle and Morbidity and Mortality in Critically Ill Children. Nutr Clin Pract 2018; 34:163-171. [DOI: 10.1002/ncp.10201] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Patrícia Zamberlan
- Division of Nutrition; Faculty of Medicine; Hospital das Clinicas Instituto da Crianca; University of São Paulo; São Paulo Brazil
| | - Rubens Feferbaum
- Division of Neonatology; Department of Pediatric; Faculty of Medicine; Hospital das Clinicas Instituto da Crianca; University of São Paulo; São Paulo Brazil
| | - Ulysses Doria Filho
- Department of Pediatric; Faculty of Medicine; Hospital das Clinicas Instituto da Crianca; University of São Paulo; São Paulo Brazil
| | | | - Artur Figueiredo Delgado
- Pediatric Intensive Care; Department of Pediatric; Faculty of Medicine; Hospital das Clinicas Instituto da Crianca; University of São Paulo; São Paulo Brazil
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Shi J, Wei L, Huang R, Liao L. Effect of combined parenteral and enteral nutrition versus enteral nutrition alone for critically ill patients: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e11874. [PMID: 30313021 PMCID: PMC6203569 DOI: 10.1097/md.0000000000011874] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND AIM The increased mortality rate and other poor prognosis make malnutrition a serious issue for adult critically ill patients in intensive care unit care. This study was to compare outcomes between combined parenteral and enteral nutrition and enteral nutrition alone for adult critically ill patients. MATERIALS AND METHODS The PubMed (June 30, 2018), EMBASE (June 30, 2018), and Cochrane library databases (June 30, 2018) were searched systematically. Randomized controlled trials (RCTs) of comparing combined PN and EN with EN alone were eligible. Relative risks (RRs), mean differences (MDs), and 95% confidence intervals (CIs) were calculated for dichotomous and continuous outcomes. RESULTS Eight RCTs involving 5360 patients met the inclusion criteria. Compared with combined PN and EN, fewer respiratory infections (RR, 1.13 [95% CI 1.01-1.25]) and shorter length of days at hospital (MD, 1.83 [95% CI 1.05-2.62]) were observed in EN alone group. And no significant differences were found on hospital mortality (RR, 0.91 [95% CI 0.74-1.12]), length of days in ICU (MD, -0.23 [95% CI -1.79 to 1.32]), duration of ventilatory support (MD, -1.10 [95% CI -3.15 to 0.94]), albumin (MD, -0.04 [95% CI, -0.12 to 0.21]), or prealbumin (MD, -0.77 [95% CI -0.22 to 1.75]) between theses 2 groups. CONCLUSION Receiving EN alone decreased the respiratory infections and length of days at hospital for critically ill patients. Combined PN and EN did not add up the potential risk from PN and EN on hospital mortality, length of days in ICU, duration of ventilatory support, albumin, and prealbumin.
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Affiliation(s)
| | | | | | - Liang Liao
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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56
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Xing J, Zhang Z, Ke L, Zhou J, Qin B, Liang H, Chen X, Liu W, Liu Z, Ai Y, Wang D, Wang Q, Zhou Q, Zhang F, Qian K, Jiang D, Zang B, Li Y, Huang X, Qu Y, Xie Y, Xu D, Zou Z, Zheng X, Liu J, Guo F, Liang Y, Sun Q, Gao H, Liu Y, Chang P, Ceng A, Yang R, Yao G, Sun Y, Wang X, Zhang Y, Wen Y, Yu J, Sun R, Li Z, Yuan S, Song Y, Gao P, Liu H, Zhang Z, Wu Y, Ma B, Guo Q, Shan F, Yang M, Li H, Li Y, Lu W, Wang L, Qian C, Wang Z, Lin J, Zhang R, Wan P, Peng Z, Gong Y, Huang L, Wu G, Sun J, Deng Y, Shi D, Zhou L, Zhou F, Shi Q, Guo X, Liu X, Wu W, Meng X, Li L, Chen W, Li S, Wan X, Chao Z, Zhang A, Gu L, Chen W, Wu J, Zhou L, Zhang Z, Weng Y, Feng Y, Yang C, Feng Y, Zhao S, Tong F, Hao D, Han H, Fu B, Gong C, Li Z, Hu K, Kou Q, Zhang H, Liu J, Fan C, Zhou X, Chen X, Sun J, Zhou X, Song B, Sun C, Zhao L, Dong X, Zhang L, Tong D, Pan Z, Cai C, Wang D, Dong Y, Gong Y, Wu Z, Meng X, Wang P, Li W. Enteral nutrition feeding in Chinese intensive care units: a cross-sectional study involving 116 hospitals. Crit Care 2018; 22:229. [PMID: 30244686 PMCID: PMC6151932 DOI: 10.1186/s13054-018-2159-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 08/10/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There is a lack of large-scale epidemiological data on the clinical practice of enteral nutrition (EN) feeding in China. This study aimed to provide such data on Chinese hospitals and to investigate factors associated with EN delivery. METHODS This cross-sectional study was launched in 118 intensive care units (ICUs) of 116 mainland hospitals and conducted on April 26, 2017. At 00:00 on April 26, all patients in these ICUs were included. Demographic and clinical variables of patients on April 25 were obtained. The dates of hospitalization, ICU admission and nutrition initiation were reviewed. The outcome status 28 days after the day of investigation was obtained. RESULTS A total of 1953 patients were included for analysis, including 1483 survivors and 312 nonsurvivors. The median study day was day 7 (IQR 2-19 days) after ICU entry. The proportions of subjects starting EN within 24, 48 and 72 h after ICU entry was 24.8% (84/352), 32.7% (150/459) and 40.0% (200/541), respectively. The proportion of subjects receiving > 80% estimated energy target within 24, 48, 72 h and 7 days after ICU entry was 10.5% (37/352), 10.9% (50/459), 11.8% (64/541) and 17.8% (162/910), respectively. Using acute gastrointestinal injury (AGI) 1 as the reference in a Cox model, patients with AGI 2-3 were associated with reduced likelihood of EN initiation (HR 0.46, 95% CI 0.353-0.599; p < 0.001). AGI 4 was significantly associated with lower hazard of EN administration (HR 0.056; 95% CI 0.008-0.398; p = 0.004). In a linear regression model, greater Sequential Organ Failure Assessment scores (coefficient - 0.002, 95% CI - 0.008 to - 0.001; p = 0.024) and male gender (coefficient - 0.144, 95% CI - 0.203 to - 0.085; p < 0.001) were found to be associated with lower EN proportion. As compared with AGI 1, AGI 2-3 was associated with lower EN proportion (coefficient - 0.206, 95% CI - 0.273 to - 0.139; p < 0.001). CONCLUSIONS The study showed that EN delivery was suboptimal in Chinese ICUs. More attention should be paid to EN use in the early days after ICU admission.
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Affiliation(s)
- Juan Xing
- Nanjing General Hospital of Nanjing Military Command, No.305 Zhongshan East Road, Nanjing, 210002 China
| | - Zhongheng Zhang
- Department of emergency medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lu Ke
- Nanjing General Hospital of Nanjing Military Command, No.305 Zhongshan East Road, Nanjing, 210002 China
| | - Jing Zhou
- Nanjing General Hospital of Nanjing Military Command, No.305 Zhongshan East Road, Nanjing, 210002 China
| | - Bingyu Qin
- Henan Provincial People’s Hospital, Zhengzhou, China
| | | | | | - Wenming Liu
- Changzhou No.2 People’s Hospital affiliated to Nanjing Medical University, Nanjing, China
| | - Zhongmin Liu
- Jilin University First Hospital, Changchun, China
| | - Yuhang Ai
- Xiangya Hospital Central South University, Changsha, China
| | - Difeng Wang
- Guizhou Medical University affiliated hospital, Guiyang, China
| | | | | | | | - Kejian Qian
- First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Dongpo Jiang
- Third Military Medical University Daping Hospital, Chongqing, China
| | - Bin Zang
- China Medical University Second Affiliated Hospital, Shenyang, China
| | - Yimin Li
- Guangzhou Medical University First Affiliated Hospital, Guangzhou, China
| | - Xiaobo Huang
- Sichuan Provincial People’s Hospital, Chengdu, China
| | - Yan Qu
- Qingdao Municipal Hospital Group, Qingdao, China
| | | | - Donglin Xu
- Guangzhou First Municipal People’s Hospital, Guangzhou, China
| | - Zhiqiang Zou
- Xiehe Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | | | - Jianbo Liu
- Inner Mongolia People’s Hospital, Huhehaote, China
| | - Feng Guo
- Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Yafeng Liang
- Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Qingdao, China
| | - Qiang Sun
- Tianjing People’s Hospital, Tianjin, China
| | - Hongmei Gao
- Tianjing First Central Hospital, Tianjin, China
| | - Yang Liu
- Tangshan Gongren Hospital, Tangshan, China
| | - Ping Chang
- Southern Medical University Zhujiang Hospital, Guangzhou, China
| | - Aibin Ceng
- North China University of Science and Technology Affiliated Hospital, Tangshan, China
| | | | - Gaiqi Yao
- Peking University Third Hospital, Beijing, China
| | - Yun Sun
- Anhui Medical University Second Affiliated Hospital, Hefei, China
| | - Xiaorong Wang
- Wenzhou Medical University First Affiliated Hospital, Wenzhou, China
| | - Yi Zhang
- Shanxi Provincial People’s Hospital, Taiyuan, China
| | - Yichao Wen
- Guangzhou Medical University Second Affiliated Hospital, Guangzhou, China
| | - Jian Yu
- Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Rongqing Sun
- Zhengzhou University First Affiliated Hospital, Zhengzhou, China
| | - Zhiwei Li
- First People’s Hospital of Kunming, Kunming, China
| | - Shiying Yuan
- Union Hospital Affiliated to Tongji Medical College of Huanzhong University of Science and Technology, Wuhan, China
| | - Yunlin Song
- Xinjiang Medical University Affiliated First Hospital, Wulumuqi, China
| | - Peiyang Gao
- Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, China
| | - Haiyan Liu
- First Affiliated Hospital of Anhui Medical University, Hefei, China
| | | | - Yunfu Wu
- Suzhou Municipal Hospital, Suzhou, China
| | - Biao Ma
- Jining Medical College Affiliated Hospital, Jining, China
| | - Qiang Guo
- First Affiliated Hospital of Soochow University, Suzhou, China
| | - Feng Shan
- Qindao University Medical College Affiliated Hospital, Qindao, China
| | - Mingshi Yang
- Central South University Third Xiangya Hospital, Changsha, China
| | - Hailing Li
- 401 Military Hospital of China, Qindao, China
| | - Yuanfei Li
- Changsha Central Hospital, Changsha, China
| | - Weihua Lu
- Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Lei Wang
- Shanxi Medical University First Affiliated Hospital, Taiyuan, China
| | - Chuangyun Qian
- Kuming Medical University First Affiliated Hospital, Kuming, China
| | - Zhiyong Wang
- Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
| | - Jiandong Lin
- First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | | | - Peng Wan
- First People’s Hospital of Yichang, Yichang, China
| | - Zhiyong Peng
- Wuhan University Zhongnan Hospital, Wuhan, China
| | - Yuqiang Gong
- Wenzhou Medical University Second Affiliated Hospital, Wenzhou, China
| | - Linxi Huang
- Shantou University Medical College First Affiliated Hospital, Shantou, China
| | - Guobao Wu
- Zhongnan University Xiangya Second Hospital, Changsha, China
| | - Jie Sun
- Yunnan Second People’s Hospital, Kunming, China
| | - Yijun Deng
- Yancheng First People’s Hospital, Yancheng, China
| | - Dongwu Shi
- Shanxi Provincial People’s Hospital, Taiyuan, China
| | - Lixin Zhou
- First People’s Hospital of Foshan, Foshan, China
| | - Fachun Zhou
- Chongqing Medical University First Affiliated Hospital, Chongqing, China
| | - Qindong Shi
- Xi’an Jiao Tong University First Affiliated Hospital, Xi’an, China
| | | | - Xueyan Liu
- Shenzhen People’s Hospital, Shenzhen, China
| | - Weidong Wu
- Shanxi Dayi Hospital of Shanxi Academy of Medical Science, Taiyuan, China
| | | | - Liandi Li
- Qingdao University Affiliated Hospital, Qingdao, China
| | - Weiwei Chen
- Linhai First People’s Hospital, Linhai, China
| | - Shusheng Li
- Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Xianyao Wan
- First Affiliated Hospital of Dalian Medical University, Dalian, China
| | | | - An Zhang
- Chongqing Medical University Second Affiliated Hospital, Chongqing, China
| | - Liming Gu
- People’s Hospital of Yuxi City, Yuxi, China
| | - Wei Chen
- Shijitan Hospital of Capital Medical University, Beijing, China
| | - Jinglan Wu
- Shenzhen Nanshan People’s Hospital, Shenzhen, China
| | - Lihua Zhou
- Affiliated Hospital of Inner Mongolia Medical College, Huhehaote, China
| | | | | | - Yongshun Feng
- Beijing Jingmei Group General Hospital, Beijing, China
| | - Chunli Yang
- Jiangxi Provincial People’s Hospital, Nanchang, China
| | - Yongjian Feng
- Jinan University First Affiliated Hospital, Jinan, China
| | - Sumin Zhao
- General Hospital of Rocket Army, Beijing, China
| | - Fei Tong
- Hebei Medical University Second Affiliated Hospital, Shijiazhuang, China
| | - Dong Hao
- Binzhou Medical College Affiliated Hospital, Binzhou, China
| | - Hui Han
- Chinese PLA General Hospital, Beijing, China
| | - Baocai Fu
- Yantai Mountain Hospital, Yantai, China
| | - Chuanyong Gong
- Tianjing Hospital of ITCWM Nankai Hospital, Tianjing, China
| | - Zhiping Li
- Hunan Provincial People’s Hospital, Changsha, China
| | - Kunlin Hu
- People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Qiuye Kou
- Sun Yat-sen University Sixth Affiliated Hospital, Guangzhou, China
| | - Han Zhang
- China Academy of Chinese Medical Sciences Xiyuan Hospital, Beijing, China
| | - Jie Liu
- Wuhan General Hospital of Guangzhou Military Region, Wuhan, China
| | - Chuming Fan
- First People’s Hospital of Yunnan, Kunming, China
| | - Xin Zhou
- Xinjiang Military General Hospital, Wulumuqi, China
| | | | - Junli Sun
- Luoyang Central Hospital, Luoyang, China
| | - Xuejun Zhou
- Huairou First Hospital of Beijing, Beijing, China
| | - Bin Song
- Military General Hospital of Beijing PLA, Beijing, China
| | - Cheng Sun
- Guangdong Provincial People’s Hospital, Guangzhou, China
| | - Liyun Zhao
- Guangdong Second TCM Hospital, Guangzhou, China
| | | | | | - Dafei Tong
- Shenyang First People’s Hospital, Shenyang, China
| | - Zhiguo Pan
- Guangzhou Military General Hospital, Guangzhou, China
| | - Chuangjie Cai
- Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | | | | | - Yuanqi Gong
- Nanchang University Second Affiliated Hospital, Nanchang, China
| | - Zhisong Wu
- Beijing University of Chinese Medicine Affiliated Dongfang Hospital, Beijing, China
| | - Xinke Meng
- Shenzhen Second People’s Hospital, Shenzhen, China
| | - Ping Wang
- Chendu Fifth People’s Hospital, Chendu, China
| | - Weiqin Li
- Nanjing General Hospital of Nanjing Military Command, No.305 Zhongshan East Road, Nanjing, 210002 China
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Effectiveness and cost-effectiveness of early nutritional support via the parenteral versus the enteral route for critically ill adult patients. J Crit Care 2018; 52:237-241. [PMID: 30224150 DOI: 10.1016/j.jcrc.2018.08.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 08/08/2018] [Accepted: 08/20/2018] [Indexed: 01/18/2023]
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Complications of percutaneous endoscopic and radiologic gastrostomy tube insertion: a KASID (Korean Association for the Study of Intestinal Diseases) study. Surg Endosc 2018; 33:750-756. [DOI: 10.1007/s00464-018-6339-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 07/06/2018] [Indexed: 12/13/2022]
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Early enteral nutrition for cardiogenic or obstructive shock requiring venoarterial extracorporeal membrane oxygenation: a nationwide inpatient database study. Intensive Care Med 2018; 44:1258-1265. [DOI: 10.1007/s00134-018-5319-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 07/12/2018] [Indexed: 12/30/2022]
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60
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Li L, Qin Y, Ma B, Cui H, Qiao P, Jiang H, Zhang M. Direct and simultaneous determination of methionine sulfoxide and pyroglutamic acid impurities in Compound Amino Acid Injection-18 AA by ion-pair reversed-phase HPLC. SEPARATION SCIENCE PLUS 2018. [DOI: 10.1002/sscp.201800059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Li Li
- Kangda College of Nanjing Medical University; Lianyungang China
| | - Yaru Qin
- Kangda College of Nanjing Medical University; Lianyungang China
| | - Bingyuan Ma
- Kangda College of Nanjing Medical University; Lianyungang China
| | - Hongyan Cui
- Kangda College of Nanjing Medical University; Lianyungang China
| | - Ping Qiao
- Kangda College of Nanjing Medical University; Lianyungang China
| | - He Jiang
- Kangda College of Nanjing Medical University; Lianyungang China
| | - Ming Zhang
- Kangda College of Nanjing Medical University; Lianyungang China
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Yandell R, Wang S, Bautz P, Shanks A, O'Connor S, Deane A, Lange K, Chapman M. A retrospective evaluation of nutrition support in relation to clinical outcomes in critically ill patients with an open abdomen. Aust Crit Care 2018; 32:237-242. [PMID: 29903605 DOI: 10.1016/j.aucc.2018.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Optimising nutrition support in critically ill patients with an open abdomen is challenging. OBJECTIVES The aims of this study were to (i) quantify the amount and adequacy of nutrition support administered and (ii) determine any relationships that exist between mode of nutrition support delivery and clinical outcomes in critically ill patients with an open abdomen. METHODS A retrospective review of critically ill patients mechanically ventilated for at least 48 h with an open abdomen in a mixed quaternary referral intensive care unit. Enteral and parenteral nutrition (ml) administered daily to patients was recorded for up to 21 days. Length of stay in the intensive care unit and hospital and duration of mechanical ventilation (days) were reported. RESULTS Thirty patients were studied [14 male, 68 y (15-90 y), body mass index 25 kg/m2 (11-51 kg/m2), Acute Physiology and Chronic Health Evaluation II score 20 (7-41), energy goal 1860 kcal/d (1250-2712 kcal/d)]. Patients received 55% (0-117%) of energy goal and 56% (0-105%) protein goal from either enteral or parenteral nutrition. When enteral nutrition was delivered alone or in combination with parenteral nutrition, patients received 48% (0-146%) of their energy and 59% (19-105%) of their protein goal. Patients fed parenteral nutrition, either alone or as supplementary to enteral nutrition (n = 18), received more energy when compared with those who only received enteral nutrition (n = 9) [65 (27-117) vs 49 (15-89) % energy goal, P = 0.025]. Parenteral nutrition was associated with an increased length of stay in hospital [63 (45-156) vs 45 (17-93) d, P = 0.037]. CONCLUSION Patients with an open abdomen receive about half of their nutrition requirements when fed exclusively via the enteral route. Providing combination enteral and parenteral nutrition to reach nutritional goals may not result in better clinical outcomes for patients with an open abdomen.
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Affiliation(s)
- Rosalie Yandell
- Department of Nutrition and Dietetics, Trauma Services, Royal Adelaide Hospital, Port Rd, Adelaide, 5000, Australia; Centre of Clinical Research Excellence (CRE) in Translating Science to Good Health, The University of Adelaide, Frome Rd, Adelaide, 5000, Australia; Discipline of Acute Care Medicine, The University of Adelaide, Frome Rd, Adelaide, 5000, Australia.
| | - Susan Wang
- Department of Critical Care Services, Trauma Services, Royal Adelaide Hospital, Port Rd, Adelaide, 5000, Australia
| | - Peter Bautz
- Hepatobiliary Surgery, Trauma Services, Royal Adelaide Hospital, Port Rd, Adelaide, 5000, Australia
| | - Alison Shanks
- Department of Nutrition and Dietetics, Trauma Services, Royal Adelaide Hospital, Port Rd, Adelaide, 5000, Australia
| | - Stephanie O'Connor
- Department of Critical Care Services, Trauma Services, Royal Adelaide Hospital, Port Rd, Adelaide, 5000, Australia; Discipline of Acute Care Medicine, The University of Adelaide, Frome Rd, Adelaide, 5000, Australia
| | - Adam Deane
- Department of Critical Care Services, Trauma Services, Royal Adelaide Hospital, Port Rd, Adelaide, 5000, Australia; Centre of Clinical Research Excellence (CRE) in Translating Science to Good Health, The University of Adelaide, Frome Rd, Adelaide, 5000, Australia; Discipline of Acute Care Medicine, The University of Adelaide, Frome Rd, Adelaide, 5000, Australia
| | - Kylie Lange
- Centre of Clinical Research Excellence (CRE) in Translating Science to Good Health, The University of Adelaide, Frome Rd, Adelaide, 5000, Australia
| | - Marianne Chapman
- Department of Critical Care Services, Trauma Services, Royal Adelaide Hospital, Port Rd, Adelaide, 5000, Australia; Centre of Clinical Research Excellence (CRE) in Translating Science to Good Health, The University of Adelaide, Frome Rd, Adelaide, 5000, Australia; Discipline of Acute Care Medicine, The University of Adelaide, Frome Rd, Adelaide, 5000, Australia
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Van Dyck L, Casaer MP, Gunst J. Autophagy and Its Implications Against Early Full Nutrition Support in Critical Illness. Nutr Clin Pract 2018; 33:339-347. [PMID: 29665131 DOI: 10.1002/ncp.10084] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/26/2018] [Indexed: 12/29/2022] Open
Abstract
The timing, dose, and route of early nutrition support in critically ill patients have been highly controversial for years. Despite the association of a caloric deficit with adverse outcome, several recent large, randomized, controlled trials have demonstrated a prolongation of organ failure and increased muscle weakness with increasing doses of nutrition in the acute phase of critical illness. A potential explanation for the negative impact of early, full feeding on outcome is feeding-induced suppression of autophagy, a cellular repair process that is necessary to clear intracellular damage. Whether nutrition management in critically ill patients should be guided by its effects on autophagy is a topic of debate. Currently, however, autophagy cannot be monitored in clinical practice. Moreover, clinical management should be guided by high-quality randomized controlled trials, which currently do not support the use of early full nutrition support.
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Affiliation(s)
- Lisa Van Dyck
- Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Belgium
| | - Michaël P Casaer
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Belgium
| | - Jan Gunst
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Belgium
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Zhao Y, Wang C. Effect of ω-3 polyunsaturated fatty acid-supplemented parenteral nutrition on inflammatory and immune function in postoperative patients with gastrointestinal malignancy: A meta-analysis of randomized control trials in China. Medicine (Baltimore) 2018; 97:e0472. [PMID: 29668624 PMCID: PMC5916652 DOI: 10.1097/md.0000000000010472] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND There are no consensus regarding the efficacy of omega-3polyunsaturated fatty acids (PUFAs) on inflammatory and immune function in postoperative patients with gastrointestinal malignancy. METHODS The literatures published randomized control trials (RCT) were searched in PubMed, Embase, Scopus, Cochrane Library, CNKI, Weipu, and Wanfang Databases. The immune efficacy outcomes of ω-3 polyunsaturated fatty acid-supplemented parenteral nutrition in patients with gastrointestinal malignancy were compared. RESULTS Sixteen RCTs involving 1008 patients (506 in the omega-3 group, 502 in the control group) were enrolled into the analysis. The results of meta-analysis: the cell immunity: The proportions of CD3, CD4, CD4/CD8 in the omega-3 group were significantly higher than those in the control group (CD3: WMD = 4.48; 95% CI, 3.34-5.62; P < .00001; I = 0%; CD4: WMD = 5.55; 95% CI, 4.75-6.34; P < .00001; I = 0%; CD4/CD8: WMD = .28; 95% CI, 0.13-0.44; P = .0004; I = 81%). In the humoral immunity: The levels of IgA, IgM and IgG in the omega-3 group were significantly higher than those in the control group (IgA: WMD = 0.31; 95% CI, 0.25-0.37; P < .00001; I = 0%; IgM: WMD = 0.12; 95% CI, 0.06-1.81; P < .00001; I = 0%; IgG: WMD = 1.19; 95% CI, 0.80-1.58; P < .00001; I = 0%). The count of lymphocyte in the omega-3 group was significantly higher than that in the control group (WMD = 0.22; 95% CI, 0.12-0.33; P < .0001; I = 40%). In the postoperative inflammatory cytokine: The levels of interleukin-6, tumor necrosis factor (TNF)-α and C-reactive protein in the omega-3 group were significantly lower than those in the control group (IL-6: WMD = -3.09; 95% CI, -3.91 to 2.27; P < .00001; I = 45%; TNF-α: WMD = -1.65; 95% CI, -2.05 to 1.25; P < .00001; I = 28%; CRP: WMD = -4.28; 95% CI, -5.26 to 3.30; P < .00001; I = 37%). The rate of postoperative infective complications in the omega-3 group was significantly lower than that in the control group (OR = 0.36; 95% CI, 0.20-0.66; P = .0008; I = 0%). CONCLUSION This meta-kanalysis confirmed that early intervention with Omega -3 fatty acid emulsion in gastrointestinal cancer can not only improve the postoperative indicators of immune function, reduce inflammatory reaction, and improve the postoperative curative effect but also improve the immune suppression induced by conventional PN or tumor. Therefore, postoperative patients with gastrointestinal cancer should add omega-3 unsaturated fatty acids in their PN formula. Further high-quality RCTs are needed to verify its efficacy.
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Powers J, Luebbehusen M, Aguirre L, Cluff J, David MA, Holly V, Linford L, Park N, Brunelle R. Improved Safety and Efficacy of Small-Bore Feeding Tube Confirmation Using an Electromagnetic Placement Device. Nutr Clin Pract 2018. [PMID: 29529335 DOI: 10.1002/ncp.10062] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Jan Powers
- Parkview Health System; Fort Wayne Indiana USA
| | | | | | - Julia Cluff
- Intermountain Medical Center; Salt Lake City Utah
| | - Mary Ann David
- Sharp Chula Vista Medical Center; Chula Vista California USA
| | - Vince Holly
- Indiana University Health Bloomington Hospital; Bloomington Indiana
| | | | - Nancy Park
- TouchPoint; St. John Hospital & Medical Center; Detroit Michigan USA
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Enteral/Parenteral Nutrition in Foals and Adult Horses Practical Guidelines for the Practitioner. Vet Clin North Am Equine Pract 2018; 34:169-180. [PMID: 29426711 DOI: 10.1016/j.cveq.2017.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Nutritional support is an important adjunct to medical therapy in the sick, injured, or debilitated equine patient. What is not clear is the optimal route, composition, or amounts of support. The enteral route should be chosen whenever possible to maximize the benefits to the gastrointestinal tract and the patient as a whole. Complete or partial parenteral nutrition is most useful as a bridge during recovery and transition to enteral feeding in the horse. The reader is encouraged to consider nutritional support whether enteral or parenteral in any anorexic, chronically debilitated, or sick equine patient.
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Vidhya C, Phoebe D, Dhina C, Jayne S, Robert F. Percutaneous endoscopic gastrostomy (PEG) versus radiologically inserted gastrostomy (RIG): A comparison of outcomes at an Australian teaching hospital. Clin Nutr ESPEN 2018; 23:136-140. [DOI: 10.1016/j.clnesp.2017.10.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 10/22/2017] [Accepted: 10/31/2017] [Indexed: 10/18/2022]
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Reignier J, Boisramé-Helms J, Brisard L, Lascarrou JB, Ait Hssain A, Anguel N, Argaud L, Asehnoune K, Asfar P, Bellec F, Botoc V, Bretagnol A, Bui HN, Canet E, Da Silva D, Darmon M, Das V, Devaquet J, Djibre M, Ganster F, Garrouste-Orgeas M, Gaudry S, Gontier O, Guérin C, Guidet B, Guitton C, Herbrecht JE, Lacherade JC, Letocart P, Martino F, Maxime V, Mercier E, Mira JP, Nseir S, Piton G, Quenot JP, Richecoeur J, Rigaud JP, Robert R, Rolin N, Schwebel C, Sirodot M, Tinturier F, Thévenin D, Giraudeau B, Le Gouge A. Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2). Lancet 2018; 391:133-143. [PMID: 29128300 DOI: 10.1016/s0140-6736(17)32146-3] [Citation(s) in RCA: 326] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/20/2017] [Accepted: 07/17/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Whether the route of early feeding affects outcomes of patients with severe critical illnesses is controversial. We hypothesised that outcomes were better with early first-line enteral nutrition than with early first-line parenteral nutrition. METHODS In this randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2 trial) done at 44 French intensive-care units (ICUs), adults (18 years or older) receiving invasive mechanical ventilation and vasopressor support for shock were randomly assigned (1:1) to either parenteral nutrition or enteral nutrition, both targeting normocaloric goals (20-25 kcal/kg per day), within 24 h after intubation. Randomisation was stratified by centre using permutation blocks of variable sizes. Given that route of nutrition cannot be masked, blinding of the physicians and nurses was not feasible. Patients receiving parenteral nutrition could be switched to enteral nutrition after at least 72 h in the event of shock resolution (no vasopressor support for 24 consecutive hours and arterial lactate <2 mmol/L). The primary endpoint was mortality on day 28 after randomisation in the intention-to-treat-population. This study is registered with ClinicalTrials.gov, number NCT01802099. FINDINGS After the second interim analysis, the independent Data Safety and Monitoring Board deemed that completing patient enrolment was unlikely to significantly change the results of the trial and recommended stopping patient recruitment. Between March 22, 2013, and June 30, 2015, 2410 patients were enrolled and randomly assigned; 1202 to the enteral group and 1208 to the parenteral group. By day 28, 443 (37%) of 1202 patients in the enteral group and 422 (35%) of 1208 patients in the parenteral group had died (absolute difference estimate 2·0%; [95% CI -1·9 to 5·8]; p=0·33). Cumulative incidence of patients with ICU-acquired infections did not differ between the enteral group (173 [14%]) and the parenteral group (194 [16%]; hazard ratio [HR] 0·89 [95% CI 0·72-1·09]; p=0·25). Compared with the parenteral group, the enteral group had higher cumulative incidences of patients with vomiting (406 [34%] vs 246 [20%]; HR 1·89 [1·62-2·20]; p<0·0001), diarrhoea (432 [36%] vs 393 [33%]; 1·20 [1·05-1·37]; p=0·009), bowel ischaemia (19 [2%] vs five [<1%]; 3·84 [1·43-10·3]; p=0·007), and acute colonic pseudo-obstruction (11 [1%] vs three [<1%]; 3·7 [1·03-13·2; p=0·04). INTERPRETATION In critically ill adults with shock, early isocaloric enteral nutrition did not reduce mortality or the risk of secondary infections but was associated with a greater risk of digestive complications compared with early isocaloric parenteral nutrition. FUNDING La Roche-sur-Yon Departmental Hospital and French Ministry of Health.
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Affiliation(s)
- Jean Reignier
- Médecine Intensive Réanimation, CHU de Nantes, Nantes, France; Université de Nantes, Nantes, France.
| | - Julie Boisramé-Helms
- EA 7293, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg, Strasbourg, France; Medical Intensive Care Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Laurent Brisard
- CHU de Nantes, Hôpital Laennec, Département d'Anesthésie et Réanimation, Nantes, France
| | - Jean-Baptiste Lascarrou
- Médecine Intensive Réanimation, CHU de Nantes, Nantes, France; Université de Nantes, Nantes, France
| | - Ali Ait Hssain
- Medical Intensive Care Unit, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Nadia Anguel
- Medical Intensive Care Unit, CHU de Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| | - Laurent Argaud
- Medical Intensive Care Unit, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Karim Asehnoune
- Surgical Intensive Care Unit, Hotel Dieu, CHU de Nantes, Nantes, France; Université de Nantes, Nantes, France
| | - Pierre Asfar
- Medical Intensive Care and Hyperbaric Oxygen Therapy Unit, Centre Hospitalier Universitaire Angers, Angers, France; Laboratoire de Biologie Neurovasculaire et Mitochondriale Intégrée, CNRS UMR 6214 - INSERM U1083, Université Angers, UBL, Angers, France
| | - Frédéric Bellec
- Medical-Surgical Intensive Care Unit, Centre Hospitalier de Montauban, Montauban, France
| | - Vlad Botoc
- Medical-Surgical Intensive Care Unit, Centre Hospitalier de Saint-Malo, Saint-Malo, France
| | - Anne Bretagnol
- Medical Intensive Care Unit, CHR Orléans, Orléans, France
| | - Hoang-Nam Bui
- Medical Intensive Care Unit, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France
| | - Emmanuel Canet
- Medical Intensive Care Unit, Saint Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Daniel Da Silva
- Medical-Surgical Intensive Care Unit, Centre Hospitalier de Saint-Denis, Saint-Denis, France
| | - Michael Darmon
- Medical-Surgical Intensive Care Unit, University Hospital, Saint Etienne, France
| | - Vincent Das
- Medical-Surgical Intensive Care Unit, Centre Hospitalier Intercommunal André Grégoire, Montreuil, France
| | - Jérôme Devaquet
- Medical-Surgical Intensive Care Unit, Hôpital Foch, Suresnes, France
| | - Michel Djibre
- Medical-Surgical Intensive Care Unit, Tenon University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | | | - Maité Garrouste-Orgeas
- UMR 1137, IAME Team 5, Decision Sciences in Infectious Diseases (DeSCID), Control and Care, Sorbonne Paris Cité, Inserm-Paris Diderot University, Paris, France; Medical-Surgical Unit, Hôpital Saint-Joseph, Paris France; Medical Unit and Palliative Research Group, French and British Institute, Levallois-Perret, France; OUTCOMEREA Research Group, Drancy, France
| | - Stéphane Gaudry
- Medical-Surgical Intensive Care Unit, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP), Colombes, France; Université Paris Diderot, ECEVE, UMR 1123, Sorbonne Paris Cité, Paris, France
| | - Olivier Gontier
- Medical-Surgical Intensive Care Unit, Hôpital de Chartres, Chartres, France
| | - Claude Guérin
- Medical Intensive Care Unit, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France; Université de Lyon, IMRB INSERM 955, Lyon, France
| | - Bertrand Guidet
- Medical Intensive Care Unit, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Sorbonne Université, UPMC Université Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: Epidémiologie Hospitalière Qualité et Organisation des Soins, Paris, France
| | | | - Jean-Etienne Herbrecht
- Medical Intensive Care Unit, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Faculté de Médecine U1121, Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Jean-Claude Lacherade
- Médecine Intensive Réanimation, Centre Hospitalier Départemental de la Vendée, La Roche sur Yon, France
| | - Philippe Letocart
- Medical-Surgical Intensive Care Unit, Hôpital Jacques Puel, Rodez, France
| | - Frédéric Martino
- Medical-Surgical Intensive Care Unit, CHU de Pointe-à-Pitre, Pointe-à-Pitre, France
| | - Virginie Maxime
- Medical-Surgical Intensive Care Unit, Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France
| | - Emmanuelle Mercier
- Médecine Intensive Réanimation, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Jean-Paul Mira
- Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Saad Nseir
- Medical Intensive Care Unit, CHU Lille, Lille, France; Université Lille, Medicine School, Lille, France
| | - Gael Piton
- Medical Intensive Care Unit, CHRU Besançon, Besançon, France; EA3920, Université de Franche Comté, Besançon, France
| | - Jean-Pierre Quenot
- Medical-Surgical Intensive Care Unit, François Mitterrand University Hospital, Dijon, France; Lipness Team, INSERM UMR 866 and LabExLipSTIC, Université de Bourgogne, Dijon, France
| | - Jack Richecoeur
- Medical-Surgical Intensive Care Unit, Hôpital de Beauvais, Beauvais, France
| | | | - René Robert
- Medical Intensive Care Unit, CHU Poitiers, Poitiers, France; Université de Poitiers, INSERM CIC1402, Poitiers, France
| | - Nathalie Rolin
- Medical-Surgical Intensive Care Unit, Centre Hospitalier de Melun, Melun, France
| | - Carole Schwebel
- Medical Intensive Care Unit, CHU Albert Michallon Grenoble, Grenoble, France; Inserm U1039, Radiopharmaceutiques Biocliniques, Université Grenoble Alpes, La Tronche, France
| | - Michel Sirodot
- Medical-Surgical Intensive Care Unit, Centre Hospitalier Annecy-Genevois, Metz-Tessy, Pringy, France
| | | | - Didier Thévenin
- Medical-Surgical Intensive Care Unit, Centre Hospitalier Docteur Schaffner, Lens, France
| | - Bruno Giraudeau
- Inserm CIC 1415, Tours, France; Université de Tours, Tours, France; CHU Tours, Tours, France; Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France
| | - Amélie Le Gouge
- Inserm CIC 1415, Tours, France; Université de Tours, Tours, France; CHU Tours, Tours, France
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Han H, Pan M, Tao Y, Liu R, Huang Z, Piccolo K, Zhong C, Liu R. Early Enteral Nutrition is Associated with Faster Post-Esophagectomy Recovery in Chinese Esophageal Cancer Patients: A Retrospective Cohort Study. Nutr Cancer 2018; 70:221-228. [PMID: 29313724 DOI: 10.1080/01635581.2018.1412477] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
We retrospectively examined a large cohort of esophageal carcinoma patients who received early enteral nutrition (EEN) to clarify the validity of EEN compared with total parenteral nutrition (TPN). Included were a total of 665 consecutive patients with histologically confirmed carcinoma of the esophagus or esophagogastric junction; and all patients underwent esophagectomy. The patients were divided into two groups: TPN (n = 262) and EEN (n = 403). The TPN group consisted of patients who only received intravenous nutrition support after operation. The postoperative length of hospital stay (PLOS), anastomotic leakage, mortality after surgery, and hospital charges were reviewed and analyzed. Compared with the TPN group, the EEN group had significantly shorter mean PLOS (15.6 days vs. 22.5 days; P < 0.01). Multivariable linear regression analysis revealed EEN to be associated with shorter PLOS even after adjustment for tumor histology, tumor location, type of esophagectomy, and postoperative albumin infusion. Hospital charges were also significantly less for those in the EEN group than the TPN group. There was no significant difference between the two groups regarding the complication of anastomotic leakage and clinical outcome after surgery. These findings suggest that EEN reduces PLOS and hospital charges of Chinese esophageal cancer patients who had an esophagectomy.
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Affiliation(s)
- Hongyu Han
- a Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine , Guangzhou , China.,b Fox Chase Cancer Center, Temple University , Philadelphia , Pennsylvania , USA
| | - Meixia Pan
- c Department of Kinesiology , Health and Nutrition, University of Texas at San Antonio , San Antonio , Texas , USA.,d Department of Nutrition , Guangdong General Hospital, Guangdong Academy of Medical Sciences , Guangzhou , China
| | - Yang Tao
- e Department of Health and Behavior Studies , Teachers College Columbia University , New York , USA
| | - Runzhong Liu
- f Department of Medical Statistic and Epidemiology , School of Public Health, Sun Yat-sen University , Guangzhou , China
| | - Zhiliang Huang
- a Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine , Guangzhou , China
| | - Korinne Piccolo
- g Clinical Nutritional Service, the Hospital of University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Caiyun Zhong
- h Department of Nutritional Science , School of Public Health, Nanjing Medical University , Nanjing , China
| | - Ranyi Liu
- a Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine , Guangzhou , China
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Abstract
Pediatric patients require specialized attention and have diverse demands for proper growth and development, and thus need a different approach and interest in nutritional assessment and supply. Enteral nutrition is the most basic and important method of nutritional intervention, and its indications should be identified. Also, the sites, modes, types, and timing of nutritional intervention according to the patient's condition should be determined. In addition, various complications associated with enteral nutrition supply should be identified, and prevention and treatment are required. This approach to enteral nutrition and proper administration can help in the proper growth and recovery of pediatric patients with nutritional imbalances or nutritional needs.
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Affiliation(s)
- Dae Yong Yi
- Department of Pediatrics, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Stability and assessment of amino acids in parenteral nutrition solutions. J Pharm Biomed Anal 2018; 147:125-139. [DOI: 10.1016/j.jpba.2017.07.064] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/12/2017] [Accepted: 07/15/2017] [Indexed: 10/19/2022]
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Adjemian D, Arendt BM, Allard JP. Assessment of parenteral nutrition prescription in Canadian acute care settings. Nutrition 2017; 49:7-12. [PMID: 29571609 DOI: 10.1016/j.nut.2017.11.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 11/11/2017] [Accepted: 11/17/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Parenteral nutrition (PN) prescription can be challenging in patients with complex conditions and has potential complications. OBJECTIVE To assess PN prescription, monitoring, and PN-related complications in a Canadian acute care setting. METHODS This was a prospective cohort study in which patients receiving PN were assessed by an auditor for nutritional status, PN-related prescription, monitoring, and complications. In addition, length of stay and mortality were recorded. RESULTS 147 patients (mean ± SD 56.1 ± 16.4 y) with complex diseases (Charlson comorbidity index, median [p25-p75] 2 [1-4]) were enrolled. Before starting PN, 18.6%, 63.9%, and 17.5% of patients were classified as subjective global assessment A, B, and C, respectively. Body mass index remained unchanged during the period on PN. On average, 89% and 73% of patients received <90% of their energy and protein requirements, respectively, but 65% received oral or enteral nutrition at some point during PN. The average daily energy provided by PN increased and stabilized on day 10, reaching 87.2 ± 20.1% of the requirements. Line sepsis (6.8% of patients) and hyperglycemia (6.9%) were the most common complications. The overall mortality was 15.6%. For those alive, length of stay was 30 (range: 4-268) d. PN was discontinued because of transitioning to an oral diet (56.6%), enteral nutrition (17.6%), home PN (14.7%), palliative care (5.1%), death (4.4%), or other (1.5%). CONCLUSION Most patients were malnourished at the start of PN. Energy and protein provided from PN were less than requirements, and the goals were reached with delay. Mortality was high, possibly as a result of complex diseases.
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Affiliation(s)
- Daniela Adjemian
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Bianca M Arendt
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Johane P Allard
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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72
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Santos DA, Alseidi A, Shannon VR, Messick C, Song G, Ledet CR, Lee H, Ngo-Huang A, Francis GJ, Asher A. Management of surgical challenges in actively treated cancer patients. Curr Probl Surg 2017; 54:612-654. [DOI: 10.1067/j.cpsurg.2017.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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73
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Terzi N, Darmon M, Reignier J, Ruckly S, Garrouste-Orgeas M, Lautrette A, Azoulay E, Mourvillier B, Argaud L, Papazian L, Gainnier M, Goldgran-Toledano D, Jamali S, Dumenil AS, Schwebel C, Timsit JF. Initial nutritional management during noninvasive ventilation and outcomes: a retrospective cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:293. [PMID: 29187261 PMCID: PMC5707783 DOI: 10.1186/s13054-017-1867-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 10/23/2017] [Indexed: 12/20/2022]
Abstract
Background Patients starting noninvasive ventilation (NIV) to treat acute respiratory failure are often unable to eat and therefore remain in the fasting state or receive nutritional support. Maintaining a good nutritional status has been reported to improve patient outcomes. In the present study, our primary objective was to describe the nutritional management of patients starting first-line NIV, and our secondary objectives were to assess potential associations between nutritional management and outcomes. Methods Observational retrospective cohort study of a prospective database fed by 20 French intensive care units. Adult medical patients receiving NIV for more than 2 consecutive days were included and divided into four groups on the basis of nutritional support received during the first 2 days of NIV: no nutrition, enteral nutrition, parenteral nutrition only, and oral nutrition only. Results Of the 16,594 patients admitted during the study period, 1075 met the inclusion criteria; of these, 622 (57.9%) received no nutrition, 28 (2.6%) received enteral nutrition, 74 (6.9%) received parenteral nutrition only, and 351 (32.7%) received oral nutrition only. After adjustment for confounders, enteral nutrition (vs. no nutrition) was associated with higher 28-day mortality (adjusted HR, 2.3; 95% CI, 1.2–4.4) and invasive mechanical ventilation needs (adjusted HR, 2.1; 95% CI, 1.1–4.2), as well as with fewer ventilator-free days by day 28 (adjusted relative risk, 0.7; 95% CI, 0.5–0.9). Conclusions Nearly three-fifths of patients receiving NIV fasted for the first 2 days. Lack of feeding or underfeeding was not associated with mortality. The optimal route of nutrition for these patients needs to be investigated. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1867-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicolas Terzi
- INSERM, U1042, Université Grenoble-Alpes, HP2, F-38000, Grenoble, France. .,Service de Réanimation Médicale, Centre Hospitalier Universitaire Grenoble - Alpes, CS10217, Grenoble, cedex 09, France.
| | - Michael Darmon
- Medical Intensive Care Unit, Saint-Etienne University Hospital, Saint-Priest en Jarez, France
| | - Jean Reignier
- Medical Intensive Care Unit, Nantes University Hospital Center, Nantes, France
| | - Stéphane Ruckly
- Department of Biostatistics, OUTCOMEREA™, Bobigny, France.,UMR 1137, Infection Antimicrobials Modelling Evolution (IAME) Team 5, Decision Sciences in Infectious Diseases (DeSCID), Control and Care, Sorbonne Paris Cité, Inserm/Paris Diderot University, Paris, France
| | | | - Alexandre Lautrette
- Medical Intensive Care Unit, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Elie Azoulay
- Service de Réanimation Médicale, CHU Saint-Louis, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Bruno Mourvillier
- UMR 1137, Infection Antimicrobials Modelling Evolution (IAME) Team 5, Decision Sciences in Infectious Diseases (DeSCID), Control and Care, Sorbonne Paris Cité, Inserm/Paris Diderot University, Paris, France.,Réanimation Médicale et Infectieuse, Hôpital Bichat Claude Bernard, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Laurent Argaud
- Medical Intensive Care Unit, Lyon University Hospital, Lyon, France
| | - Laurent Papazian
- Réanimation des Détresses Respiratoires et Infections Sévères, Hôpital Nord, Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille, Unité de Recherche sur les Maladies Infectieuses et Tropicales Émergentes (URMITE), UMR CNRS 7278, Marseille, France
| | - Marc Gainnier
- Réanimation des Urgences et Medicale, CHU la Timone 2 Marseille, Aix-Marseille Université, 13385, Marseille, France
| | | | - Samir Jamali
- Medical-Surgical Intensive Care Medicine Unit, Dourdan Hospital, Dourdan, France
| | - Anne-Sylvie Dumenil
- Medical-Surgical Intensive Care Unit, Assistance Publique - Hôpitaux de Paris, Antoine Béclère University Hospital, Clamart, France
| | - Carole Schwebel
- Service de Réanimation Médicale, Centre Hospitalier Universitaire Grenoble - Alpes, CS10217, Grenoble, cedex 09, France.,Integrated Research Center, Inserm U1039, Radiopharmaceutical Bioclinical Mixed Research Unit, University Joseph Fourier, Grenoble, France
| | - Jean-François Timsit
- UMR 1137, Infection Antimicrobials Modelling Evolution (IAME) Team 5, Decision Sciences in Infectious Diseases (DeSCID), Control and Care, Sorbonne Paris Cité, Inserm/Paris Diderot University, Paris, France.,Réanimation Médicale et Infectieuse, Hôpital Bichat Claude Bernard, Assistance Publique - Hôpitaux de Paris, Paris, France
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74
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Gonzales F, Bruno B, Alarcón Fuentes M, De Berranger E, Guimber D, Behal H, Gandemer V, Spiegel A, Sirvent A, Yakoub-Agha I, Nelken B, Duhamel A, Seguy D. Better early outcome with enteral rather than parenteral nutrition in children undergoing MAC allo-SCT. Clin Nutr 2017; 37:2113-2121. [PMID: 29097037 DOI: 10.1016/j.clnu.2017.10.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/23/2017] [Accepted: 10/05/2017] [Indexed: 10/18/2022]
Abstract
There is no consensus on the type of nutritional support to introduce in children undergoing allogeneic stem cell transplantation (allo-SCT) after myeloablative conditioning (MAC). This retrospective, multicenter, observational study compared the early administration of enteral nutrition (EN group, n = 97) versus parenteral nutrition (PN group, n = 97) in such patients with matching for important covariates. The primary endpoint was the study of day 100 overall mortality. The early outcome at day 100 was better in EN group regarding mortality rate (1% vs. 13%; p = 0.0127), non relapse mortality (1% vs. 7%; p = 0.066), acute GVHD grades II-IV (37% vs. 54%; p = 0.0127), III-IV (18% vs. 34%; p = 0.0333) and its gut localization (16% vs. 32%; p = 0.0136). Platelet engraftment was better in EN group than in PN group for the threshold of 20 G/L (97% vs. 80% p < 0.0001) and 50 G/L (92% vs. 78%, p < 0.0001). The length of stay was shorter in EN group (28 vs. 52 days, p < 0.0001). There were no differences between the two groups regarding the polynuclear neutrophil engraftment, infection rate or mucositis occurrence. These results suggest that, in children undergoing MAC allo-SCT, PN should be reserved to the only cases when up-front EN is insufficient or impossible to perform.
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Affiliation(s)
- F Gonzales
- Univ. Lille, CHU Lille, Hématologie Pédiatrique, Hôpital Jeanne de Flandre, F-59000 Lille, France
| | - B Bruno
- Univ. Lille, CHU Lille, Hématologie Pédiatrique, Hôpital Jeanne de Flandre, F-59000 Lille, France
| | - M Alarcón Fuentes
- Univ. Lille, CHU Lille, Hématologie Pédiatrique, Hôpital Jeanne de Flandre, F-59000 Lille, France
| | - E De Berranger
- Univ. Lille, CHU Lille, Hématologie Pédiatrique, Hôpital Jeanne de Flandre, F-59000 Lille, France
| | - D Guimber
- Univ. Lille, CHU Lille, Gastro-Entérologie, Hépatologie et Nutrition Pédiatrique, Hôpital Jeanne de Flandre, F-59000 Lille, France
| | - H Behal
- Univ. Lille, CHU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, Unité de biostatistiques, F-59000 Lille, France
| | - V Gandemer
- CHU Rennes, Service d'Onco-Hématologie Pédiatrique, Hôpital Sud, Rennes, France
| | - A Spiegel
- CHU Strasbourg, Service d'Hématologie et d'Oncologie Pédiatrique, Hôpital Hautepierre, Strasbourg, France
| | - A Sirvent
- CHU Montpellier, Unité d'Onco-Hématologie Pédiatrique, Montpellier, France
| | - I Yakoub-Agha
- Univ. Lille, CHU de Lille, Maladies du Sang, Hôpital Claude Huriez, F-59000 Lille, France
| | - B Nelken
- Univ. Lille, CHU Lille, Hématologie Pédiatrique, Hôpital Jeanne de Flandre, F-59000 Lille, France
| | - A Duhamel
- Univ. Lille, CHU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, Unité de biostatistiques, F-59000 Lille, France
| | - D Seguy
- Univ. Lille, Inserm, CHU Lille, Service de Nutrition, U995 - LIRIC - Lille Inflammation Research International Center, F-59000 Lille, France.
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75
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Abstract
The surgical critically ill patient is subject to a variable and complex metabolic response, which has detrimental effects on immunity, wound healing, and preservation of lean body muscle. The concept of nutrition support has evolved into nutrition therapy, whereby the primary objectives are to prevent oxidative cell injury, modulate the immune response, and attenuate the metabolic response. This review outlines the metabolic response to critical illness, describes nutritional risk; reviews the evidence for the role, dose, and timing of enteral and parenteral nutrition, and reviews the evidence for immunonutrition in the surgical intensive care unit.
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76
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Hvas CL, Farrer K, Blackett B, Lloyd H, Paine P, Lal S. Reduced 30-day gastrostomy placement mortality following the introduction of a multidisciplinary nutrition support team: a cohort study. J Hum Nutr Diet 2017; 31:413-421. [DOI: 10.1111/jhn.12520] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- C. L. Hvas
- Department of Hepatology and Gastroenterology; Aarhus University Hospital; Aarhus C Denmark
- Intestinal Failure Unit; Salford Royal NHS Foundation Trust; Mancheter UK
| | - K. Farrer
- Intestinal Failure Unit; Salford Royal NHS Foundation Trust; Mancheter UK
| | - B. Blackett
- Nutrition Support Team; Salford Royal NHS Foundation Trust; Manchester UK
| | - H. Lloyd
- Nutrition Support Team; Salford Royal NHS Foundation Trust; Manchester UK
| | - P. Paine
- Department of Gastroenterology; Salford Royal NHS Foundation Trust; Manchester UK
- The University of Manchester; Manchester UK
| | - S. Lal
- Intestinal Failure Unit; Salford Royal NHS Foundation Trust; Mancheter UK
- The University of Manchester; Manchester UK
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77
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Wikjord K, Dahl V, Søvik S. Effects on nutritional care practice after implementation of a flow chart-based nutrition support protocol in an intensive care unit. Nurs Open 2017; 4:282-291. [PMID: 29085654 PMCID: PMC5653395 DOI: 10.1002/nop2.99] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 08/29/2017] [Indexed: 01/16/2023] Open
Abstract
Background Enteral nutrition (EN) is associated with improved outcome in critically ill patients and is more affordable. We compared nutritional care practice in our ICU before and after modification of our nutrition support protocol: Several comprehensive documents were substituted with one flow chart and early EN was encouraged. Design Retrospective observational study. Methods Nutritional data were collected from admission up to 7 days in 25 patients before and 25 patients after protocol modification. Results The percentage of patients receiving EN within 72 hr of admission increased from 64% before to 88% after protocol modification. Cumulative percentage energy from EN during ICU days 1–4 increased from 26–89% of total kcal. Overall amount of nutrition administered enterally increased, with a corresponding marked decline in use of parenteral nutrition. Pre‐modification, >80% of patients received >65% of their calculated nutrition requirements by ICU Day 4; post‐modification this goal was achieved by Day 7.
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Affiliation(s)
- Kristina Wikjord
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Vegard Dahl
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway.,Department of Anaesthesia and Intensive Care Akershus University Hospital Lørenskog Norway
| | - Signe Søvik
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway.,Department of Anaesthesia and Intensive Care Akershus University Hospital Lørenskog Norway
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78
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Hyeda A, Costa ÉSMD. Economic analysis of costs with enteral and parenteral nutritional therapy according to disease and outcome. EINSTEIN-SAO PAULO 2017; 15:192-199. [PMID: 28767918 PMCID: PMC5609616 DOI: 10.1590/s1679-45082017gs4002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/04/2017] [Indexed: 11/29/2022] Open
Abstract
Objective To conduct an economic analysis of enteral and parenteral diet costs according to the type of disease and outcome (survivors versus deaths). Methods It is a cross-sectional, observational, retrospective study with a qualitative and quantitative design, based on analysis of hospital accounts from a healthcare insurance provider in the Southern region of Brazil. Results We analyzed 301 hospital accounts of individuals who used enteral and parenteral diets. The total cost of the diet was 35.4% of hospital account total costs. The enteral modality accounted for 59.8% of total dietary costs. The major costs with diets were observed in hospitalizations related to infections, cancers and cerebro-cardiovascular diseases. The major costs with parenteral diet were with admissions related by cancers (64.52%) and dementia syndromes (46.17%). The highest ratio between total diet costs with the total of hospital account costs was in dementia syndromes (46.32%) and in cancers (41.2%). The individuals who died spent 51.26% of total of hospital account costs, being 32.81% in diet (47.45% of total diet value and 58.81% in parenteral modality). Conclusion Enteral and parenteral nutritional therapies account for a significant part of the costs with hospitalized individuals, especially in cases of cancers and dementia syndromes. The costs of parenteral diets were higher in the group of patients who died.
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Affiliation(s)
- Adriano Hyeda
- Universidade Federal do Paraná, Curitiba, PR, Brazil.,Instituto Superior de Administração e Economia, Fundação Getúlio Vargas, Curitiba, PR, Brazil
| | - Élide Sbardellotto Mariano da Costa
- Universidade Federal do Paraná, Curitiba, PR, Brazil.,Instituto Superior de Administração e Economia, Fundação Getúlio Vargas, Curitiba, PR, Brazil
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79
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Saseedharan S, Pathrose EJ. Making Nutrition Management Scientific, Objective and Simple with the Help of Technology. J Clin Diagn Res 2017; 11:OM01-OM03. [PMID: 29207770 DOI: 10.7860/jcdr/2017/26221.10588] [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: 12/21/2016] [Accepted: 06/08/2017] [Indexed: 11/24/2022]
Abstract
Nutrition management is one of the cornerstones of care in the management of hospitalized patients, especially, for those who are critically ill. Significant numbers of hospitalized patients have alteration in appetite and the function of the gastrointestinal tract. Calculating the caloric goal, prescribed proteins to be delivered in a finite amount of water at a certain rate is the need of the hour and it becomes a daunting task to complete daily. With the help of technology such tasks can be completed easily and accurately. This suggestion based software called as "iNutriMon" helps to screen out the patients which are at risk of malnutrition, formulate a plan, monitor and manage enteral nutrition of patients by calculating calories, proteins and water intake as per the patient requirement.
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Affiliation(s)
- Sanjith Saseedharan
- Head, Department of Intensive Care Unit, S.L. Raheja Hospital (A Fortis Associate), Mumbai, Maharashtra, India
| | - Edwin Joseph Pathrose
- Registrar, Department of Intensive Care Unit, S.L. Raheja Hospital (A Fortis Associate), Mumbai, Maharashtra, India
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80
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Patejdl R, Kästner M, Kolbaske S, Wittstock M. Clinical nutrition and gastrointestinal dysfunction in critically ill stroke patients. Neurol Res 2017; 39:959-964. [PMID: 28828964 DOI: 10.1080/01616412.2017.1367545] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background Data on the epidemiology and risk factors of altered gastrointestinal motility (AGIM) is virtually lacking for patients suffering from non-traumatic neurologic diseases and stroke. This study investigated whether patterns of AGIM differ between patients with stroke and other severe acute brain diseases. Methods Clinical records of stroke and non-stroke patients treated at a neurological intensive care unit (ICU) were reviewed at day 1-5 and at day 10 after admission. The data was analyzed for the course of enteral/parenteral nutrition and for and for signs and symptoms of gastrointestinal dysfunction. The study included data of 76 patients, 57 with stroke (stroke group, SG) and 19 with other neurological diseases (non-stroke group, NSG). Results Basic demographic as well as clinical baseline characteristics and alimentation regime were similar in both groups. At least one sign of AGIM was seen in 33/57 (58%) SG and in 15/19 (79%) NSG patients (P = 0.099). Regurgitation was significantly more frequent among patients from the NSG (P < 0.05). Subjects from the NSG also spent a higher proportion of time with at least one symptom of AGIM present (P < 0.05). Conclusions For the first time, this study investigated the prevalence of AGIM in patients suffering from severe stroke. The prevalence of disturbed gastrointestinal function was found to be high in stroke patients, but was lower than in a group of non-stroke patients with similar general disease severity and baseline characteristics.
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Affiliation(s)
- Robert Patejdl
- a Department of Physiology , University of Rostock , Rostock , Germany
| | - Matthias Kästner
- b Department of Neurology , University of Rostock , Rostock , Germany
| | - Stephan Kolbaske
- b Department of Neurology , University of Rostock , Rostock , Germany
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81
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Vazquez-Sandoval A, Ghamande S, Surani S. Critically ill patients and gut motility: Are we addressing it? World J Gastrointest Pharmacol Ther 2017; 8:174-179. [PMID: 28828195 PMCID: PMC5547375 DOI: 10.4292/wjgpt.v8.i3.174] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 05/18/2017] [Accepted: 07/17/2017] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal (GI) dysmotility is a common problem in the critically ill population. It can be a reflection and an early sign of patient deterioration or it can be an independent cause of morbidity and mortality. GI dysmotility can be divided for clinical purposes on upper GI dysmotility and lower GI dysmotility. Upper GI dysmotility manifests by nausea, feeding intolerance and vomiting; its implications include aspiration into the airway of abdominal contents and underfeeding. Several strategies to prevent and treat this condition can be tried and they include prokinetics and post-pyloric feeds. It is important to note that upper GI dysmotility should be treated only when there are clinical signs of intolerance (nausea, vomiting) and not based on measurement of gastric residual volumes. Lower GI dysmotility manifests throughout the spectrum of ileus and diarrhea. Ileus can present in the small bowel and the large bowel as well. In both scenarios the initial treatment is correction of electrolyte abnormalities, avoiding drugs that can decrease motility and patient mobilization. When this fails, in the case of small bowel ileus, lactulose and polyethylene glycol solutions can be useful. In the case of colonic pseudo obstruction, neostigmine, endoscopic decompression and cecostomy can be tried when the situation reaches the risk of rupture. Diarrhea is also a common manifestation of GI dysmotility and the most important step is to differentiate between infectious sources and non-infectious sources.
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82
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Cavalea AC, Heidel RE, Daley BJ, Lawson CM, Benton DA, Mcloughlin JM. Pneumatosis Intestinalis in Patients Receiving Tube Feeds. Am Surg 2017. [DOI: 10.1177/000313481708300830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Pneumatosis intestinalis (PI) identified on computed tomography (CT) suggests an underlying pathology including bowel ischemia. Patients receiving tube feeds can develop PI, potentially requiring surgical intervention. We identify clinical factors in PI to predict those that may be safe to observe versus those that need immediate intervention. We retrospectively reviewed patients from a single institution from 2008 to 2016 with CT findings of PI and an enteric feeding tube. Patients who had not received tube feeds within one week of the CT were excluded. We analyzed clinical, operative, and outcome data to differentiate benign from pathologic outcomes. P values < 0.05 were set as significant. Forty patients were identified. We classified 24 as benign (no intervention) and 16 as pathologic (requiring intervention). A pathologic outcome was demonstrated for free fluid on CT [odds ratio (OR) = 5.00, confidence interval (CI) 1.23-20.30, P = 0.03)], blood urea nitrogen (BUN) elevation (OR = 8.27, CI 1.53-44.62, P = 0.01), creatinine (Cr) elevation (OR = 5.00, CI 1.27-19.62, P = 0.02), BUN/Cr ratio >30 (OR = 8.57, CI 1.79-40.98, P = 0.006), and vomiting/ feeding intolerance (OR = 9.38, CI 1.64-53.62, P = 0.01). Bowel function within 24 hours of the CT, bowel dilatation (small ≥ 3 cm; large ≥6 cm), and lactic acidemia were not significant. Peritonitis was only seen in pathologic states, but this did not reach statistical significance (P = 0.06). This represents the largest single-center retrospective analysis of tube feeding-induced PI to date. The presence of free fluid on CT, BUN and Cr elevation, BUN/Cr >30, vomiting/feeding intolerance and peritonitis were predictive of a pathologic etiology of PI.
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Affiliation(s)
- Alexander C. Cavalea
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tennesssee
| | - Robert E. Heidel
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tennesssee
| | - Brian J. Daley
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tennesssee
| | - Christy M. Lawson
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tennesssee
| | - Darrell A. Benton
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tennesssee
| | - James M. Mcloughlin
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tennesssee
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83
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Dickerson RN, Kumpf VJ, Bingham AL, Cogle SV, Blackmer AB, Tucker AM, Chan LN, Canada TW. Significant Published Articles for Pharmacy Nutrition Support Practice in 2016. Hosp Pharm 2017; 52:412-421. [PMID: 29276265 DOI: 10.1177/0018578717720313] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Purpose: To assist the pharmacist engaged in nutrition support therapy in staying current with pertinent literature. Methods: Several clinical pharmacists engaged in nutrition support therapy compiled a list of articles published in 2016 considered important to their clinical practice. The citation list was compiled into a single spreadsheet where the author participants were asked to assess whether the paper was considered important to nutrition support pharmacy practice. A culled list of publications was then identified whereby the majority of author participants (at least 5 out of 8) considered the paper to be important. Guideline and consensus papers from professional organizations, important to practice but not scored, were also included. Results: A total of 103 articles were identified; 10 from the primary literature were voted by the group to be of high importance. An additional 11 organizational guidelines, position, recommendation, or consensus papers were also identified. The top-ranked articles from the primary literature were reviewed. Conclusion: It is recommended that pharmacists, engaged in nutrition support therapy, be familiar with the majority of these articles as it pertains to their practice.
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Affiliation(s)
| | | | | | | | | | - Anne M Tucker
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Todd W Canada
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
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84
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Kher V, Srisawat N, Noiri E, Benghanem Gharbi M, Shetty MS, Yang L, Bagga A, Chakravarthi R, Mehta R. Prevention and Therapy of Acute Kidney Injury in the Developing World. Kidney Int Rep 2017. [PMCID: PMC5720672 DOI: 10.1016/j.ekir.2017.03.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Timely recognition of patients at risk or with possible acute kidney injury (AKI) is essential for early intervention to minimize further damage and improve outcome. Initial management of patients with suspected and persistent AKI should include thorough clinical assessment of all patients with AKI to identify reversible factors, including fluid volume status, potential nephrotoxins, and an assessment of the underlying health of the kidney. Based on these assessments, early interventions to provide appropriate and adequate fluid resuscitation while avoiding fluid overload, removal of nephrotoxins, and adjustment of drug doses according to the level of kidney function derangement are important. The judicious use of diuretics for fluid overload and/or in cardiac decompensated patients and introduction of early enteral nutritional support need to be considered to improve outcomes in AKI. Although these basic principles are well recognized, their application in clinical practice in low resource settings is often limited due to lack of education, availability of resources, and lack of trained personnel, which limits access to care. We report the consensus recommendations of the 18th Acute Dialysis Quality Initiative meeting in Hyderabad, India, on strategies to evaluate patients with suspected AKI and initiate measures for prevention and management to improve outcomes, particularly in low resource settings. These recomendations provide a framework for caregivers, who are often primary care physicians, nurses, and other allied healthcare personnel, to manage patients with AKI in resource poor countries.
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85
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Nutritional support for critically ill children: A Cochrane review summary. Int J Nurs Stud 2017; 76:129-130. [PMID: 28577819 DOI: 10.1016/j.ijnurstu.2017.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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86
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Nikniaz Z, Somi MH, Nagashi S, Nikniaz L. Impact of Early Enteral Nutrition on Nutritional and Immunological Outcomes of Gastric Cancer Patients Undergoing Gastrostomy: A Systematic Review and Meta-Analysis. Nutr Cancer 2017; 69:693-701. [PMID: 28569563 DOI: 10.1080/01635581.2017.1324996] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The present systematic review and meta-analysis study evaluated the impact of early enteral nutrition (EN) on postoperative nutritional and immunological outcomes of gastric cancer (GC) patients. METHOD The databases of PubMed, Embase, Springer, and Cochrane library were searched till September 2016 to identify studies which evaluated the effects of EN compared with parenteral nutrition (PN) on postoperative immunological and nutritional status and hospitalization time in GC patients. Mean difference (MD) or standard mean difference (SMD) was calculated and I-square statistic test was used for heterogeneity analysis. RESULTS The present systematic review and meta-analysis have consisted of seven trials, containing 835 GC patients. According to the result of meta-analysis, compared with PN, EN significantly resulted in more increase in the level of albumin [MD = 2.07 (0.49, 3.64)], prealbumin [MD = 9.41 (049, 33.55)], weight [MD = 1.52 (0.32, 2.72)], CD3+ [SMD = 1.96 (1.50, 2.43)], CD4+ [SMD = 2.45 (1.97, 2.93)], natural killers [MD = 5.80 (3.75, 7.85)], and also a decrease in the hospitalization time [MD=-2.39 (-2.74, -2.03)]. CONCLUSION The results demonstrated that early administration of EN is more effective in improving postsurgical nutrition status and immune index in GC patients. So, based on these results, postoperative early administration of EN is recommended for GC patients where possible.
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Affiliation(s)
- Zeinab Nikniaz
- a Liver and Gastrointestinal Disease Research Center , Tabriz University of Medical Sciences , Tabriz , Iran
| | - Mohammad Hossein Somi
- a Liver and Gastrointestinal Disease Research Center , Tabriz University of Medical Sciences , Tabriz , Iran
| | - Shahnaz Nagashi
- a Liver and Gastrointestinal Disease Research Center , Tabriz University of Medical Sciences , Tabriz , Iran
| | - Leila Nikniaz
- b Tabriz Health Services Management Research Center , Tabriz University of Medical Sciences , Tabriz , Iran
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87
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Total parenteral nutrition usage trends in the United States. J Crit Care 2017; 40:312-313. [PMID: 28434532 DOI: 10.1016/j.jcrc.2017.04.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 04/11/2017] [Indexed: 12/31/2022]
Abstract
INTRODUCTION This study examined how total parenteral nutrition (TPN) usage has changed in recent years, and whether a difference exists between teaching and non-teaching institutions. MATERIALS AND METHODS Using the National Inpatient Sample (NIS) database, total discharges of patients who received TPN (ICD-9 99.15) from 2001 to 2014 were determined. The cohort was dichotomized for teaching and non-teaching institutions, and analyzed using the Z-test statistic. RESULTS Annual patients receiving TPN at all institutions increased significantly from 25,075 in 2001 to 33,435 in 2014 (P<0.0001), peaking at 43,350 in 2012. Annual patients receiving TPN at teaching institutions increased significantly from 13,231 in 2001 to 24,630 in 2014 (P<0.0001), peaking at 26,935 in 2012. Annual patients receiving TPN at non-teaching institutions decreased significantly from 11,844 in 2001 to 8805 in 2014 (P<0.0001), peaking at 17,920 in 2011. DISCUSSION It is unclear why TPN usage trended upward in United States hospitals, and why TPN usage peaked and subsequently decreased in non-teaching institutions while continuing to uptrend in teaching institutions. Further inquiry is indicated to determine the etiology of this discrepancy. CONCLUSIONS Utilization of TPN increased in the United States between 2001 and 2014, eventually decreasing in non-teaching institutions but not in teaching institutions.
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88
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El Rahim I. Yousef A, El Gabry MM, El-Shabrawy M, Mohammed RH. Assessment of nutritional support in critically ill patients and its correlation with outcomes at respiratory intensive care unit at Zagazig University Hospitals in (2014–2015). EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2017. [DOI: 10.1016/j.ejcdt.2016.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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89
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Sanz-Paris A, Álvarez Hernández J, Ballesteros-Pomar MD, Botella-Romero F, León-Sanz M, Martín-Palmero Á, Martínez Olmos MÁ, Olveira G. Evidence-based recommendations and expert consensus on enteral nutrition in the adult patient with diabetes mellitus or hyperglycemia. Nutrition 2017; 41:58-67. [PMID: 28760429 DOI: 10.1016/j.nut.2017.02.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 02/03/2017] [Accepted: 02/21/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this study was to develop evidence-based recommendations for glycemic control of patients with diabetes mellitus or stress hyperglycemia who are receiving enteral nutrition (EN). METHODS A Delphi survey method using Grading Recommendations Assessment, Development and Evaluation criteria was utilized for evaluation of suitable studies. RESULTS In patients with diabetes or stress hyperglycemia who were on EN support, the following results were found: CONCLUSIONS: These recommendations and suggestions regarding enteral feeding in patients with diabetes and hyperglycemia have direct clinical applicability.
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Affiliation(s)
- Alejandro Sanz-Paris
- Unit of Nutrition and Dietetics, Service of Endocrinology and Nutrition, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - Julia Álvarez Hernández
- Section of Endocrinology and Nutrition, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - María D Ballesteros-Pomar
- Unit of Clinical Nutrition and Dietetics, Section of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, León, Spain
| | | | - Miguel León-Sanz
- Unit of Clinical Nutrition and Dietetics, Service of Endocrinology and Nutrition, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ángela Martín-Palmero
- Unit of Clinical Nutrition and Dietetics, Service of Endocrinology and Nutrition, Hospital San Pedro, Logroño, Spain
| | - Miguel Ángel Martínez Olmos
- Unit of Clinical Nutrition and Dietetics, Service of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Gabriel Olveira
- UGC Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga/Universidad de Málaga, CIBERDEM, CIBER of Diabetes and Associated Metabolic Diseases (Instituto de Salud Carlos III: CB07/08/0019), Spain
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90
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Greis C, Rasuly Z, Janosi RA, Kordelas L, Beelen DW, Liebregts T. Intestinal T lymphocyte homing is associated with gastric emptying and epithelial barrier function in critically ill: a prospective observational study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:70. [PMID: 28327177 PMCID: PMC5361812 DOI: 10.1186/s13054-017-1654-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 02/28/2017] [Indexed: 02/06/2023]
Abstract
Background Impaired gastric emptying is common in critically ill patients. Intestinal dysmotility, a major cause of feed intolerance, may foster infectious complications due to mucosal barrier disruption. However, little is known about gut-directed immune activation, intestinal barrier function and its association with impaired gastric emptying in critically ill patients at ICU admission. Methods We conducted a prospective observational study at two tertiary care medical ICUs. Fifty consecutive patients needing invasive mechanical ventilation were recruited within 24 h of ICU admission, prior to any nutritional support. The acute physiology and chronic health evaluation (APACHE) II score, the sequential organ failure assessment (SOFA) score and the multiple organ dysfunction score (MODS) were used to assess illness severity and multiple organ dysfunction. Gastric emptying was assessed by paracetamol absorption test. Peripheral blood mononuclear cells were freshly isolated and cultured for 24 h, and TNF-α, IL-1β and IL-10 measured in cell culture supernatants and in serum by ELISA. The intestinal epithelial barrier was assessed, quantifying serum concentrations of intestinal fatty acid binding protein (I-FABP), ileal bile-acid binding protein (I-BABP) and zonulin-1 by ELISA. Small bowel homing T lymphocytes (CD4+ α4β7 + CCR9+) were analyzed by flow cytometry. The Mann-Whitney test and Spearman correlation were used in statistical evaluation. Results CD4 + α4β7 + CCR9+ T lymphocytes were inversely correlated with gastric emptying. Patients with delayed gastric emptying at ICU admission (n = 35) had significantly higher serum and PBMC-induced TNF-α and IL-1β and increased intestinal barrier disruption reflected by higher I-FABP, I-BABP and zonulin-1. Patients who died in the ICU had significantly impaired gastric empting at admission compared to ICU survivors. No differences were observed in APACHE II, SOFA or MODS in patients with delayed gastric emptying compared to patients with normal gastric emptying. Conclusions Exaggerated CD4 + α4β7 + CCR9+ T lymphocyte homing with increased pro-inflammatory cytokine release and intestinal epithelial barrier disruption are associated with delayed gastric emptying. This is not simply due to differences in overall severity of illness at ICU admission and may represent a pathophysiological mechanism of gut-directed immune activation leading to impaired barrier function in the critically ill.
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Affiliation(s)
- Christian Greis
- Department of Bone Marrow Transplantation, University of Duisburg-Essen, University Hospital Essen, West German Cancer Center, Hufelandstr. 55, Essen, 45122, Germany
| | - Zohal Rasuly
- Department of Bone Marrow Transplantation, University of Duisburg-Essen, University Hospital Essen, West German Cancer Center, Hufelandstr. 55, Essen, 45122, Germany
| | - Rolf A Janosi
- Department of Cardiology, University Hospital Essen, Essen, Germany
| | - Lambros Kordelas
- Department of Bone Marrow Transplantation, University of Duisburg-Essen, University Hospital Essen, West German Cancer Center, Hufelandstr. 55, Essen, 45122, Germany
| | - Dietrich W Beelen
- Department of Bone Marrow Transplantation, University of Duisburg-Essen, University Hospital Essen, West German Cancer Center, Hufelandstr. 55, Essen, 45122, Germany
| | - Tobias Liebregts
- Department of Bone Marrow Transplantation, University of Duisburg-Essen, University Hospital Essen, West German Cancer Center, Hufelandstr. 55, Essen, 45122, Germany.
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Abstract
PURPOSE OF REVIEW Acute pancreatitis is one of the most common causes for hospitalization related to a gastrointestinal disorder. It carries significant morbidity, and when severe, significant mortality. Multiple interventions have been studied to treat pancreatitis. Of all these interventions, none is more important or impactful than nutrition. RECENT FINDINGS High-quality evidence along with society guidelines have recommended the use of enteral nutrition over parenteral nutrition in patients with pancreatitis. Recent systematic reviews and meta-analyses have been published and will be reviewed here. SUMMARY The use of enteral nutrition has been demonstrated to decrease mortality and infectious complications compared with parenteral nutrition. The ideal timing of initiating enteral nutrition is not clear, however, early nutrition (within 48 h) appears to be safe and tolerated. Most studies have utilized nasojejunal feeding tubes; however, some patients may tolerate nasogastric or even oral refeeding. Clinicians who manage patients with pancreatitis must be aware of the critical role of nutrition in preventing pancreatitis-related complications.
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Abstract
BACKGROUND Although small-bore tube placement is common, insertion can lead to serious complications. We investigated the use of radiographs, fluoroscopy, feeding tubes, and complications associated with blind feeding-tube placement. METHODS The electronic and paper records of adult patients receiving a small-bore feeding tube in 2005 were retrospectively reviewed for the following variables: demographics, desired location (gastric or postpyloric), number of radiographs, number of tubes per individual, time interval between medical prescription, tube placement and delivery of the diet, complications, transport for fluoroscopy, and hospital location of placement (intensive care unit vs floor). RESULTS We identified 1822 tubes placed into 729 patients (male: 449, 61.6%; female: 280, 38.4%; median age: 59 years old, range 18-98). All tubes were placed by nurses unless fluoroscopically placed in radiology or placed after head and neck surgery in the operating room. An average of 2.5 (range 1-20) tubes was used per patient. A total of 2696 radiographs were obtained for an average of 3.7 (range 0-32) films per patient and 1.5 (range 0-11) per feeding tube. Successful placement was higher for intragastric (93.3%) than for postpyloric position (60.4%; p < .001). Fluoroscopy was needed in 18.6% of the patients, mostly for postpyloric insertion (p < .001). Respiratory tree misplacement occurred in 23 (3.2%) patients; 9 (1.2%) had a pneumothorax and 4 (0.5%) died. Patients with a malpositioned feeding tube underwent more tube insertions (6.8 +/- 5.4; range 2-20) than patients without complications (2.2 +/- 1.8; range 1-18; p < .001). CONCLUSIONS The incidence of airway misplacement of feeding tubes (3.2%) at a major tertiary referral university hospital was alarming. Mandatory radiographs may eliminate the risk of respiratory administration of feedings but not misplacements. The associated costs of radiographs, unsuccessful placements, fluoroscopy, and complications are significant. A solution to this problem will require focused attention and development of specific protocols, possibly using new technologies.
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93
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Worthington P, Balint J, Bechtold M, Bingham A, Chan LN, Durfee S, Jevenn AK, Malone A, Mascarenhas M, Robinson DT, Holcombe B. When Is Parenteral Nutrition Appropriate? JPEN J Parenter Enteral Nutr 2017; 41:324-377. [PMID: 28333597 DOI: 10.1177/0148607117695251] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Parenteral nutrition (PN) represents one of the most notable achievements of modern medicine, serving as a therapeutic modality for all age groups across the healthcare continuum. PN offers a life-sustaining option when intestinal failure prevents adequate oral or enteral nutrition. However, providing nutrients by vein is an expensive form of nutrition support, and serious adverse events can occur. In an effort to provide clinical guidance regarding PN therapy, the Board of Directors of the American Society for Parenteral and Enteral Nutrition (ASPEN) convened a task force to develop consensus recommendations regarding appropriate PN use. The recommendations contained in this document aim to delineate appropriate PN use and promote clinical benefits while minimizing the risks associated with the therapy. These consensus recommendations build on previous ASPEN clinical guidelines and consensus recommendations for PN safety. They are intended to guide evidence-based decisions regarding appropriate PN use for organizations and individual professionals, including physicians, nurses, dietitians, pharmacists, and other clinicians involved in providing PN. They not only support decisions related to initiating and managing PN but also serve as a guide for developing quality monitoring tools for PN and for identifying areas for further research. Finally, the recommendations contained within the document are also designed to inform decisions made by additional stakeholders, such as policy makers and third-party payers, by providing current perspectives regarding the use of PN in a variety of healthcare settings.
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Affiliation(s)
| | - Jane Balint
- 2 Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | | | - Angela Bingham
- 4 University of the Sciences, Philadelphia, Pennsylvania, USA
| | | | - Sharon Durfee
- 6 Central Admixture Pharmacy Services, Inc, Denver, Colorado, USA
| | | | | | - Maria Mascarenhas
- 9 The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel T Robinson
- 10 Ann & Robert H. Lurie Children's Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Beverly Holcombe
- 11 American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
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Pradelli L, Graf S, Pichard C, Berger MM. Supplemental parenteral nutrition in intensive care patients: A cost saving strategy. Clin Nutr 2017; 37:573-579. [PMID: 28169021 DOI: 10.1016/j.clnu.2017.01.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 01/16/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND & AIMS The Swiss supplemental parenteral nutrition (SPN) study demonstrated that optimised energy provision combining enteral nutrition (EN) and SPN reduces nosocomial infections in critically ill adults who fail to achieve targeted energy delivery with EN alone. To assess the economic impact of this strategy, we performed a cost-effectiveness analysis using data from the SPN study. METHODS Multivariable regression analyses were performed to characterise the relationships between SPN, cumulative energy deficit, nosocomial infection, and resource consumption. The results were used as inputs for a deterministic simulation model evaluating the cost-effectiveness of SPN administered on days 4-8 in patients who fail to achieve ≥60% of targeted energy delivery with EN by day 3. Cost data were derived primarily from Swiss diagnosis-related case costs and official labour statistics. RESULTS Provision of SPN on days 4-8 was associated with a mean decrease of 2320 ± 338 kcal in cumulative energy deficit compared with EN alone (p < 0.001). Logistic regression analysis showed that each 1000 kcal decrease in cumulative energy deficit was associated with a 10% reduction in the risk of nosocomial infection (odds ratio 0.90; 95% confidence interval 0.83-0.99; p < 0.05). The incremental cost per avoided infection was -63,048 CHF, indicating that the reduction in infection was achieved at a lower cost. CONCLUSION Optimisation of energy provision using SPN is a cost-saving strategy in critically ill adults for whom EN is insufficient to meet energy requirements.
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Affiliation(s)
- Lorenzo Pradelli
- AdRes Health Economics and Outcomes Research, Via Vittorio Alfieri, 17, 10121 Turin, Italy.
| | - Séverine Graf
- Service des Soins Intensifs, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland; Nutrition Unit, Division of Intensive Care, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205 Genève Switzerland
| | - Claude Pichard
- Nutrition Unit, Division of Intensive Care, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205 Genève Switzerland
| | - Mette M Berger
- Service of Adult Intensive Care, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne Switzerland
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William W. Optimizing nutrition of the preterm infant. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2017. [PMID: 28100316 PMCID: PMC7390124 DOI: 10.7499/j.issn.1008-8830.2017.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
The goal of nutrition of the preterm infant is to meet the growth rate of the healthy fetus of the same gestational age and to produce the same body composition of the healthy fetus in terms of organ growth, tissue components, and cell number and structure. Nutritional quantity and quality are fundamental for normal growth and development of preterm infants, including neurodevelopmental outcomes. Failure to provide the necessary amounts of all of the essential nutrients has produced not only growth failure, but also increased morbidity and less than optimal neurodevelopment. Growth velocities during the NICU hospitalization period for preterm infants exert a significant effect on neurodevelopmental and anthropometric outcomes. Despite the obvious need for optimal nutrition, growth failure is almost universal among preterm infants. There is every reason, therefore, to optimize nutrition of the preterm infant, in terms of total energy and protein, but also in terms of individual components such as amino acids, specific carbohydrates and lipids, and even oxygen. This review presents scientific rationale for nutrient requirements and practical guidelines and approaches to intravenous and enteral feeding for preterm infants. Intravenous feeding, including amino acids, should be started right after birth at rates that are appropriate for the gestational age of the infant. Enteral feeding should be started as soon as possible after birth, using mother's colostrum and milk as first choices. Enteral feeding should begin with trophic amounts and advanced as rapidly as tolerated, decreasing IV nutrition accordingly, while maintaining nutrient intakes at recommended rates. Feeding protocols are valuable for improving nutrition and related outcomes. Further research is needed to determine the optimal nutrition and rate of growth in preterm infants that will achieve optimal neurocognitive benefits while minimizing the longer-term risk of chronic diseases.
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Affiliation(s)
- W.Hay,Jr William
- />Perinatal Research Center, Child Maternal Health Program, Colorado Clinical and Translational Sciences Institute University of Colorado School of Medicine, Aurora, Colorado, USA
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Harvey SE, Parrott F, Harrison DA, Sadique MZ, Grieve RD, Canter RR, McLennan BK, Tan JC, Bear DE, Segaran E, Beale R, Bellingan G, Leonard R, Mythen MG, Rowan KM. A multicentre, randomised controlled trial comparing the clinical effectiveness and cost-effectiveness of early nutritional support via the parenteral versus the enteral route in critically ill patients (CALORIES). Health Technol Assess 2017; 20:1-144. [PMID: 27089843 DOI: 10.3310/hta20280] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Malnutrition is a common problem in critically ill patients in UK NHS critical care units. Early nutritional support is therefore recommended to address deficiencies in nutritional state and related disorders in metabolism. However, evidence is conflicting regarding the optimum route (parenteral or enteral) of delivery. OBJECTIVES To estimate the effect of early nutritional support via the parenteral route compared with the enteral route on mortality at 30 days and on incremental cost-effectiveness at 1 year. Secondary objectives were to compare the route of early nutritional support on duration of organ support; infectious and non-infectious complications; critical care unit and acute hospital length of stay; all-cause mortality at critical care unit and acute hospital discharge, at 90 days and 1 year; survival to 90 days and 1 year; nutritional and health-related quality of life, resource use and costs at 90 days and 1 year; and estimated lifetime incremental cost-effectiveness. DESIGN A pragmatic, open, multicentre, parallel-group randomised controlled trial with an integrated economic evaluation. SETTING Adult general critical care units in 33 NHS hospitals in England. PARTICIPANTS 2400 eligible patients. INTERVENTIONS Five days of early nutritional support delivered via the parenteral (n = 1200) and enteral (n = 1200) route. MAIN OUTCOME MEASURES All-cause mortality at 30 days after randomisation and incremental net benefit (INB) (at £20,000 per quality-adjusted life-year) at 1 year. RESULTS By 30 days, 393 of 1188 (33.1%) patients assigned to receive early nutritional support via the parenteral route and 409 of 1195 (34.2%) assigned to the enteral route had died [p = 0.57; absolute risk reduction 1.15%, 95% confidence interval (CI) -2.65 to 4.94; relative risk 0.97 (0.86 to 1.08)]. At 1 year, INB for the parenteral route compared with the enteral route was negative at -£1320 (95% CI -£3709 to £1069). The probability that early nutritional support via the parenteral route is more cost-effective - given the data - is < 20%. The proportion of patients in the parenteral group who experienced episodes of hypoglycaemia (p = 0.006) and of vomiting (p < 0.001) was significantly lower than in the enteral group. There were no significant differences in the 15 other secondary outcomes and no significant interactions with pre-specified subgroups. LIMITATIONS Blinding of nutritional support was deemed to be impractical and, although the primary outcome was objective, some secondary outcomes, although defined and objectively assessed, may have been more vulnerable to observer bias. CONCLUSIONS There was no significant difference in all-cause mortality at 30 days for early nutritional support via the parenteral route compared with the enteral route among adults admitted to critical care units in England. On average, costs were higher for the parenteral route, which, combined with similar survival and quality of life, resulted in negative INBs at 1 year. FUTURE WORK Nutritional support is a complex combination of timing, dose, duration, delivery and type, all of which may affect outcomes and costs. Conflicting evidence remains regarding optimum provision to critically ill patients. There is a need to utilise rigorous consensus methods to establish future priorities for basic and clinical research in this area. TRIAL REGISTRATION Current Controlled Trials ISRCTN17386141. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 28. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sheila E Harvey
- Clinical Trials Unit, Intensive Care National Audit & Research Centre, London, UK
| | - Francesca Parrott
- Clinical Trials Unit, Intensive Care National Audit & Research Centre, London, UK
| | - David A Harrison
- Clinical Trials Unit, Intensive Care National Audit & Research Centre, London, UK
| | - M Zia Sadique
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard D Grieve
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ruth R Canter
- Clinical Trials Unit, Intensive Care National Audit & Research Centre, London, UK
| | - Blair Kp McLennan
- Clinical Trials Unit, Intensive Care National Audit & Research Centre, London, UK
| | - Jermaine Ck Tan
- Clinical Trials Unit, Intensive Care National Audit & Research Centre, London, UK
| | - Danielle E Bear
- Department of Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ella Segaran
- Department of Nutrition and Dietetics, Imperial College Healthcare NHS Trust, London, UK
| | - Richard Beale
- Division of Asthma, Allergy and Lung Biopsy, King's College London, London, UK
| | - Geoff Bellingan
- National Institute for Health Research Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Richard Leonard
- Department of Critical Care, Imperial College Healthcare NHS Trust, London, UK
| | - Michael G Mythen
- National Institute for Health Research Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kathryn M Rowan
- Clinical Trials Unit, Intensive Care National Audit & Research Centre, London, UK
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Stoll B, Price PT, Reeds PJ, Chang X, Henry JF, van Goudoever JB, Holst JJ, Burrin DG. Feeding an Elemental Dietvsa Milk-Based Formula Does Not Decrease Intestinal Mucosal Growth in Infant Pigs. JPEN J Parenter Enteral Nutr 2017; 30:32-9. [PMID: 16387897 DOI: 10.1177/014860710603000132] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND We previously showed that the level of enteral nutrient intake determines the rate of intestinal growth in piglets. Our objective was to determine whether providing enteral nutrition in the form of elemental nutrients (glucose, amino acids, lipid [ED]) rather than cow's milk formula (lactose, protein, lipid [FORM]) reduces small intestinal growth and lactase activity. METHODS Three-week-old piglets were fed either ED (n = 7) intragastrically or FORM (n = 6) orally for 6 days. RESULTS Intestinal protein and DNA masses, villus height, and crypt depth were not different in ED and FORM pigs. Crypt cell proliferation, measured by in vivo bromodeoxyuridine labeling, was significantly (p < .05) higher (+37%) in ED than in FORM pigs. Rates of mucosal protein synthesis (%/d), measured by in vivo 2H-leucine incorporation, were higher (p < .05) in ED than FORM (147 vs 89) pigs. Circulating concentrations (pmol/L) of the intestinotrophic peptide, glucagon-like peptide-2 (GLP-2), were also higher (p < .05) in ED than in FORM (148 vs 87) pigs. The mean lactase-specific activity (micromol/min/g) in proximal and distal segments was higher (p < .05) in FORM than in ED (124 vs 58) pigs. CONCLUSIONS We conclude that intestinal mucosal growth and villus morphology are similar in pigs fed ED and FORM, despite higher cell proliferation and protein synthesis rates and lower lactase activity with ED. This implies that elemental diets may be as trophic as polymeric formulas to simultaneously provide nutrition and a stimulus for intestinal growth during bowel rest.
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Affiliation(s)
- Barbara Stoll
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030, USA.
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Li Q, Zhang Z, Xie B, Ji X, Lu J, Jiang R, Lei S, Mao S, Ying L, Lu D, Si X, Ji M, He J, Chen M, Zheng W, Wang J, Huang J, Wang J, Ji Y, Chen G, Zhu J, Shao Y, Lin R, Zhang C, Zhang W, Luo J, Lou T, He X, Chen K, Peng W, Sun R. Effectiveness of enteral feeding protocol on clinical outcomes in critically ill patients: A before and after study. PLoS One 2017; 12:e0182393. [PMID: 28771622 PMCID: PMC5542540 DOI: 10.1371/journal.pone.0182393] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/17/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Enteral nutrition (EN) feeding protocol was proposed to have positive impact on critically ill patients. However, current studies showed conflicting results. The present study aimed to investigate whether enteral feeding protocol was able to improve clinical outcomes in critically ill patients. METHODS A before (stage 1) and after (stage 2) interventional study was performed in 10 tertiary care hospitals. All patients expected to stay in the intensive care unit (ICU) for over three days were potentially eligible. Clinical outcomes such as 28-day mortality, ICU length of stay, duration of mechanical ventilation (MV), and nosocomial infection were compared between the two stages. MAIN RESULTS A total of 410 patients were enrolled during the study period, including 236 in stage 1 and 174 in stage 2. EN feeding protocol was able to increase the proportion of EN in day 2 (41.8±22.3 vs. 50.0±28.3%; p = 0.006) and day 6 (70.3±25.2 vs. 77.6±25.8%; p = 0.006). EN percentages tended to be higher in stage 1 than that in stage 2 on other days, but statistical significance was not reached. There was no difference in 28-day mortality between stage 1 and 2 (0.14 vs. 0.14; p = 0.984). Implementation of EN feeding protocol marginally reduced ICU length of stay (19.44±18.48 vs. 16.29±16.19 days; p = 0.077). There was no difference in the duration of MV between stage a and stage 2 (14.24±14.49 vs. 14.51±17.55 days; p = 0.877). CONCLUSIONS The study found that the EN feeding protocol was able to increase the proportion of EN feeding, but failed to reduce 28-day mortality, incidence of nosocomial infection or duration of MV.
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Affiliation(s)
- Qian Li
- Department of Critical Care Medicine, Zhejiang Provincial People's Hospital, Zhejiang, P. R. China
| | - Zhongheng Zhang
- Department of emergency medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bo Xie
- Department of Critical Care Medicine, Huzhou Central Hospital, Zhejiang, China
| | - Xiaowei Ji
- Department of Critical Care Medicine, Huzhou Central Hospital, Zhejiang, China
| | - Jiahong Lu
- Department of Critical Care Medicine, Huzhou Central Hospital, Zhejiang, China
| | - Ronglin Jiang
- Department of Critical Care Medicine, Zhejiang Provincial Hospital of TCM, Zhejiang, China
| | - Shu Lei
- Department of Critical Care Medicine, Zhejiang Provincial Hospital of TCM, Zhejiang, China
| | - Shihao Mao
- Department of Critical Care Medicine, Zhejiang Provincial Hospital of TCM, Zhejiang, China
| | - Lijun Ying
- Department of Critical Care Medicine, Shaoxing People's Hospital, Zhejiang, China
| | - Di Lu
- Department of Critical Care Medicine, Shaoxing People's Hospital, Zhejiang, China
| | - Xiaoshui Si
- Department of Critical Care Medicine, YiWu Central Hospital, Zhejiang, P. R. China
| | - Mingxia Ji
- Department of Critical Care Medicine, YiWu Central Hospital, Zhejiang, P. R. China
| | - Jianxing He
- Department of Critical Care Medicine, YiWu Central Hospital, Zhejiang, P. R. China
| | - Mengyan Chen
- Department of Critical Care Medicine, YiWu Central Hospital, Zhejiang, P. R. China
| | - Wenjuan Zheng
- Department of Critical Care Medicine, YiWu Central Hospital, Zhejiang, P. R. China
| | - Jiao Wang
- Department of Critical Care Medicine, YiWu Central Hospital, Zhejiang, P. R. China
| | - Jing Huang
- Department of Critical Care Medicine, YiWu Central Hospital, Zhejiang, P. R. China
| | - Junfeng Wang
- Department of Critical Care Medicine, YiWu Central Hospital, Zhejiang, P. R. China
| | - Yaling Ji
- Department of Critical Care Medicine, YiWu Central Hospital, Zhejiang, P. R. China
| | - Guodong Chen
- Department of Critical Care Medicine, NingBo First Hospital, Zhejiang, China
| | - Jianhua Zhu
- Department of Critical Care Medicine, NingBo First Hospital, Zhejiang, China
| | - Yadi Shao
- Department of Critical Care Medicine, NingBo First Hospital, Zhejiang, China
| | - Ronghai Lin
- Department of Critical Care Medicine, TaiZhou Hospital, Zhejiang, China
| | - Chao Zhang
- Department of Critical Care Medicine, TaiZhou Hospital, Zhejiang, China
| | - Weiwen Zhang
- Department of Critical Care Medicine, QuZhou People's Hospital, Zhejiang, P. R. China
| | - Jian Luo
- Department of Critical Care Medicine, QuZhou People's Hospital, Zhejiang, P. R. China
| | - Tianzheng Lou
- Department of Critical Care Medicine, LiShui People's Hospital, Zhejiang, P. R. China
| | - Xuwei He
- Department of Critical Care Medicine, LiShui People's Hospital, Zhejiang, P. R. China
| | - Kun Chen
- Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Zhejiang, P. R. China
| | - Wei Peng
- Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Zhejiang, P. R. China
| | - Renhua Sun
- Department of Critical Care Medicine, Zhejiang Provincial People's Hospital, Zhejiang, P. R. China
- * E-mail:
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Al-Dorzi HM, Albarrak A, Ferwana M, Murad MH, Arabi YM. Lower versus higher dose of enteral caloric intake in adult critically ill patients: a systematic review and meta-analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:358. [PMID: 27814776 PMCID: PMC5097427 DOI: 10.1186/s13054-016-1539-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 10/20/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND There is conflicting evidence about the relationship between the dose of enteral caloric intake and survival in critically ill patients. The objective of this systematic review and meta-analysis is to compare the effect of lower versus higher dose of enteral caloric intake in adult critically ill patients on outcome. METHODS We reviewed MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus from inception through November 2015. We included randomized and quasi-randomized studies in which there was a significant difference in the caloric intake in adult critically ill patients, including trials in which caloric restriction was the primary intervention (caloric restriction trials) and those with other interventions (non-caloric restriction trials). Two reviewers independently extracted data on study characteristics, caloric intake, and outcomes with hospital mortality being the primary outcome. RESULTS Twenty-one trials mostly with moderate bias risk were included (2365 patients in the lower caloric intake group and 2352 patients in the higher caloric group). Lower compared with higher caloric intake was not associated with difference in hospital mortality (risk ratio (RR) 0.953; 95 % confidence interval (CI) 0.838-1.083), ICU mortality (RR 0.885; 95 % CI 0.751-1.042), total nosocomial infections (RR 0.982; 95 % CI 0.878-1.077), mechanical ventilation duration, or length of ICU or hospital stay. Blood stream infections (11 trials; RR 0.718; 95 % CI 0.519-0.994) and incident renal replacement therapy (five trials; RR 0.711; 95 % CI 0.545-0.928) were lower with lower caloric intake. The associations between lower compared with higher caloric intake and primary and secondary outcomes, including pneumonia, were not different between caloric restriction and non-caloric restriction trials, except for the hospital stay which was longer with lower caloric intake in the caloric restriction trials. CONCLUSIONS We found no association between the dose of caloric intake in adult critically ill patients and hospital mortality. Lower caloric intake was associated with lower risk of blood stream infections and incident renal replacement therapy (five trials only). The heterogeneity in the design, feeding route and timing and caloric dose among the included trials could limit our interpretation. Further studies are needed to clarify our findings.
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Affiliation(s)
- Hasan M Al-Dorzi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Intensive Care Department, King Abdulaziz Medical City, P.O. Box 22490, Riyadh, 11426, Saudi Arabia
| | | | - Mazen Ferwana
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Department of Family Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,National & Gulf Center for Evidence Based Health Practice, Riyadh, 11426, Saudi Arabia
| | - Mohammad Hassan Murad
- Center for Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA.,Preventive Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Yaseen M Arabi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. .,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. .,Intensive Care Department, King Abdulaziz Medical City, P.O. Box 22490, Riyadh, 11426, Saudi Arabia.
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Di- and tripeptide transport in vertebrates: the contribution of teleost fish models. J Comp Physiol B 2016; 187:395-462. [PMID: 27803975 DOI: 10.1007/s00360-016-1044-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/12/2016] [Accepted: 10/20/2016] [Indexed: 02/06/2023]
Abstract
Solute Carrier 15 (SLC15) family, alias H+-coupled oligopeptide cotransporter family, is a group of membrane transporters known for their role in the cellular uptake of di- and tripeptides (di/tripeptides) and peptide-like molecules. Of its members, SLC15A1 (PEPT1) chiefly mediates intestinal absorption of luminal di/tripeptides from dietary protein digestion, while SLC15A2 (PEPT2) mainly allows renal tubular reabsorption of di/tripeptides from ultrafiltration, SLC15A3 (PHT2) and SLC15A4 (PHT1) possibly interact with di/tripeptides and histidine in certain immune cells, and SLC15A5 has unknown function. Our understanding of this family in vertebrates has steadily increased, also due to the surge of genomic-to-functional information from 'non-conventional' animal models, livestock, poultry, and aquaculture fish species. Here, we review the literature on the SLC15 transporters in teleost fish with emphasis on SLC15A1 (PEPT1), one of the solute carriers better studied amongst teleost fish because of its relevance in animal nutrition. We report on the operativity of the transporter, the molecular diversity, and multiplicity of structural-functional solutions of the teleost fish orthologs with respect to higher vertebrates, its relevance at the intersection of the alimentary and osmoregulative functions of the gut, its response under various physiological states and dietary solicitations, and its possible involvement in examples of total body plasticity, such as growth and compensatory growth. By a comparative approach, we also review the few studies in teleost fish on SLC15A2 (PEPT2), SLC15A4 (PHT1), and SLC15A3 (PHT2). By representing the contribution of teleost fish to the knowledge of the physiology of di/tripeptide transport and transporters, we aim to fill the gap between higher and lower vertebrates.
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