51
|
|
52
|
Marshall A, West S. Nutritional intake in the critically ill: Improving practice through research. Aust Crit Care 2004; 17:6-8, 10-5. [PMID: 15011992 DOI: 10.1016/s1036-7314(05)80045-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Enteral feeding is the preferred method of nutritional support in the critically ill; however, evidence suggests that many critically ill patients do not meet their nutritional goals. The implementation of enteral feeding protocols has improved nutritional delivery, although protocols can be widely variable. Similarly, enteral feeding related nursing practice is also inconsistent within and between intensive care units (ICUs). These variations in enteral feeding practice can be linked to the shortage of reliable and valid research into the many issues associated with the effective delivery of enteral nutrition. In the absence of a strong research tradition and practice, rituals are embraced and rarely challenged, further contributing to the wide variations in enteral feeding practice. Of particular importance are practice issues related to the commencement of enteral feeding and the assessment of feeding tolerance. This article seeks to review the literature related to commencing enteral feeding, with particular reference to the suitability of enteral nutrition, methods of enteral feeding and adjustment of enteral feeding rates. Issues relating to feeding intolerance, including the assessment of gastric residual volume and the development of diarrhoea, will also be explored.
Collapse
Affiliation(s)
- Andrea Marshall
- Critical Care Nursing Professorial Unit, Royal North Shore Hospital, NSW
| | | |
Collapse
|
53
|
Abstract
• Background Provision of enteral nutrition via the gastric route is a common nursing procedure in pediatric intensive care units. Little research, however, has focused on children’s tolerance of different types of gastric feeding regimens.
• Objectives To examine the relationship between 2 gastric feeding regimens, continuous and intermittent, and children’s tolerance as measured by the number of stools and prevalences of diarrhea and vomiting.
• Methods A randomized controlled trial was conducted in an Australian pediatric intensive care unit; 45 children were randomly assigned to either the continuous or the intermittent gastric feeding groups. Participants remained in the assigned feeding group for the duration of the study, and values of variables used to monitor patients’ tolerance were recorded.
• Results Both feeding groups were similar with respect to Pediatric Index Mortality score, age, weight, sex, diagnosis, and use of pharmacological agents known to affect the gastrointestinal tract. Additionally, the 2 groups did not differ in study duration or the daily volume of administered enteral formula per kilogram of body weight. The number of stools per day and the prevalences of diarrhea and vomiting did not differ significantly between the 2 groups.
• Discussion Continuous and intermittent gastric feeding regimens have similar outcomes with respect to the number of stools per day and the prevalence of diarrhea and vomiting in pediatric intensive care patients. Further gastric feeding studies and the development of enteral feeding guidelines for critically ill children are needed.
Collapse
Affiliation(s)
- Desley Horn
- The Royal Children’s Hospital, Brisbane, Australia (DH), and Griffith University, Gold Coast, Australia (WC)
| | - Wendy Chaboyer
- The Royal Children’s Hospital, Brisbane, Australia (DH), and Griffith University, Gold Coast, Australia (WC)
| |
Collapse
|
54
|
Abstract
BACKGROUND Acute renal failure (ARF) is a common condition in hospitalized patients. Research has been unable to identify the optimal target for therapeutic intervention; hence, effective prevention of and/or treatment for ARF remain elusive. OBJECTIVE To examine the usefulness of current and potential pharmacologic treatments in seriously ill, hospitalized patients. DATA SOURCES A MEDLINE search (1996-June 2002) was conducted using the search terms kidney (drug effects) and acute kidney failure (drug therapy). Bibliographies of selected articles were also examined to include all relevant investigations. STUDY SELECTION AND DATA EXTRACTION Review articles, meta-analyses, and clinical trials describing prevention of and treatment for hospital-acquired ARF were identified. Results from prospective, controlled trials were given priority when available. CONCLUSIONS Appropriate management of ARF includes prospective identification of at-risk patients, fluid administration, and optimal hemodynamic support. Drug treatments, including low-dose dopamine and diuretics, have demonstrated extremely limited benefits and have not been shown to improve patient outcome. Experimental agents influence cellular processes of renal dysfunction and recovery; unfortunately, relatively few drugs show promise for the future.
Collapse
Affiliation(s)
- Maria C Pruchnicki
- Division of Pharmacy Practice and Administration, College of Pharmacy, The Ohio State University, Columbus, OH 43210-1291, USA.
| | | |
Collapse
|
55
|
De Cicco M, Bortolussi R, Fantin D, Matovic M, Fracasso A, Fabiani F, Santantonio C. Supportive therapy of elderly cancer patients. Crit Rev Oncol Hematol 2002; 42:189-211. [PMID: 12007977 DOI: 10.1016/s1040-8428(01)00162-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Elderly cancer patients often require supportive care due to the physiologic decline of organs and apparatus linked with the aging process per se, and for the effects of tumor or of anticancer treatments. Pain and nutritional deficits are some clinical aspects requiring supportive care. Lack of studies on these latter topics does not allow an in depth analysis of the problem. The present review deals with literature concerning pain and nutritional problems in the general cancer population with emphasis on aspects typical for elderly cancer subjects. Physiologic and cancer-related changes in body composition, physical function and cognitive capacity of the elderly are presented and, when appropriate, linked with pathogenetic factors of pain and malnutrition, as well as their treatment. Pain demographic data, pain intensity evaluation and currently available techniques to provide pain relief such as etiologic treatment, analgesic pharmacotherapy and invasive analgesic procedures, are extensively discussed. Causes and assessment of malnutrition as well as available nutritional approaches such as oral, enteral and parenteral nutrition are also debated.
Collapse
Affiliation(s)
- Marcello De Cicco
- Anaesthesia, Intensive Care, Clinical Nutrition and Pain Therapy Units, Centro di Riferimento Oncologico, National Cancer Institute, Via Pedemontana Occidentale 12, I-33081 Aviano (PN), Italy.
| | | | | | | | | | | | | |
Collapse
|
56
|
Lopes MAF, White NA. Parenteral nutrition for horses with gastrointestinal disease: a retrospective study of 79 cases. Equine Vet J 2002; 34:250-7. [PMID: 12108742 DOI: 10.2746/042516402776186083] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Parenteral nutrition is advocated for sick foals and horses, although there is no report which has critically evaluated its benefits in this species. Therefore, the hypothesis that parenteral nutrition (PN) is beneficial for horses with severe gastrointestinal disease was investigated in a retrospective study. Records from 79 treatment courses in horses with gastrointestinal disease were reviewed for the years 1992-2000. The fatality rate (48.1%) was attributed to the severity of the primary disease. Complications due to PN were recorded and hyperglycaemia was the most common complication associated with PN. The number of laparatomies, proportion of horses that received lipid emulsion and the daily cost were higher in nonsurvivors than in survivors. The length of PN course was longer in survivors, although glucose peak was observed later in nonsurvivors after initiation of PN. The content of vitamins in PN solution and plasma protein at the beginning of PN were higher for survivors, while the volume of plasma administered was significantly larger in nonsurvivors. In horses with inflammatory diseases, the rate of glucose infusion and the amount of vitamins administered were higher than in horses with nonstrangulated obstruction. The proportion of horses that received lipid emulsion was higher among those with nonstrangulated and strangulated obstruction than in the group with inflammatory conditions. Because of the diverse group of diseases and the variability in the clinical signs, evaluating the effect of PN on disease outcome was not possible. A prospective study to compare horses with similar clinical conditions treated and not treated with PN is needed to evaluate fully the benefits of PN, and to establish guidelines for patient selection for PN.
Collapse
Affiliation(s)
- M A F Lopes
- Marion duPont Scott Equine Medical Center, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Leesburg 20177, USA
| | | |
Collapse
|
57
|
Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN J Parenter Enteral Nutr 2002. [PMID: 11841046 DOI: 10.1177/0148607102026001011] [Citation(s) in RCA: 365] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
58
|
Pasanisi F, Orban A, Scalfi L, Alfonsi L, Santarpia L, Zurlo E, Celona A, Potenza A, Contaldo F. Predictors of survival in terminal-cancer patients with irreversible bowel obstruction receiving home parenteral nutrition. Nutrition 2001; 17:581-4. [PMID: 11448576 DOI: 10.1016/s0899-9007(01)00579-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Clinical, anthropometric, hematologic, and biochemical variables, evaluated immediately before starting nutritional treatment, were related to survival in 76 terminal-cancer patients with irreversible bowel obstruction receiving home parenteral nutrition. At baseline, abnormally low values were observed in the following percentages of patients: 40.8% for body mass index, 59.2% for serum albumin, 84.2% for hemoglobin, 48.7% for lymphocyte count, and 60% for serum cholesterol. Survival on home parenteral nutrition ranged between 6 and 301 d, with a median of 74 d. Hemoglobin, serum albumin and serum cholesterol were lower in patients with a survival of less than 3 mo. With regard to Karnofsky performance status, median survival times were 63 d for a score below or equal to 50 and 128 d for a score between 60 and 70. Albumin and a Karnofsky score above 50 (but not age, weight, body mass index, lymphocyte count, or cholesterol) emerged (with a positive sign) as predictors of survival. In conclusion, terminal-cancer patients with irreversible bowel obstruction are often malnourished, showing a high prevalence of anemia and hypoalbuminemia. Survival differs widely and can be predicted only to a limited extent from initial values of serum albumin and Karnofsky performance status.
Collapse
Affiliation(s)
- F Pasanisi
- Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
59
|
|
60
|
Abstract
Nutrition plays a vital role in maintaining and enhancing the health of an individual. As mortality within intensive care units declines because of increased expertise and better equipment, attention is being focused on better methods of feeding the critically ill child. Feeding the child is one aspect that has been relegated to the back burner of the typically busy PICU. Evidence that feeding enhances immunity, protects the gut and shortens recovery time forces us to learn to feed our patients in more effective and safer ways. This article reviews the importance of feeding, especially that of enteral feeding, in the intensive care setting. The reactions of a stressed metabolism are outlined; separate nutritional components are discussed and requirements in specific conditions are given. Parenteral nutrition remains fraught with practical difficulties in India. Metabolic and infective complications are frequent and constant monitoring coupled with the cost of these solutions raises cost beyond affordable levels. Hence the emphasis on enteral feeding, with it's proven safety, routes of administration and ready availability. The immunity enhancing properties of enteral feeding is another aspect that has gained interest in recent years. Ecoimmunonutrition is a new concept that keeps the ecology of the stressed GI tract intact while providing adequately balanced formulae along with micronutrients and fibre.
Collapse
Affiliation(s)
- S Udani
- P.D. Hinduja National Hospital & Medical Research Centre, Mumbai, India.
| |
Collapse
|
61
|
Abstract
Our understanding of the effects of total parenteral nutrition in critical illness has been refined over the past year. The importance of not overfeeding patients has been highlighted. The effects of lipid emulsions containing medium-chain triglycerides, compared with standard ones, have been investigated and show, in particular, changes in platelet membrane fatty acid composition. Although data on clinical end-points are lacking, this is likely to be a fruitful area of further research. The importance of providing enteral support, if at all possible, has been further underlined by its beneficial effects on bile composition in the intensive care setting. Finally, critical illness has been shown to be, in general, a contraindication to growth hormone therapy.
Collapse
Affiliation(s)
- Paul Kitchen
- St Mark's Hospital and Academic Institute, Harrow, UK
| | | |
Collapse
|
62
|
Font-Noguera I, Cercós-Lletí AC, Llopis-Salvia P. Quality improvement in parenteral nutrition care. Clin Nutr 2001; 20:83-91. [PMID: 11161548 DOI: 10.1054/clnu.2000.0361] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The therapeutic objective of parenteral nutrition, as well as any other pharmacological treatment, must be organized for and focused on the patient, to obtain outcomes associated with an improvement in health status and quality of life. On this basis, the present article starts with a view of quality improvement in health care, identifying the structure, process and outcome paradigm for drug therapy and parenteral nutrition elements of quality assessment, as well as strategies for quality improvement will be described. A model of the organization assigned to parenteral nutrition care is proposed. In the future, computerized programs of parenteral nutrition may increase the risk of uncoordinated and fragmented care. The programs must improve health care of patient by exposing caregivers to the full alternatives of decisions with clinical and therapeutic data on patient individual.
Collapse
Affiliation(s)
- I Font-Noguera
- Hospital Universitario La Fe, Department of Pharmacy, Avda. Campanar, 21, Valencia, 46009, Spain
| | | | | |
Collapse
|
63
|
Bleichner G. L'intestin agressé : un concept physiopathologique ou une réalité clinique ? NUTR CLIN METAB 2000. [DOI: 10.1016/s0985-0562(00)80003-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
64
|
Affiliation(s)
- T J Yeatman
- Gastrointestinal Tumor Program at H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, Tampa 33612, USA
| |
Collapse
|
65
|
Worthington P, Gilbert KA, Wagner BA. Parenteral nutrition for the acutely ill. AACN CLINICAL ISSUES 2000; 11:559-79; quiz 634-6. [PMID: 11288419 DOI: 10.1097/00044067-200011000-00008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Parenteral nutrition (PN) is one of the most sophisticated forms of intravenous therapy in use today. Intravenous feeding is a life-saving technology for patients unable to maintain their nutritional status using the gastrointestinal tract. Although PN has become an integral component of patient care, the risks associated with this therapy must be weighed against the potential benefits. Comprehensive clinical management includes selection of candidates, implementation and monitoring of therapy, and ensuring a seamless transition when PN is no longer required. Optimal parenteral nutrition demands expertise in caring for vascular access devices. A collaborative approach to care minimizes the risks associated with PN and ensures positive patient outcomes.
Collapse
Affiliation(s)
- P Worthington
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | | | | |
Collapse
|
66
|
Abstract
The use of nutrition for the medical patient, in the inpatient setting and at home, will likely continue to increase in the future. Each patient should be evaluated in an individualized but systematic fashion. Each patient in whom malnourishment is suspected should undergo a thorough assessment for the presence and degree of malnutrition with an accurate calculation of nutritional requirements. It is important to choose the correct method of delivery of nutrition, to monitor and recognize any complications or problems that may arise, and to tailor the nutritional therapy to the unique diseases that are encountered in medicine. Although increasingly new advances and changes are occurring in the field of nutrition, nutritional support and therapy are best delivered and supplied to the patient with a network of health care workers, including the physician, the nurse, the dietitian, the social worker, and pharmacist.
Collapse
Affiliation(s)
- P R Pfau
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA
| | | |
Collapse
|
67
|
Affiliation(s)
- K J Moriarty
- Department of Gastroenterology, Royal Bolton Hospital, England
| | | |
Collapse
|
68
|
|
69
|
Affiliation(s)
- C Finck
- Department of Surgery, SUNY HSC, Syracuse, New York, USA
| |
Collapse
|
70
|
Bernstein CN, Papineau N, Zajaczkowski J, Rawsthorne P, Okrusko G, Blanchard JF. Direct hospital costs for patients with inflammatory bowel disease in a Canadian tertiary care university hospital. Am J Gastroenterol 2000; 95:677-83. [PMID: 10710056 DOI: 10.1111/j.1572-0241.2000.01845.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We set out to determine the direct costs of hospitalizations of patients with Crohn's disease and ulcerative colitis admitted to a university-affiliated tertiary care hospital and to contrast the costs of medical versus surgical inpatient care, Crohn's disease versus ulcerative colitis, and to identify dominant components of inpatient costs. METHODS We used a patient-specific case costing system at Saint Boniface General Hospital, Winnipeg, Manitoba, for fiscal years 1994 and 1995. We extracted all inpatients whose hospital discharge abstracts included ICD-9-CM codes 555 (Crohn's disease) and 556 (ulcerative colitis) among the top eight discharge diagnoses, and performed a chart review on all cases to ensure that the hospitalization was for inflammatory bowel disease and the diagnoses were accurate. We analyzed cases based on their disease diagnosis, primary mode of therapy associated with the hospitalization (medical vs surgical), and their major diagnosis-related group (DRG). This study evaluated direct patient care costs only and costs are expressed in Canadian dollars. RESULTS Of 362 hospital admissions, 325 were eligible and of these admissions 275 belonged to the digestive system DRGs. Seventy-one (37%) were admitted more than once during the 2 yr of the study, accounting for 202 (62%) of the total number of admissions. The mean cost per admission of all cases of Crohn's disease was $3,149 (95% confidence interval [CI], $2,665-$3,634) and for ulcerative colitis was $3,726 (95% CI $3,008-$4,445). Surgical therapy cases accounted for 49.8% of all admissions, 57.8% of all hospital days, and 60.5% of all costs. Patients treated surgically had more costly hospitalizations than those treated medically, particularly when analyzing only nontotal parenteral nutrition (TPN) cases. Surgical treatment admissions were significantly more costly for ulcerative colitis digestive DRG admissions than Crohn's disease. The nondigestive DRG admissions were more costly than the digestive DRGs in all categories although this was only statistically different among medically treated Crohn's disease. Patients treated medically were similarly costly whether they had Crohn's disease or ulcerative colitis. There was no significant difference in cost per admission among cases admitted multiple times, compared with those admitted only once. TPN cases accounted for 9.5% of cases but 27.1% of costs. TPN-associated hospitalizations were more costly than non-TPN-use hospitalizations but these costs were primarily driven by duration of stay rather than TPN use itself. For all cases, the top five cost categories in descending order were nursing unit bed-days, drugs and pharmacy, diagnostic lab tests, operating room, and diagnostic imaging and endoscopy. CONCLUSIONS Using our system we could determine direct costs for inpatients with inflammatory bowel disease and the factors that determined increased costs. Medical therapy admissions were similarly costly between Crohn's disease and ulcerative colitis; however, surgical therapy admissions were costlier among ulcerative colitis patients. Admissions for nondigestive DRGs were more costly than those for digestive DRGs. TPN use identified a sicker group of patients who remained in the hospital longer than nonusers and, not surprisingly, these were the costliest patients.
Collapse
Affiliation(s)
- C N Bernstein
- Department of Medicine, University of Manitoba, St. Boniface General Hospital, Winnipeg, Canada
| | | | | | | | | | | |
Collapse
|
71
|
Prise en charge de la nutrition dans les unités de soins intensifs en Europe : résultats d'un questionnaire. NUTR CLIN METAB 2000. [DOI: 10.1016/s0985-0562(00)80037-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
72
|
MacFie J. Ethical and legal considerations in the provision of nutritional support to the perioperative patient. Curr Opin Clin Nutr Metab Care 2000; 3:23-9. [PMID: 10642080 DOI: 10.1097/00075197-200001000-00005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite the extensive current literature on ethics, very few publications have specifically addressed the ethical issues surrounding the provision of nutrition to perioperative patients. Four publications are particularly relevant and highly recommended [1-4]. This review is an attempt to draw attention to those ethical issues that are relevant to the use of nutritional support in the perioperative patient and offer guidance on appropriate action by clinicians. Emphasis is on adult patients rather than children and not on the issues that surround the terminally ill patient. General principles are discussed first and then the application of these principles.
Collapse
Affiliation(s)
- J MacFie
- Scarborough Hospital, North Yorkshire, UK.
| |
Collapse
|
73
|
Ortiz JS, Ordóñez González J. Nutrición parenteral y cuidados paliativos. Med Clin (Barc) 2000. [DOI: 10.1016/s0025-7753(00)71381-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
74
|
Abstract
Pancreatitis is a common disorder. Numerous factors have been implicated in the pathogenesis of acute and chronic pancreatitis, but the exact mechanisms of these conditions are still poorly understood. Depending on the cause of the disorder, patients who have pancreatitis are usually not malnourished and are able to eat within 5 to 7 days of disease onset. In these patients, nutritional support is unnecessary. However, severe disease induces a catabolic state similar to that seen in trauma and sepsis, resulting in rapid weight loss and increased morbidity and mortality. Thus, vigorous nutritional support may be useful in the treatment of severe pancreatitis. Studies have shown that parenteral and enteral nutritional support are well tolerated and can maintain or improve nutritional status in patients with pancreatitis. This article reviews nutritional assessment and therapy in pancreatitis.
Collapse
Affiliation(s)
- D J Nompleggi
- Adult Nutrition Support Service, University of Massachusetts Medical School, UMass Memorial Health Care, 55 Lake Avenue, Worcester, MA 01655, USA
| |
Collapse
|
75
|
Abstract
Total parenteral nutrition in humans began with work on neonates, and every year since then there have been important new discoveries. In the past 12 months there have been important new preliminary findings in parenteral nutrition cholestasis, and in bone mineralization. There has been further work on clinical pathways and other aspects of quality assurance, and scientists continue to find new aspects.
Collapse
Affiliation(s)
- P Ball
- University of Otago, Dunedin, New Zealand.
| |
Collapse
|
76
|
Torres A, Wiggins PA. Nutrition Support Practices in a Pediatric Intensive Care Unit. Nutr Clin Pract 1999. [DOI: 10.1177/088453369901400204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
77
|
|
78
|
Fürst P. Consensus Roundtable on Nutrition Support of Tube-Fed Patients with Diabetes, 28 February-1 March, 1998, Chicago, Illinois, USA. Introduction. Clin Nutr 1998; 17 Suppl 2:3-6. [PMID: 10205354 DOI: 10.1016/s0261-5614(98)80012-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- P Fürst
- University of Hohenheim, Institute for Biological Chemistry and Nutrition, Garbenstrabe 30, Stuttgart, D-70593 Germany
| |
Collapse
|
79
|
Reddy P, Malone M. Cost and outcome analysis of home parenteral and enteral nutrition. JPEN J Parenter Enteral Nutr 1998; 22:302-10. [PMID: 9739034 DOI: 10.1177/0148607198022005302] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Previous estimates of the cost of home parenteral and enteral nutrition (HPEN) have excluded hospitalization costs or were conducted abroad and have limited applicability in the United States. Few studies have used validated measures to determine the effect of home nutrition support on quality of life. METHOD A cost and clinical outcome analysis was performed by retrospective review of charts of patients receiving HPEN from 1991 to 1996. Questionnaires to determine the influence of therapy on lifestyle (n = 41) and a general health status questionnaire, the short form 36-item survey (n = 39), were mailed to patients. RESULTS The annual cost per patient for parenteral solutions was $55,193 +/- 30,596 (mean +/- SD) based on Medicare charges and for enteral tube feedings was $9605 +/- 9327. The annual cost of hospitalization ranged from zero to $140,220 in the parenteral nutrition group and from zero to $39,204 in the enteral nutrition group. The annual number of hospitalizations per patient for patients receiving parenteral nutrition ranged from 0.52 to 1.10, compared with 0 to 0.50 in the enteral nutrition population. The health status of HPEN patients was significantly lower (p < .05) in five of the eight short-form 36 health domains compared with the general population. The areas of lifestyle most frequently affected were travel, sleep, exercise and leisure. CONCLUSIONS The majority of the cost of therapy was associated with the direct provision of nutrition, although in some patients the hospitalization expenditure exceeded this cost. Home nutrition support had a significant negative impact on a patient's quality of life and lifestyle.
Collapse
Affiliation(s)
- P Reddy
- Hartford Hospital, University of Connecticut, Storrs, USA
| | | |
Collapse
|
80
|
Ireton-Jones CS, Stiller DL. Evaluation of outcomes for patients with AIDS receiving home total parenteral nutrition. Nutrition 1998; 14:731-5. [PMID: 9760603 DOI: 10.1016/s0899-9007(98)00053-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
This study evaluated the outcomes of patients with acquired immunodeficiency syndrome (AIDS) provided home total parenteral nutrition (HTPN) when specific criteria were used to initiate HTPN. Fifteen males who received HTPN and seven males who consumed only an oral diet were studied. The HTPN patients received an average of 55 kcal.kg-1.d-1 and 2.0 g of protein.kg-1.d-1 from HTPN and oral diet. Non-HTPN patients consumed an average of 35 kcal.kg-1.d-1 and 1.2 g protein.kg-1.d-1. Body weight (BW), lean body mass (LBM), and serum albumin (SA) were measured when HTPN was initiated or initial nutrition counseling was provided to the non-HTPN patients and again at the end of the study period. Over the study period, the HTPN patients gained an average 5.5 kg of BW and 3.0 kg of LBM, whereas the non-HTPN lost an average of 5.0 kg of BW and 3.0 kg of LBM. BW and LBM may be used to assess the response to HTPN in AIDS patients.
Collapse
Affiliation(s)
- C S Ireton-Jones
- Nutrition Program Management, Coram Healthcare, Preferred Nutrition Therapists, Carrollton, Texas, USA
| | | |
Collapse
|
81
|
Reuter JD, Marks SL, Rogers QR, Farver TB. Use of Total Parenteral Nutrition in Dogs: 209 Cases (1988-1995). J Vet Emerg Crit Care (San Antonio) 1998. [DOI: 10.1111/j.1476-4431.1998.tb00126.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
82
|
Abstracts of Communications. Proc Nutr Soc 1998. [DOI: 10.1079/pns19980069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
83
|
Jolliet P, Pichard C, Biolo G, Chioléro R, Grimble G, Leverve X, Nitenberg G, Novak I, Planas M, Preiser JC, Roth E, Schols AM, Wernerman J. Enteral nutrition in intensive care patients: a practical approach. Working Group on Nutrition and Metabolism, ESICM. European Society of Intensive Care Medicine. Intensive Care Med 1998; 24:848-59. [PMID: 9757932 DOI: 10.1007/s001340050677] [Citation(s) in RCA: 97] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Severe protein-calorie malnutrition is a major problem in many intensive care (ICU) patients, due to the increased catabolic state often associated with acute severe illness and the frequent presence of prior chronic wasting conditions. Nutritional support is thus an important part of the management of these patients. Over the years, enteral nutrition (EN) has gained considerable popularity, due to its favorable effects on the digestive tract and its lower cost and rate of complications compared to parenteral nutrition. However, clinicians caring for ICU patients are often faced with contradictory data and difficult decisions when having to determine the optimal timing and modalities of EN administration, estimation of patient requirements, and choice of formulas. The purpose of this paper is to provide practical guidelines on these various aspects of enteral nutritional support, based on presently available evidence.
Collapse
|
84
|
Lanoir D, Chambrier C, Vergnon P, Meynaud-Kraemer L, Wilkinson J, Mcpherson K, Bouletreau P, Colin C. Perioperative artificial nutrition in elective surgery: an impact study of French guidelines. Clin Nutr 1998; 17:153-7. [PMID: 10205333 DOI: 10.1016/s0261-5614(98)80051-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE In France, the consensus conference, held on 16 December 1994, produced guidelines on perioperative artificial nutrition (AN) use in patients undergoing elective surgery. The aim of this study was to assess the impact of these guidelines on practice patterns. METHODS The study was a practice pattern study with a 'before-after' design and a control group in England. A retrospective cross-sectional sample of adult patients undergoing elective resection of the digestive tract was collected in France and England before and after the consensus conference. RESULTS Malnourished patients received postoperative AN in 94% of 'before' cases and 82% 'after' but inadequate preoperative AN (40% 'before' and 26% 'after'). Postoperative AN appeared to be over-prescribed in non-malnourished patients without prolonged postoperative fasting (70% 'before' and 65% 'after'). In the English sample there was no significant variation in AN use between 'before' and 'after' periods. CONCLUSION This study shows that clinical guidelines disseminated by consensus conference had a low impact on practice patterns in France and thus confirms the need to enforce the dissemination of the guidelines.
Collapse
Affiliation(s)
- D Lanoir
- Départment d'Information Médicale - Hôpital de l'Hôtel-Dieu, Lyon, France
| | | | | | | | | | | | | | | |
Collapse
|
85
|
Marian MJ, Allen P. Nutrition support for patients in long-term acute care and subacute care facilities. AACN CLINICAL ISSUES 1998; 9:427-40. [PMID: 9855881 DOI: 10.1097/00044067-199808000-00011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Long-term acute care and subacute care facilities (also transitional care facilities) have evolved from the need to decrease costs associated with acute care in the hospital. As the length of stay in many medical centers has been reduced, patients are admitted to transitional care facilities to continue recovery and rehabilitation. Rehabilitation and recovery can be enhanced with the provision of optimal medical nutrition therapy. Nutrition screening is essential in identifying patients who are at risk of malnutrition or are malnourished. Nutrition assessment verifies the risk or presence of malnutrition followed by the development, implementation, and monitoring of nutrition intervention. Nutrition screening and intervention promote recovery from illness, minimize morbidity and mortality, and enhance quality of life. The goals of nutrition support are to prevent starvation-associated malnutrition, preserve lean tissue mass, support metabolic functions, and improve clinical outcomes. Oral nutrition is the preferred method of nourishment; however, specialized nutrition support is considered for patients unable to meet their nutrient requirements adequately. Enteral nutrition support is recommended when providing nutrition support however, parenteral nutrition support is used when the gastrointestinal tract can not be safely used. With appropriate intention, administration, and monitoring, nutrition support can be safely administered.
Collapse
Affiliation(s)
- M J Marian
- University of Arizona, College of Medicine, Tuscon, USA
| | | |
Collapse
|
86
|
Klein CJ, Stanek GS, Wiles CE. Overfeeding macronutrients to critically ill adults: metabolic complications. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 1998; 98:795-806. [PMID: 9664922 DOI: 10.1016/s0002-8223(98)00179-5] [Citation(s) in RCA: 207] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Metabolic complications from overfeeding critically ill patients are serious and sometimes fatal. Nutrition care is best provided through repeated evaluation of patients' responses to feeding. Nutrition support may need to be modified over time to maintain metabolic stability and promote recovery. This article describes the etiology of 10 metabolic complications of overfeeding. Guidelines for recommending macronutrients are discussed, as are factors that could increase the risk of overfeeding. Patients who are very small, very large, or very old are particularly vulnerable to overfeeding. Overfeeding protein has led to azotemia, hypertonic dehydration, and metabolic acidosis. Excessive carbohydrate infusion has resulted in hyperglycemia, hypertriglyceridemia, and hepatic steatosis. High-fat infusions have caused hypertriglyceridemia and fat-overload syndrome. Hypercapnia and refeeding syndrome have also been caused by aggressive overfeeding. Dietitians can prevent or curtail the metabolic complications of overfeeding by identifying patients at risk, providing adequate assessment, coordinating interdisciplinary care plans, and delivering timely and appropriate monitoring and intervention. Dietitians need to document complications, interventions, and the outcomes of their clinical care to evaluate the appropriateness of existing nutrition guidelines.
Collapse
Affiliation(s)
- C J Klein
- R. Adams Cowley Shock Trauma Center, Baltimore, MD 21201-1595, USA
| | | | | |
Collapse
|
87
|
Évaluation de l'indication et de la qualité de la prise en charge nutritionnelle en cancérologie médicale. NUTR CLIN METAB 1998. [DOI: 10.1016/s0985-0562(98)80089-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
88
|
|
89
|
Sarti G, Calogero P, Tavoni F, Berti V, Savorani G, Vulcano V. A review on enteral tube feeding in demented patients: Ethical and organizational issues. Arch Gerontol Geriatr 1998. [DOI: 10.1016/s0167-4943(98)80069-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
90
|
Klein CJ, Wiles CE. Evaluation of nutrition care provided to patients with traumatic injuries at risk for multiple organ dysfunction syndrome. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 1997; 97:1422-4. [PMID: 9404341 DOI: 10.1016/s0002-8223(97)00343-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- C J Klein
- Division of Critical Care Medicine, R Adams Cowley Shock Trauma Center, Baltimore, MD 21201-1595, USA
| | | |
Collapse
|
91
|
Colin C, Lanoir D, Chambrier C, Wilkinson J, McPherson K, Bouletreau P. Postoperative artificial nutrition. Overuse or misuse? Int J Technol Assess Health Care 1997; 13:471-2. [PMID: 9308275 DOI: 10.1017/s0266462300010746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The practice of postoperative artificial nutrition (PAN) in elective surgery was covered by a consensus conference in France (December 16,1994). Artificial nutrition was defined as the intake of at least two macronutrients (protein, lipid, and carbohydrate) through an artificial pathway (enteral/parenteral). The guidelines resulting from the conference (2) recommended prescribing artificial nutrition for only malnourished patients, patients with insufficient postoperative nutrient intake lasting 7 or more days, and patients with severe postoperative complications. These were similar to American guidelines produced in 1993 (1).
Collapse
Affiliation(s)
- C Colin
- University Claude Bernard Lyon I
| | | | | | | | | | | |
Collapse
|
92
|
|
93
|
Berger MM, Chioléro RL, Pannatier A, Cayeux MC, Tappy L. A 10-year survey of nutritional support in a surgical ICU: 1986-1995. Nutrition 1997; 13:870-7. [PMID: 9357023 DOI: 10.1016/s0899-9007(97)00270-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Total parenteral nutrition (TPN) has long been considered the optimal nutrition technique in critically ill patients, but recently the use of enteral nutrition (EN) has increased. This study describes the evolution of the different nutritional support techniques in a surgical intensive care unit (ICU) in a university hospital, through (1) a global survey over 10 y assessing the evolution of the use of EN and TPN, and (2) a prospective study performed over 6 mo. Severity of illness and diagnostic categories were stable (n = 11,539 patients). From 1986 to 1990, the proportion of TPN administered increased from 10-25% of ICU days, decreasing to 10% thereafter. EN was used in about 5% of ICU days in 1986, and had increased to 30% of total ICU treatment days in 1995. The proportion of nutrients actually delivered to the patients was 75% with EN and 88% with TPN. Major changes in nutritional support have been observed since 1986. The frequency of nutritional support provided in general has increased to 40% of ICU treatment days. TPN has been largely overtaken by EN, with the risk of insufficient energy delivery, related to the difficulties of EN in the critically ill. These results reinforce the importance of continuous quality control by daily assessment of nutrient supply.
Collapse
Affiliation(s)
- M M Berger
- Anesthesiology & Surgical Intensive Care Unit, C.H.U.V., University of Lausanne, Switzerland
| | | | | | | | | |
Collapse
|
94
|
Abstract
Comprehensive care of patients in hospitals includes assessment of nutritional status and provision of appropriate support. This approach is facilitated by knowledge of the essential differences in metabolism between starved and stressed states. Nutritional assessment and care of patients in a hospital are based on answers to the following questions: Who gets it? When do they get it? How much do they get? What route is used to administer it? What kind do they get? What are common complications of enteral and parenteral support? What nutritional aspects are pertinent to common diseases?
Collapse
Affiliation(s)
- B A Mizock
- Department of Medicine, Cook County Hospital, Chicago, Illinois, USA
| | | |
Collapse
|
95
|
Wolfe BM, Mathiesen KA. Clinical practice guidelines in nutrition support: can they be based on randomized clinical trials? JPEN J Parenter Enteral Nutr 1997; 21:1-6. [PMID: 9002077 DOI: 10.1177/014860719702100101] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
As rationing of health care services becomes an increasing reality, the pressure to justify interventions such as nutrition support will intensify. The establishment of clinical practice guidelines is one means of providing practitioners with such justification, but clinical practice guidelines for nutrition support cannot be based primarily on prospective randomized trials. This situation arises as the result of limitations specific to nutrition support whereby the most malnourished patients-those who appear most likely to show a benefit from the treatment-cannot be randomized to a no feeding group and are therefore excluded from participation in the study. As the result of this limitation, marginal candidates for nutrition support have been included in some trials, potentially masking the benefits of this treatment. An additional problem limiting present interpretation of published reports of randomized trials in nutrition support is the fact that ongoing research continues to yield improvements in the clinical practice of nutrition support. Thus the nutrition support group in such trials may not have received this treatment according to current practice. The A.S.P.E.N. Guidelines, based on both randomized prospective trials and other types of evidence, represent an important contribution to the practice of nutrition support. Testing of the performance of these and other guidelines in clinical practice and further outcomes research will be important steps toward revision and improvement of nutrition support, but may be difficult to achieve in the near future.
Collapse
Affiliation(s)
- B M Wolfe
- Department of Surgery, University of California, Davis, Sacramento 95817, USA
| | | |
Collapse
|
96
|
Bleichner G, Lesourd B, Simonet F. Pratiques hospitalières en nutrition entérale : enquête d'opinion analyse des réponses de 598 cliniciens. NUTR CLIN METAB 1997. [DOI: 10.1016/s0985-0562(97)80090-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
97
|
Abstract
Despite the many complications and minimal benefits associated with long-term enteral nutrition in patients with advanced dementia, it is, nevertheless, a widespread practice in nursing homes throughout the United States. This paper presents a review of the literature on dementia, geriatric nutrition, and enteral feeding. There appears to be limited research to support the long-term benefits and safety of enteral nutrition in advanced dementia. Additionally, it is not yet clear that long-term enteral nutrition in advanced dementia results in an improved quality of life.
Collapse
Affiliation(s)
- S L Sheiman
- University of Pennsylvania School of Nursing, Philadelphia, USA
| |
Collapse
|
98
|
Rosmarin DK, Wardlaw GM, Mirtallo J. Hyperglycemia associated with high, continuous infusion rates of total parenteral nutrition dextrose. Nutr Clin Pract 1996; 11:151-6. [PMID: 9070016 DOI: 10.1177/0115426596011004151] [Citation(s) in RCA: 136] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
A retrospective study was performed to determine whether there is an increased incidence of hyperglycemia in patients not predisposed to hyperglycemia (n = 102) who receive total parenteral nutrition (TPN) dextrose in excess of 4 to 5 mg/kg/min. Of the 37 subjects administered dextrose at > 5 mg/kg/min, 18 exhibited hyperglycemia. None did so who received dextrose at < or = 4 mg/kg/min (n = 19). TPN dextrose infusion rate was positively correlated with blood glucose concentration, over and above other variables considered in a multiple regression, including kcal/kg administered, furosemide or dopamine use, gender, age, or diagnosis. Thus, TPN dextrose infusion rates > 4 to 5 mg/kg/min increase risk of hyperglycemia.
Collapse
Affiliation(s)
- D K Rosmarin
- Mount Carmel Medical Center, Columbus, OH 43222, USA
| | | | | |
Collapse
|
99
|
Hester DD, Coghlin TM, Hsieh NL. Evaluation of the appropriate use of parenteral nutrition in an acute care setting. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 1996; 96:602-3. [PMID: 8655910 DOI: 10.1016/s0002-8223(96)00165-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- D D Hester
- Department of Nutrition and Food Services, Stanford University Medical Center, CA 94305, USA
| | | | | |
Collapse
|
100
|
Berger MM, Lemarchand-Béraud T, Cavadini C, Chioléro R. Relations between the selenium status and the low T3 syndrome after major trauma. Intensive Care Med 1996; 22:575-81. [PMID: 8814474 DOI: 10.1007/bf01708099] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Thyroxine (T4) is deiodinated to triiodothyronine (T3) by the hepatic type I iodothyronine deiodinase, a selenoprotein that is sensitive to selenium (Se) deficiency. After severe injury, T4 deiodination is decreased, leading to the low T3 syndrome. Injury increases free radical production, which inactivates the iodothyronine deiodinase. The aims were to study the Se status after major trauma and to investigate its relation to the low T3 syndrome. DESIGN Preliminary prospective descriptive study. SETTING Intensive care unit at a university teaching hospital. PATIENTS AND METHODS 11 patients aged 41 +/- 4 years (mean +/- SEM), with severe multiple injuries (Injury Severity Score 29 +/- 2 points). A balance study was performed from day 1 to day 7. Serum and urine samples were collected from the time of admission until day 7, then on days 10, 15, 20, 25 and 30. Non-parametric tests and Pearson's correlation coefficients were used for analysis. RESULTS Cumulated Se losses were 0.88 +/- 0.1 mumol/24h. Serum Se was decreased from admission to day 7. T3, free T3, and the T3/T4 ratio were low until day 5, being lowest on day 2; T4 and thyroid stimulating hormone were normal. Serum Se was correlated with T3 (r = 0.55, p = 0.0001), and with free T3 (r = 0.35). CONCLUSION Se status is altered after trauma, with decreased Se serum levels upon admission to the ICU but with no major Se losses. Se is probably redistributed to the tissues. The correlation between Se and T3, along with the parallel decrease in T4 deiodination, indicates that reduced deiodination might be related to the transient decrease in serum Se.
Collapse
Affiliation(s)
- M M Berger
- Anaesthesiology and Surgical Intensive Care Unit, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | | | | |
Collapse
|