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Le Cam E, Pardo E. Délai d’introduction de la nutrition parentérale en réanimation : nouvelles données de la littérature. ANESTHÉSIE & RÉANIMATION 2023. [DOI: 10.1016/j.anrea.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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102
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Zou B, Xi F, Yu W. Early parenteral nutrition comparing to enteral nutrition cannot reduce 28-day mortality in critically ill patients: a retrospective comparative cohort study based on the MIMIC‑IV database. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:77. [PMID: 36819575 PMCID: PMC9929832 DOI: 10.21037/atm-22-6408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/10/2023] [Indexed: 01/31/2023]
Abstract
Background Enteral nutrition (EN) is recommended as the first choice by guidelines for critical ill patients. But the timing of safe and effective delivery of parenteral nutrition (PN) is unclear and the results of previous studies are controversial. There is insufficient evidence for the use of early PN, so we designed this cohort study to compared the clinical outcomes of critical ill patients who received early PN with those who did not. Methods This retrospective study conducted using the Medical Information Mart for Intensive Care (MIMIC)-IV database. Patients who received nutrition therapy within 3 days of ICU admission were included and we categorized them as patients who received any kind of PN (PN group) or only enteral nutrition (EN group). Confounding factors were adjusted by propensity-score matching (PSM). The primary outcome was the 28-day mortality rate, and secondary outcomes included length of stay (LOS) in the hospital and ICU, hospital infection, and mechanical ventilation time. Results A total of 5,019 patients (PN group, 357; EN group, 4,662) were included in the analyses. The 28-day mortality rates showed no significant intergroup difference (EN, 22.3% vs. PN, 20.2%; P=0.378). The PN group showed a shorter median ICU LOS (EN, 8.14 vs. PN, 6.89 days, P=0.00955), and a longer median hospital LOS (PN, 21.55 vs. EN, 15.1 days, P<0.001). After PSM, each group included 355 patients, with no significant intergroup difference in the 28-day mortality rate (EN, 18.9% vs. PN, 20.3%; P=0.705). The PN group still showed a longer hospital LOS (median LOS: PN, 21.45 vs. EN, 14.81 days, P<0.001), but the other outcomes showed no differences. Conclusions PN within 3 days of ICU admission did not reduce the 28-day mortality rate and could extend hospital LOS. This study supports further fundamental and clinical research to ascertain the effect of PN for ICU patients.
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Affiliation(s)
- Bo Zou
- Department of Critical Care Medicine, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Fengchan Xi
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wenkui Yu
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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103
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Gunst J, Casaer MP, Preiser JC, Reignier J, Van den Berghe G. Toward nutrition improving outcome of critically ill patients: How to interpret recent feeding RCTs? Crit Care 2023; 27:43. [PMID: 36707883 PMCID: PMC9883882 DOI: 10.1186/s13054-023-04317-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/11/2023] [Indexed: 01/29/2023] Open
Abstract
Although numerous observational studies associated underfeeding with poor outcome, recent randomized controlled trials (RCTs) have shown that early full nutritional support does not benefit critically ill patients and may induce dose-dependent harm. Some researchers have suggested that the absence of benefit in RCTs may be attributed to overrepresentation of patients deemed at low nutritional risk, or to a too low amino acid versus non-protein energy dose in the nutritional formula. However, these hypotheses have not been confirmed by strong evidence. RCTs have not revealed any subgroup benefiting from early full nutritional support, nor benefit from increased amino acid doses or from indirect calorimetry-based energy dosing targeted at 100% of energy expenditure. Mechanistic studies attributed the absence of benefit of early feeding to anabolic resistance and futile catabolism of extra provided amino acids, and to feeding-induced suppression of recovery-enhancing pathways such as autophagy and ketogenesis, which opened perspectives for fasting-mimicking diets and ketone supplementation. Yet, the presence or absence of an anabolic response to feeding cannot be predicted or monitored and likely differs over time and among patients. In the absence of such monitor, the value of indirect calorimetry seems obscure, especially in the acute phase of illness. Until now, large feeding RCTs have focused on interventions that were initiated in the first week of critical illness. There are no large RCTs that investigated the impact of different feeding strategies initiated after the acute phase and continued after discharge from the intensive care unit in patients recovering from critical illness.
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Affiliation(s)
- Jan Gunst
- grid.5596.f0000 0001 0668 7884Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Michael P. Casaer
- grid.5596.f0000 0001 0668 7884Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Jean-Charles Preiser
- grid.4989.c0000 0001 2348 0746Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean Reignier
- grid.4817.a0000 0001 2189 0784Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Université de Nantes, Nantes, France
| | - Greet Van den Berghe
- grid.5596.f0000 0001 0668 7884Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
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[Nutrition Intake in Critically Ill Patients with Coronavirus Disease (Covid-19): A Nationwide, Multicentre, Observational Study in Argentina]. ENDOCRINOLOGIA, DIABETES Y NUTRICION 2023; 70:245-254. [PMID: 36714270 PMCID: PMC9870752 DOI: 10.1016/j.endinu.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/09/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION In 2020 the pandemic caused by SARS-COV-2 demanded an enormous number of healthcare resources in order to guarantee adequate treatment and support for those patients. This study aims to assess caloric and protein intake and evaluate its associations with relevant clinical outcomes in critically ill with Coronavirus Disease (COVID-19) patients. METHODS A nationwide, multicentre prospective observational study including twelve Argentinian intensive care units (ICUs,) was conducted between March-October 2020. INCLUSION CRITERIA Adult ICU patients >18 years admitted to the ICU with COVID-19 diagnosis and mechanical ventilation for at least 48hs. Statistical analysis was carried out using IBM-SPSS© 24 program. RESULTS One hundred and eighty-five patients were included in the study. Those who died had lower protein intake (0.73 g/kg/day (95% confidence interval (CI) 0.70-0.75 vs 0.97 g/kg/day (CI 0.95-0.99), P <0.001), and lower caloric intake than those who survived (12.94 kcal/kg/day (CI 12.48-13.39) vs 16.47 kcal/kg/day (CI 16.09-16.8), P <0.001).A model was built, and logistic regression showed that factors associated with the probability of achieving caloric and protein intake, were the early start of nutritional support, modified NUTRIC score higher than five points, and undernutrition (Subjective Global Assessment B or C). The patients that underwent mechanical ventilation in a prone position present less caloric and protein intake, similar to those with APACHE II >18. CONCLUSIONS Critically ill patients with COVID-19 associated respiratory failure requiring mechanical ventilation who died in ICU had less caloric and protein intake than those who survived. Early start on nutritional support and undernutrition increased the opportunity to achieve protein and caloric goals, whereas the severity of disease and mechanical ventilation in the prone position decreased the chance to reach caloric and protein targets.[[[es]]]RESUMENIntroducción: En 2020, la pandemia provocada por el SARS-COV-2, demandó una enorme cantidad de recursos sanitarios para garantizar el tratamiento y apoyo adecuado a estos pacientes. Este estudio tiene como objetivo evaluar la ingesta de calorías/proteínas y evaluar sus asociaciones con resultados clínicos relevantes en pacientes críticamente enfermos con enfermedad por coronavirus (COVID-19).Métodos: Se realizó un estudio observacional prospectivo multicéntrico a nivel nacional que incluyó 12 unidades de cuidados intensivos (UCI) argentinas entre marzo y octubre de 2020. Criterios de inclusión: pacientes adultos de la UCI > 18 años ingresados en la UCI con diagnóstico de COVID-19 y ventilación mecánica durante al menos 48 horas. El análisis estadístico se realizó mediante el programa IBM-SPSS© 24. RESULTADOS En el presente estudio se incluyeron 185 pacientes. Entre los que fallecieron se observó un aporte proteico más bajo (0,73 g/kg/día (intervalo de confianza (IC) del 95 % 0,70-0,75 frente a 0,97 g/kg/día (IC 0,95-0,99), P < 0,001), y menor aporte calórico que los que sobrevivieron (12,94 kcal/kg/día (IC 12,48-13,39) vs 16,47 kcal/kg/día (IC 16,09-16,8), P < 0,001).Se construyó un modelo de regresión logística para analizar qué factores estaban asociados con la probabilidad de lograrlos objetivos calóricos/proteicos. Se observo una mayor probabilidad de lograr dichos objetivos cuando el inicio del soporte nutricional era precoz, el puntaje NUTRIC modificado era superior a 5 puntos y el paciente tenía diagnóstico de desnutrición mediante la Evaluación Global Subjetiva(B o C). Por otra parte, en los pacientes que necesitaron ventilación mecánica en decúbito prono se observó menor aporte calórico y proteico, situación similar en aquellos con APACHE II > 18. CONCLUSIONES Los pacientes críticos con insuficiencia respiratoria asociada a la enfermedad por COVID-19 que requerían ventilación mecánica y que fallecieron en la UCI tuvieron una ingesta calórica y proteica menor que los que sobrevivieron. El inicio temprano del soporte nutricional y la desnutrición aumentaron la posibilidad de alcanzar los objetivos calóricos y proteicos, mientras que la gravedad de la enfermedad y la ventilación mecánica en decúbito prono disminuyeron la posibilidad de alcanzar los objetivos calóricos y proteicos.
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Pohlenz-Saw JAE, Merriweather JL, Wandrag L. (Mal)nutrition in critical illness and beyond: a narrative review. Anaesthesia 2023; 78:770-778. [PMID: 36644786 DOI: 10.1111/anae.15951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 01/17/2023]
Abstract
Close liaison with ICU-trained dietitians and early initiation of nutrition is a fundamental principle of care of critically ill patients- this should be done while monitoring closely for refeeding syndrome. Enteral nutrition delivered by volumetric pumps should be used where possible, though parenteral nutrition should be started early in patients with high nutritional risk factors. Malnutrition and loss of muscle mass are common in patients who are admitted to ICUs and are prognostic for patient-centred outcomes including complications and mortality. Obesity is part of that story, and isocaloric and high-protein provision of nutrition is important in this group of patients who comprise a growing proportion of people treated. Assessing protein stores and appropriate dosing is, however, challenging in all groups of patients. It would be beneficial to develop strategies to reduce muscle wasting as well; various strategies including amino acid supplementation, ketogenic nutrition and exercise have been trialled, but the quality of data has been inadequate to address this phenomenon. Nutritional targets are rarely achieved in practice, and all ICUs should incorporate clear guidelines to help address this. These should include local nutritional and fasting guidelines and for the management of feed intolerance, early access to post-pyloric feeding and a multidisciplinary framework to support the importance of nutritional education.
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Affiliation(s)
| | | | - L Wandrag
- Department of Nutrition & Dietetics, King's College Hospital, London, UK.,Department of Critical Care Medicine, King's College Hospital, London, UK
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106
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Cattani A, Teixeira PP, Eckert IDC, Busnello F, Gabriel F, Stein A, Silva FM. Quality appraisal of clinical nutrition practice guidelines for critically ill adult patients: a systematic review using the Advancing Guideline Development, Reporting and Evaluation in Health Care instrument II (AGREE-II) and AGREE-Recommendation Excellence (AGREE-REX). Br J Nutr 2023; 129:66-76. [PMID: 35272718 DOI: 10.1017/s0007114522000654] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Nutritional therapy should follow evidence-based practice, thus several societies regarding nutrition and critical care have developed specific Clinical Practice Guidelines (CPG). However, to be regarded as trustworthy, the quality of the CPG for critically ill patients and its recommendations need to be high. This systematic review aimed to appraise the methodology and recommendations of nutrition CPG for critically ill patients. We performed a systematic review (protocol number CRD42020184199) with literature search conducted on PubMed, Embase, Cochrane Library and other four specific databases of guidelines up to October 2021. Two reviewers, independently, assessed titles and abstracts and potentially eligible full-text reports to determine eligibility and subsequently four reviewers appraised the guidelines quality using the Advancing Guideline Development, Reporting and Evaluation in Health Care instrument II (AGREE-II) and AGREE-Recommendation Excellence (AGREE-REX). Ten CPG for nutrition in critically ill patients were identified. Only Academy of Nutrition and Dietetics and European Society of Intensive Care Medicine had a total acceptable quality and were recommended for daily practice according AGREE-II. None of the CPG recommendations had an overall quality score above 70 %, thus being classified as moderate quality according AGREE-REX. The methodological evaluation of the critically ill adult patient CPG revealed significant discrepancies and showed a need for improvement in its development and/or reporting. In addition, recommendations about nutrition care process presented a moderate quality.
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Affiliation(s)
- Aline Cattani
- Porto Alegre Federal University of Health Science, Nutrition Science Graduate Program, Porto Alegre, Brazil
| | | | | | - Fernanda Busnello
- Porto Alegre Federal University of Health Sciences, Department of Nutrition and Graduate Program in Nutrition, Porto Alegre, Brazil
| | - Franciele Gabriel
- University of São Paulo, School of Pharmaceutical Sciences, Department of Pharmacy, São Paulo, Brazil
| | - Airton Stein
- Porto Alegre Federal University of Health Sciences, Department of Public Health and Graduate Program of Health Science, Family and Community Doctor, Conceicao Hospital, Porto Alegre, Brazil
| | - Flávia Moraes Silva
- Porto Alegre Federal University of Health Sciences, Department of Nutrition and Graduate Program in Nutrition, Porto Alegre, Brazil
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Wang S, Zhao X, Wang Q, Wu Y, Xu J, Li R, Zhou T, Lv Z, Yang J, Yang L, Zou X. Impact of early enteral nutrition on ventilator associated pneumonia in intubated severe trauma patients: A propensity score-matched study. Front Nutr 2023; 10:1172526. [PMID: 37125037 PMCID: PMC10130510 DOI: 10.3389/fnut.2023.1172526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/28/2023] [Indexed: 05/02/2023] Open
Abstract
Background Early enteral nutrition (EN) is recommended for critically ill patients. However, the impact of early EN on intubated severe trauma patients remains unclear. Methods Severely traumatized adult patients who received invasive mechanical ventilation (MV) for more than 48 h during intensive care unit (ICU) stay at our institution between 2017 and 2022 were retrospectively included. Early EN was defined as EN initiation ≤48 h from ICU admission and late EN >48 h. Propensity score matching (PSM) analysis was used to compare outcomes between the groups. The primary endpoint was the incidence of ventilator-associated pneumonia (VAP). Multivariable logistic regression analysis was performed to identify independent predictors of delayed EN. Results For final analysis, 337 intubated severe trauma patients were available, including 204 (60.5%) in the early EN group and 133 (39.5%) in the late EN group. After PSM, early EN patients had a lower incidence of VAP (12.9 vs. 25.8%, p = 0.026) and a shorter length of hospital stay (21 vs. 24 days, p = 0.015) compared to late EN patients. There was no demonstrable difference in mortality between the two groups. Abdominal trauma, massive blood transfusion, and serum albumin were identified as independent risk factors for delayed EN. Conclusion Early EN decreased the VAP rate and reduced the length of hospital stay in invasively ventilated patients with severe trauma. Abdominal injury, massive blood transfusion and low albumin were associated with delayed EN.
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Affiliation(s)
- Su Wang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin Zhao
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qian Wang
- Department of Intensive Care Unit, Wuhan Third Hospital (Tongren Hospital of Wuhan University), Wuhan, China
| | - Yongran Wu
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiaxin Xu
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ruiting Li
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting Zhou
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zheng Lv
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jihong Yang
- Department of Critical Care Medicine, People’s Hospital of Chongyang County, Xianning, China
| | - Le Yang
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Le Yang,
| | - Xiaojing Zou
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Xiaojing Zou,
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108
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Zhang W, Zhang SX, Chen SF, Yu T, Tang Y. Development and validation of risk prediction model for refeeding syndrome in neurocritical patients. Front Nutr 2023; 10:1083483. [PMID: 36875840 PMCID: PMC9975392 DOI: 10.3389/fnut.2023.1083483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/18/2023] [Indexed: 02/17/2023] Open
Abstract
Background The incidence of refeeding syndrome (RFS) in critically ill patients is high, which is detrimental to their prognoses. However, the current status and risk factors for the occurrence of RFS in neurocritical patients remain unclear. Elucidating these aspects may provide a theoretical basis for screening populations at high risk of RFS. Methods A total of 357 patients from January 2021 to May 2022 in a neurosurgery ICU of a tertiary hospital in China were included using convenience sampling. Patients were divided into RFS and non-RFS groups, based on the occurrence of refeeding-associated hypophosphatemia. Risk factors for RFS were determined using univariate and logistic regression analyses, and a risk prediction model for RFS in neurocritical patients was developed. The Hosmer-Lemeshow test was used to determine the goodness of fit of the model, and the receiver operator characteristic curve was used to examine its discriminant validity. Results The incidence of RFS in neurocritical patients receiving enteral nutrition was 28.57%. Logistic regression analyses showed that history of alcoholism, fasting hours, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, Sequential Organ Failure Assessment (SOFA) scores, low serum albumin, and low baseline serum potassium were risk factors of RFS in neurocritical patients (p < 0.05). The Hosmer-Lemeshow test showed p = 0.616, and the area under the ROC curve was 0.791 (95% confidence interval: 0.745-0.832). The optimal critical value was 0.299, the sensitivity was 74.4%, the specificity was 77.7%, and the Youden index was 0.492. Conclusion The incidence of RFS in neurocritical patients was high, and the risk factors were diverse. The risk prediction model in this study had good predictive effects and clinical utility, which may provide a reference for assessing and screening for RFS risk in neurocritical patients.
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Affiliation(s)
- Wei Zhang
- Department of Neurosurgery Intensive Care Unit, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Sheng-Xiang Zhang
- Department of Neurosurgery Intensive Care Unit, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Shu-Fan Chen
- Department of Nursing, Soochow University, Suzhou, China
| | - Tao Yu
- Department of Neurosurgery Intensive Care Unit, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Yun Tang
- Department of Neurosurgery Intensive Care Unit, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
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Wang YX, Li XL, Zhang LH, Li HN, Liu XM, Song W, Pang XF. Machine learning algorithms assist early evaluation of enteral nutrition in ICU patients. Front Nutr 2023; 10:1060398. [PMID: 37125050 PMCID: PMC10140307 DOI: 10.3389/fnut.2023.1060398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/27/2023] [Indexed: 05/02/2023] Open
Abstract
Background This study applied machine learning (ML) algorithms to construct a model for predicting EN initiation for patients in the intensive care unit (ICU) and identifying populations in need of EN at an early stage. Methods This study collected patient information from the Medical Information Mart for Intensive Care IV database. All patients enrolled were split randomly into a training set and a validation set. Six ML models were established to evaluate the initiation of EN, and the best model was determined according to the area under curve (AUC) and accuracy. The best model was interpreted using the Local Interpretable Model-Agnostic Explanations (LIME) algorithm and SHapley Additive exPlanation (SHAP) values. Results A total of 53,150 patients participated in the study. They were divided into a training set (42,520, 80%) and a validation set (10,630, 20%). In the validation set, XGBoost had the optimal prediction performance with an AUC of 0.895. The SHAP values revealed that sepsis, sequential organ failure assessment score, and acute kidney injury were the three most important factors affecting EN initiation. The individualized forecasts were displayed using the LIME algorithm. Conclusion The XGBoost model was established and validated for early prediction of EN initiation in ICU patients.
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Affiliation(s)
- Ya-Xi Wang
- Department of Hospital-acquired Infection Control, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xun-Liang Li
- Department of Nephrology, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Ling-Hui Zhang
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Hai-Na Li
- Department of Nephrology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xiao-Min Liu
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Wen Song
- Department of Endoscopy, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xu-Feng Pang
- Department of Hospital-acquired Infection Control, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
- *Correspondence: Xu-Feng Pang,
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Qin Y, Liu M, Guo F, Chen D, Yang P, Chen X, Xu F. The Efficacy of Parenteral Nutrition and Enteral Nutrition Supports in Traumatic Brain Injury: A Systemic Review and Network Meta-Analysis. Emerg Med Int 2023; 2023:8867614. [PMID: 37125379 PMCID: PMC10139805 DOI: 10.1155/2023/8867614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/05/2023] [Accepted: 03/11/2023] [Indexed: 05/02/2023] Open
Abstract
Background Enteral nutrition (EN) is often used in patients with traumatic brain injury (TBI), but some studies have shown that EN has its disadvantages. However, it is not clear which nutritional support is appropriate to reduce mortality, improve prognosis, and improve nutritional status in patients with TBI. We performed this Bayesian network meta-analysis to evaluate the improvement of nutritional indicators and the clinical outcomes of patients with TBI. Methods We systematically searched PubMed, Embase, Cochrane Library, and Web of Science from inception until December 2021. All randomized controlled trials (RCTs) which compared the effects of different nutritional supports on clinical outcomes and nutritional indicators in patients with TBI were included. The co-primary outcomes included mortality and the value of serum albumin. The secondary outcomes were nitrogen balance, the length of study (LOS) in the ICU, and feeding-related complications. The network meta-analysis was performed to adjust for indirect comparison and mixed treatment analysis. Results 7 studies enroll a total of 456 patients who received different nutritional supports including parenteral nutrition (PN), enteral nutrition (EN), and PN + EN. No effects on in-hospital mortality (Median RR = 1.06, 95% Crl = 0.12 to 1.77) and the value of 0-1 days of serum albumin were found between the included regimens. However, the value of 11-13 days of serum albumin of EN was better than that of PN (WMD = -4.95, 95% CI = -7.18 to -2.72, P < 0.0001, I 2 = 0%), and 16-20 days of serum albumin of EN + PN was better than that of EN (WMD = -7.42, 95% CI = -14.51 to -0.34, P=0.04, I 2 = 90%). No effects on the 5-7 day nitrogen balance were found between the included regimens. In addition, the complications including pneumonia and sepsis have no statistical difference between EN and PN. EN was superior to PN in terms of LOS in the ICU and the incidence rate of stress ulcers. Although the difference in indirect comparisons between the included regimens was not statistically significant, the results showed that PN seemed to rank behind other regimens, and the difference between them was extremely small. Conclusion Available evidence suggests that EN + PN appears to be the most effective strategy for patients with TBI in improving clinical outcomes and nutritional support compared with other nutritional supports. Further trials are required.
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Affiliation(s)
- Yan Qin
- Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Maoxia Liu
- Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Fengbao Guo
- Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Du Chen
- Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Peng Yang
- Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xionghui Chen
- Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Feng Xu
- Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Measuring the Resting Energy Expenditure in Children on Extracorporeal Membrane Oxygenation: A Prospective Pilot Study. ASAIO J 2023; 69:122-126. [PMID: 35471245 DOI: 10.1097/mat.0000000000001714] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Both overfeeding and underfeeding critically ill children are problematic. This prospective pilot study evaluated the resting energy expenditure in infants and children requiring extracorporeal membrane oxygenation (ECMO) support. An indirect calorimeter was used to measure oxygen consumption (VO 2 ) and carbon dioxide production (VCO 2 ) from the mechanical ventilator. Blood gases were used to determine VO 2 and VCO 2 from the ECMO circuit. Values from the mechanical ventilator and ECMO circuit were added, and the resting energy expenditure (REE) (Kcal/kg/day) was calculated. Measurements were obtained > 24 hours after ECMO support was initiated (day 2 of ECMO), 1 day before ECMO discontinuation or transfer, and 1 day after decannulation. Data were compared with the predicted energy expenditure. Seven patients aged 3 months to 13 years were included. The REE varied greatly both above and below predicted values, from 26 to 154 KCal/kg/day on day 2 of ECMO support. In patients with septic shock, the REE was > 300% above the predicted value on day 2 of ECMO. Before ECMO discontinuation, two of six (33%) children continued to have a REE > 110% of predicted. Three patients had measurements after decannulation, all with a REE < 90% of predicted. REE measurements can be obtained by indirect calorimetry in children receiving ECMO support. ECMO may not provide metabolic rest for all children as a wide variation in REE was observed. For optimal care, individual testing should be considered to match calories provided with the metabolic demand.
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Robledo-Valdez M, Carrera-Quintanar L, Morante-Ruiz M, Pérez-de-Acha-Chávez A, Cervantes-Guevara G, Cervantes-Cardona GA, Torres-Mendoza BM, Ramírez-Ochoa S, Cervantes-Pérez G, González-Ojeda A, Fuentes-Orozco C, Cervantes-Pérez E. Medical nutrition therapy in patients receiving extracorporeal membrane oxygenation: knowledge in progress. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2023; 93:348-354. [PMID: 37562137 PMCID: PMC10406468 DOI: 10.24875/acm.22000109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/14/2022] [Indexed: 08/12/2023] Open
Abstract
Nutritional support in adult patients receiving extracorporeal membrane oxygenation (ECMO) therapy is controversial. Although there are guidelines for the NS (Nutritional support) in pediatric patients with ECMO, in adults these guidelines are not available for the use, type, route and timing of nutritional therapy. In critically ill patients it is well known that early enteral nutrition is beneficial, however there is the possibility that in patients with ECMO early enteral nutrition leads to gastrointestinal complications. Likewise, there have not been established caloric targets, proteins and doses or types of micronutrients to use for this specific population being a challenge for the clinician. In addition, patients with ECMO are some of the most seriously ill in intensive care units, where malnutrition is associated with increased morbidity and mortality. Regarding the use of parenteral nutrition (NP) it has not been described if it implies a risk of circuit failure at the time of introducing lipids to the oxygenator. Therefore, a correct evaluation and specific nutritional intervention by experts in the field is imperative to improve the prognosis and quality of life in this population, which is a primary goal in the care of adult patients receiving extracorporeal membrane oxygen.
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Affiliation(s)
- Miguel Robledo-Valdez
- Posgrado en Ciencias de la Nutrición Traslacional, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jal., México
| | - Lucrecia Carrera-Quintanar
- Laboratorio de Ciencias de los Alimentos, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jal., México
| | - Miguel Morante-Ruiz
- Servicio de Medicina Interna, Hospital Universitario Fundación Jiménez-Díaz, Madrid, España
| | - Andrea Pérez-de-Acha-Chávez
- Departamento de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Gabino Cervantes-Guevara
- Departamento de Bienestar y Desarrollo Sustentable, Centro Universitario del Norte, Universidad de Guadalajara, Colotlán, Jal., México
- Departamento de Gastroenterología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jal., México
| | - Guillermo A. Cervantes-Cardona
- Departamento de Disciplinas Filosófico, Metodológicas e Instrumentales, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jal., México
| | - Blanca M. Torres-Mendoza
- Departamento de Disciplinas Filosófico, Metodológicas e Instrumentales, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jal., México
| | - Sol Ramírez-Ochoa
- Departamento de Medicina Interna, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jal., México
| | - Gabino Cervantes-Pérez
- Departamento de Medicina Interna, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jal., México
| | - Alejandro González-Ojeda
- Unidad de Investigación Biomédica 2, Hospital de Especialidades, UMAE, CMNO, Instituto Mexicano del Seguro Social, Guadalajara, Jal., México
| | - Clotilde Fuentes-Orozco
- Unidad de Investigación Biomédica 2, Hospital de Especialidades, UMAE, CMNO, Instituto Mexicano del Seguro Social, Guadalajara, Jal., México
| | - Enrique Cervantes-Pérez
- Departamento de Medicina Interna, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jal., México
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Choi YK, Kim HJ, Ahn J, Ryu JA. Impact of early nutrition and feeding route on clinical outcomes of neurocritically ill patients. PLoS One 2023; 18:e0283593. [PMID: 36952527 PMCID: PMC10035931 DOI: 10.1371/journal.pone.0283593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/12/2023] [Indexed: 03/25/2023] Open
Abstract
Early proper nutritional support is important to critically ill patients. Nutritional support is also associated with clinical outcomes of neurocritically ill patients. We investigate whether early nutrition is associated with clinical outcomes in neurocritically ill patients. This was a retrospective, single-center, observational study including neurosurgical patients who were admitted to the intensive care unit (ICU) from January 2013 to December 2019. Patients who started enteral nutrition or parenteral nutrition within 72 hours after ICU admission were defined as the early nutrition group. The primary endpoint was in-hospital mortality. The secondary endpoint was an infectious complication. Propensity score matching (PSM) and propensity score weighting overlap weights (PSOW) were used to control selection bias and confounding factors. Among 1,353 patients, early nutrition was performed in 384 (28.4%) patients: 152 (11.2%) early enteral nutrition (EEN) and 232 (17.1%) early parenteral nutrition (EPN). In the overall study population, the rate of in-hospital mortality was higher in patients with late nutrition than in those with early nutrition (P<0.001). However, there was no significant difference in in-hospital mortality and infectious complications incidence between the late and the early nutrition groups in the PSM and PSOW adjusted population (all P>0.05). In the overall study population, EEN patients had a low rate of in-hospital mortality and infectious complications compared with those with EPN and late nutrition (P<0.001 and P = 0.001, respectively). In the multivariable analysis of the overall, PSM adjusted, and PSOW adjusted population, there was no significant association between early nutrition and in-hospital mortality and infectious complications (all P>0.05), but EEN was significantly associated with in-hospital mortality and infectious complications (all P<0.05). Eventually, early enteral nutrition may reduce the risk of in-hospital mortality and infectious complications in neurocritically ill patients.
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Affiliation(s)
- Young Kyun Choi
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun-Jung Kim
- Department of Dietetics, Samsung Medical Center, Seoul, Republic of Korea
| | - Joonghyun Ahn
- Statistic and Data Center, Clinical Research Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Jeong-Am Ryu
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Boshen Y, Yuankang Z, Taixi L, kaifan N, Zhixiang W, Liang L, Chengxing S, Xia L, Xian J. Effects of ondansetron treatment on outcomes of critically ill patients with myocardial infarction partly through its anti-inflammatory activity. Int J Med Sci 2023; 20:709-716. [PMID: 37213673 PMCID: PMC10198140 DOI: 10.7150/ijms.81797] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/25/2023] [Indexed: 05/23/2023] Open
Abstract
Background: Patients with myocardial infarction (MI) in intensive care units (ICU) are at high risk of death. Whether treatment with ondansetron (OND) at an early stage plays a protective role in critically ill patients with MI and its underlying mechanism remains unclear. Methods: A total of 4486 patients with MI were enrolled in the study cohort from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database and divided into OND-medication groups or not. Propensity score matching (PSM) and regression analysis were performed to investigate the effect of OND on patients, accompanied by sensitivity analysis to evaluate the robustness of the results. Integrated with causal mediation analysis (CMA), we investigated the potential causal pathway mediated by the palate-to-lymphocyte ratio (PLR) between early OND treatment and clinical outcomes. Results: Among patients with MI, 976 of them were treated with OND at the early stage while 3510 patients were not. The all-cause in-hospital mortality rate was significantly lower in the OND-medication group (5.6% vs 7.7%), accompanied by lower 28-day mortality (7.8% vs 11.3%) and 90-day mortality (9.2% vs 13.1%) rates. PSM analysis further confirmed the results for in-hospital mortality (5.7% vs 8.0%), 28-day mortality (7.8% vs 10.8%), and 90-day mortality (9.2% vs 12.5%). After adjusting for confounders, multivariate logistic regression analysis revealed that OND was associated with decreased in-hospital mortality (OR = 0.67, 95% CI: 0.49-0.91), and Cox regression confirmed the results for 28-day mortality and 90-day mortality with HR = 0.71 and 0.73, respectively. Most importantly, CMA demonstrated that the protective effect of OND on patients with MI was mediated by its anti-inflammatory effect through the regulation of PLR. Conclusion: Early use of OND in critically ill patients with MI may exert protective effects by reducing in-hospital mortality and 28- and 90-day mortality. The beneficial effects of OND on these patients were exerted through anti-inflammatory effects, at least in part.
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Affiliation(s)
- Yang Boshen
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhu Yuankang
- Institute for Developmental and Regenerative Cardiovascular Medicine, Xinhua Hospital, 12 School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li Taixi
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Niu kaifan
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wang Zhixiang
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liu Liang
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shen Chengxing
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- ✉ Corresponding authors: C.S., ; X.L., ; X. J.,
| | - Lu Xia
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- ✉ Corresponding authors: C.S., ; X.L., ; X. J.,
| | - Jin Xian
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- ✉ Corresponding authors: C.S., ; X.L., ; X. J.,
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115
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Barhorst S, Prior RM, Kanter D. Implementation of a best-practice guideline: Early enteral nutrition in a neuroscience intensive care unit. JPEN J Parenter Enteral Nutr 2023; 47:87-91. [PMID: 35616290 PMCID: PMC10084295 DOI: 10.1002/jpen.2411] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/10/2022] [Accepted: 05/23/2022] [Indexed: 01/11/2023]
Abstract
Current evidence suggests that early enteral nutrition is a best practice and leads to improved clinical outcomes. An evidence-based practice project was implemented in a busy neurointensive care unit in a midwestern tertiary care facility that was designed to improve care by implementing the early nutrition portion of Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine and the American Society for Enteral and Parenteral Nutrition. The Registered Nurses' Association of Ontario's (RNAO) Toolkit: Implementation of Best Practice Guidelines (BPGs) was selected and followed to guide implementation and achieve optimal results. During a 90-day implementation period, this project resulted in a 100% improvement in early nutrition. Interventions included the use of a series of cards that reminded the team to order enteral nutrition and prepacked bundles of nasogastric tube supplies. The RNAO toolkit served as a structured and effective step-by-step methodology for the implementation of a BPG.
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Affiliation(s)
| | - Richard M Prior
- Department of Neurology, College of Nursing, University of Cincinnati, Cincinnati, Ohio, USA
| | - Daniel Kanter
- Department of Neurology, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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116
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Cai YL, Wang SQ, Zhong HJ, He XX. The effect of anemia on the severity and prognosis of patients with acute pancreatitis: A single-center retrospective study. Medicine (Baltimore) 2022; 101:e32501. [PMID: 36596024 PMCID: PMC9803478 DOI: 10.1097/md.0000000000032501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 12/08/2022] [Indexed: 12/31/2022] Open
Abstract
Anemia was a risk factor for a worse prognosis of many diseases. This study aims to investigate the relationship between anemia and the severity and prognosis of acute pancreatitis (AP). Inpatients hospitalized at the First Affiliated Hospital of Guangdong Pharmaceutical University with a primary diagnosis of AP between 1st July 2016 to 31st December 2020 were enrolled. Subsequently, disease severity, the incidence of complications, and the prognosis of patients with AP were compared between the anemic group and the non-anemic group. A total of 282 patients with acute pancreatitis were enrolled; 68.43% of them were also diagnosed with anemia. Notably, these patients had more severe disease (higher RANSON, acute physiologic assessment and chronic health evaluation-II, bedside index for severity in acute pancreatitis, and multiple organ dysfunction syndrome scores); higher incidence of organ failure (acute kidney injury [AKI] and acute heart failure); worse prognosis (higher incidence of vasoactive and diuretic agent use, longer hospital stays, and higher hospital costs) compared to that of patients without anemia (all P < .05). After adjusting for potential confounders, acute physiologic assessment and chronic health evaluation-II, bedside index for severity in acute pancreatitis, multiple organ dysfunction syndrome scores, hospital stay, and hospital costs in anemic patients were higher than those in non-anemic patients; besides, the incidence of AKI and using a diuretic agent in anemic patients was 6.645 and 4.053 times that of non-anemic patients in AP, respectively (all P < .05). Acute pancreatitis patients with anemia have more disease severity, higher incidence of AKI, and worse prognosis compared to those without anemia.
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Affiliation(s)
- Ying-Li Cai
- Department of Gastroenterology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
- Department of Endoscope Center, Jiangmen Central Hospital, Jiangmen, Guangdong, China
| | - Si-Qi Wang
- Department of Gastroenterology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Hao-Jie Zhong
- Department of Gastroenterology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Microbial Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Guangdong Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou, China
| | - Xing-Xiang He
- Department of Gastroenterology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
- * Correspondence: Xing-Xiang He, Department of Gastroenterology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong Province, China (e-mail: )
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Wang Y, Li Y, Ye Y, Xuan L, Xu L, Li G, Zhou Y, Ma H, Zhou L, Chen Y, Wu W, Zhu W, Zhang Y. The efficacy of modified HuangLian JieDu decoction for early enteral nutrition in patients with sepsis: A randomized controlled study. Medicine (Baltimore) 2022; 101:e32583. [PMID: 36596025 PMCID: PMC9803492 DOI: 10.1097/md.0000000000032583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the efficacy of modified HuangLian JieDu decoction (MHLJDD) as a supplementary medication for early enteral nutrition in septic patients. METHODS This study was designed as a randomized controlled preliminary study. Septic patients were randomly divided into control (treated with the base treatment) and intervention (co-treated with MHLJDD and the base treatment) groups. The primary outcomes of this study were 60-day (d) mortality rate, length of mechanical ventilation (MV), and length of stay in the intensive care unit (ICU). RESULTS Of the 86 included patients, 44 and 42 were allocated to the intervention and control groups, respectively. Lengths of MV and ICU stay were significantly shorter in the intervention group than in the control group (10.31 ± 3.92 d vs 8.66 ± 2.84 d, P = .028; and 11.88 ± 5.25 d vs 10.41 ± 3.14 d, P = .029; respectively). However, the difference in 60-d mortality rate between the 2 groups was not statistically significant (20.45% vs 38.10%, P = .071). The enteral-nutrition tolerance score of the control group was higher than that of the intervention group (6.81 ± 4.28 vs 4.68 ± 4.04, P = .020). Incidence of hyperglycemia and gastric retention (gastric residual volume > 250 mL) was higher in the control group than in the intervention group (59.52% vs 29.55%, P = .005; and 28.57% vs 11.36%, P = .020, respectively). CONCLUSIONS MHLJDD can shorten the MV and ICU stay of septic patients.
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Affiliation(s)
- Yifei Wang
- ICU, Traditional Chinese Medical Hospital, Zhejiang Province, China
| | - Yue Li
- ICU, Traditional Chinese Medical Hospital, Zhejiang Province, China
| | - Yanyang Ye
- ICU, Traditional Chinese Medical Hospital, Zhejiang Province, China
| | - Lusha Xuan
- ICU, Traditional Chinese Medical Hospital, Zhejiang Province, China
| | - Lijie Xu
- Department of Science and Education, Traditional Chinese Medical Hospital, Zhejiang Province, China
| | - Guofa Li
- ICU, Traditional Chinese Medical Hospital, Zhejiang Province, China
| | - Yang Zhou
- ICU, Traditional Chinese Medical Hospital, Zhejiang Province, China
| | - Huanggang Ma
- ICU, Traditional Chinese Medical Hospital, Zhejiang Province, China
| | - Lingjie Zhou
- ICU, Traditional Chinese Medical Hospital, Zhejiang Province, China
| | - Yanjun Chen
- ICU, Traditional Chinese Medical Hospital, Zhejiang Province, China
| | - Weifei Wu
- ICU, Traditional Chinese Medical Hospital, Zhejiang Province, China
| | - Weidong Zhu
- Zhejiang Chinese Medical University, Zhejiang Province, China
| | - Yunhua Zhang
- ICU, Traditional Chinese Medical Hospital, Zhejiang Province, China
- * Correspondence: Yunhua Zhang, ICU, Traditional Chinese Medical Hospital, Zhuji 311800, Zhejiang Province, China (e-mail: )
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Relationship between the fasting status during hospitalisation, the length of hospital stay and the outcome. Br J Nutr 2022; 128:2432-2437. [PMID: 35193721 PMCID: PMC9723487 DOI: 10.1017/s0007114522000605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The effects of long-term fasting on the prognosis and hospital economy of hospitalised patient have not been established. To clarify the effects of long-term fasting on the prognosis and hospital economy of hospitalised patients, we conducted a prospective observational study on the length of hospital stay of patients hospitalised at thrity-one private university hospitals in Japan. We conducted a prospective observational study on the effects of fasting period length on the length of hospital stay and outcome of patients hospitalised for 3 months in those hospitals. Of the 14 172 cases of hospitalised patients during the target period on the reference day, 770 cases (median 71 years old) were eligible to fast for the study. The length of hospital stay for fasting patients was 33 (4-387) days, which was about 2·4 times longer than the average length of hospital stay for all patients. A comparative study showed the length of hospital stay was significantly longer in the long-term-fasting (fasting period > 10 d; n 386) group than in the medium-term-fasting (< 10 d; n 384) group (median 21 v. 50; P < 0·0001). Although the discharge to home rate was significantly higher in the medium-term-fasting group (71·4 % v. 36·5 %; P < 0·0001), the mortality rate was significantly higher in the long-term fasting group (10·8 % v. 25·8 %; P < 0·0001). It was verified that the longer the fasting period during hospitalisation, the longer the length of hospital stay and lower home discharge rate, thus indicating that patient quality of life and hospital economy may be seriously dameged.
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119
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Association of Vasopressors Dose Trajectories with Enteral Nutrition Tolerance in Patients with Shock: A Prospective Observational Study. Nutrients 2022; 14:nu14245393. [PMID: 36558552 PMCID: PMC9782535 DOI: 10.3390/nu14245393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/13/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
(1) Background: Studies on the long-term patterns of using vasopressors in patients with shock and their correlations with the risk of feeding intolerance (FI) are limited. This study aimed to characterize the norepinephrine equivalent dose (NEQ) trajectories and explore its correlations with FI in patients with shock. (2) Methods: This study prospectively enrolled patients with shock, who received vasopressors from August 2020 to June 2022. The Growth Mixed Model (GMM) was used to traverse longitudinal NEQ data at six-hour intervals and identify the latent trajectories of NEQ use in these patients. Cox proportional hazards regression models were used to examine the correlations of NEQ trajectories with FI. (3) Results: This study included a total of 210 patients with shock recruited from August 2020 to June 2022. Four trajectories of NEQ dose were identified and characterized by low-dose stable NEQ (L-NEQ, n = 98), moderate-dose stable NEQ (M-NEQ, n = 74), high-dose stable NEQ (H-NEQ, n = 21), and rapidly rising NEQ (R-NEQ, n = 17), with NEQ doses of 0.2, 0.4, 0.4, and 0.5 µg/kg/min at enteral nutrition (EN) initiation, respectively. The incidences of FI were 37.76%, 67.57%, 80.95%, and 76.47% in the L-NEQ, M-NEQ, H-NEQ, and R-NEQ groups, respectively (p < 0.001). As compared to the L-NEQ group, the risk of FI occurrence increased in the M-NEQ, H-NEQ, and R-NEQ groups (all p < 0.05). (4) Conclusions: The risk of FI was significantly associated with NEQ trajectories. It might be appropriate to initiate EN when the NEQ dose is stabilized below 0.2 µg/kg/min in patients with shock.
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Yu H, Jiang Z, Li Y, Peng F, Li W, Qu J, Ding J, Lei P, Ren Y. Construction and clinical practice of an enteral nutrition nursing quality control system for critically ill patients. Am J Transl Res 2022; 14:9031-9039. [PMID: 36628229 PMCID: PMC9827343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/30/2022] [Indexed: 01/12/2023]
Abstract
Critically ill patients are prone to a series of complications during early enteral nutrition (EEN), including gastrointestinal complications, infectious complications, metabolic complications, and mechanical complications, with an incidence of 30.5-65.7%, which attributes to prolonged hospitalization and increased mortality. Therefore, this retrospective study aimed to construct a quality control system of enteral nutrition nursing for critically ill patients as well as apply this system in clinical practice to evaluate its effect. Delphi method was utilized for this purpose, and we compared the incidence of enteral nutrition complications between patients using quality control system and using routine enteral nutrition. The mastery of enteral nutrition related knowledge by nursing staff was also compared before and after the implementation of a quality control system. Our data showed that, after applying the system to patients with critical illness in the nursing clinic, the incidence of enteral nutrition gastrointestinal complications, infectious complications, metabolic complications, and mechanical complications was significantly decreased from 11.51%, 1.96%, 3.41% and 5.88% to 1.86%, 0.52%, 1.71% and 0.97% (P<0.005), respectively. Furthermore, the awareness of enteral nutrition theory by ICU nurses was also significantly improved, and the questionnaire score was increased from 70.22±8.78 to 95.25±4.18 (t=18.792, P<0.001). Hence, the enteral nutrition nursing quality control system we developed could effectively guide nursing staff to implement enteral nutrition, reduce the occurrence of enteral nutrition complications in patients with critical illness and ensure the safety of patients, suggesting the clinical application value of our system.
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Affiliation(s)
- Hehua Yu
- Department of Emergency and Critical Care, Shanghai Changzheng Hospital, Naval Medical UniversityShanghai 200003, China
| | - Zhuojuan Jiang
- Department of Emergency and Critical Care, Shanghai Changzheng Hospital, Naval Medical UniversityShanghai 200003, China
| | - Yangyang Li
- Department of Emergency and Critical Care, Shanghai Changzheng Hospital, Naval Medical UniversityShanghai 200003, China
| | - Fei Peng
- Department of Nursing, Shanghai Changzheng Hospital, Naval Medical UniversityShanghai 200003, China
| | - Wenfang Li
- Department of Emergency and Critical Care, Shanghai Changzheng Hospital, Naval Medical UniversityShanghai 200003, China
| | - Jinglong Qu
- Department of Emergency and Critical Care, Shanghai Changzheng Hospital, Naval Medical UniversityShanghai 200003, China
| | - Jufei Ding
- Department of Emergency and Critical Care, Shanghai Changzheng Hospital, Naval Medical UniversityShanghai 200003, China
| | - Peipei Lei
- Department of Emergency and Critical Care, Shanghai Changzheng Hospital, Naval Medical UniversityShanghai 200003, China
| | - Yan Ren
- Department of Emergency and Critical Care, Shanghai Changzheng Hospital, Naval Medical UniversityShanghai 200003, China
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Enteral nutrition interruptions in critically ill patients: A prospective study on reasons, frequency and duration of interruptions of nutritional support during ICU stay. Clin Nutr ESPEN 2022; 52:178-183. [PMID: 36513451 DOI: 10.1016/j.clnesp.2022.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/20/2022] [Accepted: 10/28/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND & AIMS Enteral Nutrition (EN) may be interrupted due to various reasons in the setting of intensive care unit (ICU) care. This study aimed to investigate the reasons, frequency, and duration of EN interruptions in critically ill patients within the first 7 days of ICU stay. METHODS A total of 122 critically ill patients (median age: 63 years, 57% were males) initiating EN within the first 72 h of ICU admission and continued EN for at least 48 h during ICU stay were included in this observational prospective study conducted at a Medical ICU. Patients were followed for hourly energy intake as well as the frequency, reason, and duration of EN interruptions, for the first seven nutrition days of ICU stay or until death/discharge from ICU. RESULTS The median APACHE II score was 22 (IQR, 17-27). The per patient EN interruption frequency was 2.74 and the median total EN interruption duration was 960 (IQR, 105-1950) minutes. The most common reason for EN interruption was radiological procedures (91 episodes) and the longest duration of EN interruption was due to tube malfunctions (1230 min). Target energy intake were achieved on the 6th day at a maximum rate of 89.4%. Logistic regression showed that there was relationship between increased mortality and patients with ≥3 EN interruptions (OR: 6.73 (2.15-30.55), p = 0.004) after adjusting for confounding variables (age and APACHE II score). According to Kaplan Meier analysis, patients with ≥3 EN interruptions had significantly lower median survival times than patients with <3 EN interruptions (24.0 (95% CI 8.5-39.5) vs 18.0 (95% CI 13-23) days, p = 0.014). CONCLUSION During the first week of EN support, the most common reason of EN interruptions was related to radiological procedures and the longest EN interruptions was due to feeding tube malfunctions. There was relationship between ≥3 EN interruptions and increased mortality.
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Ortiz-Reyes L, Patel JJ, Jiang X, Coz Yataco A, Day AG, Shah F, Zelten J, Tamae-Kakazu M, Rice T, Heyland DK. Early versus delayed enteral nutrition in mechanically ventilated patients with circulatory shock: a nested cohort analysis of an international multicenter, pragmatic clinical trial. Crit Care 2022; 26:173. [PMID: 35681220 PMCID: PMC9185884 DOI: 10.1186/s13054-022-04047-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/30/2022] [Indexed: 12/12/2022] Open
Abstract
Abstract
Introduction
Real-world evidence on the timing and efficacy of enteral nutrition (EN) practices in intensive care unit (ICU) patients with circulatory shock is limited. We hypothesized early EN (EEN), as compared to delayed EN (DEN), is associated with improved clinical outcomes in mechanically ventilated (MV) patients with circulatory shock.
Methods
We analyzed a dataset from an international, multicenter, pragmatic randomized clinical trial (RCT) evaluating protein dose in ICU patients. Data were collected from ICU admission, and EEN was defined as initiating < 48 h from ICU admission and DEN > 48 h. We identified MV patients in circulatory shock to evaluate the association between the timing of EN initiation and clinical outcomes. The regression analysis model controlled for age, mNUTRIC score, APACHE II score, sepsis, and Site.
Results
We included 626 patients, from 52 ICUs in 14 countries. Median age was 60 years [18–93], 55% had septic shock, 99% received norepinephrine alone, 91% received EN alone, and 50.3% were randomized to a usual protein dose. Forty-two percent of EEN patients had persistent organ dysfunction syndrome plus death at day 28, compared to 53% in the DEN group (p = 0.04). EEN was associated with more ICU-free days (9.3 ± 9.2 vs. 5.7 ± 7.9, p = 0.0002), more days alive and free of vasopressors (7.1 ± 3.1 vs. 6.3 ± 3.2, p = 0.007), and shorter duration of MV among survivors (9.8 ± 10.9 vs. 13.8 ± 14.5, p = 0.0002). This trend was no longer observed in the adjusted analysis. There were no differences in ICU/60-day mortality or feeding intolerance rates between groups.
Conclusion
In MV patients with circulatory shock, EEN, as compared to DEN, was associated with improved clinical outcomes, but no longer when adjusting for illness severity. RCTs comparing the efficacy of EEN to DEN in MV patients with circulatory shock are warranted.
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Spies HC, Frey MA, Karstens B. Nutrition and vasoactive substances in the critically ill patient. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2022. [DOI: 10.1080/16070658.2022.2147663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- HC Spies
- Department of Nutrition and Dietetics, University of the Free State, Bloemfontein, South Africa
| | - MA Frey
- Dietetics Department, Universitas Tertiary Academic Hospital, Bloemfontein, South Africa
| | - B Karstens
- School of Nursing, University of the Free State, Bloemfontein, South Africa
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Kim GW, Roh YI, Cha KC, Hwang SO, Han JH, Jung WJ. Diet-related complications according to the timing of enteral nutrition support in patients who recovered from out-of-hospital cardiac arrest: a propensity score matched analysis. Acute Crit Care 2022; 37:610-617. [DOI: 10.4266/acc.2022.00696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/18/2022] [Indexed: 12/05/2022] Open
Abstract
Background: A proper nutritional plan for resuscitated patients is important in intensive care; however, specific nutritional guidelines have not yet been established. This study aimed to determine the incidence of diet-related complications that were affected by the timing of enteral nutrition in resuscitated patients after cardiac arrest.Methods: This retrospective and 1:1 propensity score matching study involved patients who recovered after nontraumatic, out-of-hospital cardiac arrest at a tertiary hospital. Patients were divided into an early enteral nutrition support (ENS) group and a delayed enteral nutrition support (DNS) group according to the nutritional support time within 48 hours after admission. The incidence of major clinical complications was compared between the groups.Results: A total of 46 patients (ENS, 23; DNS, 23) were enrolled in the study. There were no differences in body mass index, comorbidity, and time of cardiopulmonary resuscitation between the two groups. There were 9 patients (ENS: 4, DNS: 5) with aspiration pneumonia; 4 patients (ENS: 2, DNS: 2) with regurgitation; one patient (ENS: 0, DNS: 1) with ileus; 21 patients (ENS: 10, DNS: 11) with fever; 13 patients (ENS: 8, DNS: 5) with hypoglycemia; and 20 patients (ENS: 11, DNS: 9) with hyperglycemia. The relative risk of each complication during post-resuscitation care was no different between groups.Conclusions: There was a similar incidence of diet-related complications during post cardiac arrest care according to the timing of enteral nutrition.
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Chen Y, Tian X, Liu C, Zhang L, Xv Y, Xv S. Application of visual placement of a nasojejunal indwelling feeding tube in intensive care unit patients receiving mechanical ventilation. Front Med (Lausanne) 2022; 9:1022815. [PMID: 36482910 PMCID: PMC9722953 DOI: 10.3389/fmed.2022.1022815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/07/2022] [Indexed: 11/23/2022] Open
Abstract
Background Compared with nasogastric nutrition, nasojejunal nutrition may prevent some complications of critically ill patients by maintaining better nutritional status, and blind placement of nasojejunal dwelling feeding tubes is widely used. However, the visual placement seems to be safer and more effective than the blind placement, and is still seldom reported. Objective We tried to develop visual placement of a nasojejunal feeding tube in intensive care unit patients. Methods A total of 122 patients receiving mechanical ventilation were admitted to the Department of Critical Care Medicine of the Fifth Affiliated Hospital of Wenzhou Medical University and received the placement of nasojejunal feeding tubes. These patients were randomly and evenly assigned into two groups, one group receiving visual placement of nasojejunal dwelling feeding tubes and another group receiving blind placement. Actual tube placement was confirmed by X-ray. The primary outcome included the success rates of first placement of feeding tubes. The secondary outcome included the time of tube placement, complications, the total cost, heart rates and respiratory rates. Results The primary outcome showed that the success rates of first placement were 96.70% (59 cases/61 cases) in the visual placement group, and two cases failed due to pyloric stenosis and gastroparesis. The success rates were 83.6% (51 cases/61 cases) in the blind placement group and 10 cases failed due to either wrong placement or retrograde tube migration. The success rates in the visual placement group were higher than that in the blind placement group (P = 0.015). The secondary outcome showed that the time of tube placement in the visual placement group was shorter than that in the blind placement group (P < 0.0001). The cost of tube placement in the visual placement group was higher than that in the blind placement group (P < 0.0001). The statistical differences in complications, heart and respiratory rates were insignificant between the two groups (P > 0.05). Conclusion Compared with the blind placement, the visual placement shortened the time of nasojejunal tube placement and increased success rates of first placement. The visual placement was more efficient, easy to operate, safe, and has potential clinical applications.
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Affiliation(s)
- Yuequn Chen
- Department of Intensive Care Unit, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, China
| | - Xin Tian
- Department of Intensive Care Unit, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, China,*Correspondence: Xin Tian
| | - Cheng Liu
- Department of Intensive Care Unit, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, China
| | - Liqin Zhang
- Department of Intensive Care Unit, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, China
| | - Yueyuan Xv
- Department of Digestive Internal Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, China
| | - Shuang Xv
- Department of Equipment Department, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, China
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126
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Wang J, Zheng N, Chang X, Qian H, Han Y. Nutritional risk factors for all-cause mortality of critically ill patients: a retrospective cohort study. BMJ Open 2022; 12:e066015. [PMID: 36396305 PMCID: PMC9677028 DOI: 10.1136/bmjopen-2022-066015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This study aimed to explore the predictive value of single and multiple risk factors for the clinical outcomes of critically ill patients receiving enteral nutrition and to establish an effective evaluation model. DESIGN Retrospective cohort study. SETTING Data from the 2020-2021 period were collected from the electronic records of the First Affiliated Hospital, Nanjing Medical University. PARTICIPANTS 459 critically ill patients with enteral nutrition in the geriatric intensive care unit were included in the study. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was 28-day mortality. The secondary outcomes were 28-day invasive mechanical ventilation time, intensive care unit stay, Nutrition Risk Screening 2002 (NRS2002) score and Acute Physiology and Chronic Health Evaluation II (APACHE II) score. RESULTS Independent prognostic factors, including prealbumin/procalcitonin (PCT) ratio and APACHE II score, were identified using a logistic regression model and used in the nomogram. The area under the receiver operating characteristic curve and concordance index indicated that the predictive capacity of the model was 0.753. Moreover, both the prealbumin/PCT ratio and the combination model of PCT, prealbumin and NRS2002 had a higher predictive value for clinical outcomes. Subgroup analysis also identified that a higher inflammatory state (PCT >0.5 ng/mL) and major nutritional risk (NRS2002 >3) led to worse clinical outcomes. In addition, patients on whole protein formulae bore less nutritional risk than those on short peptide formulae. CONCLUSIONS This nomogram had a good predictive value for 28-day mortality in critically ill patients receiving enteral nutrition. Both the prealbumin/PCT ratio and the combination model (PCT, prealbumin and NRS2002), as composite models of inflammation and nutrition, could better predict the prognosis of critically ill patients.
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Affiliation(s)
- Jine Wang
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Nan Zheng
- Department of Critical Care Medicine, The First School of Clinical Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xinyi Chang
- Department of Critical Care Medicine, The First School of Clinical Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Huitao Qian
- Department of Critical Care Medicine, The First School of Clinical Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yi Han
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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127
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Kelly S, Bandt C. Inadvertent placement of an esophagostomy tube into the mediastinum of a cat. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2022; 63:1124-1128. [PMID: 36325406 PMCID: PMC9559027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
An 8-year-old neutered male Siberian forest cat was presented for respiratory distress. Endoscopy, exploratory surgery of the neck, and sternotomy confirmed initial placement of the esophagostomy tube (e-tube) into the mediastinum. The patient recovered from surgery, developed laryngeal paralysis, and then arrested and died within 48 h after surgery. Key clinical message: To the authors' knowledge, there are no other case reports documenting inadvertent placement of an e-tube into the mediastinum of a cat. This case report highlights the complications that can be associated with incorrect placement of an e-tube.
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128
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Braun G, Schäfer K. Nichtinvasive intraabdominelle Druckmessung. Med Klin Intensivmed Notfmed 2022; 117:658-666. [DOI: 10.1007/s00063-022-00958-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/07/2022] [Accepted: 08/09/2022] [Indexed: 11/06/2022]
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129
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Lee ZY, Loh CTI, Lew CCH, Ke L, Heyland DK, Hasan MS. Nutrition therapy in the older critically ill patients: A scoping review. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022. [DOI: 10.47102/annals-acadmedsg.2022160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Introduction: There is a lack of guidelines or formal systematic synthesis of evidence for nutrition therapy in older critically ill patients. This study is a scoping review to explore the state of evidence in this population.
Method: MEDLINE and Embase were searched from inception until 9 February 2022 for studies that enrolled critically ill patients aged ≥60 years and investigated any area of nutrition therapy. No language or study design restrictions were applied.
Results: Thirty-two studies (5 randomised controlled trials) with 6 topics were identified: (1) nutrition screening and assessments, (2) muscle mass assessment, (3) route or timing of nutrition therapy, (4) determination of energy and protein requirements, (5) energy and protein intake, and (6) pharmaconutrition. Topics (1), (3) and (6) had similar findings among general adult intensive care unit (ICU) patients. Skeletal muscle mass at ICU admission was significantly lower in older versus young patients. Among older ICU patients, low muscularity at ICU admission increased the risk of adverse outcomes. Predicted energy requirements using weight-based equations significantly deviated from indirect calorimetry measurements in older vs younger patients. Older ICU patients required higher protein intake (>1.5g/kg/day) than younger patients to achieve nitrogen balance. However, at similar protein intake, older patients had a higher risk of azotaemia.
Conclusion: Based on limited evidence, assessment of muscle mass, indirect calorimetry and careful monitoring of urea level may be important to guide nutrition therapy in older ICU patients. Other nutrition recommendations for general ICU patients may be used for older patients with sound clinical discretion.
Keywords: Critical care nutrition, geriatric patients, intensive care medicine, older adults, scoping review
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Affiliation(s)
| | | | | | - Lu Ke
- Medical School of Nanjing, Nanjing, China
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130
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Alves de Paula J, Rabito EI, Justino SR, Leite LS, Dantas D, Makiyama da Silva JS, Maffini LF, Júnior OR. Administration of enteral nutrition and gastrointestinal complications in Covid-19 critical patients in prone position. CLINICAL NUTRITION OPEN SCIENCE 2022; 45:80-90. [PMID: 36059438 PMCID: PMC9420200 DOI: 10.1016/j.nutos.2022.08.003] [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: 04/12/2022] [Accepted: 08/20/2022] [Indexed: 12/15/2022] Open
Abstract
Background The prone position (PP) used in the treatment of critically ill patients infected with SARS-CoV-2, may be a barrier to enteral nutrition (EN). This study aimed to analyze the effectiveness and complications of EN in the PP, as well as clinical outcomes. Methods Prospective cohort study with patients in EN and coronavirus disease 2019 (COVID-19), on mechanical ventilation (MV), which whom needed or not PP. Gastrointestinal intolerances (GII) related to PP were evaluated, and correlated with possible confounding factors. EN, days on MV, Intensive Care Unit (ICU) length of stay, hospital length of stay, ventilator-associated pneumonia (VAP) and mortality were analyzed. The data were evaluated daily and compared prone group (PG=57) and supine group (SG=69). Results The PP was associated with GII (P=0.000) and presented in 32 patients (26,44%) with no difference among groups. Association between epinephrine (P=0.003), vasopressin (P=0.018), and GII was observed. There was no difference between the total volume of enteral nutrition (TVEN) infused in the groups. However, the mean EN infused for the days when the patient was on PP was (70.0% ± 31.5) and for the days in supine position was (74.8% ± 27.3), P= 0.006. The PG had a longer time on MV (P=0.005) and ICU (P=0.003) and PP was associated with VAP (P=<0.001). The infused TVEN showed no association with VAP (P=0.09). Conclusion PP was a determining factor in GII and proved to be a risk factor for VAP, but the EN protocol seems to have ensured an adequate EN supply in PP and be a safe alternative.
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Affiliation(s)
- Jéssica Alves de Paula
- Clinical Nutrition Unit, Clinical Hospital Complex - Federal University of Paraná, Curitiba-PR, Brazil
| | | | - Sandra Regina Justino
- Nutrition Department of the Brazilian Association of Intensive Care Medicine, São Paulo-SP, Brazil
- Nutrition Department of the Intensive Care Society of Paraná Brazil, Curitiba-PR, Brazil
| | - Luíza Silva Leite
- Clinical Nutrition Unit, Clinical Hospital Complex - Federal University of Paraná, Curitiba-PR, Brazil
| | - Danielle Dantas
- Clinical Nutrition Unit, Clinical Hospital Complex - Federal University of Paraná, Curitiba-PR, Brazil
| | | | - Larissa Farinha Maffini
- Clinical Nutrition Unit, Clinical Hospital Complex - Federal University of Paraná, Curitiba-PR, Brazil
| | - Odery Ramos Júnior
- Department of Internal Medicine, Gastroenterology Division, Clinical Hospital Complex - Federal University of Paraná, Curitiba-PR, Brazil
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131
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Jaber S, Garnier M, Asehnoune K, Bounes F, Buscail L, Chevaux JB, Dahyot-Fizelier C, Darrivere L, Jabaudon M, Joannes-Boyau O, Launey Y, Levesque E, Levy P, Montravers P, Muller L, Rimmelé T, Roger C, Savoye-Collet C, Seguin P, Tasu JP, Thibault R, Vanbiervliet G, Weiss E, Jong AD. Pancréatite aiguë grave du patient adulte en soins critiques 2021. ANESTHÉSIE & RÉANIMATION 2022. [DOI: 10.1016/j.anrea.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Bourgault AM, Xie R, Talbert S, Sole ML. Association of enteral feeding with microaspiration in critically ill adults. Appl Nurs Res 2022; 67:151611. [DOI: 10.1016/j.apnr.2022.151611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 05/25/2022] [Accepted: 06/27/2022] [Indexed: 10/17/2022]
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133
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Li Y, Liu H. Application strategy and effect analysis of nutritional support nursing for critically ill patients in intensive care units. Medicine (Baltimore) 2022; 101:e30396. [PMID: 36197233 PMCID: PMC9509121 DOI: 10.1097/md.0000000000030396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We investigate nutritional support and nursing status of critical patients in intensive care units (ICUs) to understand the latest nutritional support guidelines' implementation by clinical medical staff; identify problems in nutritional support and nursing for these patients, analyze causes, and present suggestions; and provide a clinical/theoretical bases to improve nutritional support implementation and nursing strategies for them. Clinical case information of 304 critically ill ICU patients admitted from July 2017 to July 2021 was analyzed. They were divided into the experimental (nutritional support) and control (no nutritional support) groups to compare their laboratory indicators, 28-day case fatality rate, and infection incidence. Least significant difference was used for postanalysis of statistically significant items to obtain pairwise comparisons. Nutrition support strategies for ICU patients are consistent with guidelines but have an implementation gap. No statistically significant differences were found in hemoglobin (HB), total serum protein (TP), serum albumin (ALB), transferrin (TF), prealbumin (PA), and total lymphocyte count (TLC) in experimental group patients compared with the control group within 24 hours (before nutritional support, P > .05). No statistically significant differences were also found in HB, TP, TLC, and ALB between the enteral nutrition + parenteral nutrition (EN + PN), total EN (TEN), total PN (TPN), and control groups on admission day 7 (after nutritional support, P > .05), while statistically significant differences existed between PA and TF (P < .05). TF of patients supported by TEN was higher (statistically significant difference, P < .05). PA in patients receiving TEN and EN + PN support was higher than in control group patients (statistically significant difference, P < .05). Compared with the control group, in experimental group patients, infection incidence was significantly lower (40.2% vs 62.9%, P < .05); incidence of complications was lower, but not statistically significant (40.2% vs 57.1%, P > .05); and 28-day mortalities were significantly lower (26.7% vs 45.7%, P < .05). Nutritional support can reduce hospitalization complications and 28-day mortality in critical patients, but its implementation must be standardized. Especially for patients with gastrointestinal dysfunction, personalized/standardized nutrition strategies and nursing procedures are needed when PN support is applied, and training of clinical medical staff should be strengthened to improve nutrition support's efficiency.
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Affiliation(s)
- Yunting Li
- Department of Emergency Medicine, The Second Affiliated Hospital of Hainan Medical University, Haikou, 570311, China
| | - Haitang Liu
- Department of Critical Care Unit 2, The Second Affiliated Hospital of Hainan Medical University, Haikou, 570311, China
- *Correspondence: Haitang Liu, Department of Critical Care Unit 2, The Second Affiliated Hospital of Hainan Medical University, Haikou, 570311, China (e-mail: )
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134
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Related Factor Analysis and Nursing Strategies of Diarrhea in Critically Ill Patients with Enteral Nutrition. Emerg Med Int 2022; 2022:8423048. [PMID: 36186529 PMCID: PMC9519324 DOI: 10.1155/2022/8423048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/02/2022] [Accepted: 09/09/2022] [Indexed: 11/17/2022] Open
Abstract
Objective. To explore the related factors of diarrhea in critically ill patients with enteral nutrition (EN) in the intensive care unit (ICU). Methods. This single-center retrospective study analyzed the occurrence of intolerant diarrhea in ICU patients receiving EN treatment in our hospital. By collecting clinical data, univariate and multivariate logistic regression analysis was used to screen the risk factors for diarrhea. Results. Among 120 patients included in the study, 68 (48.33%) had diarrhea. Age (OR = 2.599,
), use of antibiotics (OR = 3.496,
), ICU hospitalization time (OR = 1.311,
), and mechanical ventilation time (OR = 1.273,
) were all independent risk factors for diarrhea in EN. Conclusion. Older age, frequent use of antibiotics, long ICU stay, and mechanical ventilation time can lead to diarrhea in ICU patients receiving EN treatment. It is necessary to effectively analyze the above independent factors and implement targeted interventions to improve the incidence of diarrhea in patients.
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135
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Weimann A, Hartl WH, Adolph M, Angstwurm M, Brunkhorst FM, Edel A, de Heer G, Felbinger TW, Goeters C, Hill A, Kreymann KG, Mayer K, Ockenga J, Petros S, Rümelin A, Schaller SJ, Schneider A, Stoppe C, Elke G. [Assessment and technical monitoring of nutritional status of patients in intensive and intermediate care units : Position paper of the Section Metabolism and Nutrition of the German Interdisciplinary Association for Intensive and Emergency Medicine (DIVI)]. Med Klin Intensivmed Notfmed 2022; 117:37-50. [PMID: 35482063 PMCID: PMC9046715 DOI: 10.1007/s00063-022-00918-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 11/26/2022]
Abstract
At the time of admission to an intensive or intermediate care unit, assessment of the patients' nutritional status may have both prognostic and therapeutic relevance with regard to the planning of individualized medical nutrition therapy (MNT). MNT has definitely no priority in the initial treatment of a critically ill patient, but is often also neglected during the course of the disease. Especially with prolonged length of stay, there is an increasing risk of malnutrition with considerable prognostic macro- and/or micronutrient deficit. So far, there are no structured, evidence-based recommendations for assessing nutritional status in intensive or intermediate care patients. This position paper of the Section Metabolism and Nutrition of the German Interdisciplinary Association for Intensive and Emergency Medicine (DIVI) presents consensus-based recommendations for the assessment and technical monitoring of nutritional status of patients in intensive and intermediate care units. These recommendations supplement the current S2k guideline "Clinical Nutrition in Intensive Care Medicine" of the German Society for Nutritional Medicine (DGEM) and the DIVI.
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Affiliation(s)
- Arved Weimann
- Abteilung für Allgemein‑, Viszeral- und Onkologische Chirurgie, Klinikum St. Georg gGmbH, Delitzscher Str. 141, 04129, Leipzig, Deutschland.
| | - Wolfgang H Hartl
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Ludwig-Maximilians-Universität München - Klinikum der Universität, Campus Großhadern, München, Deutschland
| | - Michael Adolph
- Universitätsklinik für Anästhesiologie und Intensivmedizin und Stabsstelle Ernährungsmanagement, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Matthias Angstwurm
- Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München - Klinikum der Universität, Campus Innenstadt, München, Deutschland
| | - Frank M Brunkhorst
- Zentrum für Klinische Studien, Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Jena, Jena, Deutschland
| | - Andreas Edel
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Geraldine de Heer
- Zentrum für Anästhesiologie und Intensivmedizin, Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Thomas W Felbinger
- Klinik für Anästhesiologie, Operative Intensivmedizin und Schmerztherapie, Kliniken Harlaching und Neuperlach, Städtisches Klinikum München GmbH, München, Deutschland
| | - Christiane Goeters
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Münster, Deutschland
| | - Aileen Hill
- Kliniken für Anästhesiologie und Operative Intensivmedizin und Intermediate Care, Uniklinik RWTH Aachen, Aachen, Deutschland
| | | | - Konstantin Mayer
- Klinik für Pneumologie und Schlafmedizin, St. Vincentius-Kliniken, Karlsruhe, Deutschland
| | - Johann Ockenga
- Medizinische Klinik II, Klinikum Bremen Mitte, Bremen, Deutschland
| | - Sirak Petros
- Interdisziplinäre Internistische Intensivmedizin, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Andreas Rümelin
- Anästhesie, Intensivmedizin und Notfallmedizin, Helios St. Elisabeth-Krankenhaus Bad Kissingen, Bad Kissingen, Deutschland
| | - Stefan J Schaller
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Andrea Schneider
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Christian Stoppe
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Gunnar Elke
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland.
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Kothekar AT, Joshi AV. Gastric Ultrasound: POCUSing an Intolerant GUT! Indian J Crit Care Med 2022; 26:981-982. [PMID: 36213718 PMCID: PMC9492748 DOI: 10.5005/jp-journals-10071-24319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
How to cite this article: Kothekar AT, Joshi AV. Gastric Ultrasound: POCUSing an Intolerant GUT! Indian J Crit Care Med 2022;26(9):981-982.
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Affiliation(s)
- Amol Trimbakrao Kothekar
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Anand Vinaykumar Joshi
- Department of Intensive Care Unit, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
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Shang Y, Wu J, Liu J, Long Y, Xie J, Zhang D, Hu B, Zong Y, Liao X, Shang X, Ding R, Kang K, Liu J, Pan A, Xu Y, Wang C, Xu Q, Zhang X, Zhang J, Liu L, Zhang J, Yang Y, Yu K, Guan X, Chen D. Expert consensus on the diagnosis and treatment of severe and critical coronavirus disease 2019 (COVID-19). JOURNAL OF INTENSIVE MEDICINE 2022; 2:199-222. [PMID: 36785648 PMCID: PMC9411033 DOI: 10.1016/j.jointm.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 07/24/2022] [Indexed: 12/16/2022]
Affiliation(s)
- You Shang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Jianfeng Wu
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510010, China
| | - Jinglun Liu
- Department of Emergency and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yun Long
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China
| | - Jianfeng Xie
- Department of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China
| | - Dong Zhang
- Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, Jilin 130021, China
| | - Bo Hu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China
| | - Yuan Zong
- Department of Critical Care Medicine, Shaanxi Provincial Hospital, Xi'an, Shannxi 710068, China
| | - Xuelian Liao
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xiuling Shang
- Department of Critical Care Medicine, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fuzhou, Fujian 350001, China
| | - Renyu Ding
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Kai Kang
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China
| | - Jiao Liu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Aijun Pan
- Department of Critical Care Medicine, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China
| | - Yonghao Xu
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, China
| | - Changsong Wang
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150001, China
| | - Qianghong Xu
- Department of Critical Care Medicine, Zhejiang Hospital Affiliated to Medical College of Zhejiang University, Hangzhou, Zhejiang 310013, China
| | - Xijing Zhang
- Department of Critical Care Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi 710032, China
| | - Jicheng Zhang
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Ling Liu
- Department of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China
| | - Jiancheng Zhang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Yi Yang
- Department of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China
| | - Kaijiang Yu
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China
- Corresponding authors: Dechang Chen, Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China. Xiangdong Guan, Department of Critical Care Medicine, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China. Kaijiang Yu, Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China.
| | - Xiangdong Guan
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510010, China
- Corresponding authors: Dechang Chen, Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China. Xiangdong Guan, Department of Critical Care Medicine, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China. Kaijiang Yu, Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China.
| | - Dechang Chen
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Corresponding authors: Dechang Chen, Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China. Xiangdong Guan, Department of Critical Care Medicine, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China. Kaijiang Yu, Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China.
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138
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Qin L, Zhang XX, Jin X, Cui CH, Tang CZ. The Effect of Acupuncture on Enteral Nutrition and Gastrointestinal Dynamics in Patients Who Have Suffered a Severe Stroke. Curr Neurovasc Res 2022; 19:275-281. [PMID: 35996236 DOI: 10.2174/1567202619666220822123023] [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: 06/20/2022] [Revised: 07/10/2022] [Accepted: 07/19/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to explore and analyze the effect of acupuncture on improving the enteral nutrition level and gastrointestinal dynamics in patients who had suffered a severe stroke. METHODS A total of 122 patients who experienced a severe stroke who were treated in the intensive care unit of the Affiliated Hospital of Hebei University (China) between September 2021 and March 2022 were randomly divided into two groups as follows: 1) the observation group, the participants of which received acupuncture combined with early enteral nutrition (61 cases); 2) the control group, the participants of which received early enteral nutrition (61 cases). Following treatment, the hemoglobin, neutrophil count, blood glucose, albumin, pre-albumin, immediate postprandial antral area, antral contraction frequency (at 2 min), and antral motility index on days 1 and 7 of treatment were compared between the two groups. RESULTS The total clinical effective rate was 96.72% in the observation group and 77.05% in the control group. The curative effect comparison between the two groups after seven days of treatment showed a lower probability of gastrointestinal bleeding, faster recovery of gastrointestinal motility, and a higher level of nutrient absorption in the observation group. Serum albumin, pre-albumin, hemoglobin, total lymphocyte count, immediate postprandial maximum (max) and minimum (mix) area of the gastric antrum, antral contraction frequency (at 2 min), and antral motility index were higher in the observation group than in the control group (P < 0.05). The difference in blood glucose levels between the two groups was not statistically significant (P > 0.05). CONCLUSION Acupuncture improved the enteral nutrition status of patients who had suffered a severe stroke and promoted gastrointestinal motility. The combination of acupuncture and early enteral nutrition could reduce damage to the gastrointestinal mucosal barrier caused by stress, changes in metabolism, and improved gastrointestinal function.
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Affiliation(s)
- Liang Qin
- Acupuncture Rehabilitation Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou, 510006, China.,Department of Rehabilitation Medicine, Affiliated Hospital of Hebei University, Baoding, 071000, China
| | - Xin-Xin Zhang
- Department of Emergency Medicine, Affiliated Hospital of Hebei University, Baoding, 071000, China
| | - Xin Jin
- Department of Neurology, Intensive Care Unit of Affiliated Hospital of Hebei University, Baoding, 071000, China
| | - Cai-Hong Cui
- Department of Rehabilitation Medicine, Affiliated Hospital of Hebei University, Baoding, 071000, China
| | - Chun-Zhi Tang
- Acupuncture Rehabilitation Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou, 510006, China
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139
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Tetamo R, Fittipaldi C, Buono S, Umbrello M. Nutrition support for critically ill patients during the COVID-19 pandemic: the Italian SIAARTI survey. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2022; 2:35. [PMID: 37386650 PMCID: PMC9361260 DOI: 10.1186/s44158-022-00063-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/25/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Critically ill, COVID-19 patients are characterized by a hypermetabolic state and a reduced food intake and are at high risk of malnutrition and lean body mass loss. An appropriate metabolic-nutritional intervention aims to reduce complications and improve the clinical outcomes. We conducted a cross-sectional, multicenter, observational, nationwide online survey involving Italian Intensivists to assess the nutritional practices in critically ill patients with COVID-19. RESULTS A group of experts in nutrition of the Italian Society of Anaesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) developed a 24-item questionnaire; the 9000 members of the Society were invited to participate through emails and social networks. Data was collected from June 1 to August 1, 2021. A total of 545 responses were collected: 56% in northern, 25% in central, and 20% in southern Italy. Artificial nutrition support is directly handled by intensivists in > 90 of the cases; the nutritional status is assessed as suggested by the guidelines in more than 70% of the cases, and a form of nutrition support is started within the first 48 h from ICU admission by > 90% of the respondents. Nutritional targets are reached in 4-7 days in > 75% of the cases, mainly by the enteral route. Indirect calorimetry, muscle ultrasound, and bioimpedance analysis are used by a limited part of the interviewees. Only about a half of the respondents reported the nutritional issues in the ICU discharge summary. CONCLUSIONS This survey among Italian Intensivists during the COVID-19 epidemic showed how the beginning, progression, and route of nutritional support adhere to international recommendations, while recommendations on the tools to set the target and monitor the efficacy of the metabolic support are less followed.
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Affiliation(s)
- Romano Tetamo
- Già Direttore UOC Anestesia E Rianimazione E Dipartimento Emergenza Urgenza, ARNAS Civico Palermo, Palermo, Italy
| | - Ciro Fittipaldi
- UOC Anesthesia and Intensive Care, Hospital Pellegrini, Naples, Italy
| | - Salvatore Buono
- Direttore UOC Anestesia, Rianimazione E Terapia Intensiva, AORN Ospedali Dei Colli Presidio Ospedaliero CTO, Naples, Italy
| | - Michele Umbrello
- SC Anestesia e Rianimazione II, ASST Santi Paolo e Carlo - Polo Universitario, Ospedale San Carlo Borromeo, Milan, Italy.
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140
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Lai J, Chen S, Chen L, Huang D, Lin J, Zheng Q. Bedside gastrointestinal ultrasound combined with acute gastrointestinal injury score to guide enteral nutrition therapy in critically patients. BMC Anesthesiol 2022; 22:231. [PMID: 35854215 PMCID: PMC9295482 DOI: 10.1186/s12871-022-01772-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To use gastric ultrasound to evaluate function and to determine the start time of enteral nutrition (EN) in patients with acute gastrointestinal injury (AGI). METHODS We reviewed records from 105 patients who suffered AGI levels two (AGI II). We recorded several data points, including ultrasonographic transverse area of gastric antrum (CSA), left descending colonic or right ascending colonic diameter (Diam), peristatic frequency (Peri), EN start time, EN dose, prealbumin (PA), and EN complications. The recovery of intestinal function after EN treatment was judged as success. If there was EN treatment complication, this was judged as failure. We analyzed the changes in gastrointestinal function after EN treatment, to determine feeding time. RESULTS There were 69 patients in the successful group, and 36 in the failure group. There were no significant differences between the two groups in age, intra abdominal pressure (IAP), APACHE II, PA and disease composition (p > 0.05).There were significant differences in terms of EN startup time, CSA, Diam, Peri, and PA, between the EN success and failure groups. We found IAP does not reflect gastrointestinal function;CSA ≤ 9cm2, Diam ≤ 2.9 cm, Peri > 3 bpm, indicated that the three indexes could reflect the recovery of gastrointestinal function. Receiver operating curve analysis showed that combined CSA, Diam, Peri evaluation determined the best time to start EN. CONCLUSIONS Monitoring gastric antrum transversal area, colonic diameter, colonic peristatic frequency using ultrasound can guide the timing of initiation of enteral nutrition treatment.
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Affiliation(s)
- Jiawei Lai
- Department of Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No 59, Shengli West Road, Zhangzhou, 363000, Fujian, China
| | - Shuhong Chen
- Department of Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No 59, Shengli West Road, Zhangzhou, 363000, Fujian, China
| | - Linli Chen
- Department of Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No 59, Shengli West Road, Zhangzhou, 363000, Fujian, China
| | - Daofeng Huang
- Department of Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No 59, Shengli West Road, Zhangzhou, 363000, Fujian, China
| | - Jinzhan Lin
- Department of Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No 59, Shengli West Road, Zhangzhou, 363000, Fujian, China
| | - Qingjiang Zheng
- Department of Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No 59, Shengli West Road, Zhangzhou, 363000, Fujian, China.
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141
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Bechtold ML, Brown PM, Escuro A, Grenda B, Johnston T, Kozeniecki M, Limketkai BN, Nelson KK, Powers J, Ronan A, Schober N, Strang BJ, Swartz C, Turner J, Tweel L, Walker R, Epp L, Malone A. When is enteral nutrition indicated? JPEN J Parenter Enteral Nutr 2022; 46:1470-1496. [PMID: 35838308 DOI: 10.1002/jpen.2364] [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: 09/29/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 11/07/2022]
Abstract
Enteral nutrition (EN) is a vital component of nutrition around the world. EN allows for delivery of nutrients to those who cannot maintain adequate nutrition by oral intake alone. Common questions regarding EN are when to initiate and in what scenarios it is safe. The answers to these questions are often complex and require an evidence-based approach. The Board of Directors of the American Society for Parenteral and Enteral Nutrition (ASPEN) established an Enteral Nutrition Committtee to address the important questions surrounding the indications for EN. Consensus recommendations were established based on eight extremely clinically relevant questions regarding EN indications as deemed by the Enteral Nutrition Committee. These consensus recommendations may act as a guide for clinicians and stakeholders on difficult questions pertaining to indications for EN. This paper was approved by the ASPEN Board of Directors.
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Affiliation(s)
| | | | | | - Brandee Grenda
- Morrison Healthcare at Atrium Health Navicant, Charlotte, North Carolina, USA
| | - Theresa Johnston
- Nutrition Support Team, Christiana Care Health System, Newark, Delaware, USA
| | | | | | | | - Jan Powers
- Nursing Research and Professional Practice, Parkview Health System, Fort Wayne, Indiana, USA
| | - Andrea Ronan
- Fanconi Anemia Research Fund, Eugene, Oregon, USA
| | - Nathan Schober
- Cancer Treatment Centers of America - Atlanta, Newnan, Georgia, USA
| | | | - Cristina Swartz
- Northwestern Medicine Delnor Cancer Center, Chicago, Illinois, USA
| | - Justine Turner
- Department of Pediatrics, Division of Gastroenterology and Nutrition, University of Alberta, Edmonton, Canada
| | | | - Renee Walker
- Michael E. DeBakey Veteran Affairs Medical Center, Houston, Texas, USA
| | - Lisa Epp
- Mayo Clinic, Rochester, Minnesota, USA
| | - Ainsley Malone
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
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142
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Nutrition in Pediatric Intensive Care: A Narrative Review. CHILDREN 2022; 9:children9071031. [PMID: 35884015 PMCID: PMC9318205 DOI: 10.3390/children9071031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/04/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022]
Abstract
Nutrition support in pediatric intensive care is an integral part of a complex approach to treating critically ill children. Smaller energy reserves with higher metabolic demands (a higher basal metabolism rate) compared to adults makes children more vulnerable to starvation. The nutrition supportive therapy should be initiated immediately after intensive care admission and initial vital sign stabilization. In absence of contraindications (unresolving/decompensated shock, gut ischemia, critical gut stenosis, etc.), the preferred type of enteral nutrition is oral or via a gastric tube. In the acute phase of critical illness, due to gluconeogenesis and muscle breakdown with proteolysis, the need for high protein delivery should be emphasized. After patient condition stabilization, the acute phase with predominant catabolism converts to the anabolic phase and intensive rehabilitation, where high energy demands are the keystone of a positive outcome.
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143
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Viner Smith E, Ridley EJ, Rayner CK, Chapple LAS. Nutrition management of critically ill adult patients requiring non-invasive ventilation: a scoping review protocol. JBI Evid Synth 2022; 20:1814-1820. [PMID: 36164714 DOI: 10.11124/jbies-21-00328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This scoping review will identify the current available literature and key concepts in the nutrition management of critically ill adult patients requiring non-invasive ventilation. INTRODUCTION Current international nutrition guidelines include recommendations for the nutrition management of critically ill patients who are receiving invasive mechanical ventilation; however, these guidelines do not address nutrition management of patients receiving non-invasive ventilation. This scoping review aims to explore and describe the existing available literature on the nutrition management of critically ill adults requiring non-invasive ventilation. INCLUSION CRITERIA This review will consider original research (qualitative, quantitative, or mixed methods studies) reporting on any nutrition parameter for critically ill adult patients (≥16 years) requiring non-invasive ventilation in the intensive care unit. Concepts of interest based on the general intensive care nutrition literature include route of nutrition, recommendations related to macro- or micro-nutrients, nutrition provision, barriers to nutrition provision, and strategies for nutrition management. METHODS This review will be conducted in accordance with JBI methodology for scoping reviews using a three-step search strategy. MEDLINE, Embase, Scopus, and Web of Science will be searched to obtain original research available in English and published after 1990. Google Scholar will be searched for gray literature. Duplicates will be removed and studies will be selected by two independent reviewers based on the inclusion criteria. The same two reviewers will extract data in duplicate using a data extraction tool. Any disagreements will be resolved via consensus with a third reviewer. Data extraction will be synthesized in tabular and diagrammatic format.
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Affiliation(s)
- Elizabeth Viner Smith
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.,Intensive Care Research Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Emma J Ridley
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Vic, Australia.,Nutrition Department, Alfred Health, Melbourne, Vic, Australia
| | - Christopher K Rayner
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.,Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia.,Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Lee-Anne S Chapple
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.,Intensive Care Research Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.,Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia
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144
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Ultrasound meal accommodation test in critically ill patients with and without feeding intolerance UMAT-ICU. Clin Nutr ESPEN 2022; 51:424-429. [DOI: 10.1016/j.clnesp.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 04/14/2022] [Accepted: 07/08/2022] [Indexed: 11/19/2022]
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145
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When Is It Safe to Feed After Surgical Feeding Tube Placement? A Survey of East Members. J Surg Res 2022; 275:218-224. [DOI: 10.1016/j.jss.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 01/05/2022] [Accepted: 01/18/2022] [Indexed: 11/23/2022]
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146
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Noyahr JK, Tatucu-Babet OA, Chapple LAS, Barlow CJ, Chapman MJ, Deane AM, Fetterplace K, Hodgson CL, Winderlich J, Udy AA, Marshall AP, Ridley EJ. Methodological Rigor and Transparency in Clinical Practice Guidelines for Nutrition Care in Critically Ill Adults: A Systematic Review Using the AGREE II and AGREE-REX Tools. Nutrients 2022; 14:2603. [PMID: 35807784 PMCID: PMC9268338 DOI: 10.3390/nu14132603] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 02/07/2023] Open
Abstract
Background: To evaluate the methodological quality of (1) clinical practice guidelines (CPGs) that inform nutrition care in critically ill adults using the AGREE II tool and (2) CPG recommendations for determining energy expenditure using the AGREE-REX tool. Methods: CPGs by a professional society or academic group, intended to guide nutrition care in critically ill adults, that used a systematic literature search and rated the evidence were included. Four databases and grey literature were searched from January 2011 to 19 January 2022. Five investigators assessed the methodological quality of CPGs and recommendations specific to energy expenditure determination. Scaled domain scores were calculated for AGREE II and a scaled total score for AGREE-REX. Data are presented as medians (interquartile range). Results: Eleven CPGs were included. Highest scoring domains for AGREE II were clarity of presentation (82% [76-87%]) and scope and purpose (78% [66-83%]). Lowest scoring domains were applicability (37% [32-42%]) and stakeholder involvement (46% [33-51%]). Eight (73%) CPGs provided recommendations relating to energy expenditure determination; scores were low overall (37% [36-40%]) and across individual domains. Conclusions: Nutrition CPGs for critically ill patients are developed using systematic methods but lack engagement with key stakeholders and guidance to support application. The quality of energy expenditure determination recommendations is low.
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Affiliation(s)
- John K. Noyahr
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (J.K.N.); (O.A.T.-B.); (C.L.H.); (J.W.); (A.A.U.)
| | - Oana A. Tatucu-Babet
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (J.K.N.); (O.A.T.-B.); (C.L.H.); (J.W.); (A.A.U.)
| | - Lee-anne S. Chapple
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia;
- Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA 5005, Australia;
| | - Christopher Jake Barlow
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland 1023, New Zealand;
| | - Marianne J. Chapman
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA 5005, Australia;
| | - Adam M. Deane
- Department of Medicine and Radiology, Melbourne Medical School, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC 3010, Australia; (A.M.D.); (K.F.)
| | - Kate Fetterplace
- Department of Medicine and Radiology, Melbourne Medical School, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC 3010, Australia; (A.M.D.); (K.F.)
- Department of Allied Health (Clinical Nutrition), Royal Melbourne Hospital, Melbourne, VIC 3050, Australia
| | - Carol L. Hodgson
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (J.K.N.); (O.A.T.-B.); (C.L.H.); (J.W.); (A.A.U.)
- Intensive Care Unit, Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Jacinta Winderlich
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (J.K.N.); (O.A.T.-B.); (C.L.H.); (J.W.); (A.A.U.)
- Paediatric Intensive Care Unit, Monash Children’s Hospital, Melbourne, VIC 3168, Australia
| | - Andrew A. Udy
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (J.K.N.); (O.A.T.-B.); (C.L.H.); (J.W.); (A.A.U.)
- Intensive Care Unit, Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Andrea P. Marshall
- Intensive Care Unit, Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia;
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Gold Coast, QLD 4222, Australia
| | - Emma J. Ridley
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (J.K.N.); (O.A.T.-B.); (C.L.H.); (J.W.); (A.A.U.)
- Nutrition Department, The Alfred Hospital, Melbourne, VIC 3004, Australia
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147
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Novel insights in endocrine and metabolic pathways in sepsis and gaps for future research. Clin Sci (Lond) 2022; 136:861-878. [PMID: 35642779 DOI: 10.1042/cs20211003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 11/17/2022]
Abstract
Sepsis is defined as any life-threatening organ dysfunction caused by a dysregulated host response to infection. It remains an important cause of critical illness and has considerable short- and long-term morbidity and mortality. In the last decades, preclinical and clinical research has revealed a biphasic pattern in the (neuro-)endocrine responses to sepsis as to other forms of critical illness, contributing to development of severe metabolic alterations. Immediately after the critical illness-inducing insult, fasting- and stress-induced neuroendocrine and cellular responses evoke a catabolic state in order to provide energy substrates for vital tissues, and to concomitantly activate cellular repair pathways while energy-consuming anabolism is postponed. Large randomized controlled trials have shown that providing early full feeding in this acute phase induced harm and reversed some of the neuro-endocrine alterations, which suggested that the acute fasting- and stress-induced responses to critical illness are likely interlinked and benefical. However, it remains unclear whether, in the context of accepting virtual fasting in the acute phase of illness, metabolic alterations such as hyperglycemia are harmful or beneficial. When patients enter a prolonged phase of critical illness, a central suppression of most neuroendocrine axes follows. Prolonged fasting and central neuroendocrine suppression may no longer be beneficial. Although pilot studies have suggested benefit of fasting-mimicking diets and interventions that reactivate the central neuroendocrine suppression selectively in the prolonged phase of illness, further study is needed to investigate patient-oriented outcomes in larger randomized trials.
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Cai Z, Zhao K, Li Y, Wan X, Li C, Niu H, Shu K, Lei T. Early Enteral Nutrition Can Reduce Incidence of Postoperative Hydrocephalus in Patients with Severe Hypertensive Intracerebral Hemorrhage. Med Sci Monit 2022; 28:e935850. [PMID: 35655416 PMCID: PMC9172265 DOI: 10.12659/msm.935850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hydrocephalus secondary to hypertensive intracerebral hemorrhage (HICH) dramatically affects the prognosis. Early enteral nutrition (EN) is beneficial to severe HICH patients, but the impact of early EN administration on hydrocephalus remains unknown. This study aimed to explore the predictors for hydrocephalus occurrence after HICH, with special focus on the effect of early EN application. MATERIAL AND METHODS We retrospectively analyzed 146 patients with severe HICH who underwent microsurgery between January 2014 and October 2019 in our department. Patients were divided into early EN (≤48 h) and delayed EN (>48 h) group according to the time-point of EN administration. The diagnosis of hydrocephalus was confirmed by both radiological evaluation and an Evan index method. Diagnosis confirmed within 2 weeks after HICH was identified as acute hydrocephalus, otherwise, it was considered as chronic hydrocephalus. RESULTS Twenty-seven patients experienced acute hydrocephalus, while 20 patients developed chronic hydrocephalus. Low preoperative Glasgow coma scale (GCS), subarachnoid hemorrhage (SAH), intraventricular hemorrhage (IVH), delayed EN administration, high levels of postoperative white blood cell, neutrophil, neutrophil-to-lymphocyte ratio, C-reactive protein (CRP), and lactate dehydrogenase were positively related to the occurrence of chronic hydrocephalus (p<0.05), while only IVH was correlated with acute hydrocephalus occurrence (p<0.05). In addition, a multivariate analysis demonstrated that preoperative GCS, SAH, IVH, and early EN administration (p<0.05) were independent predictors for chronic hydrocephalus occurrence. CONCLUSIONS Early EN administration, SAH, IVH, and preoperative GCS were associated with the occurrence of chronic hydrocephalus in severe HICH patients. Early EN administration may inhibit the inflammatory response of brain-gut axis, which in turn reduces chronic hydrocephalus occurrence.
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Jaber S, Garnier M, Asehnoune K, Bounes F, Buscail L, Chevaux JB, Dahyot-Fizelier C, Darrivere L, Jabaudon M, Joannes-Boyau O, Launey Y, Levesque E, Levy P, Montravers P, Muller L, Rimmelé T, Roger C, Savoye-Collet C, Seguin P, Tasu JP, Thibault R, Vanbiervliet G, Weiss E, De Jong A. Guidelines for the management of patients with severe acute pancreatitis, 2021. Anaesth Crit Care Pain Med 2022; 41:101060. [PMID: 35636304 DOI: 10.1016/j.accpm.2022.101060] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To provide guidelines for the management of the intensive care patient with severe acute pancreatitis. DESIGN A consensus committee of 22 experts was convened. A formal conflict-of-interest (COI) policy was developed at the beginning of the process and enforced throughout. The entire guideline construction process was conducted independently of any industrial funding (i.e. pharmaceutical, medical devices). The authors were required to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. METHODS The most recent SFAR and SNFGE guidelines on the management of the patient with severe pancreatitis were published in 2001. The literature now is sufficient for an update. The committee studied 14 questions within 3 fields. Each question was formulated in a PICO (Patients Intervention Comparison Outcome) format and the relevant evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology. RESULTS The experts' synthesis work and their application of the GRADE® method resulted in 24 recommendations. Among the formalised recommendations, 8 have high levels of evidence (GRADE 1+/-) and 12 have moderate levels of evidence (GRADE 2+/-). For 4 recommendations, the GRADE method could not be applied, resulting in expert opinions. Four questions did not find any response in the literature. After one round of scoring, strong agreement was reached for all the recommendations. CONCLUSIONS There was strong agreement among experts for 24 recommendations to improve practices for the management of intensive care patients with severe acute pancreatitis.
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Affiliation(s)
- Samir Jaber
- Department of Anaesthesiology and Intensive Care (DAR B), University Hospital Center Saint Eloi Hospital, Montpellier, France; PhyMedExp, Montpellier University, INSERM, CNRS, CHU de Montpellier, Montpellier, France.
| | - Marc Garnier
- Sorbonne Université, GRC 29, DMU DREAM, Service d'Anesthésie-Réanimation et Médecine Périopératoire Rive Droite, Paris, France
| | - Karim Asehnoune
- Service d'Anesthésie, Réanimation chirurgicale, Hôtel Dieu/HME, CHU Nantes, Nantes cedex 1, France; Inserm, UMR 1064 CR2TI, team 6, France
| | - Fanny Bounes
- Toulouse University Hospital, Anaesthesia Critical Care and Perioperative Medicine Department, Toulouse, France; Équipe INSERM Pr Payrastre, I2MC, Université Paul Sabatier Toulouse III, Toulouse, France
| | - Louis Buscail
- Department of Gastroenterology & Pancreatology, University of Toulouse, Rangueil Hospital, Toulouse, France
| | | | - Claire Dahyot-Fizelier
- Anaesthesiology and Intensive Care Department, University hospital of Poitiers, Poitiers, France; INSERM U1070, University of Poitiers, Poitiers, France
| | - Lucie Darrivere
- Department of Anaesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, F-75010, Paris, France
| | - Matthieu Jabaudon
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France; iGReD, Université Clermont Auvergne, CNRS, INSERM, Clermont-Ferrand, France
| | - Olivier Joannes-Boyau
- Service d'Anesthésie-Réanimation SUD, CHU de Bordeaux, Hôpital Magellan, Bordeaux, France
| | - Yoann Launey
- Critical Care Unit, Department of Anaesthesia, Critical Care and Perioperative Medicine, University Hospital of Rennes, Rennes, France
| | - Eric Levesque
- Department of Anaesthesia and Surgical Intensive Care, AP-HP, Henri Mondor Hospital, Créteil, France; Université Paris-Est Creteil, EnvA, DYNAMiC, Faculté de Santé de Créteil, Creteil, France
| | - Philippe Levy
- Service de Pancréatologie et d'Oncologie Digestive, DMU DIGEST, Université de Paris, Hôpital Beaujon, APHP, Clichy, France
| | - Philippe Montravers
- Université de Paris Cité, INSERM UMR 1152 - PHERE, Paris, France; Département d'Anesthésie-Réanimation, APHP, CHU Bichat-Claude Bernard, DMU PARABOL, APHP, Paris, France
| | - Laurent Muller
- Réanimations et surveillance continue, Pôle Anesthésie Réanimation Douleur Urgences, CHU Nîmes Caremeau, Montpellier, France
| | - Thomas Rimmelé
- Département d'anesthésie-réanimation, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France; EA 7426: Pathophysiology of Injury-induced Immunosuppression, Pi3, Hospices Civils de Lyon-Biomérieux-Université Claude Bernard Lyon 1, Lyon, France
| | - Claire Roger
- Réanimations et surveillance continue, Pôle Anesthésie Réanimation Douleur Urgences, CHU Nîmes Caremeau, Montpellier, France; Department of Intensive care medicine, Division of Anaesthesiology, Intensive Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Céline Savoye-Collet
- Department of Radiology, Normandie University, UNIROUEN, Quantif-LITIS EA 4108, Rouen University Hospital-Charles Nicolle, Rouen, France
| | - Philippe Seguin
- Service d'Anesthésie Réanimation 1, Réanimation chirurgicale, CHU de Rennes, Rennes, France
| | - Jean-Pierre Tasu
- Service de radiologie diagnostique et interventionnelle, CHU de Poitiers, Poitiers, France; LaTim, UBO and INSERM 1101, University of Brest, Brest, France
| | - Ronan Thibault
- Service Endocrinologie-Diabétologie-Nutrition, CHU Rennes, INRAE, INSERM, Univ Rennes, NuMeCan, Nutrition Metabolisms Cancer, Rennes, France
| | - Geoffroy Vanbiervliet
- Department of Digestive Endoscopy, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Emmanuel Weiss
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Clichy, France; University of Paris, Paris, France; Inserm UMR_S1149, Centre for Research on Inflammation, Paris, France
| | - Audrey De Jong
- Department of Anaesthesiology and Intensive Care (DAR B), University Hospital Center Saint Eloi Hospital, Montpellier, France; PhyMedExp, Montpellier University, INSERM, CNRS, CHU de Montpellier, Montpellier, France
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Grajecki D, Tacke F. [Gastrointestinal motility disorders in critically ill patients]. Dtsch Med Wochenschr 2022; 147:696-704. [PMID: 35636421 DOI: 10.1055/a-1664-1823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The gastrointestinal tract is one of the most complex organ systems of the human body. On the one hand, it forms the absorption surface for nutrients, but on the other hand it is also a barrier for toxins, food components and against up to 1014 commensal microorganisms. The complexity of the interplay between absorption, motility and immune functions of the gastrointestinal tract is particularly evident in critically ill patients. In this article, we review the latest updates on pathogenic relationships of motility disorders and diagnostic algorithms in intensive care patients. In addition to established therapies, new developments in the treatment of hypomotility are outlined.
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Affiliation(s)
- Donata Grajecki
- Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum und Campus Charité Mitte
| | - Frank Tacke
- Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum und Campus Charité Mitte
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