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Guan X, Chen D, Xu Y. Clinical practice guidelines for nutritional assessment and monitoring of adult ICU patients in China. JOURNAL OF INTENSIVE MEDICINE 2024; 4:137-159. [PMID: 38681796 PMCID: PMC11043647 DOI: 10.1016/j.jointm.2023.12.002] [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: 10/30/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 05/01/2024]
Abstract
The Chinese Society of Critical Care Medicine (CSCCM) has developed clinical practice guidelines for nutrition assessment and monitoring for patients in adult intensive care units (ICUs) in China. This guideline focuses on nutrition evaluation and metabolic monitoring to achieve optimal and personalized nutrition therapy for critically ill patients. This guideline was developed by experts in critical care medicine and evidence-based medicine methodology and was developed after a thorough review of the system and a summary of relevant trials or studies published from 2000 to July 2023. A total of 18 recommendations were formed and consensus was reached through discussions and reviews by expert groups in critical care medicine, parenteral and enteral nutrition, and surgery. The recommendations are based on currently available evidence and cover several key fields, including screening and assessment, evaluation and assessment of enteral feeding intolerance, metabolic and nutritional measurement and monitoring during nutrition therapy, and organ function evaluation related to nutrition supply. Each question was analyzed according to the Population, Intervention, Comparison, and Outcome (PICO) principle. In addition, interpretations were provided for four questions that did not reach a consensus but may have potential clinical and research value. The plan is to update this nutrition assessment and monitoring guideline using the international guideline update method within 3-5 years.
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Affiliation(s)
- Xiangdong Guan
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dechang Chen
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Xu
- Department of Critical Care Medicine, Beijing Tsinghua Changgung Hospital, Beijing, China
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2
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Yao Y, Liu J, Xue H, Wang X, Yao W, Liu N, Wang Z, Mi G. Construction of an enteral nutrition evaluation system for critically ill patients based on the Delphi method. Saudi J Gastroenterol 2024; 30:63-70. [PMID: 37721256 PMCID: PMC10852151 DOI: 10.4103/sjg.sjg_205_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/15/2023] [Accepted: 08/25/2022] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND This study aimed to construct an enteral nutrition evaluation system for critically ill patients using the Delphi method to direct the formulation of enteral nutrition support strategies and reduce interruption to enteral feeding. METHODS We used domestic and foreign databases to obtain and analyze the literature and form "The Whole-Proceeding Enteral Nutrition Evaluation System for Critically Ill Patients." The Delphi method was used to conduct two rounds of expert opinion consultation, combined with the suggestions from the research group to finalize the nutrition evaluation content of the system. RESULTS After two rounds of expert consultation, a nutrition evaluation system was formed around three dimensions: before the start, during, and after the end of nutritional support. The effective recovery rates of the two rounds of expert consultation were 90.0% (18/20) and 100.0% (18/18), respectively. Authority coefficients were 0.865 and 0.908, while Kendall coordination coefficients were 0.108 ( P < 0.05) and 0.115 ( P < 0.001), respectively. Finally, the full enteral nutrition evaluation system for critically ill patients was constructed based on the Delphi method, including three primary items and seven secondary and 28 tertiary indicators. CONCLUSION The established "Whole-Proceeding Enteral Nutrition Evaluation System for Critically Ill Patients" has high consistency from expert opinions and reliability, which can provide a practical evaluation tool for the process of enteral nutrition for severe patients.
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Affiliation(s)
- Yanrong Yao
- Department of Hepatobilology, General Hospital of Ningxia Medical University, Yin Chuan, China
| | - Jingli Liu
- Department of Hepatobilology, General Hospital of Ningxia Medical University, Yin Chuan, China
| | - Hongmei Xue
- Department of Hepatobilology, General Hospital of Ningxia Medical University, Yin Chuan, China
| | - Xiaoyan Wang
- Neonatal Intensive Care Unit, General Hospital of Ningxia Medical University, Yin Chuan, China
| | - Weijie Yao
- Department of Hepatobilology, General Hospital of Ningxia Medical University, Yin Chuan, China
| | - Na Liu
- Department of Nursing, General Hospital of Ningxia Medical University, Yin Chuan, China
| | - Zuozheng Wang
- Department of Hepatobilology, General Hospital of Ningxia Medical University, Yin Chuan, China
| | - Guangli Mi
- Department of Nursing, General Hospital of Ningxia Medical University, Yin Chuan, China
- Department of School of Nursing, Ningxia Medical University, Yin Chuan, China
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Yin Y, Fan CF. The Effects of Mukbang Watching on Enteral Feeding Intolerance Among Critically Ill Patients: Study Protocol for a Randomized Controlled Trail. Patient Prefer Adherence 2023; 17:2891-2897. [PMID: 37965439 PMCID: PMC10642568 DOI: 10.2147/ppa.s438190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/02/2023] [Indexed: 11/16/2023] Open
Abstract
Purpose With an estimated prevalence of 38%, enteral feeding intolerance (EFI) is common in critically ill patients receiving enteral nutrition (EN), and is associated with higher mortality and longer duration of mechanical ventilation. Various methods have been reported to decrease the incidence of EFI during EN, such as post-pyloric feeding, continuous EN delivery, abdominal massage, and probiotic supplementation. However, several studies reported conflicting results. Inappropriate interventions may cause gastrointestinal (GI) injury. This study aims to design a protocol based on Mukbang videos, which are widely watched online, to detect their effects on the incidence of EFI, nutritional status, incidence of infectious complications, and activities of daily living. Patients and Methods We will conduct a three-arm, parallel-design, randomized controlled trial that will be implemented in 273 patients from intensive care units. Participants will be randomized into one of the three intervention arms (1:1:1), which will be performed by a research assistant. Participants were allocated to three groups: (a) watching mukbang video, (b) watching a cooking show, and (c) watching a non-food content video. Prior to EN initiation, each participant will watch a ten-minute mukbang video, cookery show, or non-food content video. Conclusion Mukbang videos show food, expressions of mukbangers and eating sounds. If it effectively reduces the incidence of EFI, leads to greater nutritional status, lower incidence of infectious complications, and a higher level of independence among patients compared with watching cooking videos or non-food content videos, it has broad dissemination potential as a non-invasive, easily assessing, and using method.
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Affiliation(s)
- Yao Yin
- Department of Neurosurgery, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Chao-Feng Fan
- Department of Neurosurgery, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, Sichuan, People’s Republic of China
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Kagan I, Hellerman-Itzhaki M, Bendavid I, Statlender L, Fishman G, Wischmeyer PE, de Waele E, Singer P. Controlled enteral nutrition in critical care patients - A randomized clinical trial of a novel management system. Clin Nutr 2023; 42:1602-1609. [PMID: 37480797 DOI: 10.1016/j.clnu.2023.06.018] [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: 04/20/2023] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE Nutritional therapy is essential to ICU care. Successful early enteral feeding is hindered by lack of protocols, gastrointestinal intolerance and feeding interruptions, leading to impaired nutritional intake. smART+ was developed as a nutrition management feeding platform controlling tube positioning, reflux, gastric pressure, and malnutrition. This study evaluated the potential of this new ICU care platform to deliver targeted nutrition and improve ICU outcomes. METHODS Critically ill patients ≥18 years-old, mechanically ventilated and enterally fed, were randomized to receive ESPEN-guideline-based nutrition or smART+ -guided nutrition for 2-14 days. Primary endpoint was average deviation from daily targeted nutrition determined via calculation of energy targets per calorimetry. Secondary endpoints included gastric residual volumes, length of stay (LOS) and length of ventilation (LOV). RESULTS smART+ achieved a mean deviation from daily targeted nutrition of 10.5% (n = 48) versus 34.3% for control (n = 50), p < 0.0001. LOS and LOV were decreased in the smART+ group versus control (mean LOS: 10.4 days versus 13.7; reduction 3.3 days, adjusted HR 1.71, 95% CI:1.13,2.60, p = 0.012; mean LOV: 9.5 days versus 12.8 days reduction of 3.3 days, adjusted HR 1.64, 95% CI:1.08-2.51, p = 0.021). Feeding goals were met (within ±10%) on 75.7% of days for smART+ versus 23.3% for control (p < 0.001). No treatment-related adverse events occurred in either group. The study was stopped due to success in a planned interim analysis of the first 100 patients. CONCLUSION The smART+ Platform improved adherence to feeding goals and reduced LOS and LOV versus standard of care in critically ill patients. TRIAL REGISTRATION NCT04098224; registered September 23, 2019.
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Affiliation(s)
- Ilya Kagan
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, University of Tel Aviv, Petah TIkva 49100, Israel.
| | - Moran Hellerman-Itzhaki
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, University of Tel Aviv, Petah TIkva 49100, Israel
| | - Itai Bendavid
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, University of Tel Aviv, Petah TIkva 49100, Israel
| | - Liran Statlender
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, University of Tel Aviv, Petah TIkva 49100, Israel
| | - Guy Fishman
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, University of Tel Aviv, Petah TIkva 49100, Israel
| | - Paul E Wischmeyer
- Duke University School of Medicine, Department of Anesthesiology and Surgery, DUMC, Box 3094 Mail # 41, 2301 Erwin Road, 5692 HAFS Durham, NC 27710, USA
| | - Elisabeth de Waele
- Department of Clinical Nutrition, Universitair Ziekenhuis Brussels, Belgium; Department of Intensive Care, Universitair Ziekenhuis Brussel, Brussels Belgium; Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
| | - Pierre Singer
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, University of Tel Aviv, Petah TIkva 49100, Israel
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Li J, Wang L, Zhang H, Zou T, Kang Y, He W, Xu Y, Yin W. Different definitions of feeding intolerance and their associations with outcomes of critically ill adults receiving enteral nutrition: a systematic review and meta-analysis. J Intensive Care 2023; 11:29. [PMID: 37408020 DOI: 10.1186/s40560-023-00674-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/04/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND A unified clinical definition of feeding intolerance (FI) is urged for better management of enteral nutrition (EN) in critically ill patients. We aimed to identify optimum clinical FI definitions based on reported evidence. METHODS We searched clinical studies comparing FI with non-FI with a clear definition, summarized the evidence by random-effect meta-analyses, and rated the certainty of evidence by the Grading of Recommendations Assessment, Development and Evaluation frameworks. RESULTS Five thousand five hundred twenty-five records were identified, of which 26 eligible studies enrolled 25,189 adult patients. Most patient-centered outcomes were associated with FI overall. Low to very low certainty evidence established FI defined as large gastric residual volume (GRV) ≥ 250 ± 50 mL combined with any other gastrointestinal symptoms (GIS) had a significant association with high mortalities in particular all-cause hospital mortality (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.40-2.57), the incidence of pneumonia (OR 1.54, 95% CI 1.13-2.09) and prolonged length of hospital stay (mean difference 4.20, 95% CI 2.08-6.32), with a moderate hospital prevalence (41.49%, 95% CI 31.61-51.38%). 3-day enteral feeding (EF) delivered percentage < 80% had a moderate hospital prevalence (38.23%, 95% CI 24.88-51.58) but a marginally significant association with all-cause hospital mortality (OR 1.90, 95% CI 1.03-3.50). CONCLUSIONS In critically ill adult patients receiving EN, the large-GRV-centered GIS to define FI seemed to be superior to 3-day EF-insufficiency in terms of both close associations with all-cause hospital mortality and acceptable hospital prevalence (Registered PROSPERO: CRD42022326273). TRIAL REGISTRATION The protocol for this review and meta-analysis was registered with PROSPERO: CRD42022326273. Registered 10 May 2022.
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Affiliation(s)
- Jianbo Li
- Department of Critical Care Medicine, West China Hospital of Sichuan University, 37 Guo Xue Xiang St., Chengdu, 610041, Sichuan, China
| | - Lijie Wang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, 37 Guo Xue Xiang St., Chengdu, 610041, Sichuan, China
| | - Huan Zhang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, 37 Guo Xue Xiang St., Chengdu, 610041, Sichuan, China
| | - Tongjuan Zou
- Department of Critical Care Medicine, West China Hospital of Sichuan University, 37 Guo Xue Xiang St., Chengdu, 610041, Sichuan, China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, 37 Guo Xue Xiang St., Chengdu, 610041, Sichuan, China
| | - Wei He
- Department of Critical Care Medicine, Beijing Tongren Hospital of Capital Medical University, Beijing, 100730, China
| | - Yuan Xu
- Department of Critical Care Medicine, Beijing Tsinghua Chunggung Hospital, Tsinghua University, 168 Litang Rd., Beijing, 102218, China.
| | - Wanhong Yin
- Department of Critical Care Medicine, West China Hospital of Sichuan University, 37 Guo Xue Xiang St., Chengdu, 610041, Sichuan, China.
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Villar J, González-Martin JM, Añón JM, Ferrando C, Soler JA, Mosteiro F, Mora-Ordoñez JM, Ambrós A, Fernández L, Montiel R, Vidal A, Muñoz T, Pérez-Méndez L, Rodríguez-Suárez P, Fernández C, Fernández RL, Szakmany T, Burns KEA, Steyerberg EW, Slutsky AS. Clinical relevance of timing of assessment of ICU mortality in patients with moderate-to-severe Acute Respiratory Distress Syndrome. Sci Rep 2023; 13:1543. [PMID: 36707634 PMCID: PMC9883467 DOI: 10.1038/s41598-023-28824-5] [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: 09/22/2022] [Accepted: 01/25/2023] [Indexed: 01/28/2023] Open
Abstract
Mortality is a frequently reported outcome in clinical studies of acute respiratory distress syndrome (ARDS). However, timing of mortality assessment has not been well characterized. We aimed to identify a crossing-point between cumulative survival and death in the intensive care unit (ICU) of patients with moderate-to-severe ARDS, beyond which the number of survivors would exceed the number of deaths. We hypothesized that this intersection would occur earlier in a successful clinical trial vs. observational studies of moderate/severe ARDS and predict treatment response. We conducted an ancillary study of 1580 patients with moderate-to-severe ARDS managed with lung-protective ventilation to assess the relevance and timing of measuring ICU mortality rates at different time-points during ICU stay. First, we analyzed 1303 patients from four multicenter, observational cohorts enrolling consecutive patients with moderate/severe ARDS. We assessed cumulative ICU survival from the time of moderate/severe ARDS diagnosis to ventilatory support discontinuation within 7-days, 28-days, 60-days, and at ICU discharge. Then, we compared these findings to those of a successful randomized trial of 277 moderate/severe ARDS patients. In the observational cohorts, ICU mortality (487/1303, 37.4%) and 28-day mortality (425/1102, 38.6%) were similar (p = 0.549). Cumulative proportion of ICU survivors and non-survivors crossed at day-7; after day-7, the number of ICU survivors was progressively higher compared to non-survivors. Measures of oxygenation, lung mechanics, and severity scores were different between survivors and non-survivors at each point-in-time (p < 0.001). In the trial cohort, the cumulative proportion of survivors and non-survivors in the treatment group crossed before day-3 after diagnosis of moderate/severe ARDS. In clinical ARDS studies, 28-day mortality closely approximates and may be used as a surrogate for ICU mortality. For patients with moderate-to-severe ARDS, ICU mortality assessment within the first week of a trial might be an early predictor of treatment response.
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Affiliation(s)
- Jesús Villar
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, 28029, Madrid, Spain. .,Research Unit, Hospital Universitario Dr. Negrín, Barranco de La Ballena S/N, 4th Floor - South wing, 35019, Las Palmas de Gran Canaria, Spain. .,Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto, ON, M5B 1W8, Canada.
| | - Jesús M González-Martin
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, 28029, Madrid, Spain.,Research Unit, Hospital Universitario Dr. Negrín, Barranco de La Ballena S/N, 4th Floor - South wing, 35019, Las Palmas de Gran Canaria, Spain
| | - José M Añón
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, 28029, Madrid, Spain.,Intensive Care Unit, Hospital Universitario La Paz, IdiPaz, 28046, Madrid, Spain
| | - Carlos Ferrando
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, 28029, Madrid, Spain.,Surgical Intensive Care Unit, Department of Anesthesia, Hospital Clinic, IDIBAPS, 08036, Barcelona, Spain
| | - Juan A Soler
- Intensive Care Unit, Hospital Universitario Virgen de Arrixaca, 30120, Murcia, Spain
| | - Fernando Mosteiro
- Intensive Care Unit, Hospital Universitario de A Coruña, 15006, La Coruña, Spain
| | - Juan M Mora-Ordoñez
- Intensive Care Unit, Hospital Universitario Regional Carlos Haya, 29010, Málaga, Spain
| | - Alfonso Ambrós
- Intensive Care Unit, Hospital General Universitario de Ciudad Real, 13005, Ciudad Real, Spain
| | - Lorena Fernández
- Intensive Care Unit, Hospital Universitario Río Hortega, 47012, Valladolid, Spain
| | - Raquel Montiel
- Intensive Care Unit, Hospital Universitario NS de Candelaria, 38010, Santa Cruz de Tenerife, Spain
| | - Anxela Vidal
- Intensive Care Unit, Hospital Universitario Fundación Jiménez Díaz, 28040, Madrid, Spain
| | - Tomás Muñoz
- Intensive Care Unit, Hospital Universitario de Cruces, 48903, Barakaldo, Vizcaya, Spain
| | - Lina Pérez-Méndez
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, 28029, Madrid, Spain.,Research Unit, Hospital Universitario NS de Candelaria, 38010, Santa Cruz de Tenerife, Spain
| | - Pedro Rodríguez-Suárez
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, 28029, Madrid, Spain.,Thoracic Surgery, Hospital Universitario Dr. Negrín, 35019, Las Palmas de Gran Canaria, Spain
| | - Cristina Fernández
- Research Unit, Hospital Universitario Dr. Negrín, Barranco de La Ballena S/N, 4th Floor - South wing, 35019, Las Palmas de Gran Canaria, Spain
| | - Rosa L Fernández
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, 28029, Madrid, Spain.,Research Unit, Hospital Universitario Dr. Negrín, Barranco de La Ballena S/N, 4th Floor - South wing, 35019, Las Palmas de Gran Canaria, Spain
| | - Tamas Szakmany
- Department of Intensive Care Medicine and Anesthesia, Bevan University Health Board, Newport, NP20 2UB, UK.,Honorary Professor in Intensive Care, Cardiff University, Cardiff, CF14 4XW, Wales, UK
| | - Karen E A Burns
- Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto, ON, M5B 1W8, Canada.,Critical Care Medicine, Unity Health Toronto-St. Michael's Hospital, Toronto, M5B 1W8, Canada.,Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Ewout W Steyerberg
- Department Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Arthur S Slutsky
- Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto, ON, M5B 1W8, Canada.,Division of Critical Care Medicine, University of Toronto, Toronto, ON, M5T 3A1, Canada
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Incidence and Risk Factors of Feeding Intolerance in Adult Patients Given Enteral Nutrition Therapy After Liver Transplant. TOP CLIN NUTR 2023. [DOI: 10.1097/tin.0000000000000305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Lu XM, Jia DS, Wang R, Yang Q, Jin SS, Chen L. Development of a prediction model for enteral feeding intolerance in intensive care unit patients: A prospective cohort study. World J Gastrointest Surg 2022; 14:1363-1374. [PMID: 36632121 PMCID: PMC9827569 DOI: 10.4240/wjgs.v14.i12.1363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 10/15/2022] [Accepted: 11/16/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Enteral nutrition (EN) is essential for critically ill patients. However, some patients will have enteral feeding intolerance (EFI) in the process of EN.
AIM To develop a clinical prediction model to predict the risk of EFI in patients receiving EN in the intensive care unit.
METHODS A prospective cohort study was performed. The enrolled patients’ basic information, medical status, nutritional support, and gastrointestinal (GI) symptoms were recorded. The baseline data and influencing factors were compared. Logistic regression analysis was used to establish the model, and the bootstrap resampling method was used to conduct internal validation.
RESULTS The sample cohort included 203 patients, and 37.93% of the patients were diagnosed with EFI. After the final regression analysis, age, GI disease, early feeding, mechanical ventilation before EN started, and abnormal serum sodium were identified. In the internal validation, 500 bootstrap resample samples were performed, and the area under the curve was 0.70 (95%CI: 0.63-0.77).
CONCLUSION This clinical prediction model can be applied to predict the risk of EFI.
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Affiliation(s)
- Xue-Mei Lu
- School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Deng-Shuai Jia
- School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Rui Wang
- Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Qing Yang
- Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Shan-Shan Jin
- Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Lan Chen
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
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9
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Prevalence and risk factors of enteral nutrition intolerance in intensive care unit patients: a retrospective study. Chin Med J (Engl) 2022; 135:1814-1820. [PMID: 35833658 PMCID: PMC9521784 DOI: 10.1097/cm9.0000000000001974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Feeding intolerance (FI) among intensive care unit (ICU) patients undergoing early continuous enteral nutrition (EN) is related to poor outcomes. This study aimed to explore the prevalence and risk factors of FI in ICU patients. METHODS We retrospectively enrolled 1057 patients who received early continuous EN via a nasogastric tube between January 2014 and August 2019. The prevalence of FI during the first 7 days of ICU stay was calculated, and the risk factors were investigated using multivariate logistic regression analysis. RESULTS The prevalence of FI during the first 7 days of ICU stay was 10.95%. FI occurred in 159 of 1057 (15.04%) patients on ICU day 2, 114 of 977 (11.67%) patients on ICU day 3, and 86 of 715 (12.03%) patients on ICU day 7. Mechanical ventilation (MV) (odds ratio [OR]: 1.928, 95% confidence interval [CI]: 1.064-3.493, P = 0.03) was an independent risk factor for FI defined by a gastric residual volume (GRV) of 200 mL and/or vomiting, and acute renal failure (OR: 3.445, 95% CI: 1.115-10.707, P = 0.032) was an independent risk factor of FI defined by a GRV of 500 mL and/or vomiting. Continuous renal replacement therapy (CRRT) was an independent predictor regardless of the FI defined by a GRV of 200 mL (OR: 2.064, 95% CI: 1.233-3.456, P = 0.006) or 500 mL (OR: 6.199, 95% CI: 2.108-18.228, P = 0.001) in the ICU patients. CONCLUSIONS FI occurs frequently in early ICU days, especially in patients receiving MV and CRRT. However, further investigation of a consensus definition of FI and risk factors is still warranted in future studies.
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10
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Preventive strategies for feeding intolerance among patients with severe traumatic brain injury: A cross-sectional survey. Int J Nurs Sci 2022; 9:278-285. [PMID: 35891911 PMCID: PMC9304998 DOI: 10.1016/j.ijnss.2022.06.014] [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: 02/13/2022] [Revised: 05/26/2022] [Accepted: 06/13/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives This study aimed to investigate the application status of preventive measures for feeding intolerance in patients with severe traumatic brain injury (STBI) in China and analysis the differences and their causes. Methods A cross-sectional survey was conducted. From December 2019 to January 2020, ICU nurses and physicians of 89 hospitals in China were surveyed by using a questionnaire on preventive strategies for feeding intolerance in patients with STBI. The questionnaire included two parts: the general information of participants (10 items) and application of preventive measures for feeding intolerance in STBI patients (18 items). Results Totally 996 nurses and physicians completed the questionnaire. Among various methods, gastrointestinal symptoms(85.0%) and injury severity (71.4%) were mostly used to assess gastrointestinal functions and risk of feeding intolerance among STBI patients, respectively. Initiating enteral nutrition (EN) within 24–48 h (61.5%), nasogastric tubes (91.2%), 30°–45° of head-of-bed elevation (89.5%), continuous feeding by pump (72.9%), EN solution temperature of 38–40 °C (65.5%), <500 ml initial volume of EN solution (50.0%), monitoring gastric residual volume with a syringe (93.7%), and assessing gastric residual volume every 4 h (51.5%) were mostly applied for EN delivery among STBI patients. Prokinetic agents (73.3%), enema (73.6%), probiotics (79.0%), antacid agents (84.1%), and non-nutritional preparations as initial EN formula (65.6%) were commonly used for preventing feeding intolerance among STBI patients. Conclusions The survey showed that nurses and clinicians in China have a positive attitude towards preventive strategies for feeding intolerance. However, some effective new technologies and methods have not been timely applied in clinical practice. We suggest that managers, researchers, clinicians, nurses, and other health professionals should collaborate to explore effective and standard preventive strategies for feeding intolerance among patients with STBI.
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A systematic review of the definitions and prevalence of feeding intolerance in critically ill adults. Clin Nutr ESPEN 2022; 49:92-102. [DOI: 10.1016/j.clnesp.2022.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/08/2022] [Accepted: 04/15/2022] [Indexed: 12/12/2022]
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Asrani VM, McArthur C, Bissett I, Windsor JA. The intensivist's assessment of gastrointestinal function: A pilot study. Aust Crit Care 2021; 35:636-643. [PMID: 34895985 DOI: 10.1016/j.aucc.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 11/30/2022] Open
Abstract
Gastrointestinal dysfunction/failure (GDF) is a common cause of concern in critically ill patients. Although the gut plays an important role in the genesis of organ failure, its exclusion from organ severity scoring systems has made it challenging for intensivists to score it sufficiently at the bedside. We aimed to survey intensive care specialists about their perceptions, attitudes, and approaches towards the assessment of the gut in Australia and New Zealand intensive care units (ICUs). An electronic (online) questionnaire was used to survey intensive care specialists from the Australia and New Zealand Intensive Care Society (ANZICS). The survey comprised 10 questions focused on four key areas: (i) the extent of the problem with GDF in ICUs, (ii) the use and reliability of the current gut scoring tools, (iii) personal approaches and practices associated with GDF assessment, and (4) potential value of a novel GDF scoring system and its incorporation into an organ severity score. Our results showed that GDF was a significant concern amongst ICUs in Australia and New Zealand intensivists (84%; 66/79), with a small number of participants (14%; 3/79) using a gut scoring tool in their ICUs. Despite this, we have no established objective scoring tool for its assessment. The survey highlighted the need for developing a novel scoring tool to assess the gut was considered important amongst majority of the intensivists (92%; 72/78), which would prove useful in clinical practice and potentially lead to incorporation into an organ severity score in the future.
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Affiliation(s)
- Varsha M Asrani
- Surgical and Translational Research (STaR) Centre, Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Nutrition and Dietetics, Auckland City Hospital, Auckland, New Zealand; Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand.
| | - Colin McArthur
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Ian Bissett
- Surgical and Translational Research (STaR) Centre, Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of General Surgery, Auckland City Hospital, Auckland, New Zealand
| | - John A Windsor
- Surgical and Translational Research (STaR) Centre, Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of General Surgery, Auckland City Hospital, Auckland, New Zealand
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Zhu L, Gong Y. Analysis on the Application Effect of Abdominal Acupoint Massage on Feeding Intolerance in Premature Infants. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:2883597. [PMID: 34900180 PMCID: PMC8660219 DOI: 10.1155/2021/2883597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 11/24/2022]
Abstract
Objective Breast milk is the best food for newly born infants because it is more digestible and can relieve infants' gastrointestinal burdens. The purpose of this study was to investigate the application effect of abdominal acupoint massage on feeding intolerance in premature infants. Methods A total of 50 premature infants with feeding intolerance admitted to our hospital from January 2018 to October 2019 were selected and randomly divided into the control group (n = 25) and the experimental group (n = 25). Among them, the premature infants in the control group received routine therapy, while based on the treatment in the control group, the premature infants in the experimental group were treated with abdominal acupoint massage. After that, the incidence of feeding intolerance, MNA nutritional status score, body mass, development state, length of hospital stay, and response rate were all compared between the two groups to analyze the application effect of abdominal acupoint massage on feeding intolerance in premature infants. Results The incidence of feeding intolerance of the premature infants in the experimental group was significantly lower than that in the control group, with statistically significant differences (P < 0.05); the MNA nutritional status scores of the premature infants in the experimental group were significantly higher than those in the control group, with statistically significant differences (P < 0.05); the body mass and development state of the premature infants in the experimental group were significantly better than those in the control group, with statistically significant differences (P < 0.05); the length of hospital stay of the premature infants in the experimental group was significantly shorter than that in the control group, with statistically significant differences (P < 0.05); the response rate in the experimental group was significantly higher than that in the control group, with statistically significant differences (P < 0.05). Conclusions Abdominal acupoint massage therapy can significantly reduce the incidence of feeding intolerance, shorten the length of hospital stay, and improve nutritional status, development state, and response rate in premature infants, with obvious therapeutic effect, which is worthy of application and promotion in clinical practice.
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Affiliation(s)
- Li Zhu
- Department of Pediatrics, Suzhou Hospital of Traditional Chinese and Western Medicine, Suzhou 215101, Jiangsu, China
| | - Yueqiu Gong
- Department of Pediatrics, Suzhou Hospital of Traditional Chinese and Western Medicine, Suzhou 215101, Jiangsu, China
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Abstract
We conducted a prospective, observational study to determine the incidence of feeding intolerance (FI) within 7 d of initiating enteral nutrition (EN) in patients undergoing cardiopulmonary bypass (CPB) and to evaluate the association between FI and a poor prognosis. Patients who underwent CPB surgery at Fujian Medical University Union Hospital between March 2020 and June 2020 were enrolled. According to the presence or absence of FI within 7 d after EN, patients were divided into FI and non-FI groups. According to the occurrence of a poor prognosis (death, gastrointestinal haemorrhage, acute kidney injury, liver insufficiency, neurological events (cerebral infarction, cerebral haemorrhage and epilepsy) and prolonged mechanical ventilation (> 48 h)), patients were divided into poor prognosis and good prognosis groups. The mean age of the 237 CPB patients, including 139 men and ninety-eight women, was 53·80 (sd 12·25) years. The incidence of FI was 64·14 %. Multivariate logistic regression analysis showed factors independently associated with poor prognosis after CPB included FI (OR 2·138; 95 % CI 1·058, 4·320), age (OR 1·033; 95 % CI 1·004, 1·063), New York Heart Association (NYHA) class III/IV cardiac function (OR 2·410; 95 % CI 1·079, 5·383), macrovascular surgery (OR 5·434; 95 % CI 1·704, 17·333) and initial sequential organ failure assessment score (OR 1·243; 95 % CI 1·010, 1·530). Thus, the incidence of FI within 7 d of EN after CPB was high, which was associated with a poor prognosis.
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Peng R, Li H, Yang L, Zeng L, Yi Q, Xu P, Pan X, Zhang L. The efficacy and safety of prokinetics in critically ill adults receiving gastric feeding tubes: A systematic review and meta-analysis. PLoS One 2021; 16:e0245317. [PMID: 33428672 PMCID: PMC7799841 DOI: 10.1371/journal.pone.0245317] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 12/28/2020] [Indexed: 12/13/2022] Open
Abstract
Background Intolerance to gastric feeding tubes is common among critically ill adults and may increase morbidity. Administration of prokinetics in the ICU is common. However, the efficacy and safety of prokinetics are unclear in critically ill adults with gastric feeding tubes. We conducted a systematic review to determine the efficacy and safety of prokinetics for improving gastric feeding tube tolerance in critically ill adults. Methods Randomized controlled trials (RCTs) were identified by systematically searching the Medline, Cochrane and Embase databases. Two independent reviewers extracted the relevant data and assessed the quality of the studies. We calculated pooled relative risks (RRs) for dichotomous outcomes and the mean differences (MDs) for continuous outcomes with the corresponding 95% confidence intervals (CIs). We assessed the risk of bias using the Cochrane risk-of-bias tool and used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to rate the quality of the evidence. Results Fifteen RCTs met the inclusion criteria. A total of 10 RCTs involving 846 participants were eligible for the quantitative analysis. Most studies (10 of 13, 76.92%) showed that prokinetics had beneficial effects on feeding intolerance in critically ill adults. In critically ill adults receiving gastric feeding, prokinetic agents may reduce the ICU length of stay (MD -2.03, 95% CI -3.96, -0.10; P = 0.04; low certainty) and the hospital length of stay (MD -3.21, 95% CI -5.35, -1.06; P = 0.003; low certainty). However, prokinetics failed to improve the outcomes of reported adverse events and all-cause mortality. Conclusion As a class of drugs, prokinetics may improve tolerance to gastric feeding to some extent in critically ill adults. However, the certainty of the evidence suggesting that prokinetics reduce the ICU or hospital length of stay is low. Prokinetics did not significantly decrease the risks of reported adverse events or all-cause mortality among critically ill adults.
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Affiliation(s)
- Rong Peng
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
- Department of Clinical Nutrition, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Hailong Li
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Lijun Yang
- Department of General Practice Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Linan Zeng
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Qiusha Yi
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Peipei Xu
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Xiangcheng Pan
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Lingli Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
- * E-mail:
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Reintam Blaser A, Deane AM, Preiser J, Arabi YM, Jakob SM. Enteral Feeding Intolerance: Updates in Definitions and Pathophysiology. Nutr Clin Pract 2020; 36:40-49. [DOI: 10.1002/ncp.10599] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Annika Reintam Blaser
- Department of Intensive Care Medicine Lucerne Cantonal Hospital Lucerne Switzerland
- Department of Anaesthesiology and Intensive Care University of Tartu Tartu Estonia
| | - Adam M. Deane
- Department of Medicine and Radiology The University of Melbourne Melbourne Medical School Royal Melbourne Hospital Parkville Victoria Australia
| | | | - Yaseen M. Arabi
- College of Medicine King Saud bin Abdulaziz University for Health Sciences (KSAU‐HS) and King Abdullah International Medical Research Center Riyadh Saudi Arabia
| | - Stephan M. Jakob
- Department of Intensive Care Medicine University Hospital (Inselspital) Bern University of Bern Bern Switzerland
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Ma Y, Cheng J, Liu L, Chen K, Fang Y, Wang G, Zhu J, Chen L. Intermittent versus continuous enteral nutrition on feeding intolerance in critically ill adults: A meta-analysis of randomized controlled trials. Int J Nurs Stud 2020; 113:103783. [PMID: 33161333 DOI: 10.1016/j.ijnurstu.2020.103783] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/12/2020] [Accepted: 09/27/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Enteral formula delivery strategy is an important part of enteral nutrition. We aimed to synthesize up-to-date studies to clarify the effects of intermittent versus continuous feeding on feeding intolerance during enteral nutrition in critically ill adults. DESIGN A meta-analysis of randomized controlled trials. DATA SOURCES Embase, PubMed, Information Sciences Institute Web of Science, CINAHL EBSCO, Cochrane Central Register of Controlled Trials, Chinese Biomedical Literature Database, China National Knowledge Infrastructure databases were searched from inception to 17th of June 2020. REVIEW METHODS The Cochrane "risk of bias" tool was used to assess the quality of individual studies, and the quality of each outcome was assessed by GRADE approach. Fixed or random effect meta-analysis was used pending the presence of heterogeneity. Dichotomous data synthesis was presented as risk ratio and 95% confidence interval, and quantitative data synthesis was shown as mean difference and 95% confidence interval. RESULTS Fourteen trials with 1025 critically ill adults were included in the meta-analysis. We found that intermittent feeding could significantly increase the occurrence of feeding intolerance (risk ratio = 1.64, 95% confidence interval = 1.23 to 2.18, P < 0.001) compared with continuous feeding, as well as the incidence of high gastric volume (risk ratio = 3.62, 95% confidence interval = 1.43-9.12, P = 0.006) and aspiration (risk ratio = 3.29, 95% confidence interval = 1.18-9.16, P = 0.02) in > 1-week trial duration, while constipation rate was reduced in intermittent feeding group (risk ratio = 0.66, 95% confidence interval = 0.45-0.98, P = 0.04). Patients in intermittent feeding group received more calories compared with continuous feeding group (mean difference = 184.81, 95% confidence interval = 56.61-313.01, P = 0.005). The quality of all evidence synthesis was "low" or "very low". CONCLUSIONS In critically ill adults, continuous feeding was associated with lower overall incidence of feeding intolerance, especially in high gastric volume and aspiration. However, decreased constipation incidence and more calorie intake were observed in intermittent feeding group. Because quality of the synthesized evidence was "low" or "very low", there is considerable uncertainty about this estimate.
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Affiliation(s)
- Yuanyuan Ma
- 75th Army Group Hospital, Dali, Yunnan, China
| | - Jun Cheng
- 75th Army Group Hospital, Dali, Yunnan, China
| | - Liang Liu
- Department of Neurology, The General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Kexi Chen
- 75th Army Group Hospital, Dali, Yunnan, China
| | - Yuli Fang
- Department of Neurology, The General Hospital of Northern Theater Command, Shenyang, Liaoning, China; Department of Basic Nursing, School of Nursing, Army Medical University, Chongqing, China
| | | | - Jingci Zhu
- Department of Basic Nursing, School of Nursing, Army Medical University, Chongqing, China
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