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Sasaki J, Matsushima A, Ikeda H, Inoue Y, Katahira J, Kishibe M, Kimura C, Sato Y, Takuma K, Tanaka K, Hayashi M, Matsumura H, Yasuda H, Yoshimura Y, Aoki H, Ishizaki Y, Isono N, Ueda T, Umezawa K, Osuka A, Ogura T, Kaita Y, Kawai K, Kawamoto K, Kimura M, Kubo T, Kurihara T, Kurokawa M, Kobayashi S, Saitoh D, Shichinohe R, Shibusawa T, Suzuki Y, Soejima K, Hashimoto I, Fujiwara O, Matsuura H, Miida K, Miyazaki M, Murao N, Morikawa W, Yamada S. Japanese Society for Burn Injuries (JSBI) Clinical Practice Guidelines for Management of Burn Care (3rd Edition). Acute Med Surg 2022; 9:e739. [PMID: 35493773 PMCID: PMC9045063 DOI: 10.1002/ams2.739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 01/28/2023] Open
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Chen MC, Chao HC, Yeh PJ, Lai MW, Chen CC. Therapeutic Efficacy of Nasoenteric Tube Feeding in Children Needing Enteral Nutrition. Front Pediatr 2021; 9:646395. [PMID: 33816405 PMCID: PMC8012528 DOI: 10.3389/fped.2021.646395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/08/2021] [Indexed: 11/24/2022] Open
Abstract
Background: There is limited information on therapeutic benefits and tube-related complications of pediatric nasoenteric (NE) tube feeding. We viewed, from different clinical aspects, NE tube feeding in children who are under intolerable conditions. Methods: A 10-years retrospective study enrolled 77 pediatric patients who underwent an endoscopic-guided placement of the NE tube for enteral nutrition. The evaluated data, including growth parameters, feeding volume, parenteral nutrition (PN) dependence, and nutritional markers [serum hemoglobin (Hb) and albumin] before and after NE tube feeding were compared. Tube-related complications and major adverse events were also recorded. Results: A total of 77 patients (including 50 males) underwent 176 endoscopic-guided placements of the NE tube with an average duration of 133.7 (6.0-1,847.3) days. The gastroesophageal reflux disease-related symptoms (vomiting, desaturations, and aspiration pneumonia) improved in 71.4% of patients. Feeding volume increased significantly after intervention, especially in patients with delayed gastric emptying, from 144.8 ± 28.5 to 1,103.1 ± 524.7 ml/days (p < 0.001). Weaning from PN was successfully achieved in 84.3% of patients with an average of 9.33 ± 7.30 days. About 16 patients (20.8%) were subsequently highly compatible with oral feeding after NE tube placement for an average of 24.7 ± 14.1 days. Patients either without neurologic dysfunction or with no ventilator-dependent status had a higher chance of shifting to oral feeding. Weight-for-age z-scores increased by 0.15 ± 1.33 after NE tube intervention. One NE tube-related adverse event, which caused bowel perforation at 6 days post-insertion, was recorded. No direct tube-related mortality was observed. Conclusions: Endoscopic-guided NE tube placement is a relatively safe, non-invasive procedure for pediatric patients who require enteral nutrition. Feeding via NE tube showed beneficial effects such as improvement in symptoms, PN weaning, and maintenance of body growth without major tube-related complications.
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Affiliation(s)
- Mi-Chi Chen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Hsun-Chin Chao
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Pai-Jui Yeh
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Ming-Wei Lai
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Chien-Chang Chen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,Chang Gung University College of Medicine, Taoyuan City, Taiwan
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Valentini M, Seganfredo FB, Fernandes SA. Pediatric enteral nutrition therapy for burn victims: when should it be initiated? Rev Bras Ter Intensiva 2019; 31:393-402. [PMID: 31618360 PMCID: PMC7005954 DOI: 10.5935/0103-507x.20190062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 12/04/2018] [Indexed: 11/20/2022] Open
Abstract
Objective To review the scientific evidence regarding the initiation of enteral nutrition in the pediatric burn population. Methods This study was a systematic review and meta-analysis of randomized clinical trials comparing early enteral nutrition and late enteral nutrition in individuals aged 1 month to 18 years with burns. The MEDLINE/PubMed, Embase and Cochrane Library databases were searched using the terms "burns", "fires", "child nutrition disorders", "nutritional support" and related terms. Results Three articles that included a total of 781 patients were identified. There was no significant difference in the mortality rate between the early and late groups (OR = 0.72, 95%CI = 0.46 - 1.15, p = 0.17). Patients who received early enteral nutrition had a 3.69-day reduction in the length of hospital stay (mean difference = -3.69, 95%CI = -4.11 - -3.27, p < 0.00001). There was a higher incidence of diarrhea and vomiting and decreased intestinal permeability in the early group. This group also presented higher a serum insulin concentration and insulin/glucagon ratio as well as lower caloric deficit and weight loss when compared to the control group. Conclusion Analysis of the different intragroup variables suggests the importance of starting nutritional support early. Considering the number of pediatric burn patients, there is a need for robust studies with greater scientific impact.
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Affiliation(s)
- Mariéle Valentini
- Hospital de Pronto Socorro de Porto Alegre - Porto Alegre (RS), Brasil
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Creamer KM, Chan DS, Sutton C, DeLeon C, Moreno C, Shoupe BA. A Comprehensive Pediatric Inpatient Nutrition Support Package: A Multi-disciplinary Approach. Nutr Clin Pract 2016. [DOI: 10.1177/088453360101600409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Abad-Sinden AR, Vittone SB, Willson DF, Zaglul HF. Improving Timeliness of Nutrition Intervention Through a Collaborative Quality Improvement Program in a Pediatric Intensive Care Unit. Nutr Clin Pract 2016. [DOI: 10.1177/088453369801300507] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Gastric emptying and intestinal transit of various enteral feedings following severe burn injury. Dig Dis Sci 2011; 56:3172-8. [PMID: 21625963 DOI: 10.1007/s10620-011-1755-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 05/11/2011] [Indexed: 01/15/2023]
Abstract
BACKGROUND Burn-induced delayed gastric emptying and intestinal transit limits enteral feeding/resuscitation. AIMS To study (1) the effects of burn injury on gastric emptying and intestinal transit at different time points following enteral feeding/fluids, and (2) the effects of enteral resuscitative fluids on gastric emptying, intestinal transit, and plasma volume expansion. METHODS Rats were randomized into sham-burn and burn groups. They were either enterally untreated or treated by a gavage of one or multiple doses of oral rehydration solution (ORS) or, Vivonex(®), all mixed with phenol red as a marker, at different time points from 1 to 6 h after burn. Gastric emptying, intestinal transit and hematocrit values were assessed. Gastric emptying of a semi-solid methylcellulose meal served as a standard control for gastric emptying studies. RESULTS We found that (1) burn did not alter the gastric emptying of ORS, but delayed its intestinal transit at all time points; (2) burn delayed the gastric emptying of both methylcellulose or Vivonex and the intestinal transit of Vivonex, 6 h after burn; and (3) multiple doses of ORS normalized the elevated post-burn hematocrit values. The percentage of plasma volume expansion at 6 h resulting from the multiple-dose ORS was superior to that of Vivonex by 50%. Addition of Erythromycin to Vivonex improved its gastric emptying, intestinal transit, and plasma volume expansion. CONCLUSIONS Burn delays the gastric emptying of semi-solids, but not the ORS. Enteral electrolyte solution (ORS) and feeding (Vivonex) provided plasma volume expansion. Prokinetic drugs may be able to maximize the effectiveness of early post-burn feeding.
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Al-Mousawi AM, Mecott-Rivera GA, Jeschke MG, Herndon DN. Burn teams and burn centers: the importance of a comprehensive team approach to burn care. Clin Plast Surg 2009; 36:547-54. [PMID: 19793550 DOI: 10.1016/j.cps.2009.05.015] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Remarkable advances in burn care have been made over recent decades, and it is recognized that the organized efforts of burn teams are required to continue enhancing survival rates and quality of life for patients. Patients with major burns are unique, representing one of the most severe models of trauma, and therefore necessitate treatment in the best specialized facilities available for that endeavor. Burn centers have developed to meet these intricate needs but can only function most productively and efficiently through well-organized, multifaceted, patient-centered teams in the areas of both clinical care and research.
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Affiliation(s)
- Ahmed M Al-Mousawi
- Department of Surgery, The University of Texas Medical Branch, Galveston, 77555, USA
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Ista E, Joosten K. Nutritional Assessment and Enteral Support of Critically Ill Children. Crit Care Nurs Clin North Am 2005; 17:385-93, x. [PMID: 16344208 DOI: 10.1016/j.ccell.2005.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Critical care nurses play an important role in feeding of critically ill children. Many procedures and caregiving interventions, such as placement of feeding tubes, registration of gastric retention, observation and care of the mouth, and administration of nutrition (enteral or parenteral), are within the nursing domain. This article discusses nutritional assessment techniques and enteral nutrition in critically ill children.
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Affiliation(s)
- Erwin Ista
- Department of Pediatrics, Erasmus MC--Sophia Children's Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands.
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Liusuwan RA, Palmieri TL, Kinoshita L, Greenhalgh DG. Comparison of Measured Resting Energy Expenditure Versus Predictive Equations in Pediatric Burn Patients. ACTA ACUST UNITED AC 2005; 26:464-70. [PMID: 16278559 DOI: 10.1097/01.bcr.0000185786.38365.3d] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Many equations have been developed to estimate resting energy expenditure (REE) in thermally injured patients. A consensus has not been reached on the accuracy of these equations in children. The purpose of our study was to compare three predictive equations: Harris Benedict x 2 multiplier (HB x 2), Mayes (MG), and the WorId Health Organization x 2 multiplier (WHO x 2) with measured resting energy expenditure x I.3 multiplier (MREE x 1.3) in pediatric burn patients. MREE was measured by open-circuit indirect calorimetry in 10 burned children (6 boys, 4 girls) aged 2 to 10 years with TBSA burn ranges from 35% to 97%. MREE x 1.3 was compared with values obtained by HB x 2, MG, and WHO x 2 predictive equations. When comparing MREE x 1.3 with all three equations, significant differences were found when compared with HB x 2 and MG, but there were no significant difference between MREE x 1.3 vs WHO x 2. The HB x 2 and MG equations overpredicted MREE x 1.3 by 29% and 19%, respectively. Many predictive equations have been developed to predict energy expenditure in burns, but their accuracy in predicting MREE x 1.3 is variable. A larger study comparing/contrasting predictive equations and resting energy expenditure measured by indirect calorimetry is needed to improve the prediction of energy needs in burned children.
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Prelack K. Enteral Nutrition Support in the Critically III Pediatric Patient. Clin Nutr 2005. [DOI: 10.1016/b978-0-7216-0379-7.50030-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
OBJECTIVE The study assessed the adequacy of nutrition support in critically ill infants and children and identifies barriers impeding the delivery of estimated energy requirement (EER). METHODS Forty-two children (median age, 6.6 mo; range, 0-198) who were admitted to a tertiary-level pediatric intensive care unit (PICU) were studied prospectively over a 6-mo period. Patients staying in the PICU longer than a full 3 d and who received enteral or a combination of enteral and parenteral nutrition were eligible for inclusion. Patients were assigned to one of two groups: patients after cardiac surgery (n = 18) and all other diagnoses (n = 24). EERs were compared with actual energy intake, and clinical information was collected throughout the PICU admission. RESULTS Patients in the PICU received a median of 37.7% (range, 0.2-130.2%) of their EERs. The cardiac group achieved significantly lower energy intakes than did the non-cardiac group (P = 0.02). Only 22 of 42 patients (52%) achieved full EERs at any time during their admission, and this was more likely in non-cardiac patients (67% versus 33%, P = 0.03) Children undergoing cardiac surgery had a significant fall in weight-for-age Z scores (WAZ) from PICU admission to discharge (median WAZ, -1.44 versus -2.14; P < 0.001). In both groups, the major barrier to achieving EER was fluid volume restriction. Interruption of feeding for procedures and feeding intolerance reduced energy intake to a lesser degree. CONCLUSIONS This study highlights the inadequacy of nutrition support in critically ill children in the PICU. Restriction of fluid intake was the main barrier to the delivery of adequate nutrition, particularly in infants undergoing cardiac surgery.
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Affiliation(s)
- Elizabeth J Rogers
- Department of Nutrition and Food Services, Royal Children's Hospital, Melbourne, Australia.
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Briassoulis GC, Zavras NJ, Hatzis MD TD. Effectiveness and safety of a protocol for promotion of early intragastric feeding in critically ill children. Pediatr Crit Care Med 2001; 2:113-21. [PMID: 12797869 DOI: 10.1097/00130478-200104000-00004] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES: To investigate the feasibility, adequacy, and efficacy of early poststress intragastric feeding (EPIGF) in critically ill children. DESIGN: A prospective clinical study. SETTING: Pediatric intensive care unit in a tertiary care children's hospital. PATIENTS: Seventy-one consecutively enrolled critically ill children requiring prolonged mechanical ventilation. INTERVENTIONS: Full-strength intragastric tube feedings (Nutrison Pediatric, Standard) were initiated within 12 hrs of the study-entry event. Enteral feedings were advanced to a target volume of energy intake = 1/2, 1, 5/4, 6/4, and 6/4 of the predicted basal metabolic rate (PBMR) on days 1-5, respectively. MEASUREMENTS AND MAIN RESULTS: Nutritional status by the caloric intake, recommended dietary allowances, PBMR, predicted energy expenditure (PEE), anthropometry, and clinical indices were evaluated on days 1 and 5. Safety was assessed by the clinical course of disease, laboratory findings, and occurrence of complications. Success was determined by accomplishment of the PEE target. The early success rate was 94.4% and predicted late enteral feeding success accurately (p =.0001). Caloric intake approached PBMR the second day (43 +/- 1.7 kcal/kg/day vs. 43.2 +/- 1.1 kcal/kg/day) and PEE the fifth day (66.2 +/- 2.7 kcal/kg/day vs. 67.7 +/- 6.4 kcal/kg/day). Multivariate stepwise regression analysis showed that poor outcome and a high Therapeutic Intervention Scoring System score correlated with failure of EPIGF (p <.0001). Patients who succeeded EPIGF had significantly higher myocardial ejection (65% vs. 43%; p <.0001) or shortening fractions (34% vs. 20%; p =.0001) on day 1 than those who failed. Patients tolerated EPIGF well; 9.9% developed nosocomial pneumonia, 5.6% developed diarrhea, and 8.5% needed treatment with cisapride because of a delay of gastric emptying. The mortality rate (5.6%) was different between initial and final success and failure groups (p <.0001) and was lower than predicted by the admission severity scores (12% +/- 2%). CONCLUSIONS: This study showed that increases of caloric intake during the acute phase of a critical illness are well tolerated and may approach PBMR by the second day and PEE by the fourth day in critically ill children. Caloric intake lower than PBMR is associated with higher mortality and morbidity rates.
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Affiliation(s)
- G C Briassoulis
- Pediatric Intensive Care Unit, "Aghia Sophia" Children's Hospital, Athens, Greece
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Irving SY, Simone SD, Hicks FW, Verger JT. Nutrition for the critically ill child: enteral and parenteral support. AACN CLINICAL ISSUES 2000; 11:541-58; quiz 637-8. [PMID: 11288418 DOI: 10.1097/00044067-200011000-00007] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The requirements of growth and organ development create a challenge in nutrition management for the pediatric patient. The stress of critical illness further complicates the delivery of adequate nutrients. Enteral feeding has several advantages over parenteral nutrition (PN), which include preservation of the gastrointestinal mucosa and decreasing the occurrence of sepsis related to bacterial translocation. Although feeding through the gastrointestinal tract is the preferred route for nutritional management, there are specific instances when PN as adjunctive or sole therapy is necessary to meet nutritional needs. With meticulous attention to fluid, caloric, protein, and fat requirements along with monitoring the metabolic status of the patient, it is possible to provide full nutritional support for the critically ill child within 24 to 48 hours of hospital admission.
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Affiliation(s)
- S Y Irving
- University of Maryland Medical System, Department of Pediatrics, Division of Pediatric Critical Care, 22 South Greene Street, Room S5D18, Baltimore, MD 21201-1595, USA
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Abstract
Similar to adults, children under physiologic stress can develop an imbalance in defensive (mucosal layer, motility) and aggressive (gastric acid, bile salts, enzymes) factors responsible for maintaining a healthy gastrointestinal tract. Hypoxia in the gastrointestinal tract likely disrupts the defensive factors, thereby permitting damage by aggressive factors to upper gastrointestinal epithelium that may progress to stress ulceration and acute upper gastrointestinal tract bleeding (UGIB). The basic pathophysiology may be similar in children and adults; however, differences in the time to developing ulceration, ulcer location, and number of ulcers have been reported. Functional development of the gastrointestinal tract is influenced by disease, gestational and postnatal age, and exposure to and type of enteral feedings, thereby confounding the development and prophylaxis of UGIB in neonates and infants. In addition, pharmacotherapy decisions are often complicated by drug administration issues and adverse effects.
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Affiliation(s)
- C M Crill
- Department of Clinical Pharmacy, University of Tennessee, Memphis, Center for Pediatric Pharmacokinetics and Therapeutics, USA
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