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Javid Z, Shadnoush M, Khadem-Rezaiyan M, Mohammad Zadeh Honarvar N, Sedaghat A, Hashemian SM, Ardehali SH, Nematy M, Pournik O, Beigmohammadi MT, Safarian M, Moradi Moghaddam O, Khoshfetrat M, Zand F, Mohammad Alizadeh A, Kosari Monfared M, Mazaheri Eftekhar F, Mohamadi Narab M, Taheri AS, Babakhani K, Foroutan B, Jamialahmadi T, Jabbarzadeh Gangeh B, Meshkani M, Kimiaee F, Norouzy A. Nutritional adequacy in critically ill patients: Result of PNSI study. Clin Nutr 2020; 40:511-517. [PMID: 32711949 DOI: 10.1016/j.clnu.2020.05.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 05/05/2020] [Accepted: 05/24/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Critically ill patients are provided with the intensive care medicine to prevent further complications, including malnutrition, disease progression, and even death. This study was intended to assess nutritional support and its' efficacy in the Intensive Care Units (ICUs) of Iran. METHODS This cross-sectional study assessed 50 ICU's patients out of 25 hospitals in the 10 major regions of Iran's health system and was performed using the multistage cluster sampling design. The data were collected from patient's medical records, ICU nursing sheets, patients or their relatives from 2017 to 2018. Nutritional status was investigated by modified NUTRIC score and food frequency checklist. RESULTS This study included 1321 ICU patients with the mean age of 54.8 ± 19.97 years, mean mNUTRIC score of 3.4 ± 2.14, and malnutrition rate of 32.6%. The mean time of first feeding was the second day and most of patients (66%) received nutrition support, mainly through enteral (57.2%) or oral (37%) route during ICU stay. The patients received 59.2 ± 37.78 percent of required calorie and 55.5 ± 30.04 percent of required protein. Adequate intake of energy and protein was provided for 16.2% and 10.7% of the patients, respectively. The result of regression analysis showed that the odds ratio of mNUTRIC score was 0.85 (95% confidence interval [CI] = 0.74-0.98) and APACHE II was 0.92 (95%CI = 0.89-0.95) for the prediction of energy deficiency. Nutrition intake was significantly different from patient's nutritional requirements both in terms of energy (p < 0.001) and protein (p < 0.001). Also, mean mNUTRIC score varied notably (p = 0.011) with changing in energy intake, defined as underfeeding, adequate feeding, and overfeeding. CONCLUSION The present findings shown that, provided nutritional care for ICU patients is not adequate for their requirements and nutritional status.
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Affiliation(s)
- Zeinab Javid
- Student Research Committee, Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdi Shadnoush
- Semnan University of Medical Sciences, Semnan, Iran; Department of Clinical Nutrition, Faculty of Nutrition & Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Khadem-Rezaiyan
- Department of Community Medicine and Public Health, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Niyaz Mohammad Zadeh Honarvar
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences & Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Sedaghat
- Faculty of Critical Care Medicine, Lung Disease Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Mohammadreza Hashemian
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Hossein Ardehali
- Department of Anesthesiology &Critical care, Shohadaye - Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Nematy
- Biochemistry and Nutrition Department, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Omid Pournik
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Community Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Taghi Beigmohammadi
- Department of Anesthesiology and Intensive Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Safarian
- Biochemistry and Nutrition Department, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Omid Moradi Moghaddam
- Trauma and Injury Research Center & Critical Care Department, Rasoul-e-Akram Complex Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Masoum Khoshfetrat
- Anesthesiology and Critical Care Department of Anesthesiology and Intensive Care Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Farid Zand
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Afshin Mohammad Alizadeh
- Department of Bone Marrow Transplantation, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Maryam Mohamadi Narab
- Department of Nutrition, Sciences and Research Branch, Islamic Azad University, Tehran, Iran
| | - Arefe Sadat Taheri
- Kowsar Hospital, Semnan University of Medical Sciences and Health Services, Semnan, Iran
| | - Khatereh Babakhani
- Department of Nutrition, Sciences and Research Branch, Islamic Azad University, Tehran, Iran
| | - Behnam Foroutan
- Student Research Committee, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Tannaz Jamialahmadi
- Student Research Committee, Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Mehrnoush Meshkani
- Department of Nutrition, Sciences and Research Branch, Islamic Azad University, Tehran, Iran
| | - Fahime Kimiaee
- Department of Nutrition Sciences, Varastegan Institute for Medical Sciences, Mashhad, Iran
| | - Abdolreza Norouzy
- Biochemistry and Nutrition Department, Mashhad University of Medical Sciences, Mashhad, Iran.
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Kellum JA, Cerda J, Kaplan LJ, Nadim MK, Palevsky PM. Fluids for Prevention and Management of Acute Kidney Injury. Int J Artif Organs 2018; 31:96-110. [DOI: 10.1177/039139880803100204] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Fluids are the only known method of attenuating renal injury. Furthermore, whether for hydration, resuscitation or renal replacement therapy, fluid prescriptions must be tailored to the fluid and electrolyte, cardiovascular status and residual renal function of the patient. Different fluids have significantly different effects both on volume expansion as well as on the electrolyte and acid-base balance; while controversial, different fluids may even influence renal function differently. This systematic review focuses on fluids for prevention and management of acute kidney injury. We have reviewed the available evidence and have made recommendations for clinical practice and future studies.
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Affiliation(s)
- J. A. Kellum
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania - USA
| | - J. Cerda
- Division of Nephrology, Albany Medical College and Capital District Renal Physicians, Albany, New York - USA
| | - L. J. Kaplan
- Department of Surgery, Section of Trauma, Surgical Critical Care and Surgical Emergencies, Yale University School of Medicine, New Haven, Connecticut - USA
| | - M. K. Nadim
- Division of Nephrology, Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, California - USA
| | - P. M. Palevsky
- VA Pittsburgh Healthcare System, University Drive Division, Pittsburgh, Pennsylvania - USA
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Anger KE, Belisle C, Colwell MB, Dannemiller R, Alawadhi B, Wilkocki A, Szumita PM. Safety of Compounded Calcium Chloride Admixtures for Peripheral Intravenous Administration in the Setting of a Calcium Gluconate Shortage. J Pharm Pract 2013; 27:474-7. [DOI: 10.1177/0897190013513617] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Calcium gluconate is preferred over calcium chloride for intravenous (IV) repletion of calcium deficiencies in the inpatient setting. In the setting of a national shortage of IV calcium gluconate, our institution implemented a compounded calcium chloride admixture for IV administration. The objective of this analysis is to evaluate the peripheral infusion site safety of compounded IV calcium chloride admixtures in adult inpatients. A total of 222 patients, encompassing 224 inpatient admissions, from April to June 2011 were retrospectively reviewed. Sterile preparations of calcium chloride in 5% dextrose (600 mg/250 mL and 300 mg/100 mL) were used during the study time period. Adverse infusion site reactions were assessed using an institutional infiltration and phlebitis grading system. A total of 333 doses were administered peripherally. In all, 4 (1.8%) patients experienced a moderate to severe infusion site reaction, with 3 due to phlebitis and 1 due to infiltration. Naranjo Nomogram for Adverse Drug Reaction Assessment classified all 4 reactions to have a possible link to calcium chloride administration. Peripheral administration of compounded calcium chloride admixtures in 5% dextrose is associated with a low incidence of IV infusion site reactions and can be considered as an alternative in the event of a calcium gluconate shortage.
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Affiliation(s)
- Kevin E. Anger
- Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA, USA
| | - Caryn Belisle
- Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA, USA
| | - Megan B. Colwell
- Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT, USA
| | | | - Burhan Alawadhi
- Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA, USA
| | - Alex Wilkocki
- Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA, USA
| | - Paul M. Szumita
- Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA, USA
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Dias CRB, Leite HP, Nogueira PCK, Brunow de Carvalho W. Ionized hypocalcemia is an early event and is associated with organ dysfunction in children admitted to the intensive care unit. J Crit Care 2013; 28:810-5. [PMID: 23683566 DOI: 10.1016/j.jcrc.2013.03.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 03/25/2013] [Accepted: 03/26/2013] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose was to determine the frequency and risk factors of ionized hypocalcemia and to evaluate this disturbance as a predictor of mortality in a pediatric intensive care unit (ICU). MATERIALS AND METHODS In a prospective cohort study, 337 children admitted consecutively to an ICU were monitored regarding serum ionized calcium concentrations during the first 10 days of admission. The following variables were analyzed as independent of hypocalcemia: age; malnutrition; sepsis; Pediatric Index of Mortality 2; first 3 days organ dysfunction score (Pediatric Logistic Organ Dysfunction); and use of steroids, furosemide, and anticonvulsants. Hypocalcemia was defined as a serum ionized calcium concentration less than 1.15 mmol/L. RESULTS The rate of hypocalcemia was 77.15%. In a multivariate model, higher Pediatric Logistic Organ Dysfunction scores during the first 3 days of ICU stay were independently associated with hypocalcemia (odds ratio, 2.24; 95% confidence interval, 1.23-4.07; P=.008). Medications associated with hypocalcemia were furosemide (dose≥2 mg/[kg d]) and methylprednisolone (dose≥2 mg/[kg d]). No significant association was found between hypocalcemia and 10-day mortality. CONCLUSIONS Ionized hypocalcemia is common during the ICU stay, particularly in the first 3 days of admission. This disturbance was not found to be a predictor of mortality, but it is independently associated with more severe organ dysfunction.
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Bellar A, Kunkler K, Burkett M. Understanding, recognizing, and managing chronic critical illness syndrome. ACTA ACUST UNITED AC 2011; 21:571-8. [PMID: 19900217 DOI: 10.1111/j.1745-7599.2009.00451.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE No evidence-based guidelines exist for the care of patients with chronic critical illness syndrome (CCIS), a growing population of patients being cared for by nurse practitioners (NPs). The purpose of this article is to provide NPs with a beginning physiological framework, allostasis, to guide their understanding and management of patients with CCIS. DATA SOURCES Scientific publications, related clinical guidelines. CONCLUSIONS Patients with CCIS are a distinct group of critically ill patients whose care needs are different from those of patients who are acutely critically ill. These patients demonstrate widespread tissue and organ damage. The widespread tissue and organ damage results in a syndrome of interrelated elements, which include neuroendocrine problems, severe malnutrition, wounds, infections, bone loss, polyneuropathy and myopathy, delirium and depression, and suffering. IMPLICATIONS FOR PRACTICE In caring for patients with CCIS, NPs need to focus on treating the elements of the syndrome as a cohort of interrelated elements and on re-establishing normalcy for the patient.
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Affiliation(s)
- Ann Bellar
- College of Health Professions, University of Detroit Mercy, Detroit, Michigan, USA.
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Ganesan MV, Annigeri RA, Shankar B, Rao BS, Prakash KC, Seshadri R, Mani MK. The protein equivalent of nitrogen appearance in critically ill acute renal failure patients undergoing continuous renal replacement therapy. J Ren Nutr 2009; 19:161-6. [PMID: 19218043 DOI: 10.1053/j.jrn.2008.11.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2008] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To assess the nutritional status of critically ill patients with acute renal failure on continuous renal replacement therapy (CRRT) and their protein needs by estimating the protein equivalent of nitrogen appearance (PNA). DESIGN Prospective, observational study. SETTING A 74-bed intensive care unit in a single tertiary care hospital. PATIENTS Twenty-five consecutive critically ill patients with acute renal failure on CRRT. METHODS The patients were studied over a period of 24 hours, at initiation on CRRT. The nutritional status was assessed by anthropometry and bioimpedance analysis. The PNA was estimated using the Bergstrom equation and PNA was normalized to body weight. RESULTS The mean age was 58.2 +/- 17 years and 20 (80%) were male. The mean weight was 67 +/- 12 kg, body mass index was 25 +/- 3.5 kg/m(2), and triceps and subscapular skin fold thickness were 13 +/- 4.6 mm and 15 +/- 2.5 mm, respectively. Bioimpedance studies showed that the total body water was increased at 61.7 +/- 5.5% and body fat was 31.8 +/- 5.4%. The PNA was 103 +/- 35 g/day and normalized PNA was 1.57 +/- 0.4 g/kg/day. The mean protein intake was 0.56 +/- 0.38 g/kg/day, resulting in mean net negative protein balance of 1.0 +/- 0.6 g/kg/day. CONCLUSIONS Malnutrition was uncommon in patients with acute renal failure at the time of initiation on CRRT, but their total body water was increased. They exhibited hypercatabolism and the mean normalized PNA was 1.57 g/kg/day. A large negative nitrogen balance was observed in them, since their protein intake was suboptimal.
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López-Herce J, Sánchez C, Carrillo A, Mencía S, Santiago MJ, Bustinza A, Vigil D. Transpyloric enteral nutrition in the critically ill child with renal failure. Intensive Care Med 2006; 32:1599-605. [PMID: 16826386 DOI: 10.1007/s00134-006-0271-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2005] [Accepted: 06/08/2006] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To study the efficacy and tolerance of transpyloric enteral nutrition (TEN) in the critically ill child with acute renal failure (ARF). DESIGN Prospective observational study. SETTING Paediatric intensive care unit. PATIENTS Critically ill children with ARF who received TEN were included in the study. They were compared with the remaining 473 critically ill children receiving TEN in this period. Tolerance of nutrition and gastrointestinal complications were assessed. INTERVENTION Transpyloric enteral nutrition. MEASUREMENTS AND RESULTS Fifty-three critically ill children with ARF aged between 3 days and 17 years received TEN. Children with ARF more frequently received parenteral nutrition before TEN (56.6%) than the other patients (17.5%). The incidence of shock, hepatic alterations and mortality was significantly higher in patients with ARF than in the remaining children. In children with ARF the mean duration of the TEN was 16.5-27.3 days and the maximum caloric intake was 77-26.7 kcal/kg/day. Thirteen patients (24.5%) presented gastrointestinal complications, 9 (17%) abdominal distension and/or excessive gastric residue, 5 (9.4%) diarrhoea, 1 necrotising enterocolitis and 1 duodenal perforation. The frequency of gastrointestinal complications was significantly higher in children with ARF. TEN was definitive suspended in five patients due to gastrointestinal complications. Four of these patients were treated with continuous renal replacement therapy. Thirty percent of patients died during TEN. In only one patient was the death related to complications of the nutrition. CONCLUSIONS Critically ill children with ARF tolerate TEN, although the incidence of gastrointestinal complications is higher than in other critically ill children.
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Affiliation(s)
- Jesús López-Herce
- Gregorio Marañón General University Hospital, Paediatric Intensive Care Unit, Dr Castelo 47, 28009 Madrid, Spain.
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Filippatos TD, Milionis HJ, Elisaf MS. Alterations in electrolyte equilibrium in patients with acute leukemia. Eur J Haematol 2005; 75:449-60. [PMID: 16313256 DOI: 10.1111/j.1600-0609.2005.00547.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIM A wide array of disturbances in electrolyte equilibrium is commonly seen in patients with acute leukemia (AL). These abnormalities present a potential hazard in these patients, as that of enhancing the cardiotoxic effects of certain chemotherapeutic regimens. The literature dealing with AL-related electrolyte abnormalities and their interactions in leukemic patients was reviewed. DATA SYNTHESIS Sources included MEDLINE and EMBASE. The search strategy was based on the combination of 'acute leukemia', 'electrolyte abnormalities', 'acid-base disorders', 'potassium', 'sodium', 'magnesium', 'calcium', and 'phosphorus'. References of retrieved articles were also screened. A decrease in serum potassium, mainly owing to lysozyme-induced tubular damage, appears to be one of the most frequent and potentially hazardous abnormalities. Other clinically significant metabolic perturbations include hyponatremia and hypercalcemia. CONCLUSION A broad spectrum of electrolyte abnormalities is encountered in the clinical setting of AL, which are related to the disease process per se and/or to the therapeutic interventions. Clinicians should be vigilant for early detection and appropriate management of these disorders before the initiation of chemotherapy regimens as well as during treatment.
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Affiliation(s)
- Theodosios D Filippatos
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
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