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Chen XH, Zhao JJ, Chen C, Yao L. Establishment and validation of a predictive model for tracheotomy in critically ill patients and analysis of the impact of different tracheotomy timing on patient prognosis. BMC Anesthesiol 2024; 24:175. [PMID: 38760700 PMCID: PMC11100231 DOI: 10.1186/s12871-024-02558-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/14/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND In critically ill patients receiving invasive mechanical ventilation (IMV), it is unable to determine early which patients require tracheotomy and whether early tracheotomy is beneficial. METHODS Clinical data of patients who were first admitted to the ICU and underwent invasive ventilation for more than 24 h in the Medical Information Marketplace in Intensive Care (MIMIC)-IV database were retrospectively collected. Patients were categorized into successful extubation and tracheotomy groups according to whether they were subsequently successfully extubated or underwent tracheotomy. The patients were randomly divided into model training set and validation set in a ratio of 7:3. Constructing predictive models and evaluating and validating the models. The tracheotomized patients were divided into the early tracheotomy group (< = 7 days) and the late tracheotomy group (> 7 days), and the prognosis of the two groups was analyzed. RESULTS A total of 7 key variables were screened: Glasgow coma scale (GCS) score, pneumonia, traumatic intracerebral hemorrhage, hemorrhagic stroke, left and right pupil responses to light, and parenteral nutrition. The area under the receiver operator characteristic (ROC) curve of the prediction model constructed through these seven variables was 0.897 (95% CI: 0.876-0.919), and 0.896 (95% CI: 0.866-0.926) for the training and validation sets, respectively. Patients in the early tracheotomy group had a shorter length of hospital stay, IMV duration, and sedation duration compared to the late tracheotomy group (p < 0.05), but there was no statistically significant difference in survival outcomes between the two groups. CONCLUSION The prediction model constructed and validated based on the MIMIC-IV database can accurately predict the outcome of tracheotomy in critically ill patients. Meanwhile, early tracheotomy in critically ill patients does not improve survival outcomes but has potential advantages in shortening the duration of hospitalization, IMV, and sedation.
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Affiliation(s)
- Xing-Hua Chen
- Department of Intensive Care Unit, Hefei Hospital Affiliated to Anhui Medical University, The Second People's Hospital of Hefei, Hefei, Anhui, 230011, China
| | - Jing-Jing Zhao
- Department of Intensive Care Unit, Hefei Hospital Affiliated to Anhui Medical University, The Second People's Hospital of Hefei, Hefei, Anhui, 230011, China
| | - Cheng Chen
- Department of Intensive Care Unit, Hefei Hospital Affiliated to Anhui Medical University, The Second People's Hospital of Hefei, Hefei, Anhui, 230011, China
| | - Li Yao
- Department of Intensive Care Unit, Hefei Hospital Affiliated to Anhui Medical University, The Second People's Hospital of Hefei, Hefei, Anhui, 230011, China.
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Gholi Z, Rezaei M, Vahdat Shariatpanahi Z, Momen R, Fallah Bagher Shaidaei M, Gholami M, Aghaee S, Eskandari Sabzi H, Rajabi MR. Malnutrition elevates delirium and ICU stay among critically ill older adult COVID-19 patients. Front Med (Lausanne) 2024; 11:1259320. [PMID: 38799151 PMCID: PMC11116702 DOI: 10.3389/fmed.2024.1259320] [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: 09/22/2023] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Background and aim Malnutrition among intensive care unit (ICU) patients is associated with a higher risk of mortality and prolonged hospitalization. However, the influence of malnutrition on severe outcomes of ICU patients with coronavirus disease 2019 (COVID-19) is unclear. By evaluating the effect of malnutrition on the outcomes of COVID-19 in the ICU in older adult patients, this study will contribute to new knowledge of assessing the nutritional status and recovery of these patients. Methods In the current single center prospective study, 310 critically ill COVID-19 patients with an age range of ≥65 years were recruited. Data on demographic characteristics, laboratory parameters, comorbidities, medications, and types of mechanical ventilation were collected in the first 24 h of ICU admission. Malnutrition was defined based on the two-step approach of the Global Leadership Initiative on Malnutrition (GLIM) scale at baseline. During the 45 days after the baseline, we collected data on delirium incidence, mortality, invasive mechanical ventilation (IMV) requirement, length of ICU and hospital admission, and re-hospitalization. Results In this study, the prevalence of malnutrition was 63.4% among critically ill COVID-19 patients. During the 45-day follow-up, 190 (61.3%) COVID-19 deaths were recorded among the baseline 310 patients. After controlling for potential confounders, malnutrition was associated with an increased risk of delirium so malnourished COVID-19 patients had a significantly 35% higher risk of delirium than those without malnutrition (HR: 1.35, 95% CI: 1.01-1.83). Such a significant association was not for COVID-19 mortality and IMV requirement. In addition, malnutrition was associated with a significantly 84% greater odds of prolonged ICU admission (OR: 1.84, 95% CI: 1.09-3.10). No significant association was seen between malnutrition and re-hospitalization and also prolonged hospital admission. Conclusion Malnutrition was associated with an increased risk of delirium and prolonged ICU admission among critically ill older adult COVID-19 patients. Prevention, diagnosis, and treatment of malnutrition could be a key component in improving outcomes in these patients.
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Affiliation(s)
- Zahra Gholi
- Minimally Invasive Surgery Research Center; Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Rezaei
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
- Cardiovascular Nursing Research Center, Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
| | - Zahra Vahdat Shariatpanahi
- Department of Clinical Nutrition and Dietetics, National Nutrition and Food Technology Research Institute, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Momen
- MSc in Critical Care nursing, Instructor, Critical Care Nursing Department, Faculty of Nursing, Aja University of Medical Sciences, Tehran, Iran
| | | | - Mostafa Gholami
- Nursing and Midwifery Care Research Center, Health Management Research Institute, Iran University of Medical Science, Tehran, Iran
| | - Simin Aghaee
- Department of Pediatric Nursing, School of Nursing, Student Research Committee, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Hakimeh Eskandari Sabzi
- Dept. of Pediatric Nursing, School of Nursing and Midwifery, Ahvaz Jundishapour University Medical Sciences, Ahvaz, Iran, Ahvaz, Iran
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Moghaddam OM, Emam MH, Irandoost P, Hejazi M, Iraji Z, Yazdanpanah L, Mirhosseini SF, Mollajan A, Lahiji MN. Relation between nutritional status on clinical outcomes of critically ill patients: emphasizing nutritional screening tools in a prospective cohort investigation. BMC Nutr 2024; 10:69. [PMID: 38725057 PMCID: PMC11080301 DOI: 10.1186/s40795-024-00869-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 04/15/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Malnutrition is a significant concern reported in adult critically ill patients, yet there is no gold standard to assess nutritional status in this population. This study examines the association between nutritional status and clinical outcomes in intensive care unit (ICU) patients using nutritional risk assessment tools and aims to look for the best tool. METHOD In a single-center prospective cohort study among 165 patients, the predictive performance of high or low malnutrition risk assessed by Nutritional Risk Screening (NRS), Modified Nutrition Risk in Critically Ill (m-NUTRIC), Mini-Nutritional-Assessment Short-Form (MNA-SF), Controlling Nutritional status (CONUT), and Prognostic Nutritional Index (PNI) were evaluated and compared for mortality, organ failure, length of hospitalization, and mechanical ventilation (MV). RESULTS Different assessment tools showed various nutritional statuses. m-NUTRIC and NRS-2002 were found to be associated more strongly relative to other tools with mortality (RR = 1.72; 95% CI, 1.42-2.08) and (RR = 1.37; 95% CI, 1.08-1.72), organ failure (RR = 1.69; 95% CI, 1.44-1.96) and (RR = 1.22; 95% CI, 0.99-1.48), MV (RR = 1.46; 95% CI, 1.27-1.65) and (RR = 1.21; 95% CI, 1.04-1.39) respectively. There was no correlation between malnutrition levels assessed by mentioned tools except for NRS-2002 and length of hospitalization. In predicting mortality or illness severity, the cut points were different for some tools like NUTRIC-score and all assessed outcomes (3.5), MNA-SF and mortality (6.5), CONUT with mortality, and MV (6.5). CONCLUSIONS A considerable proportion of patients admitted to the ICU are at high risk for malnutrition. Compared to other tools, m-NUTRIC and NRS-2002 proved superior in predicting clinical outcomes in critically ill patients. Other tools overestimated the risk of malnutrition in the ICU so couldn't predict clinical outcomes correctly.
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Affiliation(s)
- Omid Moradi Moghaddam
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Critical Care, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Pardis Irandoost
- Department of clinical Nutrition, Rasool Akram Medical Complex Clinical Research Development Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdi Hejazi
- Department of clinical Nutrition, Rasool Akram Medical Complex Clinical Research Development Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zeinab Iraji
- Department of Biostatistics, Tarbiat Modares University, Tehran, Iran
| | - Leila Yazdanpanah
- Department of clinical Nutrition, Rasool Akram Medical Complex Clinical Research Development Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Farnaz Mirhosseini
- Department of clinical Nutrition, Rasool Akram Medical Complex Clinical Research Development Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Mollajan
- Department of Anesthesiology and Critical Care, Rasool-e-Akram Hospital, School of medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Niakan Lahiji
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Critical Care, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Sharon T, Nayak SG, Shanbhag V, Hebbar S. An Observational Study of Nutritional Assessment, Prescription, Practices, and Its Outcome among Critically Ill Patients Admitted to an Intensive Care Unit. Indian J Crit Care Med 2024; 28:364-368. [PMID: 38585326 PMCID: PMC10998518 DOI: 10.5005/jp-journals-10071-24676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 01/25/2024] [Indexed: 04/09/2024] Open
Abstract
Aim and background Optimal feeding strategy for critically ill patients of intensive care unit (ICU) is often a matter of debate as patients admitted to ICU are highly catabolic and reduction in muscle mass is very common. We aimed at early achievement of nutritional goals in preventing skeletal muscle breakdown and improving clinical outcomes among critically ill patients with high risk of malnutrition. Materials and methods Nutrition risk in the critically ill (mNUTRIC) Score was used to identify the risk of malnutrition within 24 hours of admission. Quadriceps muscle mass index was measured within 24 hours of admission to ICU and repeated on 7th day. Enteral feeding was monitored by the nutrition expert as part of routine patient care and clinical outcomes were monitored. Results A total of 287 patients admitted in ICU were screened for malnutrition and 60 (20.9%) of them had high score (>5). There was no statistically significant reduction in the quadriceps muscle mass index (p < 0.05) (t = 0.601) measured within 24 hours of admission and on the 7th day of ICU stay, signifying that the nutritional prescription and monitoring may be useful in preserving the muscle mass. This study did not find statistically significant association between the high mNUTRIC score on admission and the clinical outcomes, such as 28 days mortality, incidence of pressure ulcers, length of ICU stay, and hospital-acquired infection (p > 0.05). Conclusion Early initiation and maintenance of enteral nutrition is essential for meeting target calories and protein requirements. It may help to preserve muscle mass in critically ill patients who are otherwise at high risk of malnutrition. How to cite this article Sharon T, Nayak SG, Shanbhag V, Hebbar S. An Observational Study of Nutritional Assessment, Prescription, Practices, and Its Outcome among Critically Ill Patients Admitted to an Intensive Care Unit. Indian J Crit Care Med 2024;28(4):364-368.
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Affiliation(s)
- Teena Sharon
- Department of Nursing, Manipal College of Nursing & Kasturba Hospital Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Shalini Ganesh Nayak
- Department of Medical Surgical Nursing, Manipal College of Nursing, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Vishal Shanbhag
- Department of Critical Care, Kasturba Hospital, Manipal, Karnataka, India
| | - Suvarna Hebbar
- Department of Clinical Nutrition and Dietetics, Manipal College of Health Professions (MCHP), Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
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Keshani M, Alikiaii B, Babaei Z, Askari G, Heidari Z, Sharma M, Bagherniya M. The effects of L-carnitine supplementation on inflammation, oxidative stress, and clinical outcomes in critically Ill patients with sepsis: a randomized, double-blind, controlled trial. Nutr J 2024; 23:31. [PMID: 38444016 PMCID: PMC10916166 DOI: 10.1186/s12937-024-00934-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 02/28/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Sepsis, a life-threatening organ dysfunction caused by a host's dysregulated response to infection with an inflammatory process, becomes a real challenge for the healthcare systems. L-carnitine (LC) has antioxidant and anti-inflammatory properties as in previous studies. Thus, we aimed to determine the effects of LC on inflammation, oxidative stress, and clinical parameters in critically ill septic patients. METHODS A randomized double-blinded controlled trial was conducted. A total of 60 patients were randomized to receive LC (3 g/day, n = 30) or placebo (n = 30) for 7 days. Inflammatory and oxidative stress parameters (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), superoxide dismutase (SOD), malondialdehyde (MDA), total antioxidant capacity (TAC), 28-day mortality rate, and some monitoring variables were evaluated. RESULTS There was no statistically significant difference between study arms in baseline characteristics and disease severity scores. CRP (p < 0.001) and ESR (p: 0.004) significantly reduced, and SOD (p < 0.001) and TAC (p < 0.001) significantly improved in the LC group after 7 days. Between-group analysis revealed a significant reduction in CRP (p: 0.001) and serum chloride (p: 0.032), an increase in serum albumin (p: 0.036) and platelet (p: 0.004) significantly, and an increase in SOD marginally (p: 0.073). The 28-day mortality rate was also lower in the LC group compared with placebo (7 persons vs. 15 persons) significantly (odds ratio: 0.233, p: 0.010). CONCLUSIONS L-carnitine ameliorated inflammation, enhanced antioxidant defense, reduced mortality, and improved some clinical outcomes in critically ill patients with sepsis. TRIAL REGISTRATION IRCT20201129049534N1; May 2021.
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Affiliation(s)
- Mahdi Keshani
- Nutrition and Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Babak Alikiaii
- Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Babaei
- Department of Nursing and Midwifery, Islamic Azad University Isfahan (Khorasgan) Branch, Isfahan, Iran
| | - Gholamreza Askari
- Nutrition and Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
- Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Heidari
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Manoj Sharma
- Department of Social & Behavioral Health, School of Public Health, & Department of Internal Medicine, University of Nevada, Las Vegas, USA
| | - Mohammad Bagherniya
- Nutrition and Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
- Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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Nguyen DL, Schott LL, Lowen CC, Desai AM, Baumer DL, Miranowski MK, Cao Z, Torres KA. Characteristics and feeding intolerance in critically ill adult patients receiving peptide-based enteral nutrition: A retrospective cross-sectional study. Clin Nutr ESPEN 2024; 59:270-278. [PMID: 38220386 DOI: 10.1016/j.clnesp.2023.12.007] [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: 07/25/2023] [Revised: 11/17/2023] [Accepted: 12/05/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND & AIMS Patients who experience gastrointestinal (GI) intolerance and hyperglycemia (or glucose intolerance) may not achieve appropriate caloric requirements and experience poor outcomes. The aim was to examine patient characteristics, disease severity, and enteral nutrition (EN) formula use in relation to feeding intolerance and healthcare resource utilization. METHODS A retrospective, cross-sectional design using real-world data from PINC AI™ Healthcare Database, 2015-2019 was used. Critically ill hospitalized adults who required ≥3 days of 100% whey peptide-based EN, other peptide-based diets, or intact-protein standard and diabetic EN formulas were included. Primary outcomes were enteral feeding intolerance, including GI intolerance and hyperglycemia. Pairwise comparisons of other peptide-based and standard intact-protein groups with 100% whey-peptide were completed. Associations between EN group with GI intolerance and hyperglycemia, respectively, were evaluated via multivariable logistic regressions. RESULTS Across 67 US hospitals, 19,679 inpatients (3242,100% whey-peptide, 3121 other peptide-based, and 13,316 standard intact-protein) were included. The 100% whey-peptide group had higher severity of illness and frequencies of comorbidities compared with other peptide-based and standard intact-protein groups. Hospital length of stay, intensive care unit stay, and 30-day readmission were similar across peptide-based cohorts. After controlling for demographic, visit, and severity characteristics, odds of GI intolerance were 18% higher for the other peptide-based group and 15% higher for the standard intact-protein group compared with the 100% whey-peptide group (each P < 0.03). In secondary analysis, odds of hyperglycemia were 81% higher for the other peptide-based group compared with the subgroup of very high-protein/low carbohydrate 100% whey-peptide (P < 0.001). CONCLUSIONS Lower GI intolerance and greater glycemic control were associated with the use of 100% whey-peptide formulas relative to other formulas. Appropriate and optimal delivery of EN using specialized peptide-based formulas is a strategy to minimize feeding intolerance and benefit critically ill patients.
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Affiliation(s)
- Douglas L Nguyen
- Loma Linda University Medical Center, 11234 Anderson St., Loma Linda, CA, 92354, USA.
| | - Laura L Schott
- PINC AI™ Applied Sciences, Premier Inc., 13034 Ballantyne Corporate Pl, Charlotte, NC, 28277, USA.
| | - Cynthia C Lowen
- Nestlé Health Science, 1041 US Highway 202, Bridgewater, NJ, 08807, USA.
| | - Amarsinh M Desai
- Nestlé Health Science, 1041 US Highway 202, Bridgewater, NJ, 08807, USA.
| | - Dorothy L Baumer
- PINC AI™ Applied Sciences, Premier Inc., 13034 Ballantyne Corporate Pl, Charlotte, NC, 28277, USA.
| | - Mary K Miranowski
- Nestlé Health Science, 1041 US Highway 202, Bridgewater, NJ, 08807, USA.
| | - Zhun Cao
- PINC AI™ Applied Sciences, Premier Inc., 13034 Ballantyne Corporate Pl, Charlotte, NC, 28277, USA.
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Mastrolonardo EV, Lu JS, Elliott Z, Knops A, Philips R, Urdang Z, Mady LJ, Curry JM. Evaluating the impact of hemodynamic support measures on head and neck free tissue transfer outcomes: A population-based analysis. Oral Oncol 2023; 143:106461. [PMID: 37331035 DOI: 10.1016/j.oraloncology.2023.106461] [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: 04/15/2023] [Revised: 06/01/2023] [Accepted: 06/09/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVES This study sought to analyze the effects of perioperative blood transfusions and vasopressors on 30-day surgical complications and 1-year mortality after reconstructive surgery in head and neck free tissue transfer (FTT) and to identify predictors of administration of perioperative blood transfusions or vasopressors. MATERIALS AND METHODS TriNetX (TriNetX LLC, Cambridge, USA), an international population-level electronic health record database, was queried to identify subjects that underwent FTT requiring perioperative (intraoperative to postoperative day 7) vasopressors or blood transfusions. Primary dependent variables were 30-day surgical complications and 1-year mortality. Propensity score matching was used to control for population differences, and covariate analysis was used to identify preoperative comorbidities associated with perioperative vasopressor or transfusion requirements. RESULTS 7,631 patients met inclusion criteria. Preoperative malnutrition was associated with increased odds of perioperative transfusion (p = 0.002) and vasopressor requirement (p < 0.001). Perioperative blood transfusion (n = 941) was associated with increased odds of any surgical complication (p = 0.041) within 30 days postoperatively and specifically increased odds of wound dehiscence (p = 0.008) and FTT failure (p = 0.002), respectively. Perioperative vasopressor was (n = 197) was not associated with 30-day surgical complications. Vasopressor requirement was associated with increased hazards-ratio of mortality at 1-year (p = 0.0031). CONCLUSION Perioperative blood transfusion in FTT is associated with increased odds for surgical complications. Judicious use as a hemodynamic support measure should be considered. Perioperative vasopressor use was associated with an increased risk of one-year mortality. Malnutrition is a modifiable risk factor for perioperative transfusion and vasopressor requirement. These data warrant further investigation to assess causation and potential opportunity for practice improvement.
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Affiliation(s)
- Eric V Mastrolonardo
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, United States.
| | - Joseph S Lu
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Zachary Elliott
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Alexander Knops
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Ramez Philips
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Zachary Urdang
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Leila J Mady
- Department of Otolaryngology - Head and Neck Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Joseph M Curry
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, United States
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Kasti AN, Theodorakopoulou M, Katsas K, Synodinou KD, Nikolaki MD, Zouridaki AE, Fotiou S, Kapetani A, Armaganidis A. Factors Associated with Interruptions of Enteral Nutrition and the Impact on Macro- and Micronutrient Deficits in ICU Patients. Nutrients 2023; 15:nu15040917. [PMID: 36839275 PMCID: PMC9959226 DOI: 10.3390/nu15040917] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/02/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND AND AIM Feeding interruptions in critical care patients are often unjustified. We aimed to determine the causes, duration, and frequency of enteral nutrition interruptions (ENIs) and to assess macronutrients and antioxidant deficits according to European Society of Parenteral Enteral Nutrition (ESPEN) guidelines. METHODS We prospectively enrolled Intensive Care Unit (ICU) patients admitted for more than 48 h with an inability to orally eat from April to December 2019. The type of enteral nutrition, the number of calories administered, the time of feeding initiation, the reasons for delaying feeding, and the causes for ENI were recorded. RESULTS 81 patients were enrolled, with a median duration of ENIs of 5.2 (3.4-7.4) hours/day. Gastric residual volume (GRV) monitoring-a highly controversial practice-was the most common cause of ENI (median duration 3 (2.3-3) hours/day). The mean energy intake was 1037 ± 281 kcal/day, while 60.5% of patients covered less than 65% of the total energy needs (1751 ± 295 kcal/day, according to mean Body Mass Index (BMI)). The median daily protein intake did not exceed 0.43 ± 0.3 gr/kg/day of the actual body weight (BW), whereas ESPEN recommends 1.3 gr/kg/day for adjusted BW (p < 0.001). The average administration of micronutrients and antioxidants (arginine, selenium, zinc, vitamins) was significantly less than the dietary reference intake (p < 0.01). CONCLUSION ENIs lead to substantial caloric, protein, and antioxidant deficits.
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Affiliation(s)
- Arezina N. Kasti
- Department of Nutrition and Dietetics, Attikon University General Hospital, 12462 Athens, Greece
| | - Maria Theodorakopoulou
- 1st ICU Department, Evangelismos Hospital, Intensive Care Medicine, 10676 Athens, Greece
- 2nd ICU Department, Attikon University Hospital, Intensive Care Medicine, 12461 Athens, Greece
| | - Konstantinos Katsas
- Department of Nutrition and Dietetics, Attikon University General Hospital, 12462 Athens, Greece
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Kalliopi D. Synodinou
- Department of Nutrition and Dietetics, Attikon University General Hospital, 12462 Athens, Greece
| | - Maroulla D. Nikolaki
- Department of Nutrition and Dietetics, Attikon University General Hospital, 12462 Athens, Greece
- Department of Nutrition and Dietetics Sciences, Hellenic Mediterranean University, 72300 Crete, Greece
- Correspondence: (M.D.N.); (A.A.)
| | - Alice Efstathia Zouridaki
- Department of Nutrition and Dietetics, Attikon University General Hospital, 12462 Athens, Greece
- Department of Human Biology and Health Studies, University of Toronto, Toronto, ON M5S, Canada
| | - Stylianos Fotiou
- Department of Nutrition and Dietetics, Attikon University General Hospital, 12462 Athens, Greece
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece
| | - Aliki Kapetani
- Department of Nutrition and Dietetics, Attikon University General Hospital, 12462 Athens, Greece
| | - Apostolos Armaganidis
- 2nd ICU Department, Attikon University Hospital, Intensive Care Medicine, 12461 Athens, Greece
- Correspondence: (M.D.N.); (A.A.)
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Vaz-Rodrigues R, Mazuecos L, Villar M, Urra JM, Gortázar C, de la Fuente J. Serum biomarkers for nutritional status as predictors in COVID-19 patients before and after vaccination. J Funct Foods 2023; 101:105412. [PMID: 36644001 PMCID: PMC9829648 DOI: 10.1016/j.jff.2023.105412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/08/2023] [Accepted: 01/08/2023] [Indexed: 01/12/2023] Open
Abstract
The aim of this study was to characterize serum protein biomarkers for nutritional status that may be used as predictors for disease symptomatology in COVID-19 patients before and after vaccination. In pre-vaccine cohorts, proteomics analysis revealed significant differences between groups, with serum proteins alpha-1-acid glycoproteins (AGPs) 1 and 2, C-reactive protein (CRP) and retinol binding protein (RBP) increasing with COVID-19 severity, in contrast with serum albumin, transthyretin (TTR) and serotransferrin (TF) reduction as the symptomatology increased. Immunoassay reproduced and validated proteomics results of serum proteins albumin and RBP. In post-vaccine cohorts, the results showed the same pattern as in pre-vaccine cohorts for serum proteins AGPs, CRP, albumin and TTR. However, TF levels were similar between groups and RBP presented a slight reduction as COVID-19 symptomatology increased. In these cohorts, immunoassay validated proteomics results of serum proteins albumin, TTR and TF. Additionally, immune response to α-Gal in pre-vaccine cohorts varied in predominant immunoglobulin type profile, while post-vaccine groups presented mainly anti-α-Gal protective IgG antibodies. The study identified serum nutritional biomarkers that could potentially predict an accurate prognostic of COVID-19 disease to provide an appropriate nutritional care and guidance in non-vaccinated and vaccinated individuals against SARS-CoV-2. These results highlight the importance of designing personalized nutrition protocols to improve diet along with the application of prebiotics or probiotics for the control of COVID-19 and other infectious diseases.
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Affiliation(s)
- Rita Vaz-Rodrigues
- Health and Biotechnology (SaBio), Instituto de Investigación en Recursos Cinegéticos IREC (CSIC-UCLM-JCCM), Ronda de Toledo 12, 13071 Ciudad Real, Spain
| | - Lorena Mazuecos
- Health and Biotechnology (SaBio), Instituto de Investigación en Recursos Cinegéticos IREC (CSIC-UCLM-JCCM), Ronda de Toledo 12, 13071 Ciudad Real, Spain
| | - Margarita Villar
- Health and Biotechnology (SaBio), Instituto de Investigación en Recursos Cinegéticos IREC (CSIC-UCLM-JCCM), Ronda de Toledo 12, 13071 Ciudad Real, Spain,Biochemistry Section, Faculty of Science and Chemical Technologies, and Regional Centre for Biomedical Research (CRIB), University of Castilla-La Mancha, 13071 Ciudad Real, Spain
| | - José Miguel Urra
- Immunology, Hospital General Universitario de Ciudad Real, 13005 Ciudad Real, Spain,Medicine School, Universidad de Castilla la Mancha (UCLM), 13005 Ciudad Real, Spain
| | - Christian Gortázar
- Health and Biotechnology (SaBio), Instituto de Investigación en Recursos Cinegéticos IREC (CSIC-UCLM-JCCM), Ronda de Toledo 12, 13071 Ciudad Real, Spain
| | - José de la Fuente
- Health and Biotechnology (SaBio), Instituto de Investigación en Recursos Cinegéticos IREC (CSIC-UCLM-JCCM), Ronda de Toledo 12, 13071 Ciudad Real, Spain,Department of Veterinary Pathobiology, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK 74078, USA,Corresponding author at: SaBio, Instituto de Investigación en Recursos Cinegéticos IREC (CSIC-UCLM-JCCM), Ronda de Toledo 12, 13071 Ciudad Real, Spain
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10
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Yahyapoor F, Keshani M, Sedaghat A, Feizi A, Clark CCT, Bagherniya M, Safarian M, Badpeyma M, Norouzy A. The effects of adjunctive treatment with L-carnitine on monitoring laboratory variables in ICU patients: a double-blinded randomized controlled clinical trial. Trials 2023; 24:3. [PMID: 36597167 PMCID: PMC9808964 DOI: 10.1186/s13063-022-07010-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Critically ill patients must be monitored constantly in intensive care units (ICUs). Among many laboratory variables, nutritional status indicators are a key role in the prognosis of diseases. We investigated the effects of L-carnitine adjunctive therapy on monitoring variables in critical illness. METHOD A prospective, double-blind, randomized controlled trial was implemented in a medical ICU. Participants were 54 patients, aged > 18 years, with multiple conditions, randomly assigned to receive 3 g L-carnitine per day or placebo, along with enteral feeding, for 1 week. Primary outcomes included monitoring variables related to nutritional status. RESULT Of 54 patients randomly assigned, 51 completed the trial. Serum albumin (Alb) (P-value: 0.001), total protein (P-value: 0.003), and calcium (Ca) (0.044) significantly increased in the intervention vs. control group. Alanine transaminase (ALT) (0.022), lactate (<0.001), creatinine (Cr) (0.005), and international normalized ratio (INR) (0.049) decreased meaningfully in the intervention vs. control group. CONCLUSION L-Carnitine supplementation in critically ill patients can improve several parameters including INR, Cr, ALT, lactate, Ca, Alb, and total protein. TRIAL REGISTRATION Iranian Registry of Clinical Trials IRCT 20151108024938N2. This trial was approved by the Research Ethics Committee of Mashhad University of Medical Sciences (registration code: IR.MUMS.fm.REC.1396.671) (available at https://en.irct.ir/trial/30748 , May 2018).
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Affiliation(s)
- Farveh Yahyapoor
- grid.411583.a0000 0001 2198 6209Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdi Keshani
- grid.411036.10000 0001 1498 685XFood Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran ,grid.411036.10000 0001 1498 685XDepartment of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Sedaghat
- grid.411583.a0000 0001 2198 6209Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Awat Feizi
- grid.411036.10000 0001 1498 685XBiostatistics and Epidemiology Department, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Cain C. T. Clark
- grid.8096.70000000106754565Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5FB UK
| | - Mohammad Bagherniya
- grid.411036.10000 0001 1498 685XFood Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran ,grid.411036.10000 0001 1498 685XDepartment of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran ,grid.411036.10000 0001 1498 685XAnesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Safarian
- grid.411583.a0000 0001 2198 6209Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohaddeseh Badpeyma
- grid.412888.f0000 0001 2174 8913Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran ,grid.412888.f0000 0001 2174 8913Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abdolreza Norouzy
- grid.411583.a0000 0001 2198 6209Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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11
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Wang J, Zheng N, Chang X, Qian H, Han Y. Nutritional risk factors for all-cause mortality of critically ill patients: a retrospective cohort study. BMJ Open 2022; 12:e066015. [PMID: 36396305 PMCID: PMC9677028 DOI: 10.1136/bmjopen-2022-066015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This study aimed to explore the predictive value of single and multiple risk factors for the clinical outcomes of critically ill patients receiving enteral nutrition and to establish an effective evaluation model. DESIGN Retrospective cohort study. SETTING Data from the 2020-2021 period were collected from the electronic records of the First Affiliated Hospital, Nanjing Medical University. PARTICIPANTS 459 critically ill patients with enteral nutrition in the geriatric intensive care unit were included in the study. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was 28-day mortality. The secondary outcomes were 28-day invasive mechanical ventilation time, intensive care unit stay, Nutrition Risk Screening 2002 (NRS2002) score and Acute Physiology and Chronic Health Evaluation II (APACHE II) score. RESULTS Independent prognostic factors, including prealbumin/procalcitonin (PCT) ratio and APACHE II score, were identified using a logistic regression model and used in the nomogram. The area under the receiver operating characteristic curve and concordance index indicated that the predictive capacity of the model was 0.753. Moreover, both the prealbumin/PCT ratio and the combination model of PCT, prealbumin and NRS2002 had a higher predictive value for clinical outcomes. Subgroup analysis also identified that a higher inflammatory state (PCT >0.5 ng/mL) and major nutritional risk (NRS2002 >3) led to worse clinical outcomes. In addition, patients on whole protein formulae bore less nutritional risk than those on short peptide formulae. CONCLUSIONS This nomogram had a good predictive value for 28-day mortality in critically ill patients receiving enteral nutrition. Both the prealbumin/PCT ratio and the combination model (PCT, prealbumin and NRS2002), as composite models of inflammation and nutrition, could better predict the prognosis of critically ill patients.
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Affiliation(s)
- Jine Wang
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Nan Zheng
- Department of Critical Care Medicine, The First School of Clinical Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xinyi Chang
- Department of Critical Care Medicine, The First School of Clinical Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Huitao Qian
- Department of Critical Care Medicine, The First School of Clinical Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yi Han
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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12
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The Prognostic Accuracy Evaluation of mNUTRIC, APACHE II, SOFA, and SAPS 2 Scores for Mortality Prediction in Patients with Sepsis. Crit Care Res Pract 2022; 2022:4666594. [PMID: 36274819 PMCID: PMC9584740 DOI: 10.1155/2022/4666594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/21/2022] [Indexed: 11/18/2022] Open
Abstract
Background The modified Nutrition Risk in the Critically Ill (mNUTRIC) score is a helpful tool to evaluate nutritional risk in critically ill patients. However, there is a lack of data on the relationship between mNUTRIC score and septic patients' outcomes. So, this study aims to validate the prognostic role of the mNUTRIC score and to compare the performances of mNUTRIC, APACHE II, SOFA, and SAPS 2 scores for mortality prediction in patients with sepsis. Methods This prospective observational study was performed on 194 septic patients admitted to the Intensive Care Unit (ICU) of 108 Military Central Hospital. Sepsis was defined based on the sepsis-3 definition. The mNUTRIC score was used to evaluate the nutritional status within 24 h of ICU admission. Baseline characteristics and clinical information were collected to calculate the mNUTRIC, APACHE II, SOFA, and SAPS 2 scores. The outcome was in-hospital mortality from all causes. Results Nonsurvivors patients had a significantly higher median mNUTRIC score (6 vs. 4, P < 0.001). The mortality rate in the group with a NUTRIC score ≥5 was significantly higher than in the group with a NUTRIC score <5 (56.0% vs 10.2%; P < 0.001). The area under the ROC curves (AUC) for predicting the mortality of mNUTRIC was 0.79 (sensitivity 67.1% and specificity 81.0% (P < 0.001)). Compared with other severity scores in mortality prediction, AUC was 0.78 for APACHE II (sensitivity 84.9% and specificity 67.7%), 0.77 for SOFA score (sensitivity 76.7% and specificity 65.3%), and 0.73 for SAPS 2 (sensitivity 66.1%, specificity 77.7%). In the multivariate analysis, mNUTRIC score was associated with in-hospital mortality (HR, 2.00; 95% CI, 1.54 to 2.58; P < 0.001). Conclusions Our study showed that the mNUTRIC score was similar to severity scores (APACHE II, SOFA, SAPS 2) in mortality prediction and was the independent mortality predictor in patients with sepsis.
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Hajipour A, Afsharfar M, Jonoush M, Ahmadzadeh M, Gholamalizadeh M, Hassanpour Ardekanizadeh N, Doaei S, Mohammadi‐Nasrabadi F. The effects of dietary fiber on common complications in critically ill patients; with a special focus on viral infections; a systematic reveiw. Immun Inflamm Dis 2022; 10:e613. [PMID: 35478440 PMCID: PMC9017620 DOI: 10.1002/iid3.613] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/16/2022] [Accepted: 03/14/2022] [Indexed: 12/17/2022] Open
Abstract
Background Viral infections are mostly highly contagious and may cause widespread health problems. Some studies reported that the dietary fiber (DF) may be effective in reducing the complications of viral infections in intensive care unit (ICU) patients. The present review study aimed to investigate the effect of DF on common complications in critically ill patients with viral infections. Methods A literature review was conducted for the published papers in English from January 2001 to July 2021 using related keywords. Studies with clinical trial or case‐control design described the effects of fiber intake on the complications of viral infections in patients admitted to the ICU were collected. Results DF may reduce the mortality rate of viral infections through modulating inflammatory processes. A higher intake of DF intake may improve hyperglycemia and impaired glucose tolerance in patients with viral infections. A high‐fiber formula in enteral nutrition was reported to reduce the risk of diarrhea in patients with viral infections. Conclusion DF may reduce the complications of viral infections such as inflammation, diarrhea, hyperglycemia, and mortality in critically ill patients. Future longitudinal studies on the amount and type of DF are warranted.
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Affiliation(s)
- Azadeh Hajipour
- Department of Nutrition, School of Health Qazvin University of Medical Sciences Qazvin Iran
| | - Maryam Afsharfar
- Department of Nutrition, School of Medicine Zahedan University of Medical Sciences Zahedan Iran
| | - Mona Jonoush
- Department of Nutrition, School of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | - Mina Ahmadzadeh
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Maryam Gholamalizadeh
- School of Medicine, Cancer Research Center Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Naeemeh Hassanpour Ardekanizadeh
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Saeid Doaei
- Reproductive Health Research Center, Department of Obstetrics and Gynecology, School of Medicine, Al‐Zahra Hospital Guilan University of Medical Sciences Rasht Iran
| | - Fatemeh Mohammadi‐Nasrabadi
- Department of Food and Nutrition Policy and Planning Research, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute Shahid Beheshti University of Medical Sciences Tehran Iran
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Yahyapoor F, Sedaghat A, feizi A, Bagherniya M, Pahlavani N, Khadem-Rezaiyan M, Safarian M, Islam MS, Zarifi SH, Arabi M, Norouzy A. The effects of L-Carnitine supplementation on inflammatory markers, clinical status, and 28 days mortality in critically ill patients: A double-blind, randomized, placebo-controlled trial. Clin Nutr ESPEN 2022; 49:61-67. [DOI: 10.1016/j.clnesp.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/13/2022] [Accepted: 04/01/2022] [Indexed: 11/30/2022]
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15
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Nguyen M, Drihem A, Berthoud V, Dransart-Raye O, Bartamian L, Gounot I, Guinot PG, Bouhemad B. Fasting does not guarantee empty stomach in the intensive care unit: A prospective ultrasonographic evaluation (The NUTRIGUS study). Anaesth Crit Care Pain Med 2021; 40:100975. [PMID: 34743035 DOI: 10.1016/j.accpm.2021.100975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND In the intensive care unit (ICU), a fasting period is usually respected to avoid gastric aspiration during airway management procedures. Since there are no recognised guidelines, intensive care physicians balance the aspiration risk with the negative consequences of underfeeding. Our objective was to determine the impact of fasting on gastric emptying in critically ill patients by using gastric ultrasound. MATERIAL AND METHODS Among the 112 patients that met the inclusion criteria, 100 patients were analysed. Gastric ultrasonography was performed immediately before extubation. Patients with either 1/ an absence of visualised gastric content (qualitative evaluation) or 2/ a gastric volume < 1.5 mll/kg in case of clear fluid gastric content (quantitative evaluation) were classified as having an empty stomach. MAIN FINDINGS In our study, twenty-six (26%) patients had a full stomach at the time of extubation. The incidence of full stomach was not significantly different between patients who fasted < 6 h or patients who fasted ≥ 6 h. Among the 57 patients receiving enteral nutrition (EN) within the last 48 h, there was no correlation between the duration of EN interruption and the GAA. The absence of EN was not associated with an empty stomach. CONCLUSION At the time of extubation, the incidence of full stomach was high and not associated with the fasting characteristics (duration/absence of EN). Our results support the notions that fasting before airway management procedures is not a universal paradigm and that gastric ultrasound might represent a useful tool in the tailoring process. CLINICALTRIALS.GOV: NCT04245878.
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Affiliation(s)
- Maxime Nguyen
- Department of Anaesthesiology and Intensive Care, Dijon University Hospital, F-21000 Dijon, France; University of Burgundy and Franche-Comté, LNC UMR1231, F-21000 Dijon, France; INSERM, LNC UMR1231, F-21000 Dijon, France; FCS Bourgogne-Franche Comté, LipSTIC LabEx, F-21000 Dijon, France.
| | - Anne Drihem
- Department of Anaesthesiology and Intensive Care, Dijon University Hospital, F-21000 Dijon, France
| | - Viven Berthoud
- Department of Anaesthesiology and Intensive Care, Dijon University Hospital, F-21000 Dijon, France
| | - Ophélie Dransart-Raye
- Department of Anaesthesiology and Intensive Care, Dijon University Hospital, F-21000 Dijon, France
| | - Loic Bartamian
- Department of Anaesthesiology and Intensive Care, Dijon University Hospital, F-21000 Dijon, France
| | - Isabelle Gounot
- Department of Anaesthesiology and Intensive Care, Dijon University Hospital, F-21000 Dijon, France
| | - Pierre-Grégoire Guinot
- Department of Anaesthesiology and Intensive Care, Dijon University Hospital, F-21000 Dijon, France; University of Burgundy and Franche-Comté, LNC UMR1231, F-21000 Dijon, France; INSERM, LNC UMR1231, F-21000 Dijon, France; FCS Bourgogne-Franche Comté, LipSTIC LabEx, F-21000 Dijon, France
| | - Belaid Bouhemad
- Department of Anaesthesiology and Intensive Care, Dijon University Hospital, F-21000 Dijon, France; University of Burgundy and Franche-Comté, LNC UMR1231, F-21000 Dijon, France; INSERM, LNC UMR1231, F-21000 Dijon, France; FCS Bourgogne-Franche Comté, LipSTIC LabEx, F-21000 Dijon, France
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16
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Mohialdeen Gubari MI, Hosseinzadeh-Attar MJ, Hosseini M, Mohialdeen FA, Othman H, Hama-ghareeb KA, Norouzy A. Nutritional Status in Intensive Care Unit: A Meta-Analysis and Systematic Review. Galen Med J 2021; 9:e1678. [PMID: 34466565 PMCID: PMC8344180 DOI: 10.31661/gmj.v9i0.1678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 08/12/2019] [Accepted: 09/05/2019] [Indexed: 11/16/2022] Open
Abstract
It is important to consider the nutritional status of patients in the intensive care unit (ICU) since it is a key element in the ability to overcome and survive critical illnesses and clinical outcomes. The aim of the present study was to provide a meta-analysis and systematic overview in determining the nutritional status of patients in ICU by examining other studies. All studies published during 2015-2019 on nutritional status in ICU were retrieved from Medline (via PubMed), Embase, Scopus, and Web of Science databases. Finally, 23 articles were included in the meta-analysis. Results obtained from these studies showed that the nutritional status of patients in ICU was inappropriate (the pooled proportion of malnutrition was 0.51 in the type of study stratified), in which many patients in this unit had different degrees of malnutrition (moderate-mild malnourished and severe malnutrition is 0.46 and 20%, respectively). According to the results of this study, the nutritional status of patients in ICU was unsatisfactory; hence, it is necessary to consider the nutritional status along with other therapeutic measures at the beginning of the patient's admission.
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Affiliation(s)
| | - Mohammad Javad Hosseinzadeh-Attar
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran, Iran
- Centre of Research Excellence in Translating, Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Mostafa Hosseini
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fadhil Ahmed Mohialdeen
- Community Health Department, Technical College of Health, Sulaimani Polytechnic University, Sulaimani, Iraq
| | - Haval Othman
- General Shar Teaching Hospital, ICU Unit, Sulaimani, Iraq
| | | | - Abdolreza Norouzy
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran, Iran
- Correspondence to: Dr. Abdolreza Norouzy, Department of Clinical Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran, Iran Telephone Number: 09153145073 Email Address:
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SILVA AFDS, REIS AMD, MARCHETTI J, FRANZOSI OS, STEEMBURGO T. Two variants of the Nutritional Risk in the Critically Ill Score as predictors of mortality in Intensive Care Unit patients at a Brazilian University Hospital. REV NUTR 2020. [DOI: 10.1590/1678-9865202033e190031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective To evaluate the agreement between the modified version of the Nutritional Risk in the Critically Ill Score (without Interleukin-6) and a variant composed of C-Reactive Protein as well as its capacity to predict mortality. Methods A prospective cohort study was carried out with 315 patients in an Intensive Care Unit of a university hospital from October 2017 to April 2018. The agreement between the instruments was evaluated using the Kappa test. The predictive capacity for estimating mortality was assessed with the Receiver Operating Characteristic curve. Results The critical patients involved in the study had a mean age of 60.8±16.3 years and 53.5% were female. Most patients had C-Reactive Protein levels ?10mg/dL (n=263, 83.5%) and their admission in the Intensive Care Unit was medical (n=219, 69.5%). The prevalence of mortality was observed in 41.0% of the evaluated patients. The proportions at high nutritional risk according to Nutritional Risk in the Critically Ill without Interleukin-6 and with C-Reactive Protein were 57.5% and 55.6%, respectively. The tools showed strong and significant agreement(Kappa=0.935; p=0.020) and satisfactory performances in predicting mortality (area under the curve 0.695 [0.636-0.754] and 0.699 [0.640-0.758]). Conclusion Both versions of the Nutritional Risk in the Critically Ill tool show a satisfactory agreement and performance as predictors of mortality in critically ill patients. Further analysis of this variant and the association between nutrition adequacy and mortality is needed.
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Allen K, Hoffman L. Enteral Nutrition in the Mechanically Ventilated Patient. Nutr Clin Pract 2019; 34:540-557. [PMID: 30741491 DOI: 10.1002/ncp.10242] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Mechanically ventilated patients are unable to take food orally and therefore are dependent on enteral nutrition for provision of both energy and protein requirements. Enteral nutrition is supportive therapy and may impact patient outcomes in the intensive care unit. Early enteral nutrition has been shown to decrease complications and hospital length of stay and improve the prognosis at discharge. Nutrition support is unique for patients on mechanical ventilation and, as recently published literature shows, should be tailored to the individuals' underlying pathology. This review will discuss the most current literature and recommendations for enteral nutrition in patients receiving mechanical ventilation.
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Affiliation(s)
- Karen Allen
- Section of Pulmonary and Critical Care, The University of Oklahoma Health Sciences Center and VA Medical Center Oklahoma City, Oklahoma City, Oklahoma, USA
| | - Leah Hoffman
- Department of Nutritional Sciences, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Xu J, Zhou X, Zheng C. The geriatric nutritional risk index independently predicts adverse outcomes in patients with pyogenic liver abscess. BMC Geriatr 2019; 19:14. [PMID: 30651062 PMCID: PMC6335828 DOI: 10.1186/s12877-019-1030-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 01/08/2019] [Indexed: 11/23/2022] Open
Abstract
Background Geriatric nutritional risk index (GNRI) is a simple and useful nutritional marker for predictor of adverse outcomes in patients undergoing a variety of conditions. This study explored the relationship between GNRI and adverse outcomes of Pyogenic Liver Abscess (PLA) patients and assessed GNRI predictive value. Methods This was one retrospective study involving 240 PLA patients. According to one GNRI cutoff value of 90, the patients were divided into two groups. Besides, demographic, laboratory, adverse outcomes were compared between the two groups. Multivariate logistic regression analyses and receiver-operating characteristic (ROC) curve analysis were performed. Results Compared with high GNRI patients, those with low GNRI had a higher risk of mortality (13.4% vs. 2.0%, P = 0.002), metastatic infection (17.7% vs. 8.2%, P = 0.050), acute hepatic failure (6.8% vs. 1.0%, P = 0.036), acute respiratory failure (7.4% vs. 1.0%, P = 0.024), upper gastrointestinal (UGI) bleeding (11.9% vs. 2.1%, P = 0.006) and empyema (20.1% vs. 10.2%, P = 0.047). Multivariate logistic regression analysis demonstrated GNRI (< 90) as one independent factor in death prediction (odds ratio (OR) = 5.36, 95% of confidence interval (CI) = 1.17–24.48), and adverse outcomes (OR = 2.04, 95% CI = 1.05–3.98). GNRI had the largest area under receiver operating characteristic (ROC) curve than albumin, BMI, platelet, prothrombin time and hemoglobin in death prediction (area under ROC curves (AUC) = 0.771, cutoff value = 79.45, P < 0.01) and all adverse outcomes (AUC = 0.656, cutoff value = 87.43, P < 0.01). Conclusions Lower levels of GNRI are an independent risk factor for poor PLA prognosis. Physicians should consider GNRI for PLA outcomes and consider more careful resuscitation and timely and appropriate treatment, especially in those with GNRI< 87.43.
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Affiliation(s)
- Jing Xu
- Diabetes Center and Department of Endocrinology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109 West Xueyuan Road, Wenzhou, China
| | - Xinhe Zhou
- Diabetes Center and Department of Endocrinology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109 West Xueyuan Road, Wenzhou, China
| | - Chao Zheng
- Diabetes Center and Department of Endocrinology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109 West Xueyuan Road, Wenzhou, China.
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Current Evidence for the Use of Smoflipid® Emulsion in Critical Care Patients for Parenteral Nutrition. Crit Care Res Pract 2018; 2018:6301293. [PMID: 30584476 PMCID: PMC6280253 DOI: 10.1155/2018/6301293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/12/2018] [Indexed: 12/14/2022] Open
Abstract
There are strong data showing that malnutrition is highly prevalent in intensive care unit patients (20–50% in the worldwide), presenting a negative accumulated body energy balance. This results in an increased mortality, infections, and hospital length stay with high costs associated with the total treatment. Parenteral nutrition is the first option when the patient's physical condition is not suitable for oral nutrient intake. It is composed essentially by lipids as an energy source, metabolic, and structural function. However, these patients also require a mixture of essential and nonessential fatty acids (SMOF emulsions) to supply not only energy needs but also restore immunological, anti-inflammatory, and proregenerative functions. A revision of the safety and efficacy of Smoflipid® in patients requiring long-term parenteral nutrition was discussed here. Although controversial data are available indicating the contraindications or effectiveness of its use, most of studies presented indicate favorable benefits associated with improved clinical outcomes. The reported roles of this supplementation include positive immunomodulatory and anti-inflammatory effects, positive impact in liver function, reduction of hospital stay, and nosocomial infections as additional contributions to its energetic role, which in many cases results in reduced total costs per patient. Finally, many authors propose that the use of Smoflipid® should become a gold standard of parenteral nutrition in intensive unit care patients and that the costs associated with this supplement should not be limiting for its use, not only to improve the clinical outcome but also to reduce the treatment costs.
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Protein Requirements in Critically Ill Older Adults. Nutrients 2018; 10:nu10030378. [PMID: 29558388 PMCID: PMC5872796 DOI: 10.3390/nu10030378] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/11/2018] [Accepted: 03/13/2018] [Indexed: 12/19/2022] Open
Abstract
Critically ill elderly patients' nutritional needs are not well understood and vary with the phase of illness and recovery. Patients' nutritional needs should be assessed early in hospitalization and re-assessed throughout the stay with additional attention during the transitions from critical illness, to severe illness, to post-hospital rehabilitation. In this review, we summarize recent findings and highlight recommendations for protein supplementation in critically ill geriatric patients throughout the stages of recovery. Future research specifically focusing on protein dose, its relationship with caloric needs, and delivery modality must be conducted to provide more specific guidelines for clinical practice.
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22
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Nurse's perceptions of barriers to optimal nutritional therapy for hospitalized patients. Clin Nutr ESPEN 2017; 22:92-96. [DOI: 10.1016/j.clnesp.2017.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 07/18/2017] [Accepted: 08/09/2017] [Indexed: 01/07/2023]
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23
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Xu T, Wick EC, Makary MA. Sleep deprivation and starvation in hospitalised patients: how medical care can harm patients. BMJ Qual Saf 2015; 25:311-4. [PMID: 26350065 PMCID: PMC4853558 DOI: 10.1136/bmjqs-2015-004395] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 08/17/2015] [Indexed: 12/29/2022]
Affiliation(s)
- Tim Xu
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth C Wick
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Martin A Makary
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
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