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Bett GDS, Schuelter-Trevisol F, Trevisol DJ. Response to "Nutritional considerations with antiobesity medications". Obesity (Silver Spring) 2024. [PMID: 39370393 DOI: 10.1002/oby.24139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 06/27/2024] [Indexed: 10/08/2024]
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Ziqiang S, Jiale L, Renhua S, Aiping W, Yin N, Jingquan L, Feng G, Lijun Y, Guoping G, Aijun D, Yunchao S, Changwen L, Lei X, Ronglin J, Jun L, Ronghai L, Yannan Z, Weidong W, Bo X, Bangchuan H. Ventilatory pressure parameters impact the association between acute gastrointestinal injury and all-cause mortality in mechanically ventilated patients. Sci Rep 2024; 14:20763. [PMID: 39237608 PMCID: PMC11377789 DOI: 10.1038/s41598-024-71556-3] [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: 02/24/2024] [Accepted: 08/29/2024] [Indexed: 09/07/2024] Open
Abstract
Acute gastrointestinal injury (AGI) is common in mechanically ventilated (MV) patients, but the potential association between ventilatory pressure parameters and AGI grade and their impact on mortality remains unclear. This study aimed to explore the association between ventilatory pressure parameters and AGI grade, and their interaction on all-cause mortality in MV patients. This study was a secondary analysis of a multicenter, prospective, observational study that enrolled adult patients with an expected duration of mechanical ventilation ≥ 48 h from 14 general intensive care units in Zhejiang Province between March and August 2014. The AGI grade was assessed daily on the basis of gastrointestinal symptoms, intra-abdominal pressures, and feeding intolerance in the first week of admission to the ICU. This study included 331 patients (69.2% men; mean age, 64.6 ± 18.9 years). Multivariate regression analysis showed that plateau pressure (Pplat) (OR 1.044, 95% CI 1.009-1.081, P = 0.013), serum creatinine (OR 1.003, 95% CI 1.001-1.006, P = 0.042) and APACHE II score (OR 1.035, 95% CI 1.021-1.072, P = 0.045) were independently associated with global AGI grade III/IV within 7 days of ICU admission. Moreover, global AGI grade (HR 2.228, 95% CI 1.561-3.182, P < 0.001), serum creatinine (HR 1.002, 95% CI 1.001-1.003, P = 0.012) and APACHE II score (HR 1.039, 95% CI 1.015-1.063, P = 0.001) were independently associated with 60-day mortality. In addition, there were significant (Pint ≤ 0.028) interactions of Pplat and DP with AGI grade in relation to 60-days mortality, whereas no interaction (Pint = 0.061) between PEEP and AGI grade on 60-days mortality was observed. In the presence of Pplat ≥ 19 cmH2O, the patients with AGI grade III/IV had 60-day mortality rate of 72.2%, significantly higher than those with AGI grade I/II (48.7%, P = 0.018), whereas there were no significant differences (27.9% vs. 33.7%, P = 0.39) in 60-days mortality between AGI grade I/II and III/IV among the patients with Pplat < 19 cmH2O. In comparison with Pplat, DP had a similar interaction (Pint = 0.028) with AGI grade on 60-day mortality. Ventilatory pressure parameters (Pplat and DP) are independent risk factors of AGI grade III/IV. Pplat and DP interact with AGI grade on 60-days mortality, highlighting the importance of optimizing ventilatory pressure parameters to improve gastrointestinal function and survival outcomes of MV patients.Trial registration: ChiCTR-OCS-13003824.
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Affiliation(s)
- Shao Ziqiang
- Emergency and Critical Care Center, ICU, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Shangtang Road 158, Hangzhou, 310014, Zhejiang, China
| | - Li Jiale
- Emergency and Critical Care Center, ICU, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Shangtang Road 158, Hangzhou, 310014, Zhejiang, China
| | - Sun Renhua
- Emergency and Critical Care Center, ICU, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Shangtang Road 158, Hangzhou, 310014, Zhejiang, China
| | - Wu Aiping
- Emergency and Critical Care Center, ICU, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Shangtang Road 158, Hangzhou, 310014, Zhejiang, China
| | - Ni Yin
- Emergency and Critical Care Center, ICU, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Shangtang Road 158, Hangzhou, 310014, Zhejiang, China
| | - Liu Jingquan
- Emergency and Critical Care Center, ICU, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Shangtang Road 158, Hangzhou, 310014, Zhejiang, China
| | - Guo Feng
- ICU, Sir Run Run Shaw Hospital Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, Zhejiang, China
| | - Ying Lijun
- ICU, Shaoxing People's Hospital, Zhongxing North Road, Shaoxing, 321000, China
| | - Ge Guoping
- ICU, Jinhua People's Hospital, 228 Xinhua Street, Jinhua, 321000, China
| | - Ding Aijun
- ICU, The Third Affiliated Hospital of Zhejiang Chinese Medical University, 219 Moganshan Road, Hangzhou, 310014, China
| | - Shi Yunchao
- ICU, The First Hospital of Jiaxing, 529 Hexin South Road, Jiaxing, 314000, China
| | - Liu Changwen
- ICU, Hangzhou First People's Hospital, 261, Huansha Road, Hangzhou, 310006, China
| | - Xu Lei
- ICU, Ningbo Medical Treatment Center Lihuili Hospital, 57 Xingning Road, Ningbo, 315000, China
| | - Jiang Ronglin
- ICU, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Hangzhou, 310006, China
| | - Lu Jun
- ICU, The Second Affiliated Hospital of Zhejiang Chinese Medical University, 318 Chaowang Road, Hangzhou, 310005, China
| | - Lin Ronghai
- ICU, Taizhou Hospital of Zhejiang Province, 150 Ziyang Old Street, Linhai, 317000, China
| | - Zhu Yannan
- ICU, Zhuji People's Hospital of Zhejiang Province, 9 Jianming Road, Shaoxin, China
| | - Wu Weidong
- ICU, The Central Hospital of Lishui City, 15 Dazhong Street, Lishui, 323000, China
| | - Xie Bo
- ICU, Huzhou Central Hospital, 198 Hongqi Road, Huzhou, 313003, China
| | - Hu Bangchuan
- Emergency and Critical Care Center, ICU, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Shangtang Road 158, Hangzhou, 310014, Zhejiang, China.
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Roedl K, Fuhrmann V. [Liver diseases in the intensive care unit]. Med Klin Intensivmed Notfmed 2024; 119:449-457. [PMID: 38937335 DOI: 10.1007/s00063-024-01157-5] [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: 05/22/2024] [Accepted: 06/04/2024] [Indexed: 06/29/2024]
Abstract
The frequency of liver diseases in the intensive care unit has increased significantly in recent years and is now observed in up to 20% of critically ill patients. The occurrence of liver disease is associated with significantly increased morbidity and mortality. Two groups of liver diseases in the intensive care unit can be distinguished. First, the group of "primary hepatic dysfunctions", which includes primary acute liver failure as well as acute-on-chronic liver failure in patients with pre-existing liver cirrhosis. The second group of "secondary or acquired liver diseases" includes cholestatic liver diseases, as well as hypoxic liver injury and mixed forms, as well as other rarer liver diseases. Due to the diversity of liver diseases and the very different triggers, sufficient knowledge of the underlying changes (including hemodynamic changes, inflammatory states or drug-related) is essential. Early recognition, diagnosis, and treatment of the underlying disease are essential for all liver dysfunction in critically ill patients in the intensive care unit. This review article aims to take a closer look at liver diseases in the intensive care unit and provides insight into diagnostics and treatment options.
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Affiliation(s)
- Kevin Roedl
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
| | - Valentin Fuhrmann
- Abteilung für Innere Medizin und Gastroenterologie, Heilig-Geist-Krankenhaus, Köln, Deutschland
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Chapple LS, Neuts A, O'Connor SN, Williams P, Hurford S, Young PJ, Hammond NE, Knowles S, Chapman MJ, Peake S. Nutrition practices in Australia and New Zealand in response to evolving evidence: Results of three point-prevalence audits. Aust Crit Care 2024:S1036-7314(24)00208-X. [PMID: 39179491 DOI: 10.1016/j.aucc.2024.07.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/05/2024] [Accepted: 07/21/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND The Augmented versus Routine Approach to Giving Energy Trial (TARGET) was a 4000-patient trial in which augmented enteral calorie dose did not influence outcomes. AIM We aimed to quantify practice change following TARGET. METHODS Three single-day, prospective, multicentre, point-prevalence audits of adult patients receiving enteral nutrition (EN) in participating Australian and New Zealand intensive care units at 10:00 AM were conducted: (i) 2010 (before conducting TARGET); (ii) 2018 (immediately before publishing TARGET results); and (iii) 2020 (2 years after TARGET publication). Data included baseline characteristics, clinical outcomes, and nutrition data. Data are n (%), mean ± standard deviation, or median [interquartile range]. Differences in enteral calorie prescription between 2018 and 2020 were compared using the Mann-Whitney test. RESULTS The percentage of patients receiving EN (2010 42%, 2018 38%, 2020 33%; P = 0.012) and the prescription of calorie-dense EN formula (≥1.5 kcal/ml) (2010 33%, 2018 24%, 2020 23%; P = 0.038) decreased over time. However, when comparing prepublication and postpublication (2018-2020), calorie dose and calorie density were similar: 22.9 ± 8.6 versus 23.4 ± 12.8 kcal/kg/day (P = 0.816) and <1.5 kcal/ml: 76 versus 77% (P = 0.650), respectively. CONCLUSION In Australian and New Zealand intensive care units, enteral calorie dose and calorie density of prescribed EN were similar before TARGET publication and 2 years later.
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Affiliation(s)
- L S Chapple
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Adelaide Medical School, The University of Adelaide, South Australia, Australia; Centre of Research Excellence in Nutritional Physiology, The University of Adelaide, South Australia, Australia; Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - A Neuts
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Department of Anesthesiology and Intensive Care Medicine, Jessa Hospital, Hasselt, Belgium
| | - S N O'Connor
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Adelaide Medical School, The University of Adelaide, South Australia, Australia; Centre of Research Excellence in Nutritional Physiology, The University of Adelaide, South Australia, Australia
| | - P Williams
- Adelaide Medical School, The University of Adelaide, South Australia, Australia; Centre of Research Excellence in Nutritional Physiology, The University of Adelaide, South Australia, Australia; Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Intensive Care Unit, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - S Hurford
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - P J Young
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Medical Research Institute of New Zealand, Wellington, New Zealand; Intensive Care Unit, Wellington Hospital, Wellington, New Zealand; Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
| | - N E Hammond
- Critical Care Program, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Newtown, NSW, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia
| | - S Knowles
- Critical Care Program, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Newtown, NSW, Australia
| | - M J Chapman
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Adelaide Medical School, The University of Adelaide, South Australia, Australia; Centre of Research Excellence in Nutritional Physiology, The University of Adelaide, South Australia, Australia; Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - S Peake
- Adelaide Medical School, The University of Adelaide, South Australia, Australia; Centre of Research Excellence in Nutritional Physiology, The University of Adelaide, South Australia, Australia; Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Intensive Care Unit, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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de Man AME, Gunst J, Reintam Blaser A. Nutrition in the intensive care unit: from the acute phase to beyond. Intensive Care Med 2024; 50:1035-1048. [PMID: 38771368 PMCID: PMC11245425 DOI: 10.1007/s00134-024-07458-9] [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: 12/27/2023] [Accepted: 04/21/2024] [Indexed: 05/22/2024]
Abstract
Recent randomized controlled trials (RCTs) have shown no benefit but dose-dependent harm by early full nutritional support in critically ill patients. Lack of benefit may be explained by anabolic resistance, suppression of cellular repair processes, and aggravation of hyperglycemia and insulin needs. Also early high amino acid doses did not provide benefit, but instead associated with harm in patients with organ dysfunctions. However, most studies focused on nutritional interventions initiated during the first days after intensive care unit admission. Although the intervention window of some RCTs extended into the post-acute phase of critical illness, no large RCTs studied nutritional interventions initiated beyond the first week. Hence, clear evidence-based guidance on when and how to initiate and advance nutrition is lacking. Prolonged underfeeding will come at a price as there is no validated metabolic monitor that indicates readiness for medical nutrition therapy, and an adequate response to nutrition, which likely varies between patients. Also micronutrient status cannot be assessed reliably, as inflammation can cause redistribution, so that plasma micronutrient concentrations are not necessarily reflective of total body stores. Moreover, high doses of individual micronutrients have not proven beneficial. Accordingly, current evidence provides clear guidance on which nutritional strategies to avoid, but the ideal nutritional regimen for individual patients remains unclear. In this narrative review, we summarize the findings of recent studies, discuss possible mechanisms explaining the results, point out pitfalls in interpretation of RCTs and their effect on clinical practice, and formulate suggestions for future research.
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Affiliation(s)
- Angelique M E de Man
- Department of Intensive Care, Amsterdam UMC, Location Vrije Universiteit, Amsterdam, The Netherlands.
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
| | - Jan Gunst
- Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Annika Reintam Blaser
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia
- Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland
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Abbaszadeh SH, Yousefi M, Arefhosseini SR, Mahmoodpoor A, Mameghani ME. Effect of a seven-strain probiotic on dietary intake, inflammatory markers, and T-cells in severe traumatic brain injury patients: A randomized, double-blind, placebo-controlled trial. Sci Prog 2024; 107:368504241259299. [PMID: 39196597 PMCID: PMC11363228 DOI: 10.1177/00368504241259299] [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] [Indexed: 08/29/2024]
Abstract
BACKGROUND Inflammatory processes are key factors in pathological events associated with severe traumatic brain injury (STBI). The aim of this trial was to determine the effect of probiotics on anthropometric measures, disease severity, inflammatory markers, and T cells in patients with STBI. METHODS Forty adult patients with STBI were enrolled in this parallel randomized, double-blind, placebo-controlled trial. Energy and protein status, Acute Physiology and Chronic Health Evaluation (APACHE II) score, Sequential Organ Failure Assessment (SOFA), interleukin 10 (IL-10), interleukin 1β (IL-1β), tumor necrosis factor-alpha (TNF-α), transforming growth factor beta (TGF-β), T-helper 17 (Th17), and T- Regulator (T-reg) cells were assessed at baseline (day 1), and week 2 (day 14) for each patient. RESULTS Probiotic supplementation led to a substantial reduction in the serum levels of TNF-α (from 10.15 ± 6.52 to 5.05 ± 3.27) (P = 0.034), IL-1β (from 11.84 ± 7.74 to 5.87 ± 3.77) (P < 0.001), and Th17 cells (from 5.19 ± 1.69 to 2.67 ± 1.89) (P < 0.001) and a substantial increase in the serum levels of IL-10 (from 3.35 ± 1.45 to 6.17 ± 2.04) (P = 0.038), TGF-β (from 30.5 ± 15.27 to 46.25 ± 21.05) (P < 0.001), and T-reg cells (from 2.83 ± 1.43 to 4.29 ± 1.89) (P < 0.001) compared with the placebo group. Furthermore, no notable changes were observed in energy and protein intake and also, terms of SOFA and APACHE II scores following probiotic treatment compared with the placebo. CONCLUSIONS Probiotics could reduce inflammation and improve cellular immunity and may be considered as an adjunctive therapy in STBI patients.
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Affiliation(s)
- Seyed Hamze Abbaszadeh
- Department of Biochemistry and Diet Therapy, School of Nutrition & Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehdi Yousefi
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Rafie Arefhosseini
- Department of Biochemistry and Diet Therapy, School of Nutrition & Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ata Mahmoodpoor
- Department of Anesthesiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehrangiz Ebrahimi Mameghani
- Department of Biochemistry and Diet Therapy, School of Nutrition & Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
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Sumritpradit P, Shantavasinkul PC, Ungpinitpong W, Noorit P, Gajaseni C. Effect of high-protein peptide-based formula compared with isocaloric isonitrogenous polymeric formula in critically ill surgical patient. World J Gastrointest Surg 2024; 16:1765-1774. [PMID: 38983323 PMCID: PMC11230013 DOI: 10.4240/wjgs.v16.i6.1765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/03/2024] [Accepted: 04/22/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Malnutrition is common in critically ill patients, and it is associated with an increased risk of complications. Early enteral nutrition with adequate caloric and protein intake is critical nevertheless it is difficult to achieve. Peptide-based formulas have been shown to be beneficial in patients with feeding intolerance. However, there are limited studies showing the efficacy and safety of high-protein peptide-based formula in critically ill surgical patients. AIM To determine the effects of a high-protein peptide formulation on gastrointestinal tolerance, nutritional status, biochemical changes, and adverse events in patients in the surgery intensive care unit (SICU) compared to an isocaloric isonitrogenous standard polymeric formulation. METHODS This study was a multi-center double-blind, randomized controlled trial. We enrolled adult patients in the surgical intensive care unit, age ≥ 15 years and expected to receive enteral feeding for at least 5-14 d post-operation. They were randomly assigned to receive either the high-protein peptide-based formula or the isocaloric isonitrogenous standard formula for 14 d. Gastric residual volume (GRV), nutritional status, body composition and biochemical parameters were assessed at baseline and on days 3, 5, 7, 9, 11, and 14. RESULTS A total of 19 patients were enrolled, 9 patients in the peptide-based formula group and 10 patients in the standard formula group. During the study period, there were no differences of the average GRV, body weight, body composition, nutritional status and biochemical parameters in the patients receiving peptide-based formula, compared to the standard regimen. However, participants in the standard formula lost their body weight, body mass index (BMI) and skeletal muscle mass significantly. While body weight, BMI and muscle mass were maintained in the peptide-based formula, from baseline to day 14. Moreover, the participants in the peptide-based formula tended to reach their caloric target faster than the standard formula. CONCLUSION The study emphasizes the importance of early nutritional support in the SICU and showed the efficacy and safety of a high-protein, peptide-based formula in meeting caloric and protein intake targets while maintaining body weight and muscle mass.
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Affiliation(s)
- Preeda Sumritpradit
- Division of Trauma Surgery and Surgical Critical Care, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Prapimporn Chattranukulchai Shantavasinkul
- Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
- Graduate Program in Nutrition, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | | | - Pinit Noorit
- Department of Surgery, Chonburi Hospital, Chonburi 20000, Thailand
| | - Chotip Gajaseni
- Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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Lawson CM, Jones C, Herman M, Kim C, Mannino E, Omer E, Venegas C. Does Ileus Represent the Forgotten End Organ Failure in Critical Illness? Curr Gastroenterol Rep 2024; 26:166-171. [PMID: 38558135 DOI: 10.1007/s11894-023-00910-8] [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] [Accepted: 12/12/2023] [Indexed: 04/04/2024]
Abstract
PURPOSE OF REVIEW This review evaluates the current literature on ileus, impaired gastrointestinal transit (IGT), and acute gastrointestinal injury (AGI) and its impact on multiple organ dysfunction syndrome. RECENT FINDINGS Ileus is often under recognized in critically ill patients and is associated with significant morbidity and is potentially a marker of disease severity as seen in other organs like kidneys (ATN).
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Affiliation(s)
- Christy M Lawson
- Department of Trauma Surgery, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA.
| | - Chris Jones
- Department of Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Michael Herman
- Department of Gastroenterology, Borland Groover Clinic, Fleming Island, FL, USA
| | - Cecilia Kim
- Department of Trauma Surgery, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Elizabeth Mannino
- Department of Trauma Surgery, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Endashaw Omer
- Department of Gastroenterology, University of Louisville, Louisville, KY, USA
| | - Carlas Venegas
- Department of Neurology, Mayo Clinc, Jacksonville, FL, USA
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Breeding T, Nasef H, Patel H, Awan MU, Chin B, Cruz F, Zito T, Smith CP, Elkbuli A. Clinical Outcomes of Early Versus Late Enteral Nutrition Support in Critically Ill Trauma Patients With Isolated Traumatic Brain Injury. Am Surg 2024; 90:1187-1194. [PMID: 38197391 DOI: 10.1177/00031348241227203] [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] [Indexed: 01/11/2024]
Abstract
INTRODUCTION This study aims to compare the impact of early initiation of enteral feeding initiation on clinical outcomes in critically ill adult trauma patients with isolated traumatic brain injuries (TBI). METHODS A retrospective cohort analysis of the American College of Surgeons Trauma Quality Program Participant Use File 2017-2021 dataset of critically ill adult trauma patients with moderate to severe blunt isolated TBI. Outcomes included ICU length of stay (ICU-LOS), ventilation-free days (VFD), and complication rates. Timing cohorts were defined as very early (<6 hours), early (6-24 hours), intermediate (24-48 hours), and late (>48 hours). RESULTS 9210 patients were included in the analysis, of which 952 were in the very early enteral feeding initiation group, 652 in the early, 695 in intermediate, and 6938 in the late group. Earlier feeding was associated with significantly shorter ICU-LOS (very early: 7.82 days; early: 11.28; intermediate 12.25; late 17.55; P < .001) and more VFDs (very early: 21.72 days; early: 18.81; intermediate 18.81; late 14.51; P < .001). Patients with late EF had a significantly higher risk of VAP than very early (OR .21, CI 0.12-.38, P < .001) or early EF (OR .33, CI 0.17-.65, P = .001), and higher risk of ARDS than the intermediate group (OR .23, CI 0.05-.925, P = .039). CONCLUSION Early enteral feeding in critically ill adult trauma patients with moderate to severe isolated TBI resulted in significantly fewer days in the ICU, more ventilation-free days, and lower odds of VAP and ARDS the sooner enteral feeding was initiated, with the most optimized outcomes within 6 hours.
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Affiliation(s)
- Tessa Breeding
- NOVA Southeastern University, Kiran Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - Hazem Nasef
- NOVA Southeastern University, Kiran Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - Heli Patel
- NOVA Southeastern University, Kiran Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - Muhammad Usman Awan
- NOVA Southeastern University, Kiran Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - Brian Chin
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Francis Cruz
- University of Alabama School of Medicine, Birmingham, AL, USA
| | - Tracy Zito
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL, USA
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA
| | - Chadwick P Smith
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL, USA
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL, USA
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA
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Liang XY, Wu XA, Tian Y, Gao H, Chen JJ, Feng QX. Effects of Early Versus Delayed Feeding in Patients With Acute Pancreatitis: A Systematic Review and Meta-analysis. J Clin Gastroenterol 2024; 58:522-530. [PMID: 37428071 DOI: 10.1097/mcg.0000000000001886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 05/22/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND The aim of this study was to summarize the optimal strategy for early feeding in patients with acute pancreatitis. METHODS The search was undertaken in electronic databases, which compared early with delayed feeding in acute pancreatitis. The primary outcome was the length of hospital stay (LOHS). The second outcomes were intolerance of refeeding, mortality, and total cost of each patient. This meta-analysis followed the "Preferred Reporting Items for Systematic Reviews and Meta-analyses" guideline. Research is registered by PROSPERO, CRD42020192133. RESULTS A total of 20 trials involving 2168 patients were included, randomly assigned to the early feeding group (N = 1033) and delayed feeding group (N = 1135). The LOHS was significantly lower in the early feeding group than the delayed feeding group (mean difference: -2.35, 95% CI: -2.89 to -1.80; P < 0.0001), no matter the mild or severe subgroup ( Pint = 0.69). The secondary outcome of feeding intolerance and mortality were no significant difference (risk ratio: 0.96, 0.40 to 2.16, P = 0.87 and 0.91, 0.57 to 1.46, P = 0.69; respectively). Moreover, the hospitalization cost was significantly less in the early feeding group, resulting in an average savings of 50%. In patients with severe pancreatitis, early feeding after 24 hours may be beneficial ( Pint = 0.001). CONCLUSION Early oral feeding can significantly reduce the LOHS and hospitalization costs in patients with acute pancreatitis without increasing feeding intolerance or mortality. In patients with severe pancreatitis, early feeding after 24 hours may be beneficial.
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Affiliation(s)
- Xi-Ying Liang
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University
- Pancreatic Disease Center, Xi'an Peoples Hospital
| | - Xin-An Wu
- Pancreatic Disease Center, Xi'an Peoples Hospital
| | - Ying Tian
- Pancreatic Disease Center, Xi'an Peoples Hospital
| | - Hang Gao
- Pancreatic Disease Center, Xi'an Peoples Hospital
| | | | - Quan-Xin Feng
- Pancreatic Disease Center, Xi'an Peoples Hospital
- Intensive Care Unit of Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaaxi, China
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11
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Ozhathil DK, Powell CM, Corley CV, Golovko G, Song J, El Ayadi A, Wolf SE, Kahn SA. A retrospective analysis of mortality risk and immunosuppressive therapy for Stevens-Johnson Syndrome and toxic epidermal necrolysis syndrome using the TriNetX research network. Burns 2024; 50:75-86. [PMID: 37734977 DOI: 10.1016/j.burns.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/17/2023] [Accepted: 08/16/2023] [Indexed: 09/23/2023]
Abstract
Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) exist on a spectrum of autoimmune conditions which cause epidermal detachment and keratinocyte necrosis. Due to the rare incidence of these conditions, a dramatic heterogeneity in treatment algorithms exists. To better appreciate pharmacologic immunosuppressive therapies' impact on survival, the authors queried a multi-institutional data network. Data for this study was extracted from TriNetX Research Network, a platform that contains ICD-9/ICD-10 coding data from a consortium of international healthcare organizations. Seventy-one institutions were queried to identify adult patients diagnosed with SJS, TEN or SJS-TEN Overlap. Cohorts were created based on the therapy received: systemic steroids (SS), diphenhydramine (DH), cyclosporine (CS), intravenous immunoglobulin (IVIG), tumor necrosis factor alpha inhibitors (TNFαi), or a combination of treatments. Cohorts were then propensity matched with patients who received supportive care. Patients who only received one of the above treatments showed no significant reduction in 90-day mortality. Patients who received CS or IVIG as part of their multitherapy showed a significantly increased risk of death when compared to supportive care (CS: RR = 1.583, 95% CI [1.119, 2.240]; IVIG: RR = 2.132, 95% CI [1.485, 3.059]). Despite their frequent utilization, this study's analysis suggests that none of these therapies confer significant 90-day mortality survival over supportive care alone. These results highlight the heterogeneity of therapies and emphasize the need for critical prospective appraisal of their outcomes in SJS and TEN.
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Affiliation(s)
- Deepak K Ozhathil
- Department of Surgery, Medical University of South Carolina, 96 Jonathen Lucas Street CSB 420 MSC 613, Charleston, SC 29425, USA.
| | - Carter M Powell
- Department of Surgery, Medical University of South Carolina, 96 Jonathen Lucas Street CSB 420 MSC 613, Charleston, SC 29425, USA
| | - Caroline V Corley
- Department of Surgery, Medical University of South Carolina, 96 Jonathen Lucas Street CSB 420 MSC 613, Charleston, SC 29425, USA
| | - George Golovko
- 301 University Boulevard, Department of Pharmacology, University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA
| | - Juquan Song
- 301 University Boulevard, Department of Surgery, University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA
| | - Amina El Ayadi
- 301 University Boulevard, Department of Surgery, University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA
| | - Steven E Wolf
- 301 University Boulevard, Department of Surgery, University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA
| | - Steven A Kahn
- Department of Surgery, Medical University of South Carolina, 96 Jonathen Lucas Street CSB 420 MSC 613, Charleston, SC 29425, USA
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12
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Liang B, Su J, Chen J, Shao H, Shen L, Xie B. Glutamine enteral therapy for critically ill adult patients: An updated meta-analysis of randomized controlled trials and trial sequential analysis. Clin Nutr 2024; 43:124-133. [PMID: 38041938 DOI: 10.1016/j.clnu.2023.11.011] [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: 09/21/2023] [Revised: 11/08/2023] [Accepted: 11/12/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND The efficacy of supplemental enteral glutamine (GLN) in critical illness patients remains uncertainty. OBJECTIVE Based on a recently published large-scale randomized controlled trials (RCTs) as regards the use of enteral GLN, we updated a meta-analysis of RCTs for further investigating the effects of enteral GLN administration in critically ill patients. METHODS We searched RCTs reporting the impact of supplemental enteral GLN about clinical outcomes in adult critical illness patients from EMBASE, PubMed, Clinical Trials.gov, Scopus and Web of Science and subsequently registered the protocol in the PROSPERO (CRD42023399770). RCTs of combined enteral-parenteral GLN or parenteral GLN only were excluded. Hospital mortality was designated as the primary outcome. We conducted subgroup analyses of primary outcome based on specific patient populations, dosages and therapy regimens, and further performed trial sequential analysis (TSA) for clinical outcomes. RESULTS Eighteen RCTs involving 2552 adult critically ill patients were identified. There were no remarkable influences on hospital mortality regardless of different subgroups (OR, 1.05; 95% CI, 0.85-1.30; p = 0.67), intensive care unit (ICU) length of stay (LOS) (MD, -0.07; 95% CI, -1.12 - 0.98; p = 0.89) and infectious complications (OR, 0.90; 95% CI, 0.75-1.10; p = 0.31) with enteral GLN supplementation. Additionally, the results of hospital mortality were confirmed by TSA. However, enteral GLN therapy was related to a reduction of hospital LOS (MD, -2.85; 95% CI, -5.27 to -0.43; p = 0.02). CONCLUSIONS In this meta-analysis, it seems that enteral GLN supplementation is unlikely ameliorate clinical outcomes in critical illness patients except for the reduction of hospital LOS. Our data do not support enteral GLN supplementation used routinely in critical illness patients.
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Affiliation(s)
- Baofang Liang
- Department of Healthcare-associated Infection Management, The Tenth Affiliated Hospital of Southern Medical University (Dongguan People's Hospital), Dongguan, Guangdong, China
| | - Jianwei Su
- Department of Clinical Pharmacy, Dongguan Tungwah Hospital, Dongguan, Guangdong, China
| | - Jie Chen
- Department of Critical Care Medicine, The Tenth Affiliated Hospital of Southern Medical University (Dongguan People's Hospital), Dongguan, Guangdong, China
| | - Hanquan Shao
- Department of Critical Care Medicine, The Tenth Affiliated Hospital of Southern Medical University (Dongguan People's Hospital), Dongguan, Guangdong, China
| | - Lihan Shen
- Department of Critical Care Medicine, The Tenth Affiliated Hospital of Southern Medical University (Dongguan People's Hospital), Dongguan, Guangdong, China.
| | - Baocheng Xie
- Department of Pharmacy, The Tenth Affiliated Hospital of Southern Medical University (Dongguan People's Hospital), Dongguan, Guangdong, China.
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13
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Elmahdi A, Eisa M, Omer E. Aspiration pneumonia in enteral feeding: A review on risks and prevention. Nutr Clin Pract 2023; 38:1247-1252. [PMID: 37227191 DOI: 10.1002/ncp.11020] [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: 12/19/2022] [Revised: 04/02/2023] [Accepted: 04/30/2023] [Indexed: 05/26/2023] Open
Abstract
Enteral feeding plays a critical role in the management of hospitalized patients, especially in intensive care units. In addition to delivering important nutrients, it also maintains the integrity of the gut and microbiota. Enteral feeding is also associated with complications and adverse events, some are related to access placement, metabolic and electrolytes disturbances, and aspiration pneumonia. In tube-fed patients, aspiration pneumonia has a prevalence ranging from 4% to 95% with a mortality rate of 17%-62%. Our review has not showed any significant difference in the incidence of aspiration pneumonia between gastric and postpyloric feeding and, given the ease of gastric access, we therefore suggest using gastric feeding as an initial strategy for the delivery of nutrition unless postpyloric access is otherwise indicated for other clinical reasons.
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Affiliation(s)
- Alsiddig Elmahdi
- Internal Medicine, Virginia Commonwealth University Health Systems, Richmond, Virginia, USA
| | - Mohamed Eisa
- Allegheny Center for Digestive Health, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Endashaw Omer
- Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville School of Medicine, Louisville, Kentucky, USA
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14
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Haseeb M, Goiporia MH, Siddiqui MS, Sangle AL, Quadri SF, Ravali RL. Challenges Encountered in the Provision of Enteral Nutrition in Pediatric Intensive Care Unit: An Observational Study. Cureus 2023; 15:e49285. [PMID: 38143607 PMCID: PMC10747421 DOI: 10.7759/cureus.49285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
Background Enteral nutrition (EN) represents the preferred modality for nutrient administration in critically ill patients. However, it is fraught with challenges such as delayed initiation and recurrent interruptions, which can significantly impact patient clinical outcomes. A substantial proportion of these interruptions can be mitigated. In the present investigation, our objective was to scrutinize the practice of EN in the Pediatric Intensive Care Unit (PICU). We sought to ascertain the frequency and underlying causes of EN interruptions and assess their ramifications for nutrient delivery. Study design We conducted an observational study within the PICU of Mahatma Gandhi Mission's (MGM) Medical College and Hospital, Aurangabad. The study encompassed children admitted to the PICU for a period exceeding 24 hours who were receiving enteral feeds. We documented the time of commencing EN from the point of PICU admission, instances of enteral feeding interruptions, the number and duration of each interruption episode, and the reasons behind these interruptions. Subsequently, we categorized the causes of feeding interruptions into avoidable and non-avoidable determinants. Results Out of the 100 patients enrolled in this study, only 34% presented with normal nutritional status upon admission. Sixty-five percent of patients had their nutritional support initiated within the first 48 hours of admission to the PICU. The median duration from PICU admission to the initiation of EN was 32.5 hours, with a median interruption duration per patient of 40.96 hours. Common causes of interruptions included radiological procedures, respiratory distress, altered sensorium, presence of gastric aspirates, and surgical procedures. Upon analysis, it was determined that a substantial majority, constituting 74%, of these interruptions were avoidable. Conclusions The primary challenges associated with EN in the PICU encompass delayed initiation of enteral feeds and frequent interruptions. Importantly, a significant proportion of these issues are avoidable.
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Affiliation(s)
- Mohammad Haseeb
- Department of Pediatrics, Mahatma Gandhi Mission's (MGM) Medical College and Hospital, a Constituent Unit of MGM Institute of Health Sciences, Aurangabad, IND
| | - Mahafrin H Goiporia
- Department of Pediatrics, Mahatma Gandhi Mission's (MGM) Medical College and Hospital, a Constituent Unit of MGM Institute of Health Sciences, Aurangabad, IND
| | - Mohd Saeed Siddiqui
- Department of Pediatrics, Mahatma Gandhi Mission's (MGM) Medical College and Hospital, a Constituent Unit of MGM Institute of Health Sciences, Aurangabad, IND
| | - Avinash L Sangle
- Department of Pediatrics, Mahatma Gandhi Mission's (MGM) Medical College and Hospital, a Constituent Unit of MGM Institute of Health Sciences, Aurangabad, IND
| | - Syed F Quadri
- Department of Public Health, John Snow, Inc. (JSI), Delhi, IND
| | - Ramula L Ravali
- Department of Pediatrics, Mahatma Gandhi Mission's (MGM) Medical College and Hospital, a Constituent Unit of MGM Institute of Health Sciences, Aurangabad, IND
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15
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Haines KL, Ohnuma T, Grisel B, Krishnamoorthy V, Raghunathan K, Sulo S, Kerr KW, Besecker B, Cassady BA, Wischmeyer PE. Early enteral nutrition is associated with improved outcomes in critically ill mechanically ventilated medical and surgical patients. Clin Nutr ESPEN 2023; 57:311-317. [PMID: 37739674 DOI: 10.1016/j.clnesp.2023.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND AIMS Data suggest that guidelines for enteral nutrition (EN) initiation are not closely followed in clinical practice. In addition, critically ill mechanically ventilated (MV) patients have varying metabolic needs, which often increase and persist over time, requiring personalized nutrition intervention. While both over- and under-nutrition can impact patient outcomes, recent data suggest that targeted early EN delivery may reduce mortality and improve clinical outcomes. This study examined if early EN improves clinical outcomes and decreases costs in critically ill patients on MV. METHODS Data from a nationwide administrative-financial database between 2018 and 2020 was utilized to identify eligible adult critical care patients. Patients who received EN within 3 days after intubation (early EN) were compared to patients who started EN after 3 days of intubation (late EN). Outcomes of interest included hospital mortality, discharge disposition, hospital and intensive care unit (ICU) length of stay (LOS), MV days, and total cost. After inverse-probability-of-treatment weighting, outcomes were modeled using a nominal logistic regression model for hospital mortality and discharge disposition, a linear regression model for cost, and Cox proportional-hazards model for MV days, hospital and ICU LOS. RESULTS A total of 27,887 adult patients with early MV were identified, of which 16,772 (60.1%) received early EN. Regression analyses showed that the early EN group had lower hospital mortality (OR = 0.88, 95% CI, 0.82 to 0.94), were more likely to be discharged home (OR = 1.47, 95% CI 1.38 to 1.56), had fewer MV days (HR = 1.23, 95% CI, 1.11 to 1.37), shorter hospital LOS (HR = 1.43, 95% CI, 1.33 to 1.54) and ICU LOS (HR = 1.36, 95% CI, 1.27 to 1.46), and lower cost (-$21,226; 95% CI, -$23,605 to -$18,848) compared to the late EN group. CONCLUSIONS Early EN within 3 days of MV initiation in real-world practice demonstrated improved clinical and economic outcomes. These data suggest that early EN is associated with decreased hospital mortality, increased discharge to home, and decreased hospital and ICU LOS, time on MV, and cost compared to delayed initiation of EN; highlighting the importance of early EN to optimize utcomes ando support the recovery of critically ill patients on MV.
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Affiliation(s)
- Krista L Haines
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA; The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
| | - Tetsu Ohnuma
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA; Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
| | - Braylee Grisel
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
| | - Vijay Krishnamoorthy
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA; Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA
| | - Karthik Raghunathan
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA; Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
| | - Suela Sulo
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
| | - Kirk W Kerr
- Scientific and Medical Affairs, Abbott Nutrition, Columbus, OH, USA.
| | - Beth Besecker
- Scientific and Medical Affairs, Abbott Nutrition, Columbus, OH, USA.
| | - Bridget A Cassady
- Scientific and Medical Affairs, Abbott Nutrition, Columbus, OH, USA.
| | - Paul E Wischmeyer
- Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
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16
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Zhang J, Deng J, Li J, Su Y, Hu J, Lin D, Su M, Chen Y, Liao S, Bai X, Lv M, Xu T, Zhong Q, Guo X. Changes of gut microbiota under different nutritional methods in elderly patients with severe COVID-19 and their relationship with prognosis. Front Immunol 2023; 14:1260112. [PMID: 37781374 PMCID: PMC10533997 DOI: 10.3389/fimmu.2023.1260112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
Background The clinical progression of individuals afflicted with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection exhibits significant heterogeneity, particularly affecting the elderly population to a greater extent. Consequently, the association between nutrition and microbiota has garnered considerable interest. Hence, the objective of this study was to gather clinical data pertaining to the influence of diverse nutritional support interventions on the prognosis of geriatric patients with COVID-19, while additionally examining the fecal microbiota of these individuals to assess the repercussions of microecological alterations on their prognostic outcomes. Results A total of 71 elderly patients diagnosed with severe COVID-19 were included in this study. These patients were subsequently divided into two groups, namely the enteral nutrition (EN) group and the parenteral nutrition (PN) group, based on the type of nutritional support therapy they received after admission. The occurrence of complications was observed in 10.4% of patients in the EN group, whereas it was significantly higher at 69.6% in the PN group (P<0.001). Furthermore, the 60-day mortality rate was 2.1% (1/48) in the EN group, while it was notably higher at 30.4% (7/23) in the PN group (P=0.001). To identify the independent predictors of 60-day mortality, stepwise logistic regression analysis was employed. Among different bacterial groups, Enterococcus_faecium (18.19%) and Pseudomonas_aeruginosa (1.91%) had higher average relative abundance in the PN group (P<0.05). However, the relative abundance of Ruminococcus was higher in the EN group. Further Spearman correlation analysis showed that Enterococcus_faecium was positively correlated with poor clinical prognosis, while Ruminococcus was negatively correlated with poor clinical prognosis. Conclusions This study shows that the changes in the composition of intestinal flora in elderly COVID-19 patients receiving different nutritional support strategies may be related to different clinical outcomes. The abundance of Enterococcus_faecium in elderly COVID-19 patients receiving PN is significantly increased and is closely related to poor clinical outcomes. It highlights the potential of microbiome-centric interventions to mitigate and manage COVID-19 in older adults with different nutritional support options.
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Affiliation(s)
- Jiawei Zhang
- Department of General Surgery (Endoscopic Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Human Microbiome and Chronic Diseases (Sun Yat-sen University), Ministry of Education, Guangzhou, China
| | - Jiaxin Deng
- Department of General Surgery (Endoscopic Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Human Microbiome and Chronic Diseases (Sun Yat-sen University), Ministry of Education, Guangzhou, China
| | - Juan Li
- Department of General Surgery (Endoscopic Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Human Microbiome and Chronic Diseases (Sun Yat-sen University), Ministry of Education, Guangzhou, China
| | - Yuping Su
- Department of General Surgery (Endoscopic Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Human Microbiome and Chronic Diseases (Sun Yat-sen University), Ministry of Education, Guangzhou, China
| | - Jiancong Hu
- Department of General Surgery (Endoscopic Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Human Microbiome and Chronic Diseases (Sun Yat-sen University), Ministry of Education, Guangzhou, China
| | - Dezheng Lin
- Department of General Surgery (Endoscopic Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Human Microbiome and Chronic Diseases (Sun Yat-sen University), Ministry of Education, Guangzhou, China
| | - Mingli Su
- Department of General Surgery (Endoscopic Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Human Microbiome and Chronic Diseases (Sun Yat-sen University), Ministry of Education, Guangzhou, China
| | - Yongcheng Chen
- Department of General Surgery (Endoscopic Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Human Microbiome and Chronic Diseases (Sun Yat-sen University), Ministry of Education, Guangzhou, China
| | - Sen Liao
- Department of General Surgery (Endoscopic Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Human Microbiome and Chronic Diseases (Sun Yat-sen University), Ministry of Education, Guangzhou, China
| | - Xuhao Bai
- The Medical College of Xizang Minzu University, Xianyang, Shaanxi, China
| | - Miwei Lv
- The Medical College of Xizang Minzu University, Xianyang, Shaanxi, China
| | - Tian Xu
- The Medical College of Xizang Minzu University, Xianyang, Shaanxi, China
| | - Qinghua Zhong
- Department of General Surgery (Endoscopic Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Human Microbiome and Chronic Diseases (Sun Yat-sen University), Ministry of Education, Guangzhou, China
| | - Xuefeng Guo
- Department of General Surgery (Endoscopic Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Human Microbiome and Chronic Diseases (Sun Yat-sen University), Ministry of Education, Guangzhou, China
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17
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Singer P, Blaser AR, Berger MM, Calder PC, Casaer M, Hiesmayr M, Mayer K, Montejo-Gonzalez JC, Pichard C, Preiser JC, Szczeklik W, van Zanten ARH, Bischoff SC. ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit. Clin Nutr 2023; 42:1671-1689. [PMID: 37517372 DOI: 10.1016/j.clnu.2023.07.011] [Citation(s) in RCA: 90] [Impact Index Per Article: 90.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 06/27/2023] [Accepted: 07/10/2023] [Indexed: 08/01/2023]
Abstract
Following the new ESPEN Standard Operating Procedures, the previous 2019 guideline to provide best medical nutritional therapy to critically ill patients has been shortened and partially revised. Following this update, we propose this publication as a practical guideline based on the published scientific guideline, but shortened and illustrated by flow charts. The main goal of this practical guideline is to increase understanding and allow the practitioner to implement the Nutrition in the ICU guidelines. All the items discussed in the previous guidelines are included as well as special conditions.
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Affiliation(s)
- Pierre Singer
- Intensive Care Unit, Herzlia Medical Center and Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, and Intensive Care Unit, Herzlia Medical Center, Israel.
| | - Annika Reintam Blaser
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia; Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Mette M Berger
- Faculty of Biology and Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Philip C Calder
- School of Human Development and Health, Faculty of Medicine, University of Southampton and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United Kingdom
| | - Michael Casaer
- Clinical Department and Laboratory of Intensive Care Medicine, Catholic University Hospitals (UZLeuven) and Catholic University Leuven, Leuven, Belgium
| | - Michael Hiesmayr
- Division Cardiac-, Thoracic-, Vascular Anaesthesia and Intensive Care, Medical University Vienna, Vienna, Austria
| | - Konstantin Mayer
- Department of Pneumonology, Infectious Diseases and Sleep Medicine, St. Vincentius Kliniken gAG, Karlsruhe, Germany
| | | | - Claude Pichard
- Department of Clinical Nutrition, Geneva University Hospital, Geneva, Switzerland
| | - Jean-Charles Preiser
- Medical Direction, Hopital Universitaire de Bruxelles, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Wojciech Szczeklik
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College & Anesthesia and Intensive Care Department, 5th Military Hospital, Krakow, Poland
| | - Arthur R H van Zanten
- Department of Intensive Care, Gelderse Vallei Hospital, Ede, The Netherlands & Wageningen University & Research, Wageningen, the Netherlands
| | - Stephan C Bischoff
- Department of Nutritional Medicine/Prevention, University of Hohenheim, Stuttgart, Germany
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18
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Lin ZW, Liu YY, Chen XH, Zheng YR, Cao H, Chen Q. Clinical effect of early enteral nutrition support on critically ill neonates with extracorporeal membrane oxygenation. BMC Pediatr 2023; 23:359. [PMID: 37442946 PMCID: PMC10339525 DOI: 10.1186/s12887-023-04171-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023] Open
Abstract
OBJECTIVE To investigate the feasibility and clinical outcomes of early enteral nutrition (EN) in critically ill neonates supported by extracorporeal membrane oxygenation (ECMO). METHODS We retrospectively analyzed the clinical data of 16 critically ill neonates who received ECMO support for respiratory and circulatory failure from July 2021 to December 2022 at our center. The patients were divided into two groups: the early EN group (< 24 h) and the late EN group (> 24 h). The related clinical and nutrition-related indicators between the groups were compared. RESULTS There was a significant difference in the time from ECMO treatment to the start of EN between the early EN group (9 patients, 56.2%) and the late EN group (7 patients, 43.8%) (P < 0.05). However, there were no significant differences in ECMO duration, hospitalization time, vasoactive-inotropic score (VIS), intestinal oxygen saturation, or routine stool occult blood (OB) test between the two groups (all P > 0.05). The incidence of complications such as intestinal obstruction, abdominal distension, diarrhea, and necrotizing enterocolitis (NEC) was slightly lower in the early EN group, but the differences were not statistically significant (all P > 0.05). The early EN group had a shorter time [3.6 (3.5, 5) vs. 7.5 (5.9, 8.5) d] to reach full gastrointestinal nutrition compared to the late EN group (P < 0.05). CONCLUSION Providing early nutritional support through enteral feeding to critically ill neonates receiving ECMO treatment is both safe and practical, but close monitoring of clinical and nutritional indicators is essential.
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Affiliation(s)
- Ze-Wei Lin
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Ying-Ying Liu
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xiu-Hua Chen
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Yi-Rong Zheng
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.
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19
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Ciríaco GV, Menezes-Júnior LAAD, Oliveira WWD, Talvani A, Turbino Ribeiro SML. Pressure ulcer incidence in critically ill patients: Role of body mass index, nutrition therapy, and other non-nutritional factors. Clin Nutr ESPEN 2023; 55:285-291. [PMID: 37202058 DOI: 10.1016/j.clnesp.2023.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/28/2023] [Accepted: 03/30/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To assess the clinical and nutritional risk factors related to the occurrence of pressure ulcers (PUs) in patients admitted to an Intensive Care Unit (ICU). METHODS This is a cohort retrospective study, carried out by analyzing the medical records of patients admitted to the ICU of a hospital, containing information on sociodemographic, clinical, dietary, and anthropometric data, presence of mechanical ventilation, sedation, and use of noradrenaline. To verify the clinical and nutritional risk factors, multivariate Poisson's regression with robust variance was used to estimate the relative risk (RR) according to the explanatory variables. RESULTS A total of 130 patients were evaluated from January 1 to December 31, 2019. The incidence of PUs in the study population was 29.2%. In univariate analysis, male sex, suspended or enteral diet, use of mechanical ventilation, and sedatives had a significant association with the PUs (p < 0.05). However, when adjusted for potential confounders, only suspended diet remained associated with the PUs. Furthermore, in an analysis stratified by hospitalization time, it was observed that for each 1 kg/m2 increase in body mass index, there is a 10% increased risk of PUs occurrence (RR: 1.10; 95%CI: 1.01-1.23). CONCLUSION Patients with suspended diet, diabetics, with longer-time hospitalization, and overweight have a higher risk of presenting pressure ulcers.
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Affiliation(s)
| | - Luiz Antônio Alves de Menezes-Júnior
- Pós-doctorate Researcher in the Post-graduate Program in Health and Nutrition, Nutrition School, Federal University of Ouro Preto. Ouro Preto, Minas Gerais, Brazil.
| | - Wandeir Wagner de Oliveira
- Department of Family Medicine, Mental Health and Public Health, School of Medicine, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil.
| | - André Talvani
- Associate Professor in the Post-graduate Program in Health and Nutrition, Nutrition School, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil.
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20
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Umbrello M, Marini JJ, Formenti P. Metabolic Support in Acute Respiratory Distress Syndrome: A Narrative Review. J Clin Med 2023; 12:jcm12093216. [PMID: 37176655 PMCID: PMC10179727 DOI: 10.3390/jcm12093216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/14/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Nutritional support for acute respiratory distress syndrome (ARDS) patients shares metabolic notions common to other critically ill conditions. Nevertheless, it generates specific concern regarding the primary limitation of oxygen supply and the complications of carbon dioxide elimination, as well as the significant metabolic alterations due to the body's response to illness. In the present narrative review, after briefly summarizing the pathophysiology of critical illness stress response and patients' metabolic requirements, we focus on describing the characteristics of metabolic and artificial nutrition in patients with acute respiratory failure. In patients with ARDS, several aspects of metabolism assume special importance. The physiological effects of substrate metabolism are described for this setting, particularly regarding energy consumption, diet-induced thermogenesis, and the price of their clearance, transformation, and storage. Moreover, we review the possible direct effects of macronutrients on lung tissue viability during ARDS. Finally, we summarize the noteworthy characteristics of metabolic control in critically ill patients with ARDS and offer a suggestion as to the ideal methods of metabolic support for this problem.
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Affiliation(s)
- Michele Umbrello
- Unità Operativa di Anestesia e Rianimazione II, Ospedaliera San Carlo, ASST Santi Paolo e Carlo, 20148 Milan, Italy
| | - John J Marini
- Department of Pulmonary and Critical Care Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - Paolo Formenti
- SC Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy
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21
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Dehghani MH, Saghafi F, Bordbari Z, Zare-Kamali J, Jafari-Nedooshan J, Sahebnasagh A. Investigating the effect of oral synbiotic on enteral feeding tolerance in critically ill patients: A double-blinded controlled clinical trial of gut microbiota. Nutr Clin Pract 2023; 38:402-410. [PMID: 35809224 DOI: 10.1002/ncp.10895] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/28/2022] [Accepted: 05/14/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Probiotics are beneficial live microorganisms that can modify the gut microbiota. It is assumed that they help improve enteral feeding intolerance (EFI) and nosocomial infections in critically ill patients. The present clinical trial aimed to investigate the efficacy of synbiotics in improving EFI and oropharyngeal aspiration in patients admitted to the intensive care unit (ICU). METHODS This randomized clinical trial was conducted on 105 critically ill patients admitted to the ICU of a tertiary referral hospital affiliated with a medical university. The patients were randomly assigned to either a synbiotic or control group and underwent 7 days of investigation. The primary end point was reduced gastric residual volume, which is suggestive of an improvement in EFI. The secondary end point included requirement for prokinetics, frequency of aspiration, duration of mechanical ventilation, length of ICU stay, and level of consciousness. RESULTS The present clinical trial showed that synbiotic intervention has resulted in a significantly diminished requirement for prokinetics (P = 0.019), fewer oropharyngeal aspirations (P = 0.01), improved volume of bolus administration, and decreased gastric residual volume during the 7-day follow-up period. The patients who received synbiotic had an improved level of consciousness (P = 0.01). CONCLUSION This clinical trial showed that the prescription of synbiotic from the initial days of enteral feeding has resulted in a significantly diminished requirement for prokinetics, less oropharyngeal aspiration, decreased gastric residual volume, improved volume of bolus administration, and hence, better tolerance of enteral feeding.
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Affiliation(s)
- Mohammad Hossein Dehghani
- Department of Anesthesiology and Critical Care, Shahid Rahnemoun Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Fatemeh Saghafi
- Department of Clinical Pharmacy, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Zeinab Bordbari
- Department of Clinical Pharmacy, Faculty of Pharmacy, Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Javad Zare-Kamali
- Department of Clinical Pharmacy, Faculty of Pharmacy, Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Jamal Jafari-Nedooshan
- Department of Surgery, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Adeleh Sahebnasagh
- Clinical Research Center, Department of Internal Medicine, School of Medicine, Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
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22
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Solana MJ, Manrique G, Slocker M, Fernández R, Gil R, Yun C, García M, Redondo S, Balaguer M, Rodríguez E, González-Posada A, Goñi C, Martín CM, Santiago C, Sánchez M, Miñambres M, López-Herce J. Early vs late enteral nutrition in pediatric intensive care unit: Barriers, benefits, and complications. Nutr Clin Pract 2023; 38:442-448. [PMID: 36268895 DOI: 10.1002/ncp.10922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 09/08/2022] [Accepted: 09/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to define the existing barriers for early enteral nutrition (EEN) in critically ill children and to analyze the differences in nutrient supply, complications, and outcomes between EEN and late EN (LEN). METHODS This is a secondary analysis of a multicenter observational, prospective study including critically ill children receiving EN. Variables analyzed included demographic and anthropometric features, caloric and nutrient supply, outcomes, and complications according to the EN onset. Patients were classified into two groups according to the start of EN: 24-EEN vs EN started after 24 h (24-LEN) and 48-EEN vs EN started after 48 h (48-LEN). RESULTS Sixty-eight children were enrolled; 22.1% received 24-EEN, and 67.6% received 48-EEN. EN was most frequently delayed in patients older than 12 months, in patients with cardiac disease, and in those requiring mechanical ventilation (MV). Children in the 24-EEN group had shorter duration of MV compared with those in the 24-LEN group (P = 0.04). The 48-EEN group received a higher caloric intake (P = 0.04), reached the caloric target earlier (P < 0.01), and had lower incidence of constipation (P = 0.01) than the 48-LEN group. There was a positive correlation between the time required to reach the maximum caloric intake and the length of pediatric intensive care stay (r = 0.46; P < 0.01). CONCLUSION EEN may improve nutrient delivery, reduce time on MV, and prevent constipation in critically ill children. No relevant differences between 24-EEN and 48-EEN were found. Cardiac disease, MV, and age older than 12 months were risk factors associated with LEN.
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Affiliation(s)
- María José Solana
- Gregorio Marañón University Hospital, Madrid, Spain.,Research Network on Maternal and Child Health and Development (RedSAMID), Madrid, Spain.,Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
| | - Gema Manrique
- Gregorio Marañón University Hospital, Madrid, Spain.,Research Network on Maternal and Child Health and Development (RedSAMID), Madrid, Spain.,Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
| | - María Slocker
- Research Network on Maternal and Child Health and Development (RedSAMID), Madrid, Spain.,Clínico Universitario de la Arrixaca, Murcia, Spain
| | | | - Raquel Gil
- H. Regional Universitario de Málaga, Málaga, Spain
| | - Cristina Yun
- H. Regional Universitario de Málaga, Málaga, Spain
| | | | | | | | - Eva Rodríguez
- H. Nuestra Señora de la Candelaria, Santa Cruz, Spain
| | | | | | | | | | | | | | - Jesús López-Herce
- Gregorio Marañón University Hospital, Madrid, Spain.,Research Network on Maternal and Child Health and Development (RedSAMID), Madrid, Spain.,Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain.,Maternal and Child Public Health Department, School of Medicine, Complutense University of Madrid, Madrid, Spain
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23
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Aadal L, Holst M, Rasmussen HH, Nielsen JF, Odgaard L. Malnutrition in Patients With Moderate to Severe Acquired Brain Injury: Prevalence During 4 Weeks of Subacute Rehabilitation. J Neurosci Nurs 2023; 55:38-44. [PMID: 36749958 DOI: 10.1097/jnn.0000000000000688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
ABSTRACT BACKGROUND: Malnutrition is associated with high rates of complication, longer hospital stays, and increased morbidity and mortality. Malnutrition defined as undernutrition is common in patients with acquired brain injury (ABI); however, estimates vary remarkably. This study aimed to describe malnutrition at admission and after 4 weeks of subacute inpatient neurorehabilitation in patients with ABI using the new global consensus definition of malnutrition. METHODS: One hundred thirty-three patients with moderate to severe ABI consecutively admitted to a specialized neurorehabilitation hospital within a period of 4 months were screened for inclusion, of which 92 were included. Malnutrition was defined as at least 1 phenotypic criterion (weight loss, low body mass index, low muscle mass) and at least 1 etiologic criterion (reduced food intake, inflammation). Malnutrition on admission and after 4 weeks was compared using the McNemar test. RESULTS: The proportion of patients with malnutrition at admission was 42%, with more men (46%) than women (36%) fulfilling the criteria for malnutrition. The most frequent phenotypic and etiologic criteria were weight loss (56%) and inflammation (74%), respectively. During the 4 weeks of rehabilitation, the proportion of male patients fulfilling the individual criteria "weight loss" (difference, -21.4%) and "inflammation" (difference, -18.9%) decreased significantly; "low muscle mass" decreased borderline significant (difference, -8.9%), whereas "low body mass index" did not change. The proportion of female patients fulfilling individual criteria for malnutrition was stable or increased nonsignificantly. CONCLUSION: Malnutrition was common at admission to neurorehabilitation in patients with moderate to severe ABI, with more men than women fulfilling the criteria for malnutrition. The nutritional status improved after 4 weeks of rehabilitation in male patients, whereas it was largely unchanged in female patients. The results provide the basis for monitoring high-quality nutritional nursing care.
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24
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Wang Z, Zhang L, Huang T, Yang R, Cheng H, Wang H, Yin H, Lyu J. Developing an explainable machine learning model to predict the mechanical ventilation duration of patients with ARDS in intensive care units. Heart Lung 2023; 58:74-81. [PMID: 36423504 PMCID: PMC9678346 DOI: 10.1016/j.hrtlng.2022.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/25/2022] [Accepted: 11/11/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) is common in intensive care units with high mortality rate and mechanical ventilation (MV) is the most important related treatment. Early prediction of MV duration has benefit for patients risk stratification and care strategies support. OBJECTIVE To develop an explainable model for predicting mechanical ventilation (MV) duration in patients with ARDS using the machine learning (ML) approach. METHOD The number of 1,148, 1,697, and 29 ARDS patients admitted to intensive care units (ICU) in the MIMIC-IV, eICU-CRD, and AmsterdamUMCdb databases were included in the study. Features at MV initiation from the MIMIC-IV dataset were used to train prediction models based on seven supervised machine learning algorithms. After 5-fold cross-validation for hyperparameters tuning, the hyperparameters- optimized model of different algorithms was tested by external datasets extracted from eICU-CRD and Amsterdamumcdb. Finally, three descriptive machine learning explanation methods were conducted for the model explanation. RESULT The XGBoosting model showed the most stable and accurate performance among two testing datasets (RMSE= 5.57 and 5.46 days in eICU-CRD and AmsterdamUMCdb) and was selected as the optimal model. The model explanation based on SHAP, LIME, and DALEX results showed a consistent result, vasopressor, PH, and SOFA score had the highest effect on MV duration prediction. CONCLUSION ML models with features at MV initiation can accurate predict MV duration in patients with ARDS in ICUs. Among seven algorithms, XGB models showed the best performance (RMSE= 5.57 and 5.46 in two external datasets). LIME, SHAP, and Breakdown methods showed good performance as AXI methods.
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Affiliation(s)
- Zichen Wang
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China; Department of Public Health, University of California, Irvine, Irvine, California, United State
| | - Luming Zhang
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China; Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Tao Huang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Rui Yang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China; School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Hongtao Cheng
- School of Nursing, Jinan University, Guangzhou, China
| | - Hao Wang
- Department of Statistics, Iowa State University, Ames, Iowa, Unite States
| | - Haiyan Yin
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China.
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China; Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, Guangdong, China.
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25
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Hiesmayr M, Fischer A, Veraar C, Mora B, Tarantino S, Weimann A, Volkert D. [Nutrition practices in intensive care units: nutritionDay from 2007-2021]. Med Klin Intensivmed Notfmed 2023; 118:89-98. [PMID: 36853418 PMCID: PMC9992071 DOI: 10.1007/s00063-023-00996-y] [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: 01/18/2023] [Revised: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 03/01/2023]
Abstract
In intensive care units (ICU), patients who are not able to eat or are considered at nutritional risk typically receive medical nutrition therapy based on partially contradictory guidelines as well as the strategies used in large randomized trials. The aim of this study is to analyze patient data from the nutritionDay project in intensive care to describe current clinical approaches to nutrition support worldwide, in Europe and in the group of German-speaking countries, the DACH (i.e., Germany, Austria, Switzerland) region. From 2007-2021, data of 18,918 adult patients in 1595 ICUs from 63 different countries were included in this cross-sectional study. The aim was to recruit all patients present in ICUs. Median stay in the ICU was 4 days on nutritionDay. Little difference in patient characteristics were observed between worldwide, Europe, and the DACH region. Patient were 64 years old, 40% female, 50% ventilated, 29% sedated, and 10% needed renal replacement therapy. A quarter of the patients died in hospital within 60 days and about half of the patients had been discharged home. Enteral nutrition was given twice as frequently as parenteral nutrition (48% versus 24%). Many patients received oral nutrition (39%) and a substantial number received no nutrition support (10%). Parenteral nutrition was used more frequently in Europe than in other world regions, the lowest use being observed in North America. The amount of nutrition given is very similar in all regions regardless of the nutrition route with about 1500 kcal and 60 g of protein per day. A clear association with body weight was not observed and the variation around the median was very large with half of patients receiving amounts 25% below or above the median. Upon completion of data entry, the nutritionDay project allows each ICU to download a unit report summarizing data that allows comparison with worldwide data in numeric and graphical form to permit easy benchmarking of medical nutrition therapy.
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Affiliation(s)
- Michael Hiesmayr
- Zentrum für Medical Data Science, Medizinische Universität Wien, Wien, Österreich.
- Klinische Abteilung Herz-Thorax-Gefäßchirurgische Anästhesie und Intensivmedizin, Medizinische Universität Wien, Spitalgasse 23, 1090, Wien, Österreich.
| | - Arabella Fischer
- Klinische Abteilung Herz-Thorax-Gefäßchirurgische Anästhesie und Intensivmedizin, Medizinische Universität Wien, Spitalgasse 23, 1090, Wien, Österreich
| | - Cecilia Veraar
- Klinische Abteilung Herz-Thorax-Gefäßchirurgische Anästhesie und Intensivmedizin, Medizinische Universität Wien, Spitalgasse 23, 1090, Wien, Österreich
| | - Bruno Mora
- Klinische Abteilung Herz-Thorax-Gefäßchirurgische Anästhesie und Intensivmedizin, Medizinische Universität Wien, Spitalgasse 23, 1090, Wien, Österreich
| | - Silvia Tarantino
- Zentrum für Medical Data Science, Medizinische Universität Wien, Wien, Österreich
| | - Arved Weimann
- Abteilung für Allgemein‑, Viszeral- und Onkologische Chirurgie, Klinikum St. Georg, Leipzig, Deutschland
| | - Dorothee Volkert
- Institut für Biomedizin des Alterns, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Nürnberg, Deutschland
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26
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Yu G, Ma H, Lv W, Zhou P, Liu C. Association of the time in targeted blood glucose range of 3.9-10 mmol/L with the mortality of critically ill patients with or without diabetes. Heliyon 2023; 9:e13662. [PMID: 36879975 PMCID: PMC9984777 DOI: 10.1016/j.heliyon.2023.e13662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
Purpose The relationship between the TIR and mortality may be influenced by the presence of diabetes and other glycemic indicators. The purpose of this study was to investigate the relationship between TIR and in-hospital mortality in diabetic and non-diabetic patients in ICU. Methods A total of 998 patients with severe diseases in the ICU were selected for this retrospective analysis. The TIR is defined as the percentage of time spent in the target blood glucose range of 3.9-10.0 mmol/L within 24 h. The relationship between TIR and in-hospital mortality in diabetic and non-diabetic patients was analyzed. The effect of glycemic variability was also analyzed. Results The binary logistic regression model showed that there was a significant association between the TIR and the in-hospital death of severely ill non-diabetic patients. Furthermore, TIR≥70% was significantly associated with in-hospital death (OR = 0.581, P = 0.003). The study found that the coefficient of variation (CV) was significantly associated with the mortality of severely ill diabetic patients (OR = 1.042, P = 0.027). Conclusions Both diabetic and non-diabetic critically ill patients should control blood glucose fluctuations and maintain blood glucose levels within the target range, it may be beneficial in reducing mortality.
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Affiliation(s)
- Guo Yu
- School of Nursing, Jinan University, No. 601, West Huangpu Avenue, Tianhe District, Guangzhou City, Guangdong Province, China
| | - Haoming Ma
- School of Nursing, Jinan University, No. 601, West Huangpu Avenue, Tianhe District, Guangzhou City, Guangdong Province, China
| | - Weitao Lv
- Division of Critical Care, The First Affiliated Hospital of Jinan, No. 613, West Huangpu Avenue, Tianhe District, Guangzhou City, Guangdong Province, China
| | - Peiru Zhou
- Health Management Centre, The Fifth Affiliated Hospital of Jinan, South Yingke Avenue, Jiangdong New District, Heyuan City, Guangdong Province, China
| | - Cuiqing Liu
- Division of Critical Care, The First Affiliated Hospital of Jinan, No. 613, West Huangpu Avenue, Tianhe District, Guangzhou City, Guangdong Province, China
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27
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Berger MM, Singer P. Comment: Early nutrition prescription in critically ill patients-learnings from the FRANS study. Crit Care 2023; 27:64. [PMID: 36803191 PMCID: PMC9940383 DOI: 10.1186/s13054-023-04346-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/03/2023] [Indexed: 02/22/2023] Open
Affiliation(s)
- Mette M. Berger
- grid.9851.50000 0001 2165 4204Lausanne University Hospital (CHUV), University of Lausanne, 1011 Lausanne, Switzerland
| | - Pierre Singer
- grid.12136.370000 0004 1937 0546Department of Intensive Care, Institute for Nutrition Research, Rabin Medical Center, Beillison Hospital, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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28
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Pardo E, Lescot T, Preiser JC, Massanet P, Pons A, Jaber S, Fraipont V, Levesque E, Ichai C, Petit L, Tamion F, Taverny G, Boizeau P, Alberti C, Constantin JM, Bonnet MP. Association between early nutrition support and 28-day mortality in critically ill patients: the FRANS prospective nutrition cohort study. Crit Care 2023; 27:7. [PMID: 36611211 PMCID: PMC9826592 DOI: 10.1186/s13054-022-04298-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/28/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Current guidelines suggest the introduction of early nutrition support within the first 48 h of admission to the intensive care unit (ICU) for patients who cannot eat. In that context, we aimed to describe nutrition practices in the ICU and study the association between the introduction of early nutrition support (< 48 h) in the ICU and patient mortality at day 28 (D28) using data from a multicentre prospective cohort. METHODS The 'French-Speaking ICU Nutritional Survey' (FRANS) study was conducted in 26 ICUs in France and Belgium over 3 months in 2015. Adult patients with a predicted ICU length of stay > 3 days were consecutively included and followed for 10 days. Their mortality was assessed at D28. We investigated the association between early nutrition (< 48 h) and mortality at D28 using univariate and multivariate propensity-score-weighted logistic regression analyses. RESULTS During the study period, 1206 patients were included. Early nutrition support was administered to 718 patients (59.5%), with 504 patients receiving enteral nutrition and 214 parenteral nutrition. Early nutrition was more frequently prescribed in the presence of multiple organ failure and less frequently in overweight and obese patients. Early nutrition was significantly associated with D28 mortality in the univariate analysis (crude odds ratio (OR) 1.69, 95% confidence interval (CI) 1.23-2.34) and propensity-weighted multivariate analysis (adjusted OR (aOR) 1.05, 95% CI 1.00-1.10). In subgroup analyses, this association was stronger in patients ≤ 65 years and with SOFA scores ≤ 8. Compared with no early nutrition, a significant association was found of D28 mortality with early enteral (aOR 1.06, 95% CI 1.01-1.11) but not early parenteral nutrition (aOR 1.04, 95% CI 0.98-1.11). CONCLUSIONS In this prospective cohort study, early nutrition support in the ICU was significantly associated with increased mortality at D28, particularly in younger patients with less severe disease. Compared to no early nutrition, only early enteral nutrition appeared to be associated with increased mortality. Such findings are in contrast with current guidelines on the provision of early nutrition support in the ICU and may challenge our current practices, particularly concerning patients at low nutrition risk. Trial registration ClinicalTrials.gov Identifier: NCT02599948. Retrospectively registered on November 5th 2015.
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Affiliation(s)
- Emmanuel Pardo
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Département d'Anesthésie-Réanimation, Hôpital Saint-Antoine, Assistance publique-hôpitaux de Paris, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France.
| | - Thomas Lescot
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Département d'Anesthésie-Réanimation, Hôpital Saint-Antoine, Assistance publique-hôpitaux de Paris, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Jean-Charles Preiser
- Service des Soins intensifs, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Pablo Massanet
- Département Anesthésie-Réanimation, Centre Hospitalier Universitaire Nîmes, 30000, Nîmes, France
| | - Antoine Pons
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Département d'Anesthésie-Réanimation, Hôpital Pitié-Salpêtrière, Assistance publique-hôpitaux de Paris, 75013, Paris, France
| | - Samir Jaber
- Department of Anaesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier. PhyMedExp, INSERM U1046, CNRS UMR, 9214, Montpellier Cedex 5, France
| | - Vincent Fraipont
- Service de Soins Intensifs, Centre Hospitalier Régional de Liège, 4000, Liège, Citadelle, Belgium
| | - Eric Levesque
- Service d'anesthésie-réanimation chirurgicale, GHU Henri-Mondor, 94000, Créteil, France
| | - Carole Ichai
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Département Anesthésie-Réanimation, Nice, France
| | - Laurent Petit
- Service de réanimation chirurgicale et traumatologique Pellegrin place Amélie Raba-Léon, 33000, Bordeaux, France
| | - Fabienne Tamion
- Service de Médecine Intensive Réanimation, CHU Rouen, Université de Normandie, UNIROUEN, INSERM U1096, 76000, Rouen, France
| | - Garry Taverny
- AP-HP, Hôpital Robert-Debré, Unité d'Epidémiologie Clinique, 48 bd Serurier, 75019, Paris, France
| | - Priscilla Boizeau
- AP-HP, Hôpital Robert-Debré, Unité d'Epidémiologie Clinique, 48 bd Serurier, 75019, Paris, France
| | - Corinne Alberti
- AP-HP, Hôpital Robert-Debré, Unité d'Epidémiologie Clinique, 48 bd Serurier, 75019, Paris, France
| | - Jean-Michel Constantin
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Département d'Anesthésie-Réanimation, Hôpital Pitié-Salpêtrière, Assistance publique-hôpitaux de Paris, 75013, Paris, France
| | - Marie-Pierre Bonnet
- Sorbonne Université, Département Anesthésie-Réanimation, Hôpital Armand Trousseau, DMU DREAM, GRC 29, AP-HP, Paris, France
- Université Paris Cité, INSERM, INRA, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Maternité Port Royal, 53 avenue de l'Observatoire, 75014, Paris, France
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Zhang W, Zhang SX, Chen SF, Yu T, Tang Y. Development and validation of risk prediction model for refeeding syndrome in neurocritical patients. Front Nutr 2023; 10:1083483. [PMID: 36875840 PMCID: PMC9975392 DOI: 10.3389/fnut.2023.1083483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/18/2023] [Indexed: 02/17/2023] Open
Abstract
Background The incidence of refeeding syndrome (RFS) in critically ill patients is high, which is detrimental to their prognoses. However, the current status and risk factors for the occurrence of RFS in neurocritical patients remain unclear. Elucidating these aspects may provide a theoretical basis for screening populations at high risk of RFS. Methods A total of 357 patients from January 2021 to May 2022 in a neurosurgery ICU of a tertiary hospital in China were included using convenience sampling. Patients were divided into RFS and non-RFS groups, based on the occurrence of refeeding-associated hypophosphatemia. Risk factors for RFS were determined using univariate and logistic regression analyses, and a risk prediction model for RFS in neurocritical patients was developed. The Hosmer-Lemeshow test was used to determine the goodness of fit of the model, and the receiver operator characteristic curve was used to examine its discriminant validity. Results The incidence of RFS in neurocritical patients receiving enteral nutrition was 28.57%. Logistic regression analyses showed that history of alcoholism, fasting hours, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, Sequential Organ Failure Assessment (SOFA) scores, low serum albumin, and low baseline serum potassium were risk factors of RFS in neurocritical patients (p < 0.05). The Hosmer-Lemeshow test showed p = 0.616, and the area under the ROC curve was 0.791 (95% confidence interval: 0.745-0.832). The optimal critical value was 0.299, the sensitivity was 74.4%, the specificity was 77.7%, and the Youden index was 0.492. Conclusion The incidence of RFS in neurocritical patients was high, and the risk factors were diverse. The risk prediction model in this study had good predictive effects and clinical utility, which may provide a reference for assessing and screening for RFS risk in neurocritical patients.
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Affiliation(s)
- Wei Zhang
- Department of Neurosurgery Intensive Care Unit, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Sheng-Xiang Zhang
- Department of Neurosurgery Intensive Care Unit, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Shu-Fan Chen
- Department of Nursing, Soochow University, Suzhou, China
| | - Tao Yu
- Department of Neurosurgery Intensive Care Unit, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Yun Tang
- Department of Neurosurgery Intensive Care Unit, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
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Barhorst S, Prior RM, Kanter D. Implementation of a best-practice guideline: Early enteral nutrition in a neuroscience intensive care unit. JPEN J Parenter Enteral Nutr 2023; 47:87-91. [PMID: 35616290 PMCID: PMC10084295 DOI: 10.1002/jpen.2411] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/10/2022] [Accepted: 05/23/2022] [Indexed: 01/11/2023]
Abstract
Current evidence suggests that early enteral nutrition is a best practice and leads to improved clinical outcomes. An evidence-based practice project was implemented in a busy neurointensive care unit in a midwestern tertiary care facility that was designed to improve care by implementing the early nutrition portion of Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine and the American Society for Enteral and Parenteral Nutrition. The Registered Nurses' Association of Ontario's (RNAO) Toolkit: Implementation of Best Practice Guidelines (BPGs) was selected and followed to guide implementation and achieve optimal results. During a 90-day implementation period, this project resulted in a 100% improvement in early nutrition. Interventions included the use of a series of cards that reminded the team to order enteral nutrition and prepacked bundles of nasogastric tube supplies. The RNAO toolkit served as a structured and effective step-by-step methodology for the implementation of a BPG.
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Affiliation(s)
| | - Richard M Prior
- Department of Neurology, College of Nursing, University of Cincinnati, Cincinnati, Ohio, USA
| | - Daniel Kanter
- Department of Neurology, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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Enteral nutrition interruptions in critically ill patients: A prospective study on reasons, frequency and duration of interruptions of nutritional support during ICU stay. Clin Nutr ESPEN 2022; 52:178-183. [PMID: 36513451 DOI: 10.1016/j.clnesp.2022.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/20/2022] [Accepted: 10/28/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND & AIMS Enteral Nutrition (EN) may be interrupted due to various reasons in the setting of intensive care unit (ICU) care. This study aimed to investigate the reasons, frequency, and duration of EN interruptions in critically ill patients within the first 7 days of ICU stay. METHODS A total of 122 critically ill patients (median age: 63 years, 57% were males) initiating EN within the first 72 h of ICU admission and continued EN for at least 48 h during ICU stay were included in this observational prospective study conducted at a Medical ICU. Patients were followed for hourly energy intake as well as the frequency, reason, and duration of EN interruptions, for the first seven nutrition days of ICU stay or until death/discharge from ICU. RESULTS The median APACHE II score was 22 (IQR, 17-27). The per patient EN interruption frequency was 2.74 and the median total EN interruption duration was 960 (IQR, 105-1950) minutes. The most common reason for EN interruption was radiological procedures (91 episodes) and the longest duration of EN interruption was due to tube malfunctions (1230 min). Target energy intake were achieved on the 6th day at a maximum rate of 89.4%. Logistic regression showed that there was relationship between increased mortality and patients with ≥3 EN interruptions (OR: 6.73 (2.15-30.55), p = 0.004) after adjusting for confounding variables (age and APACHE II score). According to Kaplan Meier analysis, patients with ≥3 EN interruptions had significantly lower median survival times than patients with <3 EN interruptions (24.0 (95% CI 8.5-39.5) vs 18.0 (95% CI 13-23) days, p = 0.014). CONCLUSION During the first week of EN support, the most common reason of EN interruptions was related to radiological procedures and the longest EN interruptions was due to feeding tube malfunctions. There was relationship between ≥3 EN interruptions and increased mortality.
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Ghorbani Dehbalaei M, Sahebkar A, Safarian M, Khadem-Rezaiyan M, Rezaee H, Naeini F, Norouzy A. Study protocol for a pilot randomised controlled trial evaluating the effectiveness of oral trehalose on inflammatory factors, oxidative stress, nutritional and clinical status in traumatic head injury patients receiving enteral nutrition. BMJ Open 2022; 12:e060605. [PMID: 36123055 PMCID: PMC9486343 DOI: 10.1136/bmjopen-2021-060605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION In traumatic brain injury (TBI) patients, inflammatory processes and oxidative stress have been linked to the development of neurodegenerative diseases, disability, increased rate of muscle catabolism, malnutrition, hospital stay and mortality. Previous in vitro and in vivo studies have shown that trehalose can decrease inflammatory and oxidative factors. Therefore, the present study was designed to evaluate the effect of oral trehalose consumption on this marker in critically ill TBI patients at intensive care unit (ICU). METHODS AND ANALYSIS This study is a pilot randomised, prospective and double-blind clinical trial. The study sample size is of 20 (10 patients in each group) TBI patients aged 18-65 years at ICU. Randomisation is performed by permuted block randomisation method. The allocation ratio is 1:1. An intervention group will receive 30 g of trehalose instead, as a part of the carbohydrate of daily bolus enteral feeding and the control group will receive standard isocaloric hospital bolus enteral feeding for 12 days. The inflammatory factors (C reactive protein, interleukin 6) and oxidative stress markers (glutathione, malondialdehyde, superoxide dismutase, pro-oxidant-antioxidant balance, total antioxidant capacity) will be measured at the baseline, at the 6th day, and at the end of the study (12th day). Sequential Organ Failure Assessment, Acute Physiology and Chronic Health Evaluation II, Nutrition Risk in the Critically ill scores, 28-day mortality, anthropometric assessments and the clinical and nutritional status will be measured. Each patient's nutritional needs will be calculated individually. The statistical analysis would be based on the intention to treat. ETHICS AND DISSEMINATION The vice-chancellor of the research centre of Mashhad University of Medical Sciences is sponsoring this study. IR.MUMS.MEDICAL.REC.1400.113. TRIAL REGISTRATION NUMBER Iranian Registry of Clinical Trials (IRCT) Id: IRCT20210508051223N1, Registration date: 26 July 2021.
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Affiliation(s)
- Moazzameh Ghorbani Dehbalaei
- Department of Clinical Nutrition, School of Nutritional Science, Mashhad University of Medical Sciences, Mashhad, Iran
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhossein Sahebkar
- School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Safarian
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Khadem-Rezaiyan
- Resident of Community Medicine, Community Medicine Department, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Rezaee
- Department of Neurosurgery, Shahid Kamyab Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Naeini
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdolreza Norouzy
- Nutrition Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Lv C, Jiang X, Long Y, Liu Z, Lin J, Wu C, Ye X, Ye R, Liu Y, Liu M, Liu Y, Chen W, Gao L, Tong Z, Ke L, Jiang Z, Li W. Association between caloric adequacy and short-term clinical outcomes in critically ill patients using a weight-based equation: Secondary analysis of a cluster-randomized controlled trial. Front Nutr 2022; 9:902986. [PMID: 36118758 PMCID: PMC9478102 DOI: 10.3389/fnut.2022.902986] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThere is controversy over the optimal energy delivery in intensive care units (ICUs). In this study, we aimed to evaluate the association between different caloric adequacy assessed by a weight-based equation and short-term clinical outcomes in a cohort of critically ill patients.MethodsThis is a secondary analysis of a cluster-randomized controlled trial (N = 2,772). The energy requirement was estimated as 25 kcal/kg of body weight. The study subjects were divided into three groups according to their caloric adequacy as calculated by the mean energy delivered from days 3 to 7 of enrollment divided by the estimated energy requirements: (1) received < 70% of energy requirement (hypocaloric), (2) received 70–100% of energy requirement (normocaloric), and (3) received > 100% of energy requirement (hypercaloric). Cox proportional hazards models were used to analyze the association between caloric adequacy and 28-day mortality and time to discharge alive from the ICU.ResultsA total of 1,694 patients were included. Compared with normocaloric feeding, hypocaloric feeding significantly increased the risk of 28-day mortality (hazard ratio [HR] = 1.590, 95% confidence interval [CI]: 1.162–2.176, p = 0.004), while hypercaloric feeding did not. After controlling for potential confounders, the association remained valid (adjusted HR = 1.596, 95% CI: 1.150–2.215, p = 0.005). The caloric adequacy was not associated with time to discharge alive from the ICU in the unadjusted and the adjusted models.ConclusionEnergy delivery below 70% of the estimated energy requirement during days 3–7 of critical illness is associated with 28-day mortality.Clinical trial registration[https://www.isrctn.com/ISRCTN12233792], identifier [ISRCTN12233792].
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Affiliation(s)
- Cheng Lv
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xingwei Jiang
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Yi Long
- Department of Critical Care Medicine, Chongqing University Cancer Hospital, Chongqing, China
| | - Zirui Liu
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jiajia Lin
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Cuili Wu
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xianghong Ye
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ruiling Ye
- Department of Critical Care Medicine, Chongqing University Cancer Hospital, Chongqing, China
| | - Yuxiu Liu
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Man Liu
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yang Liu
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wensong Chen
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Lin Gao
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhihui Tong
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Lu Ke
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China
- *Correspondence: Lu Ke,
| | - Zhengying Jiang
- Department of Critical Care Medicine, Chongqing University Cancer Hospital, Chongqing, China
- Zhengying Jiang,
| | - Weiqin Li
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China
- Weiqin Li,
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Park H, Lim SY, Kim S, Kim HS, Kim S, Yoon HI, Cho YJ. Effect of a nutritional support protocol on enteral nutrition and clinical outcomes of critically ill patients: a retrospective cohort study. Acute Crit Care 2022; 37:382-390. [PMID: 35977898 PMCID: PMC9475161 DOI: 10.4266/acc.2022.00220] [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: 02/18/2022] [Accepted: 06/03/2022] [Indexed: 11/30/2022] Open
Abstract
Background Enteral nutrition (EN) supply within 48 hours after intensive care unit (ICU) admission improves clinical outcomes. The “new ICU evaluation & development of nutritional support protocol (NICE-NST)” was introduced in an ICU of tertiary academic hospital. This study showed that early EN through protocolized nutritional support would supply more nutrition to improve clinical outcomes. Methods This study screened 170 patients and 62 patients were finally enrolled; patients who were supplied nutrition without the protocol were classified as the control group (n=40), while those who were supplied according to the protocol were classified as the test group (n=22). Results In the test group, EN started significantly earlier (3.7±0.4 days vs. 2.4±0.5 days, P=0.010). EN calorie (4.0±1.0 kcal/kg vs. 6.7±0.9 kcal/kg, P=0.006) and protein (0.17±0.04 g/kg vs. 0.32±0.04 g/kg, P=0.002) supplied were significantly higher in the test group. Although EN was supplied through continuous feeding in the test group, there was no difference in complications such as feeding hold due to excessive gastric residual volume or vomit, and hyper- or hypo-glycemia between the two groups. Hospital mortality was significantly lower in the group that started EN within 1.5 days (42.9% vs. 11.8%, P=0.018). The proportion of patients who started EN within 1.5 days was higher in the test group (40.9% vs. 17.5%, P=0.044). Conclusions The NICE-NST may improve EN supply and mortality of critically ill patients without increasing complications.
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Kouw IW, Heilbronn LK, van Zanten AR. Intermittent feeding and circadian rhythm in critical illness. Curr Opin Crit Care 2022; 28:381-388. [PMID: 35797531 PMCID: PMC9594144 DOI: 10.1097/mcc.0000000000000960] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Circadian rhythms, i.e., periodic oscillations in internal biological processes, modulate metabolic processes such as hormonal signalling, nutrient absorption, and xenobiotic detoxification. Meal timing is a strong entraining cue for peripheral clocks in various organs, and eating out of circadian phases can impair glucose, gastrointestinal, and muscle metabolism. Sleep/wake cycles and circadian rhythms are extremely disrupted during critical illness. Timing of nutritional support may help preserve circadian rhythms and improve post-Intensive Care Unit (ICU) recovery. This review summarises circadian disruptors during ICU admission and evaluates the potential benefits of intermittent feeding on metabolism and circadian rhythms. RECENT FINDINGS Rhythmic expression of core clock genes becomes rapidly disturbed during critical illness and remains disturbed for weeks. Intermittent, bolus, and cyclic enteral feeding have been directly compared to routine continuous feeding, yet no benefits on glycaemic control, gastrointestinal tolerance, and muscle mass have been observed and impacts of circadian clocks remain untested. SUMMARY Aligning timing of nutritional intake, physical activity, and/or medication with circadian rhythms are potential strategies to reset peripheral circadian rhythms and may enhance ICU recovery but is not proven beneficial yet. Therefore, selecting intermittent feeding over continuous feeding must be balanced against the pros and cons of clinical practice.
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Affiliation(s)
- Imre W.K. Kouw
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Leonie K. Heilbronn
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
- Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Arthur R.H. van Zanten
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
- Department of Intensive Care Medicine, Gelderse Vallei Hospital, Ede, The Netherlands
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Nutrition in Pediatric Intensive Care: A Narrative Review. CHILDREN 2022; 9:children9071031. [PMID: 35884015 PMCID: PMC9318205 DOI: 10.3390/children9071031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/04/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022]
Abstract
Nutrition support in pediatric intensive care is an integral part of a complex approach to treating critically ill children. Smaller energy reserves with higher metabolic demands (a higher basal metabolism rate) compared to adults makes children more vulnerable to starvation. The nutrition supportive therapy should be initiated immediately after intensive care admission and initial vital sign stabilization. In absence of contraindications (unresolving/decompensated shock, gut ischemia, critical gut stenosis, etc.), the preferred type of enteral nutrition is oral or via a gastric tube. In the acute phase of critical illness, due to gluconeogenesis and muscle breakdown with proteolysis, the need for high protein delivery should be emphasized. After patient condition stabilization, the acute phase with predominant catabolism converts to the anabolic phase and intensive rehabilitation, where high energy demands are the keystone of a positive outcome.
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Challenges to Provision of Adequate Medical Nutrition Therapy in a Critically Ill COVID-19 Patient Fed in the Prone Position. TOP CLIN NUTR 2022; 37:218-226. [PMID: 35761886 PMCID: PMC9222785 DOI: 10.1097/tin.0000000000000285] [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] [Indexed: 11/25/2022]
Abstract
Adults with acute respiratory distress syndrome (ARDS) may experience enteral nutrition (EN) intolerance. They often require mechanical ventilation and other specialized management including prone positioning. There is a controversy as to whether patients fed in prone position experience more EN intolerance than when they are in supine position. This narrative review synthesizes the literature published between 2001 and 2021 in adults with ARDS who are fed EN while in the prone position to determine safety and tolerance. A case of an adult patient with Down syndrome who developed ARDS due to COVID-19 and required EN while in prone position is presented.
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Liu F, Liu G, Sun R, Wang J, Li M, Gong L, Su Y, Zhang Y, Wang Y. Comparison of Two Different Threshold Values for the Measurement of Gastric Residual Volume on Enteral Nutrition Support in the Neurocritically Ill Patients. Front Nutr 2022; 9:871715. [PMID: 35799592 PMCID: PMC9253574 DOI: 10.3389/fnut.2022.871715] [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: 02/08/2022] [Accepted: 05/26/2022] [Indexed: 12/05/2022] Open
Abstract
Background Although recommendations on gastric residual volume (GRV) have been applied to the clinical practice of patients who are intubated, evidence-based data about the GRV of patients who are neurocritically ill are still lacking. We conducted this study to investigate the safety of increased GRV in patients who are neurocritically ill on enteral nutrition (EN) support. Methods Patients who are neurocritically ill feeding through intragastric enteral tubes were recruited consecutively between July 2018 and June 2021. Patients were divided into a control group (GRV 100 ml) and a study group (GRV 200 ml). Demographic data, admission diagnosis, and severity scores were collected from the patient medical records. The frequency of diet volume ratio (diet received/diet prescribed), the incidence of gastrointestinal complications, and outcome variables were evaluated. Results There were 344 patients enrolled, of whom 197 had mechanical ventilation support. High GRV events in the control group were more frequent than those in the study group (38.1 vs. 22.8%, p = 0.002). The total gastrointestinal complication rate did not differ significantly between the two groups (study group: 61.1%, 102/167 vs. control group: 67.9%, 114/168). In the study group, two patients had aspiration (1.2 vs. 0%, p = 0.245). The study group showed a superior diet volume ratio, but the difference was not significant. The outcomes of the study group were slightly better than those of the control group; however, no significant differences were observed between the two groups concerning the length of stay in the neurointensive care unit (19.5 days vs. 25.3 days) and mortality (10.8 vs. 14.9%) at discharge. Conclusion Our results suggest that 200 ml may be a safe normal limit for GRV in patients who are neurocritically ill.
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Affiliation(s)
- Fang Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Gang Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- China National Brain Injury Evaluation Quality Control Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Rui Sun
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jinli Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Miao Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lichao Gong
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yingying Su
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- China National Brain Injury Evaluation Quality Control Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yan Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- China National Brain Injury Evaluation Quality Control Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuan Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yuan Wang,
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Novel insights in endocrine and metabolic pathways in sepsis and gaps for future research. Clin Sci (Lond) 2022; 136:861-878. [PMID: 35642779 DOI: 10.1042/cs20211003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 11/17/2022]
Abstract
Sepsis is defined as any life-threatening organ dysfunction caused by a dysregulated host response to infection. It remains an important cause of critical illness and has considerable short- and long-term morbidity and mortality. In the last decades, preclinical and clinical research has revealed a biphasic pattern in the (neuro-)endocrine responses to sepsis as to other forms of critical illness, contributing to development of severe metabolic alterations. Immediately after the critical illness-inducing insult, fasting- and stress-induced neuroendocrine and cellular responses evoke a catabolic state in order to provide energy substrates for vital tissues, and to concomitantly activate cellular repair pathways while energy-consuming anabolism is postponed. Large randomized controlled trials have shown that providing early full feeding in this acute phase induced harm and reversed some of the neuro-endocrine alterations, which suggested that the acute fasting- and stress-induced responses to critical illness are likely interlinked and benefical. However, it remains unclear whether, in the context of accepting virtual fasting in the acute phase of illness, metabolic alterations such as hyperglycemia are harmful or beneficial. When patients enter a prolonged phase of critical illness, a central suppression of most neuroendocrine axes follows. Prolonged fasting and central neuroendocrine suppression may no longer be beneficial. Although pilot studies have suggested benefit of fasting-mimicking diets and interventions that reactivate the central neuroendocrine suppression selectively in the prolonged phase of illness, further study is needed to investigate patient-oriented outcomes in larger randomized trials.
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Daou M, Dionne JC, Teng JFT, Taran S, Zytaruk N, Cook D, Wilcox ME. Prophylactic acid suppressants in patients with primary neurologic injury: A systematic review and meta-analysis of randomized controlled trials. J Crit Care 2022; 71:154093. [PMID: 35714455 DOI: 10.1016/j.jcrc.2022.154093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 01/30/2023]
Abstract
PURPOSE Neurocritical care patients are at risk of stress-induced gastrointestinal ulceration. We performed a systematic review and meta-analysis of stress ulcer prophylaxis (SUP) in critically ill adults admitted with a primary neurologic injury. MATERIALS AND METHODS We included randomized controlled trials (RCTs) comparing SUP with histamine-2-receptor antagonists (H2RAs) or proton pump inhibitors (PPIs) to placebo/no prophylaxis, as well as to each other. The primary outcome was in-ICU gastrointestinal bleeding (GIB). Predefined secondary outcomes were all-cause 30-day mortality, ICU length of stay (LOS), nosocomial pneumonia, and other complications. RESULTS We identified 14 relevant trials enrolling 1036 neurocritical care patients; 11 trials enrolling 930 patients were included in the meta-analysis. H2RAs resulted in a lower incidence of GIB as compared to placebo or no prophylaxis (Risk ratio [RR] 0.42, 95% CI 0.30-0.58; p < 0.001); PPIs with a lower risk of GIB compared to placebo/no prophylaxis (RR 0.37, 95% CI 0.23-0.59; p < 0.001). No significant difference was observed in GIB comparing PPIs with H2RAs (RR 0.53, 95% CI 0.26-1.06; p = 0.07; I2 = 0%). CONCLUSIONS In neurocritical care patients, the overall high or unclear risk of bias of individual trials, the low event rates, and modest sample sizes preclude strong clinical inferences about the utility of SUP.
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Affiliation(s)
| | - Joanna C Dionne
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer F T Teng
- Department of Pharmacy, University Health Network, Toronto, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Shaurya Taran
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada; Department of Medicine (Respirology), University Health Network, Toronto, Canada
| | - Nicole Zytaruk
- St. Joseph's HealthCare Hamilton, Hamilton, Ontario, Canada
| | - Deborah Cook
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; St. Joseph's HealthCare Hamilton, Hamilton, Ontario, Canada
| | - M Elizabeth Wilcox
- Toronto Western Hospital, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada; Department of Medicine (Respirology), University Health Network, Toronto, Canada.
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Yon HJ, Oh ES, Jang JY, Jang JY, Shim H. Physician Compliance with Nutrition Support Team Recommendations: Effects on the Outcome of Treatment for Critically Ill Patients. JOURNAL OF ACUTE CARE SURGERY 2022. [DOI: 10.17479/jacs.2022.12.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose: Attending physicians in Korea are aware of the existence of the Nutrition Support Team (NST), but even when the NST are consulted, compliance with their recommendations may be low. This study was performed to identify physicians’ compliance with the NST advice and how this affected the outcome of treatment for critically ill patients.Methods: This study was a retrospective observational study. Critically ill patients who were older than 18 years, younger than 90 years, and had been admitted and managed in the intensive care unit were selected for this study. Patients were assigned to either the compliance group or the non-compliance group according to physician compliance with the NST advice. Each group were compared using variables such as calorie supply, protein supply, laboratory findings, hospital stay, 30-day mortality, and survival rate.Results: The compliance group (81% of cases) was supplied with a significantly higher energy (1,146.36 ± 473.45 kcal vs. 832.45 ± 364.28 kcal, p < 0.01) and a significantly higher protein (55.00 ± 22.30 g/day vs. 42.98 ± 24.46 g/day, p = 0.04) compared with the non-compliance group. There was no significant difference in the basic demographics between groups, although the compliance group had a better outcome in the 30-day mortality rate (8% vs. 26%, p = 0.02), and in survival beyond 1 year (Crude model, hazard ratio: 2.42, CI: 1.11-5.29).Conclusion: Critically ill patients whose attending physician complied with the NST advice, received an increased energy intake and supply of protein which was positively associated with survival.
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Wang K, Zeng Q, Li KX, Wang Y, Wang L, Sun MW, Zeng J, Jiang H. Efficacy of probiotics or synbiotics for critically ill adult patients: a systematic review and meta-analysis of randomized controlled trials. BURNS & TRAUMA 2022; 10:tkac004. [PMID: 35291228 PMCID: PMC8918756 DOI: 10.1093/burnst/tkac004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/01/2021] [Indexed: 12/26/2022]
Abstract
Background Microbial dysbiosis in critically ill patients is a leading cause of mortality and septic complications. Probiotics and synbiotics have emerged as novel therapy on gut microbiota to prevent septic complications. However, current evidence on their effects is conflicting. This work aims to systematically review the impact of probiotics or synbiotics in critically ill adult patients. Methods A comprehensive search of the PubMed, CBM, Embase, CENTRAL, ISI, and CNKI databases was performed to identify randomized controlled trials that evaluate probiotics or synbiotics in critically ill patients. The quality assessment was based on the modified Jadad's score scale and the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1. The major outcome measure was mortality. Secondary outcomes included incidence of septic complications, sepsis incidence, length of intensive care unit (ICU) stay, incidence of non-septic complication, and ventilator day. Data synthesis was conduct by Review Manager 5.4. Results A total of 25 randomized controlled trials reporting on 5049 critically ill patients were included. In the intervention group, 2520 participants received probiotics or synbiotics, whereas 2529 participants received standard care or placebo. Pooling data from randomized controlled trials demonstrated a significant reduction in the incidence of ventilator-associated pneumonia (VAP) in the treatment group [(risk ratio (RR) 0.86; 95% confidence interval (CI): 0.78–0.95; p < 0.003, I2 = 85%)]. However, in the subgroup analysis, the reduction of incidence of VAP was only significant in patients receiving synbiotics (RR = 0.61, 95% CI: 0.47–0.80, p = 0.0004, I2 = 40%) and not significant in those receiving only probiotics (RR = 0.91, 95% CI: 0.82–1.01, p = 0.07, I2 = 65%). Moreover, sepsis incidence of critically ill patients was only significantly reduced by the addition of synbiotics (RR = 0.41; 95% CI: 0.22–0.72, p = 0.005, I2 = 0%). The incidence of ICU-acquired infections was significantly reduced by the synbiotics therapy (RR = 0.72; 95% CI: 0.58–0.89, p = 0.0007, I2 = 79%). There was no significant difference in mortality, diarrhea, or length of ICU stay between the treatment and control groups. Conclusions Synbiotics is an effective and safe nutrition therapy in reducing septic complications in critically ill patients. However, in such patients, administration of probiotics alone compared with placebo resulted in no difference in the septic complications.
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Affiliation(s)
- Kai Wang
- Department of Acute Care Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610000, China
| | - Qin Zeng
- Department of Reproductive Medicine, Sichuan Provincial Maternity and Child Health Care Hospital, The Affiliated Women's and children's Hospital of Chengdu Medical College, Chengdu 610045, China
| | - Ke-Xun Li
- Department of Acute Care Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610000, China
| | - Yu Wang
- Department of Acute Care Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610000, China
| | - Lu Wang
- Department of Acute Care Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610000, China
| | - Ming-Wei Sun
- Department of Acute Care Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610000, China
| | - Jun Zeng
- Department of Acute Care Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610000, China
| | - Hua Jiang
- Department of Acute Care Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610000, China
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Di Girolamo FG, Fiotti N, Sisto UG, Nunnari A, Colla S, Mearelli F, Vinci P, Schincariol P, Biolo G. Skeletal Muscle in Hypoxia and Inflammation: Insights on the COVID-19 Pandemic. Front Nutr 2022; 9:865402. [PMID: 35529457 PMCID: PMC9072827 DOI: 10.3389/fnut.2022.865402] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/09/2022] [Indexed: 12/23/2022] Open
Abstract
SARS-CoV-2 infection is often associated with severe inflammation, oxidative stress, hypoxia and impaired physical activity. These factors all together contribute to muscle wasting and fatigue. In addition, there is evidence of a direct SARS-CoV-2 viral infiltration into skeletal muscle. Aging is often characterized by sarcopenia or sarcopenic obesity These conditions are risk factors for severe acute COVID-19 and long-COVID-19 syndrome. From these observations we may predict a strong association between COVID-19 and decreased muscle mass and functions. While the relationship between physical inactivity, chronic inflammation, oxidative stress and muscle dysfunction is well-known, the effects on muscle mass of COVID-19-related hypoxemia are inadequately investigated. The aim of this review is to highlight metabolic, immunity-related and redox biomarkers potentially affected by reduced oxygen availability and/or muscle fatigue in order to shed light on the negative impact of COVID-19 on muscle mass and function. Possible countermeasures are also reviewed.
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Affiliation(s)
- Filippo G. Di Girolamo
- Department of Medical Surgical ad Health Science, Clinica Medica, Cattinara Hospital, University of Trieste, Trieste, Italy
- SC Assistenza Farmaceutica, Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
- *Correspondence: Filippo G. Di Girolamo
| | - Nicola Fiotti
- Department of Medical Surgical ad Health Science, Clinica Medica, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Ugo G. Sisto
- Department of Medical Surgical ad Health Science, Clinica Medica, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Alessio Nunnari
- Department of Medical Surgical ad Health Science, Clinica Medica, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Stefano Colla
- SC Assistenza Farmaceutica, Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Filippo Mearelli
- Department of Medical Surgical ad Health Science, Clinica Medica, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Pierandrea Vinci
- Department of Medical Surgical ad Health Science, Clinica Medica, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Paolo Schincariol
- SC Assistenza Farmaceutica, Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Gianni Biolo
- Department of Medical Surgical ad Health Science, Clinica Medica, Cattinara Hospital, University of Trieste, Trieste, Italy
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Kamel AY, Robayo L, Liang D, Rosenthal MD, Croft CA, Gabriela G, Babette B, Efron PA, Mohr A, Moore FA, Brakenridge SC. Estimated versus measured energy expenditure in ventilated surgical-trauma critically Ill patients. JPEN J Parenter Enteral Nutr 2021; 46:1431-1440. [PMID: 34921708 DOI: 10.1002/jpen.2314] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The American and European guidelines recommend measuring resting energy expenditure (REE) using indirect calorimetry (IC). Predictive equations (PEs) are used to estimate REE, but there is limited evidence for their use in critically ill patients. The aim of this study is to evaluate the degree of agreement and accuracy between IC-REE and ten different PEs in mechanically ventilated surgical-trauma critically ill patients who met their estimated caloric requirement. METHODS IC-REE was retrospectively compared to PE-REE by 10 PEs. Degree of agreement between REE-PE and REE-IC was analyzed by the Bland-Altman test (BAt) and the Concordance Correlation Coefficient (CCC). The accuracy was calculated by the percentage of patients whose REE-PE values differ by up to ±10% in relation to REE-IC. All analyses were stratified by gender and BMI (< 25 vs ≥ 25). RESULTS 104 patients were analyzed and the closest estimate to IC-REE was the modified Harris-Benedict equation (mHB) by the BAt with a mean difference of 49.2 overall, 61.6 for males, 28.5 for females, 67.5 for BMI < 25 and 42.5 for BMI ≥ 25. The overall CCC between the IC-REE and mHB was 0.652; 0.560 for males; 0.496 for females; 0.570 for BMI < 25; and 0.598 for BMI ≥ 25. Modified HB equation was the most accurate with overall accuracy of 44.2%. CONCLUSIONS Effectiveness of PEs for estimating REE of mechanically ventilated surgical-trauma critically ill patients is limited. Nonetheless, of all the 10 equations examined, the closest to IC measured REE was the modified HB equation. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Amir Y Kamel
- Department of Pharmacy, UF Health shands Hospital, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Laura Robayo
- Department of Pharmacy, UF Health shands Hospital, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Debbie Liang
- Department of Pharmacy, UNC Healthcare Raleigh, North Carolina, USA
| | - Martin D Rosenthal
- Division of Acute Care Surgery and Center for Sepsis and Critical Illness Research, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Chasen A Croft
- Division of Acute Care Surgery and Center for Sepsis and Critical Illness Research, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Ghita Gabriela
- Department of Biostatistics, University of Florida Health Hospital, College of Public Health & Health Professions College of Medicine, Gainesville, FL, United States
| | - Brumback Babette
- Department of Biostatistics, University of Florida Health Hospital, College of Public Health & Health Professions College of Medicine, Gainesville, FL, United States
| | - Philip A Efron
- Division of Acute Care Surgery and Center for Sepsis and Critical Illness Research, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Alicia Mohr
- Division of Acute Care Surgery and Center for Sepsis and Critical Illness Research, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Frederick A Moore
- Division of Acute Care Surgery and Center for Sepsis and Critical Illness Research, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Scott C Brakenridge
- Division of Acute Care Surgery and Center for Sepsis and Critical Illness Research, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
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Brotfain E, Erblat A, Luft P, Elir A, Gruenbaum BF, Livshiz-Riven I, Koyfman A, Fridrich D, Koyfman L, Friger M, Grivnev A, Zlotnik A, Klein M. Nurse-performed ultrasound assessment of gastric residual volume and enteral nasogastric tube placement in the general intensive care unit. Intensive Crit Care Nurs 2021; 69:103183. [PMID: 34924254 DOI: 10.1016/j.iccn.2021.103183] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Ultrasonography is an essential imaging modality in the critical care population and has been increasingly utilized to check gastric residual volume . Various studies have shown that intensive care unit nurses untrained in ultrasound can easily be trained in its accurate interpretation. We prospectively analyzed nurse-performed repeated measurements of gastric residual volume and nasogastric tube positioning via an ultrasound technique in the intensive care unit. DESIGN This was a single-center, cross-sectional prospective study. Four intensive care unit nurses, evenly divided into two groups (teams A and B), underwent four hours of formal ultrasound training by three critical care staff physicians. The trained nurses provided bedside ultrasound assessments of gastric residual volume and nasogastric tube positioning which were compared to a standard protocol of syringe aspiration. RESULTS Ninety patients were recruited to the study. Four measurements per patient were performed, for a total of 360 assessments. The ultrasound gastric residual volume assessments were correlated with the syringe aspiration protocol and demonstrated high Intraclass Correlation Coefficient rates of 0.814 (0.61-0.92) for team A and 0.85 (0.58-0.91) for team B. Nasogastric tube placement was successfully and independently verified by ultrasound in most of the critically ill patients (78% of team A and 70% of team B). The comparative ultrasound assessments of tube positioning demonstrated good correlation of 0.733 (0.51-0.88) between each team's two independent observers. CONCLUSION Our study demonstrated a strong correlation between US utilization for assessment of gastric residual volume and nasogastric tube positioning and standard protocol methods, suggesting it is a safe, simple and effective practice for intensive care unit nurses.
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Affiliation(s)
- Evgeni Brotfain
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | - Alexander Erblat
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Peter Luft
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Adina Elir
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Benjamin F Gruenbaum
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Ilana Livshiz-Riven
- Infection Control Unit, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel; Department of Nursing, Faculty of Health Science, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Anna Koyfman
- Department of Radiology, Meir Medical Center, Kfar Saba, Israel
| | | | - Leonid Koyfman
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Michael Friger
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ana Grivnev
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Alexander Zlotnik
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Moti Klein
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Bae E, Kim J, Jang J, Kim J, Kim S, Chang Y, Kim MY, Jeon M, Kang S, Lee JK, Kim TG. Effects of a low-FODMAP enteral formula on diarrhea on patients in the intensive care unit. Nutr Res Pract 2021; 15:703-714. [PMID: 34858549 PMCID: PMC8601948 DOI: 10.4162/nrp.2021.15.6.703] [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: 02/16/2021] [Revised: 04/01/2021] [Accepted: 05/13/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/OBJECTIVES A dietary restriction on the intake of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) has been reported to be effective in the treatment of gastrointestinal (GI) tract complications. Enteral nutrition (EN) is widely used for patients who cannot obtain their nutritional requirements orally, but many studies have reported EN complications, especially diarrhea, in up to 50% of patients. SUBJECTS/METHODS We performed a single-center, non-randomized, controlled trial to determine the effects of a low-FODMAP enteral formula on GI complications in patients in intensive care units (ICUs). Patients in the ICU who needed EN (n = 66) were alternately assigned to the low-FODMAP group (n = 33) or the high-FODMAP group (n = 33). RESULTS Anthropometric and biochemical parameters were measured, and stool assessment was performed using King's Stool Chart. We excluded patients who received laxatives, GI motility agents, proton pump inhibitors, antifungal agents, and antibiotics other than β-lactams. There were no differences in GI symptoms during 7 days of intervention, including bowel sound, abdominal distension, and vomiting between the 2 groups. However, diarrhea was more frequent in the high-FODMAP group (7/33 patients) than the low-FODMAP group (1/33 patients) (P = 0.044). CONCLUSIONS Our results suggest that a low-FODMAP enteral formula may be a practical therapeutic approach for patients who exhibit enteral formula complications. Our study warrants further randomized clinical trials and multicenter trials. Trial Registration Clinical Research Information Service Identifier: KCT0005660
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Affiliation(s)
- Eunjoo Bae
- Department of Food and Nutrition, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Korea.,Department of Medical Nutrition, Kyung Hee University, Yongin 17104, Korea
| | - Jiyoon Kim
- Department of Food and Nutrition, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Korea
| | - Jinyoung Jang
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Korea
| | - Junghyun Kim
- Division of Pulmonology, Allergy, and Critical Care Medicine, Department of Internal Medicine, CHA Bundang Medical Center, School of Medicine, CHA University, Seongnam 13496, Korea
| | - Suyeon Kim
- Department of Pharmacy, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Korea
| | - Youngeun Chang
- Department of Food and Nutrition, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Korea
| | - Mi Yeon Kim
- Department of Nursing, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Korea
| | - Mira Jeon
- Department of Nursing, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Korea
| | - Seongsuk Kang
- Department of Nursing, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Korea
| | - Jung Keun Lee
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Korea
| | - Tae Gon Kim
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Korea
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Chen C, Wang W, Chen F, Yang D, Wang P, Li Y. Bloodstream Infection in Patients With Intestinal Fistula: A Retrospective Study. J Surg Res 2021; 271:24-31. [PMID: 34814049 DOI: 10.1016/j.jss.2021.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 08/04/2021] [Accepted: 08/27/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND To delineate the clinical characteristics of intestinal fistula patients with Bloodstream infection (BSI). METHODS Retrospective case series in Surgical Intensive Care Unit (SICU), Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China. Among a cohort of 204 patients with a diagnosis of intestinal fistula, 46 who were complicated with BSI were analysed retrospectively. Data was collected from January 1, 2018 to February 1, 2020. RESULTS Among the 204 patients with intestinal fistula, 46 patients showed positive blood cultures, which clearly had BSIs. Parenteral nutrition (PN) time (OR 1.08, 95% CI 1.04∼1.12, P < 0.01), transferred from external ICU (OR 3.68, 95% CI 1.48∼9.17, P = 0.01), septic shock (OR 4.61, 95% CI 1.77∼11.97, P < 0.01), APACHE II (OR 1.11, 95% CI 1.01∼1.22, P = 0.04) were significantly associated with BSI in patients with intestinal fistula. When APACHE II score exceeds 12.0 points or PN time exceeds 18.0 D, the chance of BSI in patients with intestinal fistula increases significantly. In addition, compared with the non-BSI group, BSI group had a higher mortality and expenses in ICU, longer stay in ICU and total hospital stay, and worse quality of life (all P < 0.05). A total of 105 isolates from samples (including sputum, pus and blood) of 46 patients in the BSI group, among which were mainly gram negative rods and fungi, as well as blood isolates. Importantly, in patients with intestinal fistula, BSIs caused by fungi accounted for 23.4%. CONCLUSION Long-term PN, transfer from external ICU, septic shock, and higher APACHE II scores are often associated with an increased probability of BSIs in patients with intestinal fistula and a higher mortality. Gram-negative bacteria are the main pathogenic bacteria in intestinal fistula patients with BSI, and patients with intestinal fistula are more likely to develop fungal BSIs.
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Affiliation(s)
- Chen Chen
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200011, China
| | - Wenyue Wang
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200011, China
| | - Fen Chen
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200011, China
| | - Dongliang Yang
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200011, China
| | - Pengfei Wang
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200011, China.
| | - Yousheng Li
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200011, China.
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Yahyapoor F, Dehnavi Z, Askari G, Ranjbar G, Hejri Zarifi S, Bagherniya M, Rezaian MK, Moghadaam AB, Fazeli F, Sedaghat A. The prevalence and possible causes of enteral tube feeding intolerance in critically ill patients: A cross-sectional study. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2021; 26:60. [PMID: 34729068 PMCID: PMC8506243 DOI: 10.4103/jrms.jrms_689_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/08/2020] [Accepted: 04/07/2021] [Indexed: 01/03/2023]
Abstract
Background: Enteral tube feeding intolerance (ETFI) is one of the most common complications of enteral nutrition (EN), which may lead to increased mortality and length of intensive care unit (ICU) stay. This study aimed to determine the prevalence of ETFI and effects on feeding intolerance on nutrition and clinical outcomes in Iran. Materials and Methods: This cross-sectional study was conducted in 2019 at the three general ICUs of Imam Reza Hospital in Mashhad, Iran, during 7 days on 245 patients. The collected data included demographic characteristics, primary diagnosis, the Acute Physiology and Chronic Health Evaluation II (APACHE ІІ) score, Sequential Organ Failure Assessment (SOFA) score, duration of mechanical ventilation, and length of ICU stay. Feeding intolerance was assessed using daily questionnaires for 7 days. ETFI was determined as the interruption of EN based on gastrointestinal causes, including large gastric residuals, abdominal distension, vomiting, diarrhea, and subjective discomfort. Results: Overall, 245 critically ill patients (122 males and 123 females) were included in this study, with a mean age of 58.43 ± 19.2 years in three general ICUs. The highest prevalence rate of ETFI was 91.8%, which occurred on the 2nd day although the rate decreased in the following days. The minimum ETFI was observed on the last day (38.8%). Feeding intolerance was associated with the increased APACHE II scores (P = 0.04), SOFA scores (P < 0.001), and duration of mechanical ventilation (P < 0.001) compared with the tolerant patients. The most common causes of ETFI in the patients admitted to the ICU were gastric residual volume (GRV), large GRV, vomiting, and distension. Conclusion: ETFI was prevalent in almost two-third (66%) of the critically ill patients receiving EN based on the GRV. ETFI was associated with deteriorated nutritional status and clinical outcomes.
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Affiliation(s)
- Farveh Yahyapoor
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Dehnavi
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gholamreza Askari
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Golnaz Ranjbar
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sudiyeh Hejri Zarifi
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Bagherniya
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Khadem Rezaian
- Clinical Research Development Unit, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ahmad Bagheri Moghadaam
- Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farzane Fazeli
- Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Sedaghat
- Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Gonzalez-Granda A, Schollenberger A, Thorsteinsson R, Haap M, Bischoff SC. Impact of an interdisciplinary nutrition support team (NST) on the clinical outcome of critically ill patients. A pre/post NST intervention study. Clin Nutr ESPEN 2021; 45:486-491. [PMID: 34620359 DOI: 10.1016/j.clnesp.2021.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 03/13/2021] [Accepted: 06/08/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Intensive care unit (ICU) patients are at particular risk for malnutrition with major impact for outcome and prognosis. Nutrition support teams (NST) have been proposed to improve nutrition care in ICU patients. OBJECTIVE To assess the effectiveness of an interdisciplinary NST on anthropometry and clinical outcome of ICU patients. METHODS Before NST implementation, we assessed 120 patients (before NST group; SAPS II score 44 ± 16), afterwards 60 patients (after NST group), of whom 29 received NST guidance (after NST + group; SAPS II 65 ± 19) and 31 not (after NST - group; SAPS II, 54 ± 16). The primary outcome parameter was length of stay in the hospital (hospital-LOS). Severity of disease was assessed by the APACHE II score and the nutritional risk (NUTRIC) score. RESULTS NST intervention resulted in a more pronounced improvement of disease severity (APACHE II, from 27 ± 8 to 18 ± 6, p < 0.001; NUTRIC, from 7 ± 2 to 4 ± 2, p < 0.001) compared to no NST intervention (APACHE II from 24 ± 7 to 21 ± 7, p < 0.05; NUTRIC from 6 ± 2 to 5 ± 2, p < 0.01). The mean hospital-LOS was not reduced, neither in the NST intervention group nor in the control group without NST intervention. NST intervention failed to improve nutritional status or mortality compared to no NST intervention. CONCLUSION In our study the NST intervention had a positive effect on disease severity, but failed to improve mortality, hospital-LOS or nutritional status in ICU patients, likely because of a large patient heterogeneity. TRIAL REGISTRATION ClinicalTrials.gov (NCT02200874).
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Affiliation(s)
- Anita Gonzalez-Granda
- Institute of Nutritional Medicine, University of Hohenheim, Fruwirthstr. 12, 70593, Stuttgart, Germany.
| | - Asja Schollenberger
- Institute of Nutritional Medicine, University of Hohenheim, Fruwirthstr. 12, 70593, Stuttgart, Germany; Centre of Nutritional Medicine, University Hospital of Tübingen and University of Hohenheim, Otfried-Mueller-Str. 14, 72076, Tübingen, Germany.
| | - Regina Thorsteinsson
- Centre of Nutritional Medicine, University Hospital of Tübingen and University of Hohenheim, Otfried-Mueller-Str. 14, 72076, Tübingen, Germany.
| | - Michael Haap
- Medical Intensive Care Unit, Dept. of Medicine, University Hospital of Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany.
| | - Stephan C Bischoff
- Institute of Nutritional Medicine, University of Hohenheim, Fruwirthstr. 12, 70593, Stuttgart, Germany; Centre of Nutritional Medicine, University Hospital of Tübingen and University of Hohenheim, Otfried-Mueller-Str. 14, 72076, Tübingen, Germany.
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50
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Mostafa MS, Gamal Y, Soliman MH. Peptide-based enteral formula vs a whole protein enteral formula after major intestinal surgeries in children. ANNALS OF PEDIATRIC SURGERY 2021. [DOI: 10.1186/s43159-021-00112-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Malnutrition is a common finding after major abdominal surgeries especially after prolonged period of fasting in children. Enteral feeding is the commonest support way postoperatively for stimulating gut hormones, modulating immunity, and maintaining the barrier function of the intestinal mucosa.
Our aim was to compare the results and outcome regarding tolerance, nutritional status, and hospital stay following a postoperative diet of peptide-based enteral formula against a whole protein enteral formula after major intestinal surgeries in pediatric patients who had resection and re-anastomosis after intussusception.
Results
This is a prospective cohort study on two groups of patients with a total of 30 patients during the period between January 2019 and June 2020.
All patients in both groups underwent major intestinal surgeries (resection and re-anastomosis after intussusception). The first group received postoperative whole protein formula exclusively on the 3rd postoperative day while the other group received peptide-based formula exclusively on the same day.
Postoperative mean serum albumin and pre-albumin levels were significantly higher in peptide-based formula group compared to those who had protein-based formula as their initial feeds (P value < 0.05). The average hospital stay was also significantly shorter in the peptide group (P value < 0.05). Peptide formula was easily tolerated than protein formula in postoperative children who had major intestinal surgeries.
Conclusion
Peptide-based enteral formulas are better tolerated and more useful as regards nutritional status than whole-protein formulas in post-operative course of pediatric patients regarding clinical outcome and better economically with shorter hospital stay.
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