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Twose P, Terblanche E, Jones U, Firshman P, Merriweather J, Rock C, Wallace S. Protected therapy services for critical care: A subanalysis of the UK-wide workforce survey. Aust Crit Care 2023; 36:821-827. [PMID: 36604266 DOI: 10.1016/j.aucc.2022.11.011] [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: 07/19/2022] [Revised: 11/07/2022] [Accepted: 11/13/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The existing United Kingdom (UK) allied health professional (AHP) workforce in critical care does not meet national standards, with widespread variation in the source of funding, service availability, and regularity of input. OBJECTIVES The aim of this subanalysis was to determine the impact of protected services on the involvement of AHPs on direct and nondirect aspects of patient care. METHODS This is a subanalysis of the previously published AHPs in critical care UK-wide workforce survey, an observational study using online surveys distributed to 245 critical care units across the UK. RESULTS/FINDINGS Services with protected funding provided more daily input within critical care. This was most apparent for occupational therapy where daily input varied from 82.1% of units with protected services compared to just 10.3% in those without (p < 0.001). For all professions, most notably occupational therapy and speech and language therapy, protected services increased the regularity in which specific interventions were completed and had impact on involvement in nonclinical aspects of care including involved in multidisciplinary team meetings, clinical governance, and research. CONCLUSIONS The absence of protected AHP services reduces compliance with national standards for therapy workforce. Based on these findings, UK and international critical care guidelines should promote protected AHP services for critical care.
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Affiliation(s)
- Paul Twose
- School of Healthcare Sciences, Cardiff University, UK; Physiotherapy Department, Cardiff and Vale UHB, UK.
| | - Ella Terblanche
- Kings College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London SE1 8WA, UK.
| | - Una Jones
- School of Healthcare Sciences, Cardiff University, UK.
| | | | | | - Claire Rock
- Mid and South Essex NHS Foundation Trust, UK.
| | - Sarah Wallace
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, UK.
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Almeida KMM, Dourado KF, Barros Neto JA, Rodrigues IG, Arcoverde GMFP, Petribú MDMV. Association between nutritional therapy and complications in patients diagnosed with COVID-19 followed in the state of Pernambuco. REVISTA CIÊNCIAS EM SAÚDE 2022. [DOI: 10.21876/rcshci.v12i4.1301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective: To analyze the association between nutritional therapy and complications in patients diagnosed with COVID-19 followed in Pernambuco. Methods: A prospective cohort study was conducted to investigate secondary data from multicenter research from June 2020 to June 2021. Patients of both sexes over 18 years old were hospitalized for COVID-19 in wards or intensive care units of eight hospitals. Sociodemographic and economic data, nutritional status, nutritional therapy, gastrointestinal complications, and clinical outcome were collected during admission and at the end of hospitalization. Results: The sample consisted of 272 patients, with a median age of 67 years (IQR 54 - 76), equally distributed between men and women (50.4% vs. 49.6%). A higher frequency of overweight/obesity (40.31%) was observed. The most frequent alterations were inappetence (12.88%) and dysgeusia (8.28%). It was observed that 84.6% received an early diet, the caloric adequacy varied between 72.1% and 60.7%, the oral route between 82.4% and 70.7%, the majority (58%) received up to 1.3 g of protein per day, and 46.7% died. Caloric adequacy was associated with dysgeusia (p = 0.040) and clinical outcome (p = 0.044) and tended to be associated with vomiting (p = 0.077). No association was found with proteins. Conclusion: Nutritional therapy is associated with gastrointestinal symptoms such as vomiting and dysgeusia and the clinical outcome of patients with COVID-19.
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Nakamura K, Hatakeyama J, Liu K, Kanda N, Yamakawa K, Nishida T, Ohshimo S, Inoue S, Hashimoto S, Maruyama S, Kawakami D, Ogata Y, Hayakawa K, Shimizu H, Oshima T, Fuchigami T, Nishida O. Relation between nutrition therapy in the acute phase and outcomes of ventilated patients with COVID-19 infection: a multicenter prospective observational study. Am J Clin Nutr 2022; 115:1115-1122. [PMID: 35044427 PMCID: PMC8807204 DOI: 10.1093/ajcn/nqac014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/14/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Optimal nutrition therapy has not yet been established for the acute phase of severe coronavirus disease 2019 (COVID-19) infection. OBJECTIVES We aimed to examine the effects of nutrition delivery in the acute phase on mortality and the long-term outcomes of post-intensive care syndrome (PICS). METHODS A multicenter prospective study was conducted on adult patients with COVID-19 infection requiring mechanical ventilation during an intensive care unit (ICU) stay. Daily total energy (kcal/kg) and protein (g/kg) deliveries in the first week of the ICU stay were calculated. The questionnaire for PICS evaluation was mailed within a median of 6 mo after hospital discharge. The primary outcome was in-hospital mortality, and secondary outcomes were the PICS components of physical impairment, cognitive dysfunction, and mental illness. RESULTS Among 414 eligible patients, 297 who received mechanical ventilation for 7 d or longer were examined. PICS was evaluated in 175 patients among them. High protein delivery on days 4-7 correlated with a low in-hospital mortality rate. In contrast, high protein delivery on days 1-3 correlated with physical impairment. A multivariate logistic regression analysis adjusted for age, sex, BMI, and severity revealed that average energy and protein deliveries on days 4-7 correlated with decreased in-hospital mortality (OR: 0.94; 95% CI: 0.89, 0.99; P = 0.013 and OR: 0.40; 95% CI: 0.17, 0.93; P = 0.031, respectively). Nutrition delivery did not correlate with PICS outcomes after adjustments. In the multivariate regression using a restricted cubic spline model, in-hospital mortality monotonically decreased with increases in average nutrition delivery on days 4-7. CONCLUSIONS In patents with COVID-19 on mechanical ventilation for ≥7 d, nutrition delivery in the late period of the acute phase was monotonically associated with a decrease in in-hospital mortality. Adequate protein delivery is needed on days 4-7.This trial was registered at https://www.umin.ac.jp as UMIN000041276.
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Affiliation(s)
- Kensuke Nakamura
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Hitachi, Japan,Address correspondence to KN (E-mail: )
| | - Junji Hatakeyama
- Department of Emergency and Critical Care Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Naoki Kanda
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Hitachi, Japan
| | - Kazuma Yamakawa
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Takeshi Nishida
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shigeaki Inoue
- Department of Disaster and Emergency Medicine, School of Medicine, Kobe University, Hyogo, Japan
| | - Satoru Hashimoto
- Department of Intensive Care Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shuhei Maruyama
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, Osaka, Japan
| | - Daisuke Kawakami
- Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Yoshitaka Ogata
- Department of Critical Care Medicine, Yao Tokushukai General Hospital, Osaka, Japan
| | - Katsura Hayakawa
- Department of Emergency and Critical Care Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Hiroaki Shimizu
- Acute Care Medical Center, Hyogo Prefectural Kakogawa Medical Center, Hyogo, Japan
| | - Taku Oshima
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tatsuya Fuchigami
- Intensive Care Unit, University of the Ryukyus Hospital, Okinawa, Japan
| | - Osamu Nishida
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Aichi, Japan
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Karayiannis D, Kakavas S, Sarri A, Giannopoulou V, Liakopoulou C, Jahaj E, Kanavou A, Pitsolis T, Malachias S, Adamos G, Mantelou A, Almperti A, Morogianni K, Kampouropoulou O, Kotanidou A, Mastora Z. Does Route of Full Feeding Affect Outcome among Ventilated Critically Ill COVID-19 Patients: A Prospective Observational Study. Nutrients 2021; 14:nu14010153. [PMID: 35011026 PMCID: PMC8746666 DOI: 10.3390/nu14010153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/25/2021] [Accepted: 12/26/2021] [Indexed: 01/17/2023] Open
Abstract
The outbreak of the new coronavirus strain SARS-CoV-2 (COVID-19) highlighted the need for appropriate feeding practices among critically ill patients admitted to the intensive care unit (ICU). This study aimed to describe feeding practices of intubated COVID-19 patients during their second week of hospitalization in the First Department of Critical Care Medicine, Evaggelismos General Hospital, and evaluate potential associations with all cause 30-day mortality, length of hospital stay, and duration of mechanical ventilation. We enrolled adult intubated COVID-19 patients admitted to the ICU between September 2020 and July 2021 and prospectively monitored until their hospital discharge. Of the 162 patients analyzed (52.8% men, 51.6% overweight/obese, mean age 63.2 ± 11.9 years), 27.2% of patients used parenteral nutrition, while the rest were fed enterally. By 30 days, 34.2% of the patients in the parenteral group had died compared to 32.7% of the patients in the enteral group (relative risk (RR) for the group receiving enteral nutrition = 0.97, 95% confidence interval = 0.88–1.06, p = 0.120). Those in the enteral group demonstrated a lower duration of hospital stay (RR = 0.91, 95% CI = 0.85-0.97, p = 0.036) as well as mechanical ventilation support (RR = 0.94, 95% CI = 0.89–0.99, p = 0.043). Enteral feeding during second week of ICU hospitalization may be associated with a shorter duration of hospitalization and stay in mechanical ventilation support among critically ill intubated patients with COVID-19.
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Affiliation(s)
- Dimitrios Karayiannis
- Department of Clinical Nutrition, “Evangelismos” General Hospital of Athens, Ypsilantou 45-47, 10676 Athens, Greece; (A.A.); (K.M.)
- Correspondence: ; Tel.: +30-213-2045035; Fax: +30-213-2041385
| | - Sotirios Kakavas
- Intensive Care Unit, Center for Respiratory Failure, “Sotiria” General Hospital of Chest Diseases, 152 Mesogeion Avenue, 11527 Athens, Greece;
| | - Aikaterini Sarri
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.S.); (V.G.); (C.L.); (E.J.); (A.K.); (T.P.); (S.M.); (G.A.); (A.M.); (O.K.); (A.K.); (Z.M.)
| | - Vassiliki Giannopoulou
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.S.); (V.G.); (C.L.); (E.J.); (A.K.); (T.P.); (S.M.); (G.A.); (A.M.); (O.K.); (A.K.); (Z.M.)
| | - Christina Liakopoulou
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.S.); (V.G.); (C.L.); (E.J.); (A.K.); (T.P.); (S.M.); (G.A.); (A.M.); (O.K.); (A.K.); (Z.M.)
| | - Edison Jahaj
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.S.); (V.G.); (C.L.); (E.J.); (A.K.); (T.P.); (S.M.); (G.A.); (A.M.); (O.K.); (A.K.); (Z.M.)
| | - Aggeliki Kanavou
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.S.); (V.G.); (C.L.); (E.J.); (A.K.); (T.P.); (S.M.); (G.A.); (A.M.); (O.K.); (A.K.); (Z.M.)
| | - Thodoris Pitsolis
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.S.); (V.G.); (C.L.); (E.J.); (A.K.); (T.P.); (S.M.); (G.A.); (A.M.); (O.K.); (A.K.); (Z.M.)
| | - Sotirios Malachias
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.S.); (V.G.); (C.L.); (E.J.); (A.K.); (T.P.); (S.M.); (G.A.); (A.M.); (O.K.); (A.K.); (Z.M.)
| | - George Adamos
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.S.); (V.G.); (C.L.); (E.J.); (A.K.); (T.P.); (S.M.); (G.A.); (A.M.); (O.K.); (A.K.); (Z.M.)
| | - Athina Mantelou
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.S.); (V.G.); (C.L.); (E.J.); (A.K.); (T.P.); (S.M.); (G.A.); (A.M.); (O.K.); (A.K.); (Z.M.)
| | - Avra Almperti
- Department of Clinical Nutrition, “Evangelismos” General Hospital of Athens, Ypsilantou 45-47, 10676 Athens, Greece; (A.A.); (K.M.)
| | - Konstantina Morogianni
- Department of Clinical Nutrition, “Evangelismos” General Hospital of Athens, Ypsilantou 45-47, 10676 Athens, Greece; (A.A.); (K.M.)
| | - Olga Kampouropoulou
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.S.); (V.G.); (C.L.); (E.J.); (A.K.); (T.P.); (S.M.); (G.A.); (A.M.); (O.K.); (A.K.); (Z.M.)
| | - Anastasia Kotanidou
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.S.); (V.G.); (C.L.); (E.J.); (A.K.); (T.P.); (S.M.); (G.A.); (A.M.); (O.K.); (A.K.); (Z.M.)
| | - Zafeiria Mastora
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.S.); (V.G.); (C.L.); (E.J.); (A.K.); (T.P.); (S.M.); (G.A.); (A.M.); (O.K.); (A.K.); (Z.M.)
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