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Zhu LH, Shen YF, Ren Q, Lin J. Construction of a Risk Prediction Model for the Occurrence of Acute Skin Failure in Critically Ill Patients: A Prospective Study. J Nurs Res 2024; 32:e338. [PMID: 39046359 DOI: 10.1097/jnr.0000000000000627] [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: 07/25/2024] Open
Abstract
BACKGROUND The risk factors for acute skin failure (ASF), a serious complication of the skin, are not fully understood. PURPOSE This study was designed to explore the risk factors for ASF in critically ill patients and construct a clinical prediction model. METHODS Intensive care unit patients were prospectively observed and assigned into two groups: with and without ASF. A logistic regression model was constructed, and its predictive power and clinical utility were evaluated. RESULTS Of the 204 eligible patients enrolled as participants, 58 (28.43%) developed ASF. Sepsis, vasoactive drugs, and age were shown to be risk factors for ASF, whereas peripheral perfusion index ratio and albumin level were shown to be protective factors. The area under the receiver operating characteristic curve was 0.83. The maximum Youden index of the model was 0.39 (specificity: 0.87, sensitivity: 0.77). The Hosmer-Lemeshow test (p = .20) and calibration curve showed good fitness and predictive utility with respect to the model. CONCLUSIONS The developed model effectively predicts ASF risk, allowing for the early identification of high-risk patients. Identifying risk factors such as sepsis, vasoactive drugs, and age and considering protective factors such as peripheral perfusion index and albumin levels may help optimize care plans. Clinical staff should pay special attention to these factors and their impact on skin health in critically ill patients.
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Affiliation(s)
- Li-Hong Zhu
- MSN, RN, Intensive Care Specialist Nurse, Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang Province, People's Republic of China
| | - Yan-Fei Shen
- PhD, MD, Professor, Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang Province, People's Republic of China
| | - Qi Ren
- MSN, RN, Intensive Care Specialist Nurse, Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang Province, People's Republic of China
| | - Juan Lin
- MSN, RN, Head Nurse, Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang Province, People's Republic of China
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García-Delgado M, Rodríguez-García R, Ochagavía A, Rodríguez-Esteban MDLÁ. The medical treatment of cardiogenic shock. Med Intensiva 2024; 48:477-486. [PMID: 38834498 DOI: 10.1016/j.medine.2024.05.012] [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: 05/10/2024] [Accepted: 05/18/2024] [Indexed: 06/06/2024]
Abstract
Cardiogenic shock is characterized by tissue hypoperfusion due to the inadequate cardiac output to maintain the tissue oxygen demand. Despite some advances in cardiogenic shock management, extremely high mortality is still associated with this clinical syndrome. Its management is based on the immediate stabilization of hemodynamic parameters through medical care and the use of mechanical circulatory supports in specialized centers. This review aims to understand the cardiogenic shock current medical treatment, consisting mainly of inotropic drugs, vasopressors and coronary revascularization. In addition, we highlight the relevance of applying measures to other organ levels based on the optimization of mechanical ventilation and the appropriate initiation of renal replacement therapy.
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Affiliation(s)
- Manuel García-Delgado
- Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Raquel Rodríguez-García
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Spain; CIBER-Enfermedades Respiratorias, Instituto de Salud Carlos III, Spain.
| | - Ana Ochagavía
- Servicio de Medicina Intensiva, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Yébenes JC, Bordeje-Laguna ML, Lopez-Delgado JC, Lorencio-Cardenas C, Martinez De Lagran Zurbano I, Navas-Moya E, Servia-Goixart L. Smartfeeding: A Dynamic Strategy to Increase Nutritional Efficiency in Critically Ill Patients-Positioning Document of the Metabolism and Nutrition Working Group and the Early Mobilization Working Group of the Catalan Society of Intensive and Critical Care Medicine (SOCMiC). Nutrients 2024; 16:1157. [PMID: 38674847 PMCID: PMC11054493 DOI: 10.3390/nu16081157] [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: 03/01/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Adequate medical nutrition therapy for critically ill patients has an impact on their prognoses. However, it requires an individualized approach that takes into account the activity (phases of metabolic stress) and particularity of these patients. We propose a comprehensive strategy considering the patients' nutritional status and the set of modifiable circumstances in these patients, in order to optimize/support nutritional efficiency: (1) A detailed anamnesis and an adequate initial nutritional assessment must be performed in order to implement medical nutrition therapy that is in line with the needs and characteristics of each patient. Furthermore, risks associated with refeeding syndrome, nutritrauma or gastrointestinal dysfunction must be considered and prevented. (2) A safe transition between nutrition therapy routes and between health care units will greatly contribute to recovery. The main objective is to preserve lean mass in critically ill patients, considering metabolic factors, adequate protein intake and muscle stimulation. (3) Continuous monitoring is required for the successful implementation of any health strategy. We lack precise tools for calculating nutritional efficiency in critically ill patients, therefore thorough monitoring of the process is essential. (4) The medical nutrition approach in critically ill patients is multidisciplinary and requires the participation of the entire team involved. A comprehensive strategy such as this can make a significant difference in the functional recovery of critically ill patients, but leaders must be identified to promote training, evaluation, analysis and feedback as essential components of its implementation, and to coordinate this process with the recognition of hospital management.
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Affiliation(s)
- Juan Carlos Yébenes
- Institut d’Assistència Sanitària (IAS)—Hospital Santa Caterina, 17007 Girona, Spain
| | | | - Juan Carlos Lopez-Delgado
- Hospital Clinic, Medical ICU, Clinical Institute of Internal Medicine & Dermatology (ICMiD), 08036 Barcelona, Spain;
| | | | | | | | - Lluis Servia-Goixart
- Intensive Care Department, Hospital Universitari Arnau de Vilanova, LLeida, 25198 Lleida, Spain;
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Flordelís Lasierra JL, Montejo González JC, López Delgado JC, Zárate Chug P, Martínez Lozano-Aranaga F, Lorencio Cárdenas C, Bordejé Laguna ML, Maichle S, Terceros Almanza LJ, Trasmonte Martínez MV, Mateu Campos L, Servià Goixart L, Vaquerizo Alonso C, Vila García B. Enteral Nutrition in Critically Ill Patients Under Vasoactive Drug Therapy. The NUTRIVAD Study. JPEN J Parenter Enteral Nutr 2022; 46:1420-1430. [PMID: 35274345 DOI: 10.1002/jpen.2371] [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: 01/05/2022] [Revised: 02/18/2022] [Accepted: 03/08/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Enteral nutrition (EN) in critically ill patients requiring vasoactive drug (VAD) support is controversial. This study assesses the tolerability and safety of EN in such patients. METHODS This prospective observational study was conducted in 23 ICUs over 30 months. Inclusion criteria were a need for VAD and/or mechanic circulatory support (MCS) over a minimum of 48 h, a need for at least 48 h of mechanical ventilation, an estimated life expectancy longer than 72 h, and at least 72 h of ICU stay. Patients with refractory shock were excluded. EN was performed according to established protocols during which descriptive, daily hemodynamic and efficacy and safety data were collected. An independent research group conducted the statistical analysis. RESULTS Of 200 patients included, 30 (15%) required MCS and 145 (73%) met early multiorgan dysfunction criteria. Mortality was 24%. Patients needed a mean dose of norepinephrine in the first 48 h of 0.71 μg/kg/min (95%CI: 0.63-0.8) targeting a mean arterial pressure of 68 mmHg (95%CI: 67-70) during the first 48 h. EN was started 34 h (95%CI: 31-37) after ICU admission. Mean energy and protein delivered by EN/patient/day were 1159 Kcal (95%CI: 1098-1220) and 55.6 g (52.4-58.7) respectively. Daily energy balance during EN/patient/day was -432 (95%CI: -496 to -368). 154 (77%) patients experienced EN-related complications. However, severe complications such as mesenteric ischemia were recorded in only 1 patient (0.5%). CONCLUSIONS EN in these patients seems feasible, safe and unrelated to serious complications. Reaching the energy target only through EN is difficult. CLINICAL RELEVANCY STATEMENT Enteral nutrition (EN) in critically ill patients requiring vasoactive drugs (VAD) is currently a subject of controversy. Factors such as when to start EN, dosing, monitoring, or whether to avoid EN altogether are a real challenge because of its link to a risk of bowel ischemia. We describe our experience with EN in 200 critically ill patients on mechanical ventilation and requiring VAD. Under adequate supervision, EN proved feasible and safe. Our findings require confirmation in clinical intervention trials. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- José Luis Flordelís Lasierra
- Intensive Care Medicine Service. Research Institute Hospital 12 de Octubre (i+12), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Juan Carlos Montejo González
- Intensive Care Medicine Service. Research Institute Hospital 12 de Octubre (i+12), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Juan Carlos López Delgado
- Intensive Care Medicine Department. L'Hospitalet de Llobregat, Hospital Universitari de Bellvitge, (Barcelona), Spain
| | - Paola Zárate Chug
- Intensive Care Medicine Service, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | - María Luisa Bordejé Laguna
- Intensive Care Medicine Service, Hospital Universitario Germans Trias i Pujol, Barcelona, Cataluña, Spain
| | - Silmary Maichle
- Intensive Care Medicine Service, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | | | - Lidón Mateu Campos
- Hospital General Universitario de Castellón, Comunidad Valenciana, Spain
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Marsella CP, Taslim NA, Syam N, Syauki AY. Medical nutrition therapy in hemodynamically unstable patients due to cardiogenic shock with infected bronchiectasis and severe protein-energy malnutrition. GACETA SANITARIA 2021; 35 Suppl 2:S506-S509. [PMID: 34929887 DOI: 10.1016/j.gaceta.2021.10.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Cardiogenic shock is defined as tissue hypoperfusion due to cardiac dysfunction. It is associated with hemodynamic unstability and elevated arterial lactate as one indicator for anaerobic metabolism. Hypercatabolic state in this condition leads to increasing nutritional requirement and negative nitrogen balance. Therefore, medical nutrition therapy by considering metabolic tolerance can prevent further metabolic deterioration and loss of lean mass and improve the patient's clinical outcome. METHODS A 44-years-old female patient with severe protein-energy malnutrition (Subjective Global Assessment Score C; MUAC 15cm) suffered from hemodynamic unstability due to cardiogenic shock and infected bronchiectasis at the infection center of Wahidin Sudirohusodo Hospital. Intake was postponed due to mean arterial pressure 56mmHg on vasopressor support and oxygen saturation below 93%. Physical examinations showed loss of subcutaneous fat, lung crackles and wheezing, muscle wasting, and pretibial edema. Laboratory assessments showed elevated arterial lactate (3.2mmol/L), hypoalbuminemia (2.4g/dL), lymphocytopenia (650/μL), elevated liver enzymes (SGOT 780U/L; SGPT 868U/L), and urine urea nitrogen (5g/24h). Nutritional therapy was started after mean arterial pressure ≥65mmHg with a stable dosage of the vasopressor drug and decreased arterial lactate level to 2.2mmol/L then given gradually with a target calorie of 1500kcal and protein 1.5-1.8g/kg ideal body weight/day using high protein diet. Arterial lactate and blood gass analyses were controlled every day to determine the target of nutritional therapy day by the day. Snakehead fish extract, zinc, vitamin B complex, Thiamine, vitamin C, vitamin A, vitamin D3, and Curcumin were supplied. RESULT After 15 days of nutritional therapy, the patient was discharged from the hospital with stable hemodynamic without vasopressor support, adequate nutritional intake, improvement of anthropometric parameters, and laboratory test results (arterial lactate 1.6mmol/L, albumin 3.1g/dL, lymphocyte 1.871/μL, SGOT 34U/L, SGPT 41U/L, urine urea nitrogen 0.72g/24h). CONCLUSION Adequate nutritional therapy, which is planned by evaluating hemodynamic tolerance, can improve patient clinical outcomes and positive nitrogen balance in the hemodynamically unstable patient.
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Affiliation(s)
- Caroline Prisilia Marsella
- Clinical Nutrition Specialist Program, Department of Nutrition, Hasanuddin University School of Medicine, Makassar, Indonesia.
| | | | - Nurbaya Syam
- Department of Nutrition, Hasanuddin University School of Medicine, Makassar, Indonesia
| | - Andi Yasmin Syauki
- Department of Nutrition, Hasanuddin University School of Medicine, Makassar, Indonesia
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Vasopressors and Nutrition Therapy: Safe Dose for the Outset of Enteral Nutrition? Crit Care Res Pract 2020; 2020:1095693. [PMID: 32104602 PMCID: PMC7035530 DOI: 10.1155/2020/1095693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 11/04/2019] [Accepted: 11/15/2019] [Indexed: 12/24/2022] Open
Abstract
Background and Aims Patients with hemodynamic instability need to receive intensive treatment as fluid replacement and vasoactive drugs. In the meantime, it is supposed to initiate nutritional therapy within 24 to 48 hours after admission to the intensive care unit (ICU), as an essential part of patient's intensive care and better outcomes. However, there are many controversies tangential to the prescription of enteral nutrition (EN) concomitant to the use of vasopressor and its doses. In this way, the present study aimed to identify what the literature presents of evidence to guide the clinical practice concerning the safe dose of vasopressors for the initiation of nutritional therapy in critically ill patients. Methods This review was carried out in PubMed, ProQuest, Web of Science, and Medline databases. The descriptors were used to perform the search strategy: Critical Care, Intensive Care Units, Vasoconstrictor Agents, and Enteral Nutrition. Inclusion criteria were patients of both genders, over 18 years of age, using vasoactive drugs, with the possibility of receiving EN therapy, and articles written in English, Portuguese, and Spanish. In addition, exclusion criteria were case reports, non-papers, and repeated papers. Results 10 articles met our inclusion criteria. Conclusion It was observed that there are many controversies about the supply of EN in critically ill patients using vasopressor, especially about the safe dose, and it was not possible to identify a cutoff value for the beginning therapy. Despite the drug doses, clinical signs are still the most important parameters in the evaluation of EN tolerance.
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Ong CS, Brown PM, Yesantharao P, Zhou X, Young A, Canner JK, Quinlan M, Brown EF, Sussman MS, Whitman GJ. Vasoactive and Inotropic Support, Tube Feeding, and Ischemic Gut Complications After Cardiac Surgery. JPEN J Parenter Enteral Nutr 2020; 44:1461-1467. [DOI: 10.1002/jpen.1769] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/12/2019] [Indexed: 01/05/2023]
Affiliation(s)
- Chin Siang Ong
- Division of Cardiac Surgery Johns Hopkins Hospital Baltimore Maryland USA
- Division of Cardiac Surgery Massachusetts General Hospital Boston Massachusetts USA
| | - Patricia M. Brown
- Division of Cardiac Surgery Johns Hopkins Hospital Baltimore Maryland USA
| | - Pooja Yesantharao
- Division of Cardiac Surgery Johns Hopkins Hospital Baltimore Maryland USA
| | - Xun Zhou
- Division of Cardiac Surgery Johns Hopkins Hospital Baltimore Maryland USA
| | - Allen Young
- Division of Cardiac Surgery Johns Hopkins Hospital Baltimore Maryland USA
| | - Joseph K. Canner
- Department of Surgery Johns Hopkins Hospital Baltimore Maryland USA
| | - Munirih Quinlan
- Division of Cardiac Surgery Johns Hopkins Hospital Baltimore Maryland USA
| | - Evan F. Brown
- Division of Cardiac Surgery Johns Hopkins Hospital Baltimore Maryland USA
| | - Marc S. Sussman
- Division of Cardiac Surgery Johns Hopkins Hospital Baltimore Maryland USA
| | - Glenn J.R. Whitman
- Division of Cardiac Surgery Johns Hopkins Hospital Baltimore Maryland USA
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8
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Impact of Intravenous Fluids and Enteral Nutrition on the Severity of Gastrointestinal Dysfunction: A Systematic Review and Meta-analysis. ACTA ACUST UNITED AC 2020; 6:5-24. [PMID: 32104727 PMCID: PMC7029405 DOI: 10.2478/jccm-2020-0009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 01/30/2020] [Indexed: 12/11/2022]
Abstract
Introduction Gastrointestinal dysfunction (GDF) is one of the primary causes of morbidity and mortality in critically ill patients. Intensive care interventions, such as intravenous fluids and enteral feeding, can exacerbate GDF. There exists a paucity of high-quality literature on the interaction between these two modalities (intravenous fluids and enteral feeding) as a combined therapy on its impact on GDF. Aim To review the impact of intravenous fluids and enteral nutrition individually on determinants of gut function and implications in clinical practice. Methods Randomized controlled trials on intravenous fluids and enteral feeding on GDF were identified by a comprehensive database search of MEDLINE and EMBASE. Extraction of data was conducted for study characteristics, provision of fluids or feeding in both groups and quality of studies was assessed using the Cochrane criteria. A random-effects model was applied to estimate the impact of these interventions across the spectrum of GDF severity. Results Restricted/ goal-directed intravenous fluid therapy is likely to reduce ‘mild’ GDF such as vomiting (p = 0.03) compared to a standard/ liberal intravenous fluid regime. Enterally fed patients experienced increased episodes of vomiting (p = <0.01) but were less likely to develop an anastomotic leak (p = 0.03) and peritonitis (p = 0.03) compared to parenterally fed patients. Vomiting (p = <0.01) and anastomotic leak (p = 0.04) were significantly lower in the early enteral feeding group. Conclusions There is less emphasis on the combined approach of intravenous fluid resuscitation and enteral feeding in critically ill patients. Conservative fluid resuscitation and aggressive enteral feeding are presumably key factors contributing to severe life-threatening GDF. Future trials should evaluate the impact of cross-interaction between conservative and aggressive modes of these two interventions on the severity of GDF.
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Mehta Y, Sunavala JD, Zirpe K, Tyagi N, Garg S, Sinha S, Shankar B, Chakravarti S, Sivakumar MN, Sahu S, Rangappa P, Banerjee T, Joshi A, Kadhe G. Practice Guidelines for Nutrition in Critically Ill Patients: A Relook for Indian Scenario. Indian J Crit Care Med 2018; 22:263-273. [PMID: 29743765 PMCID: PMC5930530 DOI: 10.4103/ijccm.ijccm_3_18] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background and Aim: Intensive-care practices and settings may differ for India in comparison to other countries. While international guidelines are available to direct the use of enteral nutrition (EN), there are no recommendations specific to Indian settings. Advisory board meetings were arranged to develop the practice guidelines specific to Indian context, for the use of EN in critically ill patients and to overcome challenges in this field. Methods: Various existing guidelines, meta-analyses, randomized controlled trials, controlled trials, and review articles were reviewed for their contextual relevance and strength. A systematic grading of practice guidelines by advisory board was done based on strength of the supporting evidence. Wherever Indian studies were not available, references were taken from the international guidelines. Results: Based on the literature review, the recommendations for developing the practice guidelines were made as per the grading criteria agreed upon by the advisory board. The recommendations were to address challenges regarding EN versus parenteral nutrition; nutrition screening and assessment; nutrition in hemodynamically unstable; route of nutrition; tube feeding and challenges; tolerance; optimum calorie-protein requirements; selection of appropriate enteral feeding formula; micronutrients and immune-nutrients; standard nutrition in hepatic, renal, and respiratory diseases and documentation of nutrition practices. Conclusion: This paper summarizes the optimum nutrition practices for critically ill patients. The possible solutions to overcome the challenges in this field are presented as practice guidelines at the end of each section. These guidelines are expected to provide guidance in critical care settings regarding appropriate critical-care nutrition practices and to set up Intensive Care Unit nutrition protocols.
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Affiliation(s)
- Yatin Mehta
- Department of Critical Care, Institute of Critical Care and Anesthesiology, Medanta the Medicity, Gurugram, Haryana, India
| | - J D Sunavala
- Department of Critical Care Medicine, Jaslok Hospital, Mumbai, India
| | - Kapil Zirpe
- Department of Critical Care Medicine, Intensive Care and Neurotrauma - Stroke Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Niraj Tyagi
- Department of Intensive Care and Emergency Medicine, Sir Gangaram Hospital, New Delhi, India
| | - Sunil Garg
- Department of Critical Care Medicine, Max Hospital, New Delhi, India
| | - Saswati Sinha
- Department of Critical Care Medicine, AMRI Hospitals, Kolkata, West Bengal, India
| | | | - Sanghamitra Chakravarti
- Department of Nutrition and Dietetics, Medica Superspeciality Hospital, Kolkata, West Bengal, India
| | - M N Sivakumar
- Department of Critical Care Medicine, KMCH, Coimbatore, Tamil Nadu, India
| | - Sambit Sahu
- Department of Critical care Medicine, KIMS Hospital, Hyderabad, Telangana, India
| | - Pradeep Rangappa
- Department of Intensive Care Medicine, Columbia Asia Hospitals, Bengaluru, Karnataka, India
| | - Tanmay Banerjee
- Department of Intensive Care Medicine, Medica Institute of Critical Care, Medica Super speciality Hospital, Kolkata, West Bengal, India
| | - Anshu Joshi
- Department of Scientific and Medical Affairs, Abbott Nutrition International, ANI-, Mumbai, India
| | - Ganesh Kadhe
- Department of Scientific and Medical Affairs, Abbott Nutrition International, ANI-, Mumbai, India
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Nasiri M, Farsi Z, Ahangari M, Dadgari F. Comparison of Intermittent and Bolus Enteral Feeding Methods on Enteral Feeding Intolerance of Patients with Sepsis: A Triple-blind Controlled Trial in Intensive Care Units. Middle East J Dig Dis 2017; 9:218-227. [PMID: 29255580 PMCID: PMC5726335 DOI: 10.15171/mejdd.2017.77] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND
Recent trials have shown controversial results on which enteral feeding methods has a lower
risk of enteral feeding intolerance. Therefore, we aimed to compare two methods of bolus and
intermittent feeding on enteral feeding intolerance of patients with sepsis.
METHODS
This triple-blind randomized controlled trial was conducted on 60 patients with sepsis, who
were fed through tubes for at least 3 days. The patients were randomly assigned into bolus feeding,
intermittent feeding, and control groups. Enteral feeding intolerance of all patients was recorded in
3 consecutive days by a researcher-made checklist including the data on gastric residual volume,
vomiting, diarrhea, constipation, and abdominal distension.
RESULTS
There were no significant differences between the three studied groups in none of the intervention
days pertaining to constipation, diarrhea, vomiting, abdominal distention, and gastric residual volume
(p > 0.05). Also, no statistically significant difference was found between all variables in the three
studied groups during the 3 days (p > 0.05).
CONCLUSION
As enteral feeding intolerance of patients with sepsis was similar in both bolus and intermittent
feeding methods, it can be concluded that bolus method can still be used as a standard method to
decrease the risk of enteral feeding intolerance if it is used properly
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Affiliation(s)
- Morteza Nasiri
- Gastroenterology and Hepatology Disease Research Center, Qom University of Medical Sciences, Qom, Ira
| | - Zahra Farsi
- Associate Professor, Department of Medical-Surgical, Faculty of Nursing, AJA University of Medical Sciences, Tehran, Iran
| | - Mojtaba Ahangari
- Department of Critical Care, Faculty of Nursing, AJA University of Medical Sciences, Tehran, Iran
| | - Fahimeh Dadgari
- Department of Psychiatric, Faculty of Nursing, AJA University of Medical Sciences, Tehran, Iran
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