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Jahn T, Overgaard J, Mondloch M, Plante E, Burris J, Suresh M, Berndt J. Reducing Lung Injury from Blind Insertion of Small-Bore Feeding Tubes. Am J Nurs 2024; 124:28-34. [PMID: 38837249 DOI: 10.1097/01.naj.0001025188.79366.be] [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: 06/07/2024]
Abstract
ABSTRACT Using a blind insertion technique to insert small-bore feeding tubes can result in inadvertent placement in the lungs, leading to lung perforation and even mortality. In a Magnet-designated, 500-bed, level 2 trauma center, two serious patient safety events occurred in a four-week period due to nurses blindly inserting a small-bore feeding tube. A patient safety event review team convened and conducted an assessment of reported small-bore feeding tube insertion events that occurred between March 2019 and July 2021. The review revealed six lung perforations over this two-year period. These events prompted the creation of a multidisciplinary team to evaluate alternative small-bore feeding tube insertion practices. The team reviewed the literature and evaluated several evidence-based small-bore feeding tube placement methods, including placement with fluoroscopy, a two-step X-ray, electromagnetic visualization, and capnography. After the evaluation, capnography was selected as the most effective method to mitigate the complications of blind insertion. In this article, the authors describe a quality improvement project involving the implementation of capnography-guided small-bore feeding tube placement to reduce complications and the incidence of lung perforation. Since the completion of the project, which took place from December 13, 2021, through April 18, 2022, no lung injuries or perforations have been reported. Capnography is a relatively simple, noninvasive, and cost-effective technology that provides nurses with a means to safely and effectively insert small-bore feeding tubes, decrease the incidence of adverse events, and improve patient care.
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Affiliation(s)
- Teresa Jahn
- Teresa Jahn is an advanced practice nurse at CentraCare Heart and Vascular Center, St. Cloud Hospital, St. Cloud, MN, where Jenelle Overgaard is a nurse clinician in the ICU, Mallory Mondloch is a nurse clinician in the surgical care unit, Elizabeth Plante is a nurse clinician in the neuroscience/spine unit, Jennifer Burris is director of inpatient and outpatient nursing practice and innovation, and Mithun Suresh is a hospitalist. Jodi Berndt is associate professor at the College of Saint Benedict and Saint John's University, St. Joseph, MN. Contact author: Teresa Jahn, . The authors and planners have disclosed no potential conflicts of interest, financial or otherwise
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Bukowski JS, Jamer T, Kowalska-Duplaga K, Marczuk M, Stelmaszczyk-Emmel A, Banasiuk M, Banaszkiewicz A. Very early and early nutrition in children with pancreatitis-A randomised trial. J Pediatr Gastroenterol Nutr 2024. [PMID: 38938000 DOI: 10.1002/jpn3.12301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 06/03/2024] [Accepted: 06/17/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVES The aim of our study was to assess the impact of the very early introduction of refeeding on the course of acute pancreatitis (AP) in children. Additionally, we evaluated the effect of nutrition on inflammatory markers, including cytokines. METHODS This prospective randomised study was conducted in three university hospitals in Poland. Patients, aged 1-18 years with AP, were randomised into two groups: A-refeeding within 24 h of hospital admission (very early), and B-refeeding at least 24 h after admission (early nutrition). The severity of AP was assessed after 48 h. The serum concentrations of four cytokines (tumour necrosis factor α [TNFα], interleukin-1β [IL-1β], interleukin-6 [IL-6] and interleukin-8 [IL-8]) and C-reactive protein, as well as the activity of amylase, lipase and aminotransferases, were measured during the first 3 days of hospitalisation. RESULTS A total of 94 children were recruited to participate in the study. The statistical analysis included 75 patients with mild pancreatitis: 42-group A and 33-group B. The two groups did not differ in the length of hospitalisation (p = 0.22), AP symptoms or results of laboratory tests. Analysis of cytokine levels was conducted for 64 children: 38-group A and 26-group B. We did not find a difference in concentrations of the measured cytokines, except for IL-1β on the third day of hospitalisation (p = 0.01). CONCLUSIONS The time of initiation of oral nutrition within 24 h (very early) or after 24 h (early) from the beginning of hospitalisation had no impact on the length of hospitalisation, concentrations of TNF-α, IL-1β, IL-6 and IL-8, activity of amylase and lipase or occurrence of symptoms in children with mild AP.
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Affiliation(s)
- Jan S Bukowski
- Department of Paediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
| | - Tatiana Jamer
- Department of Paediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, Wroclaw, Poland
| | - Kinga Kowalska-Duplaga
- Department of Paediatrics, Gastroenterology and Nutrition, Jagiellonian University Medical College, Cracow, Poland
| | - Martyna Marczuk
- Department of Paediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
| | - Anna Stelmaszczyk-Emmel
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Banasiuk
- Department of Paediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
| | - Aleksandra Banaszkiewicz
- Department of Paediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
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Yin Y, Li Y, Liu Y, Fan C, Jiang Y. Baseline immune status and the effectiveness of response to enteral nutrition among ICU patients with COVID-19: An observational, retrospective study. Nutrition 2024; 122:112387. [PMID: 38430844 DOI: 10.1016/j.nut.2024.112387] [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: 11/07/2023] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES This study aimed to compare how immunocompromised and immunocompetent patients responded differently to enteral nutrition (EN) support in intensive care units (ICUs) during the COVID-19 pandemic, including serum nutritional biomarkers, inflammatory biomarkers, gastrointestinal (GI) intolerance symptoms, and clinical outcomes. METHODS An observational, retrospective study was conducted in the ICUs of a teaching hospital in southwest China. We recruited a convenience sample of 154 patients between December 2022 and February 2023. We defined immunocompromise as primary immunodeficiency diseases, active malignancy, receiving cancer chemotherapy, HIV infection, solid organ transplantation, hematopoietic stem cell transplantation, receiving corticosteroid therapy with a target dose, receiving biological immune modulators, or receiving disease-modifying antirheumatic drugs or other immunosuppressive drugs. We conducted a Mann-Whitney U test, χ2 test, or generalized estimation equation model to explore the differences between immunocompromised and immunocompetent patients. RESULTS Among the 154 study participants, 41 (27%) were defined as immunocompromised. The immunocompromised patients were younger than the immunocompetent patients. There were no statistically significant differences between the two groups with respect to serum nutritional biomarkers, inflammatory biomarkers, incidence of GI intolerance symptoms, and in-hospital mortality. However, the immunocompromised patients exhibited a longer hospitalization duration than the immunocompetent patients. CONCLUSION We found that the immunocompromised patients spent more time in the hospital. These findings may help us to standardize the participants before EN interventional studies better and better individualize EN supports based on patients' immunity status.
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Affiliation(s)
- Yao Yin
- Department of Neurosurgery, West China Hospital, Sichuan University/West China School of Nursing, Chengdu, People's Republic of China.
| | - Yijing Li
- Evidence-based Nursing Center, West China Hospital, Sichuan University/West China School of Nursing, Chengdu, People's Republic of China.
| | - Yan Liu
- Department of Neurosurgery, West China Hospital, Sichuan University/West China School of Nursing, Chengdu, People's Republic of China.
| | - Chaofeng Fan
- Department of Neurosurgery, West China Hospital, Sichuan University/West China School of Nursing, Chengdu, People's Republic of China.
| | - Yan Jiang
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Chengdu, People's Republic of China.
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Chan KS, Shelat VG. The Ongoing Debate on the Use of Prophylactic Antibiotics in Acute Pancreatitis-Is There a Conclusion? A Comprehensive Narrative Review. Antibiotics (Basel) 2024; 13:411. [PMID: 38786140 PMCID: PMC11117274 DOI: 10.3390/antibiotics13050411] [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: 04/03/2024] [Revised: 04/28/2024] [Accepted: 04/28/2024] [Indexed: 05/25/2024] Open
Abstract
Acute pancreatitis (AP) is a common but often self-limiting disease in the majority of patients. However, in the minority, who may progress to moderately severe or severe AP, high mortality risk has been reported. Infected pancreatitis necrosis (IPN) in necrotising pancreatitis has been shown to result in more than twice the mortality rate compared with in sterile pancreatic necrosis. This raises the question on whether prophylactic antibiotics (PABs) should be given in subgroups of AP to prevent superimposed infection to improve survival outcomes. Despite numerous randomised controlled trials (RCTs), meta-analyses, and guidelines on the management of AP, there is a lack of strong evidence to suggest the use of PABs in AP. Additionally, use of PABs is associated with antimicrobial resistance. Considerable heterogeneity exists and limits the interpretation of results-subgroup of AP benefitting from PAB use, choice/class of PAB, and timing of administration from symptom onset and duration of PAB use. Only a minority of existing meta-analyses suggest mortality benefits and reduction in IPN. The majority of existing guidelines do not recommend the use of PABs in AP. More research is required to make more definitive conclusions. Currently, PAB should only be administered after multidisciplinary discussions led by pancreatology experts.
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Affiliation(s)
- Kai Siang Chan
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore;
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Vishal G. Shelat
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore;
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
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Patel JJ, Lopez-Delgado JC, Stoppe C, McClave SA. Enteral nutrition in septic shock: a call for a paradigm shift. Curr Opin Crit Care 2024; 30:165-171. [PMID: 38441124 DOI: 10.1097/mcc.0000000000001134] [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: 03/12/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to identify contemporary evidence evaluating enteral nutrition in patients with septic shock, outline risk factors for enteral feeding intolerance (EFI), describe the conundrum of initiating enteral nutrition in patients with septic shock, appraise current EFI definitions, and identify bedside monitors for guiding enteral nutrition therapy. RECENT FINDINGS The NUTRIREA-2 and NUTRIREA-3 trial results have better informed the dose of enteral nutrition in critically ill patients with circulatory shock. In both trials, patients with predominant septic shock randomized to receive early standard-dose nutrition had more gastrointestinal complications. Compared to other contemporary RCTs that included patients with circulatory shock, patients in the NUTRIREA-2 and NUTRIREA-3 trials had higher bowel ischemia rates, were sicker, and received full-dose enteral nutrition while receiving high baseline dose of vasopressor. These findings suggest severity of illness, vasopressor dose, and enteral nutrition dose impact outcomes. SUMMARY The provision of early enteral nutrition preserves gut barrier functions; however, these benefits are counterbalanced by potential complications of introducing luminal nutrients into a hypo-perfused gut, including bowel ischemia. Findings from the NUTRIREA2 and NUTRIREA-3 trials substantiate a 'less is more' enteral nutrition dose strategy during the early acute phase of critical illness. In the absence of bedside tools to guide the initiation and advancement of enteral nutrition in patients with septic shock, the benefit of introducing enteral nutrition on preserving gut barrier function must be weighed against the risk of harm by considering dose of vasopressor, dose of enteral nutrition, and severity of illness.
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Affiliation(s)
- Jayshil J Patel
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Christian Stoppe
- University Hospital, Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Charité Berlin, Berlin, Germany
| | - Stephen A McClave
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville, Louisville, Kentucky, USA
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Shen Y, Qiu B, Ge Q, Hu L, Cong Z, Wu Y. Effect of early enteral nutrition on short-term outcomes and survival in patients in the cardiothoracic intensive care unit: An inverse probability weighted retrospective study. Nutrition 2024; 119:112328. [PMID: 38237353 DOI: 10.1016/j.nut.2023.112328] [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: 09/28/2023] [Revised: 11/15/2023] [Accepted: 12/09/2023] [Indexed: 02/12/2024]
Abstract
OBJECTIVES The merits of early enteral nutrition (EEN) in patients in the cardiothoracic intensive care unit (CTICU) remain unclear. This retrospective study aimed to address this issue. METHODS We analyzed data from the MIMIC IV v2.0 database, including patients with a CTICU stay of ≥4 d. Patients were divided into early and delayed enteral nutrition (EN) groups. Differences in baseline data were corrected using an inverse probability weighting (IPW) approach. Generalized linear models (GLMs) were used to compare trends over time between groups, and survival effects were evaluated with weighted logistic and Cox regression, supplemented by weighted Kaplan-Meier curves. Subgroup analysis facilitated the exploration of potential interactions. RESULTS The study included 720 CTICU patients. Following IPW, all baseline variables were balanced. EEN led to shorter hospital and CTICU stays, lower incidence of respiratory and blood infections, and reduced total insulin usage in the first week of CTICU admission, albeit with an increased total gastric residual volume. Mortality risk between the groups did not significantly differ at 28 d or at 1 y. Excessive early energy and protein intake elevated the risk of 28-d mortality, but the relationship may not be linear. Overweight patients or those with fewer comorbidities had a higher mortality risk with EEN. CONCLUSIONS EEN may improve short-term outcomes in CTICU patients without a clear survival benefit. Early high caloric and protein intake could lead to adverse outcomes, suggesting a careful evaluation for initiating EN in specific patients.
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Affiliation(s)
- Yi Shen
- Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Jiangsu, China; Department of Cardiothoracic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Jiangsu, China
| | - Bingmei Qiu
- Department of Cardiothoracic Surgery, Jinling Hospital, Jiangsu, China
| | - Qiyue Ge
- Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Jiangsu, China
| | - Liwen Hu
- Department of Cardiothoracic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Jiangsu, China
| | - Zhuangzhuang Cong
- Department of Cardiothoracic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Jiangsu, China
| | - Yuheng Wu
- Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Jiangsu, China.
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Zeng W, Wu J, Xie H, Xu H, Liang D, He Q, Yang X, Liu C, Gong J, Zhang Q, Luo Z, Chen Y, He Z, Lan P. Enteral nutrition promotes the remission of colitis by gut bacteria-mediated histidine biosynthesis. EBioMedicine 2024; 100:104959. [PMID: 38215690 PMCID: PMC10827402 DOI: 10.1016/j.ebiom.2023.104959] [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: 06/27/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Exclusive enteral nutrition (EEN) is an important alternative strategy for patients with Crohn's disease (CD), and during this process, microbiota alterations have been observed. However, the underlying mechanisms by which EEN reduces intestinal inflammation are currently unclear. METHODS The therapeutic potential of enteral nutrition (EN) was assessed using various mouse models. Fecal full-length 16S rDNA sequencing analysis and several CD metagenome datasets were used to identify the candidate therapeutic bacteria Faecalibaculum rodentium (F. rodentium). Whole genome sequencing of F. rodentium and widely-targeted metabolome analysis of the supernatant showed that EN-induced F. rodentium accumulation protected against colitis via histidine biosynthesis. FINDINGS The therapeutic potential of EN therapy was observed in both dextran sulfate sodium (DSS)-induced colitis and Il10-/- spontaneous colitis mouse models. Accumulation of F. rodentium after EN therapy was determined using full-length 16S rDNA sequencing and verified with several metagenome datasets from patients with CD. Colonization of an isolated F. rodentium could reduce colitis in Il10-/- mice. Significant histidine enrichment was observed in the F. rodentium culture supernatant, and a series of histidine biosynthesis genes were observed in the F. rodentium genome. Engineered Escherichia coli Nissle 1917 (EcN), encoding the heterologous hisG of F. rodentium (EcN-hisG), which was a key driver of histidine biosynthesis in F. rodentium, was found to protect against colitis. INTERPRETATION This study suggests that EN-induced F. rodentium accumulation protects against colitis in mice via gut bacteria-mediated histidine biosynthesis. FUNDING A full list of funding bodies can be found in the Acknowledgements section.
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Affiliation(s)
- Wanyi Zeng
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China; Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China; School of Medicine, Shenzhen Campus of Sun Yat-sen University, No. 66, Gongchang Road, Guangming District, Shenzhen, Guangdong 518107, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China
| | - Jinjie Wu
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China; Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China
| | - Hongyu Xie
- Department of Anesthesia, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China
| | - Haoyang Xu
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China; Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China
| | - Dayi Liang
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China; Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China
| | - Qilang He
- School of Medicine, Shenzhen Campus of Sun Yat-sen University, No. 66, Gongchang Road, Guangming District, Shenzhen, Guangdong 518107, China
| | - Xiaoya Yang
- School of Medicine, Shenzhen Campus of Sun Yat-sen University, No. 66, Gongchang Road, Guangming District, Shenzhen, Guangdong 518107, China
| | - Chen Liu
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China; Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China
| | - Junli Gong
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China; Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China
| | - Qiang Zhang
- School of Medicine, Shenzhen Campus of Sun Yat-sen University, No. 66, Gongchang Road, Guangming District, Shenzhen, Guangdong 518107, China
| | - Zhanhao Luo
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China
| | - Yuan Chen
- School of Medicine, Shenzhen Campus of Sun Yat-sen University, No. 66, Gongchang Road, Guangming District, Shenzhen, Guangdong 518107, China
| | - Zhen He
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China; Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China; Key Laboratory of Human Microbiome and Chronic Diseases (Sun Yat-sen University), Ministry of Education, Guangzhou, Guangdong 510655, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China.
| | - Ping Lan
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China; Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China; State Key Laboratory of Oncology in South China, Guangzhou, Guangdong 510655, China.
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Li D, Wang L, Zhao Z, Bai C, Li X. A novel model for predicting deep-seated candidiasis due to Candida glabrata among cancer patients: A 6-year study in a cancer center of China. Med Mycol 2024; 62:myae010. [PMID: 38318635 DOI: 10.1093/mmy/myae010] [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: 10/11/2023] [Revised: 01/16/2024] [Accepted: 02/02/2024] [Indexed: 02/07/2024] Open
Abstract
Followed by Candida albicans, Candida glabrata ranks as the second major species contributing to invasive candidiasis. Given the higher medical burden and lower susceptibility to azoles in C. glabrata infections, identifying these infections is critical. From 2016 to 2021, patients with deep-seated candidiasis due to C. glabrata and non-glabrata Candida met the criteria to be enrolled in the study. Clinical data were randomly divided into training and validation cohorts. A predictive model and nomogram were constructed using R software based on the stepwise algorithm and logistic regression. The performance of the model was assessed by the area under the receiver operating characteristic curve and decision curve analysis (DCA). A total of 197 patients were included in the study, 134 of them infected with non-glabrata Candida and 63 with C. glabrata. The predictive model for C. glabrata infection consisted of gastrointestinal cancer, co-infected with bacteria, diabetes mellitus, and kidney dysfunction. The specificity was 84.1% and the sensitivity was 61.5% in the validation cohort when the cutoff value was set to the same as the training cohort. Based on the model, treatment for patients with a high-risk threshold was better than 'treatment for all' in DCA, while opting low-risk patients out of treatment was also better than 'treatment for none' in opt-out DCA. The predictive model provides a rapid method for judging the probability of infections due to C. glabrata and will be of benefit to clinicians making decisions about therapy strategies.
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Affiliation(s)
- Ding Li
- Department of Clinical Laboratory, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Lin Wang
- Department of Clinical Laboratory, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Zhihong Zhao
- Department of Clinical Laboratory, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Changsen Bai
- Department of Clinical Laboratory, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Xichuan Li
- Tianjin Key Laboratory of Animal and Plant Resistance, College of Life Sciences, Tianjin Normal University, Tianjin, China
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Wang Y, Li Y, Song C, Ke J, Zheng Y, Chen G, Li N. Licochalcone A promotes renewal of intestinal mucosa through modulating uc.173. JOURNAL OF ETHNOPHARMACOLOGY 2024; 318:117044. [PMID: 37586439 DOI: 10.1016/j.jep.2023.117044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/18/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Licorice can nourish Pi (spleen) and thereby strengthening the digestive system according to the theory of traditional Chinese medicine. Licorice has been generally used in the compound prescription to treat intestinal inflammatory disease. Licochalcone A (Lico A) is one of the characteristic molecules from licorice. T-UCRs, which are transcribed from ultraconserved regions, are a new class of long noncoding RNAs related to the renewal of intestinal epithelial renewal. AIM OF THE STUDY This study aimed to investigate the effect and the uc.173-related mechanism of Lico A on intestinal epithelial renewal. MATERIALS AND METHODS IE-6 and Caco-2 cells were used to evaluate the effect of Lico A on apoptosis, proliferation, and migration of IECs. The intestinal organoid was used to investigate ex vivo effect and mechanism of Lico A promoting intestinal organoid development. C57BL/6J mice (both normal and uc.173-deficient ones) were used to examine the in vivo effect of Lico A on the renewal of intestinal mucosa. RESULTS The expression of three T-UCRs related to the intestinal mucosa renewal was altered in Lico A-treated IECs. Lico A promoted the proliferation and inhibited the apoptosis of IECs through uc.173/miR-195 pathway. The development of intestinal organoids and the renewal of intestinal mucosa of mice subjected to the 48-h FAST were all promoted by the treatment of Lico A. Moreover, the growth arrest of uc.173-deficient intestinal organoids and the atrophy of intestinal mucosa in uc.173-deficient mice could be rescued by the Lico A administration. CONCLUSION Results in this paper suggest that targeting T-UCRs may be the novel therapeutic approach for the promotion of epithelial regeneration, and through stimulating the regeneration of intestinal mucosa, Lico A may become a new therapeutic agent for the maintenance of intestinal epithelial integrity.
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Affiliation(s)
- Yajun Wang
- School of Traditional Chinese Materia Medica, Key Laboratory of Innovative Traditional Chinese Medicine for Major Chronic Diseases of Liaoning Province, Key Laboratory for TCM Material Basis Study and Innovative Drug Development of Shenyang City, Shenyang Pharmaceutical University, Shenyang, 110016, China.
| | - Yanwu Li
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.
| | - Chunhui Song
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.
| | - Junyu Ke
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China.
| | - Yanqiu Zheng
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.
| | - Gang Chen
- School of Traditional Chinese Materia Medica, Key Laboratory of Innovative Traditional Chinese Medicine for Major Chronic Diseases of Liaoning Province, Key Laboratory for TCM Material Basis Study and Innovative Drug Development of Shenyang City, Shenyang Pharmaceutical University, Shenyang, 110016, China.
| | - Ning Li
- School of Traditional Chinese Materia Medica, Key Laboratory of Innovative Traditional Chinese Medicine for Major Chronic Diseases of Liaoning Province, Key Laboratory for TCM Material Basis Study and Innovative Drug Development of Shenyang City, Shenyang Pharmaceutical University, Shenyang, 110016, China.
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Wang Y, Li Y, Li Y, Li H, Zhang D. Enteral feeding strategies in patients with acute gastrointestinal injury: From limited to progressive to open feeding. Nutrition 2024; 117:112255. [PMID: 37897987 DOI: 10.1016/j.nut.2023.112255] [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: 07/19/2023] [Revised: 09/21/2023] [Accepted: 09/29/2023] [Indexed: 10/30/2023]
Abstract
Acute gastrointestinal injury (AGI) is very common in critically ill patients, and its severity is positively correlated with mortality. Critically ill patients with digestive and absorption dysfunction caused by AGI face higher nutritional risks, making nutritional support particularly important. Early enteral nutrition (EN) support is extremely important because it can promote the recovery of intestinal function, protect the intestinal mucosal barrier, reduce microbiota translocation, reduce postoperative complications, shorten hospital stay, and improve clinical prognosis. In recent years, many nutritional guidelines have been proposed for critically ill patients; however, there are few recommendations for the implementation of EN in patients with AGI, and their quality of evidence is low. The use of EN feeding strategies in critically ill patients with AGI remains controversial. The aim of this review was to elaborate on how EN feeding strategies should transition from limited to progressive to open feeding and explain the time window for this transition.
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Affiliation(s)
- Youquan Wang
- Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, China.
| | - Yanhua Li
- Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, China.
| | - Yuting Li
- Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, China.
| | - Hongxiang Li
- Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, China.
| | - Dong Zhang
- Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, China.
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11
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Lin Y, Wang X, Li L, Gou Y, Zhang L, Wang L, Yang J. Nomogram to predict feeding intolerance in critically ill children. Eur J Pediatr 2023; 182:5293-5302. [PMID: 37723295 DOI: 10.1007/s00431-023-05205-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/28/2023] [Accepted: 09/13/2023] [Indexed: 09/20/2023]
Abstract
Feed intolerance (FI) is significantly associated with poor prognosis in critically ill patients. This study aimed to understand the characteristics of children with FI and identify the factors predicting FI in critically ill children. This retrospective cohort study was conducted between January 2017 and June 2022 in the Pediatric Intensive Care Unit of a specialized children's hospital. Eighteen factors, including age, body mass index for age z-score (BAZ) < -2, paediatric index of mortality (PIM)3 score, Glasgow coma scale score, mechanical ventilation (MV), enteral nutrition delay, vasoactive drugs, sedatives, sepsis, heart disease, neurological disease, hypokalemia, arterial PH < 7.35, arterial partial pressure of oxygen (PaO2), blood glucose, hemoglobin, total protein, and albumin, were retrieved to predict FI. The outcome was FI during PICU stay. During the study period, a total of 854 children were included, of which 215 children developed FI. Six predictors of FI were selected: PIM3 score, MV, sepsis, hypokalemia, albumin, and PaO2. Multivariate logistic regression analysis showed that higher PIM3 score, MV, sepsis, hypokalemia, and lower PaO2 were independent risk factors for FI, whereas higher albumin was an independent protective factor for FI. The C-index of the predictive nomogram of 0.943 was confirmed at internal validation to be 0.940, indicating a good predictive value of the model. Decision curve analysis shows good clinical applicability of the nomogram in predicting FI. Conclusion: The nomogram was verified to have a good prediction performance based on discrimination, calibration, and clinical decision analysis. What is Known: • Research has demonstrated that gastrointestinal (GI) dysfunction is not only a fundamental element of Multiple Organ Dysfunction Syndrome (MODS), but also the initiator of MODS. • Previous study has demonstrated a significant association between FI and poor prognosis in critically ill patients. What is New: • We excluded patients with primary gastrointestinal tract disease from our study, and we observed an incidence of FI of 25.2% in the Pediatric Intensive Care Unit (PICU). • Our study revealed that PIM3 score, MV, sepsis, hypokalemia, albumin, and PaO2 are significant predictors of FI.
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Affiliation(s)
- Ying Lin
- Department of Nutrition, Tianjin Children's Hospital /Tianjin University Children's Hospital, 225 Longyan Rd, Beichen Dist, Tianjin, China.
| | - Xiaomin Wang
- Pediatric Intensive Care Unit, Tianjin Children's Hospital /Tianjin University Children's Hospital, Tianjin, China
| | - Lingyan Li
- Department of Nutrition, Tianjin Children's Hospital /Tianjin University Children's Hospital, 225 Longyan Rd, Beichen Dist, Tianjin, China
| | - Yun Gou
- Department of Nutrition, Tianjin Children's Hospital /Tianjin University Children's Hospital, 225 Longyan Rd, Beichen Dist, Tianjin, China
| | - Liping Zhang
- Pediatric Intensive Care Unit, Tianjin Children's Hospital /Tianjin University Children's Hospital, Tianjin, China
| | - Lijing Wang
- Pediatric Intensive Care Unit, Tianjin Children's Hospital /Tianjin University Children's Hospital, Tianjin, China
| | - Junhong Yang
- Department of Nutrition, Tianjin Children's Hospital /Tianjin University Children's Hospital, 225 Longyan Rd, Beichen Dist, Tianjin, China
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12
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Yin Y, Fan CF. The Effects of Mukbang Watching on Enteral Feeding Intolerance Among Critically Ill Patients: Study Protocol for a Randomized Controlled Trail. Patient Prefer Adherence 2023; 17:2891-2897. [PMID: 37965439 PMCID: PMC10642568 DOI: 10.2147/ppa.s438190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/02/2023] [Indexed: 11/16/2023] Open
Abstract
Purpose With an estimated prevalence of 38%, enteral feeding intolerance (EFI) is common in critically ill patients receiving enteral nutrition (EN), and is associated with higher mortality and longer duration of mechanical ventilation. Various methods have been reported to decrease the incidence of EFI during EN, such as post-pyloric feeding, continuous EN delivery, abdominal massage, and probiotic supplementation. However, several studies reported conflicting results. Inappropriate interventions may cause gastrointestinal (GI) injury. This study aims to design a protocol based on Mukbang videos, which are widely watched online, to detect their effects on the incidence of EFI, nutritional status, incidence of infectious complications, and activities of daily living. Patients and Methods We will conduct a three-arm, parallel-design, randomized controlled trial that will be implemented in 273 patients from intensive care units. Participants will be randomized into one of the three intervention arms (1:1:1), which will be performed by a research assistant. Participants were allocated to three groups: (a) watching mukbang video, (b) watching a cooking show, and (c) watching a non-food content video. Prior to EN initiation, each participant will watch a ten-minute mukbang video, cookery show, or non-food content video. Conclusion Mukbang videos show food, expressions of mukbangers and eating sounds. If it effectively reduces the incidence of EFI, leads to greater nutritional status, lower incidence of infectious complications, and a higher level of independence among patients compared with watching cooking videos or non-food content videos, it has broad dissemination potential as a non-invasive, easily assessing, and using method.
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Affiliation(s)
- Yao Yin
- Department of Neurosurgery, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Chao-Feng Fan
- Department of Neurosurgery, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, Sichuan, People’s Republic of China
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Fang D, Li Y, He B, Gu D, Zhang M, Guo J, Ren H, Li X, Zhang Z, Tang M, Li X, Yang D, Xu C, Hu Y, Wang H, Jose PA, Han Y, Zeng C. Gastrin attenuates sepsis-induced myocardial dysfunction by down-regulation of TLR4 expression in macrophages. Acta Pharm Sin B 2023; 13:3756-3769. [PMID: 37719375 PMCID: PMC10502292 DOI: 10.1016/j.apsb.2023.06.012] [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: 12/12/2022] [Revised: 04/10/2023] [Accepted: 06/06/2023] [Indexed: 09/19/2023] Open
Abstract
Myocardial dysfunction is the most serious complication of sepsis. Sepsis-induced myocardial dysfunction (SMD) is often associated with gastrointestinal dysfunction, but its pathophysiological significance remains unclear. The present study found that patients with SMD had higher plasma gastrin concentrations than those without SMD. In mice, knockdown of the gastrin receptor, cholecystokinin B receptor (Cckbr), aggravated lipopolysaccharide (LPS)-induced cardiac dysfunction and increased inflammation in the heart, whereas the intravenous administration of gastrin ameliorated SMD and cardiac injury. Macrophage infiltration plays a significant role in SMD because depletion of macrophages by the intravenous injection of clodronate liposomes, 48 h prior to LPS administration, alleviated LPS-induced cardiac injury in Cckbr-deficient mice. The intravenous injection of bone marrow macrophages (BMMs) overexpressing Cckbr reduced LPS-induced myocardial dysfunction. Furthermore, gastrin treatment inhibited toll-like receptor 4 (TLR4) expression through the peroxisome proliferator-activated receptor α (PPAR-α) signaling pathway in BMMs. Thus, our findings provide insights into the mechanism of the protective role of gastrin/CCKBR in SMD, which could be used to develop new treatment modalities for SMD.
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Affiliation(s)
- Dandong Fang
- Department of Cardiology, Daping Hospital, the Third Military Medical University (Army Medical University), Chongqing 400000, China
- Key Laboratory of Geriatric Cardiovascular and Cerebrovascular Disease Research, Ministry of Education of China, Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing 400010, China
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210000, China
| | - Yu Li
- Department of Cardiology, Daping Hospital, the Third Military Medical University (Army Medical University), Chongqing 400000, China
- Key Laboratory of Geriatric Cardiovascular and Cerebrovascular Disease Research, Ministry of Education of China, Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing 400010, China
| | - Bo He
- Department of Cardiology, Daping Hospital, the Third Military Medical University (Army Medical University), Chongqing 400000, China
- Key Laboratory of Geriatric Cardiovascular and Cerebrovascular Disease Research, Ministry of Education of China, Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing 400010, China
| | - Daqian Gu
- Department of Cardiology, Daping Hospital, the Third Military Medical University (Army Medical University), Chongqing 400000, China
- Key Laboratory of Geriatric Cardiovascular and Cerebrovascular Disease Research, Ministry of Education of China, Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing 400010, China
| | - Mingming Zhang
- Department of Cardiology, Daping Hospital, the Third Military Medical University (Army Medical University), Chongqing 400000, China
- Key Laboratory of Geriatric Cardiovascular and Cerebrovascular Disease Research, Ministry of Education of China, Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing 400010, China
| | - Jingwen Guo
- Department of Cardiology, Daping Hospital, the Third Military Medical University (Army Medical University), Chongqing 400000, China
- Key Laboratory of Geriatric Cardiovascular and Cerebrovascular Disease Research, Ministry of Education of China, Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing 400010, China
| | - Hongmei Ren
- Department of Cardiology, Daping Hospital, the Third Military Medical University (Army Medical University), Chongqing 400000, China
- Key Laboratory of Geriatric Cardiovascular and Cerebrovascular Disease Research, Ministry of Education of China, Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing 400010, China
| | - Xinyue Li
- Department of Cardiology, Daping Hospital, the Third Military Medical University (Army Medical University), Chongqing 400000, China
- Key Laboratory of Geriatric Cardiovascular and Cerebrovascular Disease Research, Ministry of Education of China, Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing 400010, China
| | - Ziyue Zhang
- Department of Cardiology, Daping Hospital, the Third Military Medical University (Army Medical University), Chongqing 400000, China
- Key Laboratory of Geriatric Cardiovascular and Cerebrovascular Disease Research, Ministry of Education of China, Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing 400010, China
| | - Ming Tang
- Department of Cardiology, Daping Hospital, the Third Military Medical University (Army Medical University), Chongqing 400000, China
- Key Laboratory of Geriatric Cardiovascular and Cerebrovascular Disease Research, Ministry of Education of China, Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing 400010, China
| | - Xingbing Li
- Department of Cardiology, Daping Hospital, the Third Military Medical University (Army Medical University), Chongqing 400000, China
- Key Laboratory of Geriatric Cardiovascular and Cerebrovascular Disease Research, Ministry of Education of China, Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing 400010, China
| | - Donghai Yang
- Department of Cardiology, Daping Hospital, the Third Military Medical University (Army Medical University), Chongqing 400000, China
- Key Laboratory of Geriatric Cardiovascular and Cerebrovascular Disease Research, Ministry of Education of China, Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing 400010, China
| | - Chunmei Xu
- Department of Cardiology, Daping Hospital, the Third Military Medical University (Army Medical University), Chongqing 400000, China
- Key Laboratory of Geriatric Cardiovascular and Cerebrovascular Disease Research, Ministry of Education of China, Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing 400010, China
| | - Yijie Hu
- Department of Cardiac Surgery, Daping Hospital, Third Military Medical University, Chongqing 400010, China
| | - Hongyong Wang
- Department of Cardiology, Daping Hospital, the Third Military Medical University (Army Medical University), Chongqing 400000, China
- Key Laboratory of Geriatric Cardiovascular and Cerebrovascular Disease Research, Ministry of Education of China, Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing 400010, China
| | - Pedro A. Jose
- Division of Renal Disease & Hypertension, the George Washington University School of Medicine & Health Sciences, Washington, DC 20237, USA
| | - Yu Han
- Department of Cardiology, Daping Hospital, the Third Military Medical University (Army Medical University), Chongqing 400000, China
- Key Laboratory of Geriatric Cardiovascular and Cerebrovascular Disease Research, Ministry of Education of China, Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing 400010, China
| | - Chunyu Zeng
- Department of Cardiology, Daping Hospital, the Third Military Medical University (Army Medical University), Chongqing 400000, China
- Key Laboratory of Geriatric Cardiovascular and Cerebrovascular Disease Research, Ministry of Education of China, Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing 400010, China
- State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, the Third Military Medical University, Chongqing 400010, China
- Cardiovascular Research Center of Chongqing College, Chinese Academy of Sciences, University of Chinese Academy of Sciences Chongqing 400010, China
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14
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Wang L, Wang Y, Li HX, Zhang RP, Chang L, Zeng J, Jiang H. Optimizing enteral nutrition delivery by implementing volume-based feeding protocol for critically ill patients: an updated meta-analysis and systematic review. Crit Care 2023; 27:173. [PMID: 37147701 PMCID: PMC10161662 DOI: 10.1186/s13054-023-04439-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/11/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND This study aims to provide an updated assessment of the efficacy of optimized enteral nutrition (EN) delivery by implementing the volume-based feeding (VBF) protocol in critically ill patients. METHODS We updated our previous literature retrieval with no language restrictions. The inclusion criteria were:1) Participants: Critically ill patients (Patients who was admitted in ICU; 2) Intervention: The VBF protocol was adopted for EN administration; 3) Comparison: The rate-based feeding (RBF) protocol was adopted for EN administration; 4) Major outcomes: EN nutrition delivery. The exclusion criteria included participants aged < 18 years, duplicated literature, animal and cellular experiments, and studies lacking any of the outcomes mentioned in the inclusion criteria. The databases included MEDLINE (through PubMed), Web of Science, Cochrane Library, Chinese Biomedical Literature Service System (SinoMed), Wanfang Data Knowledge Service Platform, and China National Knowledge Infrastructure. RESULT Sixteen studies involving a total of 2896 critically ill patients are included in the updated meta-analysis. Compared with the previous meta-analysis, nine new studies were added that included 2205 more patients. The VBF protocol significantly improved energy (MD = 15.41%, 95% CI: [10.68, 20.14], p < 0.00001) and protein (MD = 22.05%, 95% CI: [10.89, 33.22], p = 0.0001) delivery. The patients in the VBF group stayed in the ICU for a shorter time (MD = 0.78, 95% CI: [0.01, 1.56], p = 0.05). The VBF protocol did not increase the risk of death (RR = 1.03, 95% CI: [0.85, 1.24], p = 0.76) or prolong the mechanical ventilation duration (MD = 0.81, 95% CI: [-0.30,1.92], p = 0.15). In addition, the VBF protocol did not affect EN complications, such as diarrhea (RR = 0.91, 95% CI: [0.73, 1.15], p = 0.43), emesis (RR = 1.23, 95% CI: [0.76, 1.99], p = 0.41), feeding intolerance (RR = 1.14, 95% CI: [0.63, 2.09], p = 0.66), and gastric retention (RR = 0.45, 95% CI: [0.16, 1.30], p = 0.14). CONCLUSION Our study revealed that the VBF protocol significantly improved calorie and protein delivery in critically ill patients with no additional risk.
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Affiliation(s)
- Lu Wang
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
- Sichuan Provincial Research Center for Emergency Medicine and Critical Illness, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Yu Wang
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
- Sichuan Provincial Research Center for Emergency Medicine and Critical Illness, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Hua-Xin Li
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
- Sichuan Provincial Research Center for Emergency Medicine and Critical Illness, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Rui-Peng Zhang
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
- Sichuan Provincial Research Center for Emergency Medicine and Critical Illness, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Li Chang
- Department of Emergency Intensive Care Unit, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, Sichuan Province, China
| | - Jun Zeng
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
- Sichuan Provincial Research Center for Emergency Medicine and Critical Illness, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
| | - Hua Jiang
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
- Sichuan Provincial Research Center for Emergency Medicine and Critical Illness, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
- Department of Emergency Intensive Care Unit, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, Sichuan Province, China.
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15
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Talebi S, Zeraattalab-Motlagh S, Vajdi M, Nielsen SM, Talebi A, Ghavami A, Moradi S, Sadeghi E, Ranjbar M, Habibi S, Sadeghi S, Mohammadi H. Early vs delayed enteral nutrition or parenteral nutrition in hospitalized patients: An umbrella review of systematic reviews and meta-analyses of randomized trials. Nutr Clin Pract 2023; 38:564-579. [PMID: 36906848 DOI: 10.1002/ncp.10976] [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: 08/30/2022] [Revised: 01/02/2023] [Accepted: 02/05/2023] [Indexed: 03/13/2023] Open
Abstract
We conducted an umbrella review to summarize the existing evidence on the effect of early enteral nutrition (EEN) compared with other approaches, including delayed enteral nutrition (DEN), parenteral nutrition (PN), and oral feeding (OF) on clinical outcomes in hospitalized patients. We performed a systematic search up to December 2021, in MEDLINE (via PubMed), Scopus, and Institute for Scientific Information Web of Science. We included systematic reviews with meta-analyses (SRMAs) of randomized trials investigating EEN compared with DEN, PN, or OF for any clinical outcomes in hospitalized patients. We used "A Measurement Tool to Assess Systematic Reviews" (AMSTAR2) and the Cochrane risk-of-bias tool for assessing the methodological quality of the systematic reviews and their included trial, respectively. The certainty of the evidence was rated using the "Grading of Recommendations Assessment, Development, and Evaluation" (GRADE) approach. We included 45 eligible SRMAs contributing with a total of 103 randomized controlled trials. The overall meta-analyses showed that patients who received EEN had statistically significant beneficial effects on most outcomes compared with any control (ie, DEN, PN, or OF), including mortality, sepsis, overall complications, infection complications, multiorgan failure, anastomotic leakage, length of hospital stay, time to flatus, and serum albumin levels. No statistically significant beneficial effects were found for risk of pneumonia, noninfectious complications, vomiting, wound infection, as well as number of days of ventilation, intensive care unit days, serum protein, and pre-serum albumin levels. Our results indicate that EEN may be preferred over DEN, PN, and OF because of the beneficial effects on many clinical outcomes.
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Affiliation(s)
- Sepide Talebi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.,Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Sheida Zeraattalab-Motlagh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Vajdi
- Student Research Committee, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan, Iran
| | - Sabrina Mai Nielsen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Ali Talebi
- Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Abed Ghavami
- Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sajjad Moradi
- Halal Research Center of IRI, FDA, Tehran, Iran.,Nutritional Sciences Department, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Erfan Sadeghi
- Research Consultation Center (RCC), Shiraz University Of Medical Sciences, Shiraz, Iran
| | - Mahsa Ranjbar
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sajedeh Habibi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Sadeghi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Mohammadi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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16
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Feeding intolerance during prolonged prone position in overweight and obese patients with severe COVID-19. NUTR HOSP 2023; 40:250-256. [PMID: 36880718 DOI: 10.20960/nh.04553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
OBJECTIVE the aim of this study was to compare the incidence rate of feeding intolerance (FI) during supine (SP) or prone positioning (PP) in critically ill COVID-19 patients. METHODS this was a retrospective cohort study of critically ill patients with overweight or obesity who received enteral nutrition (EN) in prone or supine positioning continuously during the first five days of mechanical ventilation. Nutritional risk, anthropometric measurements and body composition were assessed at the first 24 hours upon Intensive Care Unit (ICU) admission. Biochemical and clinical variables (Sequential Organ Failure Assessment [SOFA], Acute Physiology and Chronic Health Evaluation II [APACHE II], Acute Kidney Injury [AKI] or comorbidities diagnosis) were collected. Pharmacotherapy (prokinetics, sedatives or neuromuscular blocking agents) and FI incidence (gastric residual volume [GRV] ≥ 200 ml or ≥ 500 ml, vomiting or diarrhea) were daily recorded. Constipation was defined as the absence of evacuation for five consecutive days. RESULTS eighty-two patients were included. Higher rate of prophylactic prokinetic prescription was observed in PP (42.8 vs 12.5 %, p = 0.002). GRV ≥ 200 in supine position was not different when compared to PP (p = 0.47). Vomiting episodes in supine compared to PP showed no difference between groups (15 % vs 24 %, p = 0.31). No differences in diarrhea events were detected (10 % vs 4.7 %, p = 0.36). Constipation was common in both groups (95 % vs 82 %, p = 0.06). CONCLUSION FI during prone position was not different in comparison to supine position. Routinely use of prokinetics in continuous prone position may help to prevent FI incidence. Algorithm development is necessary for FI prevention and treatment so to avoid EN interruptions and adverse clinical outcomes.
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Clinical Experience, Characteristics, and Performance of an Acetaminophen Absorption Test in Critically Ill Patients. Am J Ther 2023; 30:e95-e102. [PMID: 34387562 DOI: 10.1097/mjt.0000000000001436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Altered drug and nutrient absorption presents a unique challenge in critically ill patients. Performing an acetaminophen absorption test (AAT) has been used as a marker for gastric motility and upper small bowel absorption; thus, it may provide objective data regarding enteral absorptive ability in critically ill patients. STUDY QUESTION What is the clinical experience with AAT when used as a surrogate marker for enteral absorption in critically ill patients? STUDY DESIGN This single-center, retrospective, cohort study evaluated serum acetaminophen concentrations within 180 minutes following 1-time enteral administration of an AAT. Patients admitted to the surgical and medical intensive care units and medical intensive care units over a 7-year period were evaluated. Groups were defined as positive (acetaminophen concentration of ≥10 mg/L) or negative (acetaminophen concentration of <10 mg/L) AAT. MEASURES AND OUTCOMES The outcomes were to describe the clinical experience, characteristics, and performance of AAT. RESULTS Forty-eight patients were included. Patients were 58.5 ± 14 years of age, mostly male (58.3%), and admitted to the surgical intensive care unit (66.7%). Median hospital length of stay was 47.5 (27-78.8) days. Thirty-four patients (70.8%) had a positive AAT [median concentration, 14 (12-18) mg/L]. Median time to first detectable concentration was 37 (33-64) minutes. AAT characteristics were similar between the groups including total dose, weight-based dose, time to first and second assays, drug formulation, and site of administration between groups. There were no independent risk factors identified on regression analysis for negative AAT. CONCLUSIONS An acetaminophen dose of 15 mg/kg with 2 coordinated serum concentrations approximately 30 and 60 minutes after administration is a reasonable construct for AAT. Future research is needed to assess AAT utility, safety, and clinical outcomes for predicting patient ability to absorb enteral feeds and medications.
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Percutaneous trans-stomal jejunostomy: a new technique. Updates Surg 2023; 75:261-264. [PMID: 36418719 DOI: 10.1007/s13304-022-01431-1] [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: 05/20/2022] [Accepted: 11/17/2022] [Indexed: 11/26/2022]
Abstract
AIM We propose a new technique for feeding a malnourished patient with a "high" double-barrel jejunostomy (at about 60 cm from the Treitz Ligament). The procedure aims to restore an adequate nutritional state maintaining a correct diet for 24 h a day, without complications and without interfering with the normal activity of the nurses caring for the stoma. METHOD Using local anesthesia, we introduced a Reverdin needle through the efferent loop of jejunostomy and externalized it through the skin, medially from jejunostomy of about 10 cm. Using this guide, we inserted an enteral feeding tube with a blunt tip and then introduced it through the efferent loop to reach about 40 cm distantly into the bowel. RESULTS The stoma output decreased from 3 to 1.5 L/day; kidney status was restored to normal function. CONCLUSION The main advantages are the minimal invasiveness of the implantation procedure, the possibility of nutrition during all 24 h, and the easy management by nurses.
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19
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Tian W, Yao Z, Xu X, Luo S, Zhao R. Effect of preoperative predigested formula vs. polymeric formula on bowel function recovery after definitive surgery for small intestinal entero-atmospheric fistula in patients with chyme reinfusion. Front Nutr 2022; 9:923191. [DOI: 10.3389/fnut.2022.923191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeThe purpose of this study is to compare the effect of preoperative predigested formula vs. polymeric formula on bowel function recovery following definitive surgery (DS) for small intestinal enteroatmospheric fistula (EAF).MethodsIn this retrospective study, from January 2005 to December 2019, the patients with small intestinal EAF and receiving a DS were enrolled. During the preoperative treatment, each patient received enteral nutrition via nasojejunal feeding and chyme reinfusion. The enrolled subjects were classified into two groups, based on their formula type: polymeric formula and predigested formula. Then, propensity scores matching (PSM) was used to further divide these patients into PSM polymeric formula group or PSM predigested formula group. The clinical characteristics of the groups were analyzed.ResultA total of 137 patients were finally enrolled, with 72 patients in the polymeric formula group and 65 patients in predigested formula group. The postoperative ileus was manifested in a total of 61 (44.5%) cases, with 27 (37.5%) in the polymeric formula group and 34 (52.3%) in the predigested formula group (P = 0.04). It was predicted that the polymeric formula could result in a reduction in postoperative ileus (OR = 0.47; 95% CI: 0.21–0.95; P = 0.04). After 1:1 PSM, there were 110 patients included. The postoperative ileus was observed in 47 patients, with 18 (32.7%) in the polymeric formula group and 29 (52.7%) in the predigested formula group (P = 0.03). After PSM, the polymeric formula demonstrated a reduction in the incidence of postoperative ileus (OR = 0.42; 95% CI: 0.19–0.92; P = 0.03).ConclusionCompared with predigested formula, the preoperative polymeric formula appears to be associated with earlier recovery of bowel function after DS for EAF.
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Cotogni P, Bozzetti F, Goldwasser F, Jimenez-Fonseca P, Roelsgaard Obling S, Valle JW. Supplemental parenteral nutrition in cancer care: why, who, when. Ther Adv Med Oncol 2022; 14:17588359221113691. [PMID: 36188487 PMCID: PMC9520136 DOI: 10.1177/17588359221113691] [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: 01/16/2022] [Accepted: 06/28/2022] [Indexed: 11/15/2022] Open
Abstract
Malnutrition is an often-overlooked challenge for patients with cancer. It is associated with muscle mass reduction, poor compliance and response to cancer treatments, decreased quality of life, and reduced survival time. The nutritional assessment and intervention should be a vital part of any comprehensive cancer treatment plan. However, data on artificial nutrition supplied based on caloric needs during cancer care are scarce. In this review, we discuss the recommendations of the European and American societies for clinical nutrition on the use of nutritional interventions in malnourished patients with cancer in the context of current clinical practice. In particular, when enteral nutrition (oral or tube feeding) is not feasible or fails to meet the complete nutritional needs, supplemental parenteral nutrition (SPN) can bridge the gap. We report the available evidence on SPN in cancer patients and identify the perceived barriers to the wider application of this intervention. Finally, we suggest a ‘permissive’ role of SPN in cancer care but highlight the need for rigorous clinical studies to further evaluate the use of SPN in different populations of cancer patients.
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Affiliation(s)
- Paolo Cotogni
- Pain Management and Palliative Care, Department of Anesthesia, Intensive Care and Emergency, Molinette Hospital, University of Turin, Corso Bramante 88-90, Turin 10126, Italy
| | | | - François Goldwasser
- Medical Oncology Department, URP 4466, Cochin Hospital, AP-HP, Paris University, Paris, France
| | - Paula Jimenez-Fonseca
- Medical Oncology Department, Asturias Central University Hospital, ISPA, Oviedo, Spain
| | - Sine Roelsgaard Obling
- Department of Medical Gastroenterology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Juan W Valle
- Division of Cancer Sciences, The University of Manchester, Manchester, UK.,Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
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21
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Bourgault AM, Xie R, Talbert S, Sole ML. Association of enteral feeding with microaspiration in critically ill adults. Appl Nurs Res 2022; 67:151611. [DOI: 10.1016/j.apnr.2022.151611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 05/25/2022] [Accepted: 06/27/2022] [Indexed: 10/17/2022]
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22
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Wang N, Zuo H, Xu Y, Zhou Y, Wei A, Li K. Relation of gut microbiota and postoperative gastrointestinal dysfunction in older patients with colon cancer undergoing elective colon resection: a protocol for a prospective, observational cohort study. BMJ Open 2022; 12:e057391. [PMID: 36691223 PMCID: PMC9462128 DOI: 10.1136/bmjopen-2021-057391] [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] [Received: 09/14/2021] [Accepted: 02/18/2022] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Gut microbiota (GM) appears critical for gastrointestinal symptoms, but whether alterations in GM are associated with increased risk of postoperative gastrointestinal dysfunction (POGID) in older patients with colon cancer (CC) undergoing elective colon resection remains unclear. METHODS AND ANALYSIS This study aims to prospectively recruit 284 elderly patients with CC undergoing elective colon resection. GM of fresh faeces specimens is characterised using 16S rRNA gene sequencing. Data are collected preoperatively, daily postoperatively during the in-hospital stay, and follow-up visits are scheduled four times within 30 days after discharge. Associations with POGID will be investigated using logistic regression models to calculate ORs with 95% CIs. The models include the adjustment for age, sex, frequency of spicy diet, coffee drinking and tea drinking, tobacco and alcohol history, diabetes, obesity, gastroenteritis, preoperative gut microbial composition. Furthermore, we will use joint modelling for longitudinal data to study several outcome variables simultaneously. ETHICS AND DISSEMINATION This study was approved by the Institutional Review Board of West China Hospital, Sichuan University (IRB Number: 20201334). The results will be disseminated through peer-reviewed publications or conference presentations. TRIAL REGISTRATION NUMBER It has been registered in PROSPERO, number CRD42019145032. It has been registered in the Chinese clinical trial registry, number ChiCTR2100043646.
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Affiliation(s)
- Na Wang
- West China School of Nursing, Sichuan University/ West China Hospital, Sichuan University, Chengdu, China
| | - Haojiang Zuo
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Yujie Xu
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Yong Zhou
- Department of Gastrointestinal Surgery, Sichuan University West China Hospital, Chengdu, China
| | - Ailing Wei
- Department of Pancreatic Surgery, Sichuan University West China Hospital, Chengdu, China
| | - Ka Li
- West China School of Nursing, Sichuan University/ West China Hospital, Sichuan University, Chengdu, China
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23
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Casting Light on the Necessary, Expansive, and Evolving Role of the Critical Care Dietitian: An Essential Member of the Critical Care Team. Crit Care Med 2022; 50:1289-1295. [PMID: 35984051 DOI: 10.1097/ccm.0000000000005607] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Wozniak H, Beckmann TS, Fröhlich L, Soccorsi T, Le Terrier C, de Watteville A, Schrenzel J, Heidegger CP. The central and biodynamic role of gut microbiota in critically ill patients. Crit Care 2022; 26:250. [PMID: 35982499 PMCID: PMC9386657 DOI: 10.1186/s13054-022-04127-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 08/13/2022] [Indexed: 11/10/2022] Open
Abstract
AbstractGut microbiota plays an essential role in health and disease. It is constantly evolving and in permanent communication with its host. The gut microbiota is increasingly seen as an organ, and its failure, reflected by dysbiosis, is seen as an organ failure associated with poor outcomes. Critically ill patients may have an altered gut microbiota, namely dysbiosis, with a severe reduction in “health-promoting” commensal intestinal bacteria (such as Firmicutes or Bacteroidetes) and an increase in potentially pathogenic bacteria (e.g. Proteobacteria). Many factors that occur in critically ill patients favour dysbiosis, such as medications or changes in nutrition patterns. Dysbiosis leads to several important effects, including changes in gut integrity and in the production of metabolites such as short-chain fatty acids and trimethylamine N-oxide. There is increasing evidence that gut microbiota and its alteration interact with other organs, highlighting the concept of the gut–organ axis. Thus, dysbiosis will affect other organs and could have an impact on the progression of critical diseases. Current knowledge is only a small part of what remains to be discovered. The precise role and contribution of the gut microbiota and its interactions with various organs is an intense and challenging research area that offers exciting opportunities for disease prevention, management and therapy, particularly in critical care where multi-organ failure is often the focus. This narrative review provides an overview of the normal composition of the gut microbiota, its functions, the mechanisms leading to dysbiosis, its consequences in an intensive care setting, and highlights the concept of the gut–organ axis.
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25
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Pérez-Cordón L, Yébenes JC, Martínez de Lagrán I, Campins L. Transition from total parenteral nutrition to enteral nutrition in critically ill patients in Spain: A national survey. Med Intensiva 2022; 46:475-477. [PMID: 35760732 DOI: 10.1016/j.medine.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/20/2021] [Accepted: 08/29/2021] [Indexed: 06/15/2023]
Affiliation(s)
- L Pérez-Cordón
- Servicio de Farmacia, Hospital de Mataró, Mataró, Barcelona, Spain.
| | - J C Yébenes
- Servicio de Medicina Intensiva, Hospital de Mataró, Mataró, Barcelona, Spain
| | | | - L Campins
- Servicio de Farmacia, Hospital de Mataró, Mataró, Barcelona, Spain
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26
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Hof S, Truse R, Weber L, Herminghaus A, Schulz J, Weber APM, Maleckova E, Bauer I, Picker O, Vollmer C. Local Mucosal CO 2 but Not O 2 Insufflation Improves Gastric and Oral Microcirculatory Oxygenation in a Canine Model of Mild Hemorrhagic Shock. Front Med (Lausanne) 2022; 9:867298. [PMID: 35573010 PMCID: PMC9096873 DOI: 10.3389/fmed.2022.867298] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/07/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Acute hemorrhage results in perfusion deficit and regional hypoxia. Since failure of intestinal integrity seem to be the linking element between hemorrhage, delayed multi organ failure, and mortality, it is crucial to maintain intestinal microcirculation in acute hemorrhage. During critical bleeding physicians increase FiO2 to raise total blood oxygen content. Likewise, a systemic hypercapnia was reported to maintain microvascular oxygenation (μHbO2). Both, O2 and CO2, may have adverse effects when applied systemically that might be prevented by local application. Therefore, we investigated the effects of local hyperoxia and hypercapnia on the gastric and oral microcirculation. Methods Six female foxhounds were anaesthetized, randomized into eight groups and tested in a cross-over design. The dogs received a local CO2-, O2-, or N2-administration to their oral and gastric mucosa. Hemorrhagic shock was induced through a withdrawal of 20% of estimated blood volume followed by retransfusion 60 min later. In control groups no shock was induced. Reflectance spectrophotometry and laser Doppler were performed at the gastric and oral surface. Oral microcirculation was visualized by incident dark field imaging. Systemic hemodynamic parameters were recorded continuously. Statistics were performed using a two-way-ANOVA for repeated measurements and post hoc analysis was conducted by Bonferroni testing (p < 0.05). Results The gastric μHbO2 decreased from 76 ± 3% to 38 ± 4% during hemorrhage in normocapnic animals. Local hypercapnia ameliorated the decrease of μHbO2 from 78 ± 4% to 51 ± 8%. Similarly, the oral μHbO2 decreased from 81 ± 1% to 36 ± 4% under hemorrhagic conditions and was diminished by local hypercapnia (54 ± 4%). The oral microvascular flow quality but not the total microvascular blood flow was significantly improved by local hypercapnia. Local O2-application failed to change microvascular oxygenation, perfusion or flow quality. Neither CO2 nor O2 changed microcirculatory parameters and macrocirculatory hemodynamics under physiological conditions. Discussion Local hypercapnia improved microvascular oxygenation and was associated with a continuous blood flow in hypercapnic individuals undergoing hemorrhagic shock. Local O2 application did not change microvascular oxygenation, perfusion and blood flow profiles in hemorrhage. Local gas application and change of microcirculation has no side effects on macrocirculatory parameters.
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Affiliation(s)
- Stefan Hof
- Department of Anesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany
| | - Richard Truse
- Department of Anesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany
| | - Lea Weber
- Department of Anesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany
| | - Anna Herminghaus
- Department of Anesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany
| | - Jan Schulz
- Department of Anesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany
| | - Andreas P M Weber
- Institute of Plant Biochemistry, Cluster of Excellence on Plant Sciences (CEPLAS), Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Eva Maleckova
- Institute of Plant Biochemistry, Cluster of Excellence on Plant Sciences (CEPLAS), Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Inge Bauer
- Department of Anesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany
| | - Olaf Picker
- Department of Anesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany
| | - Christian Vollmer
- Department of Anesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany
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Duan J, Cheng M, Xu Y, Tang S, Li X, Chen Y, Lu H, Gao T, Yu W. Comparison of the effects of different calorie amounts of enteral nutrition in hypercatabolism associated with ghrelin-POMC in endotoxemic rats. Nutr Metab (Lond) 2022; 19:28. [PMID: 35428321 PMCID: PMC9013094 DOI: 10.1186/s12986-022-00663-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 03/30/2022] [Indexed: 11/12/2022] Open
Abstract
Background Hypercatabolism often occurs in critically ill patients, and it increases infection rates and mortality in these patients. Enteral nutrition (EN) is commonly used in case of hypercatabolism. However, the effect of amount of calories in EN on hypercatabolism remains unexplored. Objective Here, we compared the effect of low-calorie, medium-calorie and high-calorie EN on hypercatabolism in the acute phase of endotoxemia, which is associated with gastrointestinal hormones and hypothalamic neuropeptide proopiomelanocortin (POMC).
Methods Overall 84 adult male Sprague–Dawley rats were used for research. A set of rats were divided into 5 groups, Control (NS) and lipopolysaccharide (LPS) groups were fed a standard chow diet; LPS + L (LPS + 40 kcal/kg/day EN), LPS + M (LPS + 80 kcal/kg/day EN) and LPS + H (LPS + 120 kcal/kg/day EN) groups received EN through a gastric tube for 3 days. Another set of rats were used for parallel control experiment and divided into 5 groups: NS + F (saline + fasting) and LPS + F (LPS + fasting) groups were given no food, NS + L (saline + 40 kcal/kg/day EN), NS + M (saline + 80 kcal/kg/day EN) and NS + H (saline + 120 kcal/kg/day EN) groups received EN through a gastric tube for 3 days. Hypercatabolism was evaluated by assessing skeletal muscle protein synthesis and atrophy, insulin resistance, and corticosterone levels. Moreover, serum inflammatory factors, gastrointestinal hormones, hypothalamic ghrelin, growth hormone secretagogue receptor-1α, hypothalamic neuropeptide, and intestinal injury indicators were detected. Results Low-calorie EN effectively increased serum and hypothalamic ghrelin possibly due to slight intestinal barrier damage, thereby decreasing hypothalamic POMC expression; consequently, it alleviated rat insulin resistance, reduced blood cortisol levels and muscle atrophy, and improved the survival rate of rats in the acute phase of endotoxemia. Interestingly, with an increase in calories in enteral nutrition, the aforementioned effects did not increase. Conclusions Low-calorie EN could effectively increase gastrointestinal hormone ghrelin by reducing intestinal damage and suppressing POMC expression to ameliorate hypercatabolism when compared with medium-calorie and high-calorie EN. Therefore Low-calorie EN may be preferred for providing EN in the acute stage of endotoxemia. Supplementary Information The online version contains supplementary material available at 10.1186/s12986-022-00663-7.
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Affiliation(s)
- Jianfeng Duan
- Affiliated Drum Tower Hospital, Medical School of Nanjing University, 321st Zhongshan Road, Nanjing, Jiangsu, People's Republic of China.,Medical School, Nanjing University, 22nd Hankou Road, Nanjing, Jiangsu, People's Republic of China
| | - Minhua Cheng
- Affiliated Drum Tower Hospital, Medical School of Nanjing University, 321st Zhongshan Road, Nanjing, Jiangsu, People's Republic of China
| | - Yali Xu
- Affiliated Drum Tower Hospital, Medical School of Nanjing University, 321st Zhongshan Road, Nanjing, Jiangsu, People's Republic of China.,Medical School, Nanjing University, 22nd Hankou Road, Nanjing, Jiangsu, People's Republic of China
| | - Shaoqiu Tang
- Nanjing University Hospital, 22nd Hankou Road, Nanjing, Jiangsu, People's Republic of China
| | - Xiaoyao Li
- Affiliated Drum Tower Hospital, Medical School of Nanjing University, 321st Zhongshan Road, Nanjing, Jiangsu, People's Republic of China
| | - Yan Chen
- Affiliated Drum Tower Hospital, Medical School of Nanjing University, 321st Zhongshan Road, Nanjing, Jiangsu, People's Republic of China
| | - Huimin Lu
- Affiliated Drum Tower Hospital, Medical School of Nanjing University, 321st Zhongshan Road, Nanjing, Jiangsu, People's Republic of China.,Medical School, Nanjing University, 22nd Hankou Road, Nanjing, Jiangsu, People's Republic of China
| | - Tao Gao
- Affiliated Drum Tower Hospital, Medical School of Nanjing University, 321st Zhongshan Road, Nanjing, Jiangsu, People's Republic of China
| | - Wenkui Yu
- Affiliated Drum Tower Hospital, Medical School of Nanjing University, 321st Zhongshan Road, Nanjing, Jiangsu, People's Republic of China. .,Medical School, Nanjing University, 22nd Hankou Road, Nanjing, Jiangsu, People's Republic of China.
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Li X, Wang JX, Wang YP, Shen JX, Zheng YX, Zhang PH, Wei JJ, Zhuang ZH. Comparison of Pull and Introducer Techniques for Percutaneous Endoscopic Gastrostomy. J Multidiscip Healthc 2022; 15:733-741. [PMID: 35411150 PMCID: PMC8994609 DOI: 10.2147/jmdh.s356865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/15/2022] [Indexed: 12/03/2022] Open
Abstract
Objective To compare indications, success rates and complications of pull [P] and introducer [I] techniques for percutaneous endoscopic gastrostomy (PEG). Methods In this retrospective study, inpatients who underwent primary PEG tube insertion between January 2015 and February 2020 at the Endoscopy Center of the First Affiliated Hospital of Fujian Medical University were included. Results A total of 103 inpatients were included in this study (P group, n = 67; I group, n = 36). The rates of tube replacement within first six months in the P and I groups were 1.5% and 11.1%, respectively (P = 0.049). The most common primary indication of PEG was malignancy. The proportion of patients with esophageal cancer was significantly lower in the P group (24.4% vs 54.2%, P = 0.015). No significant difference was found in the overall, major, or minor complications between the two groups. In patients with esophageal stenosis, the pull method was a risk factor for complications (P = 0.03; odds ratio [OR] = 12, 95% confidence interval [CI]: 1.164–123.684). Logistic regression analysis showed that the risk factors for major and minor complications were the admission-to-gastrostomy interval (OR = 1.078, 95% CI: 1.016–1.145, P = 0.014) and lack of antibiotic use (OR = 4.735, 95% CI: 1.247–17.979, P = 0.022), respectively. Conclusion Both PEG techniques have high clinical success rates. The introducer technique is more suitable for patients with esophageal stricture, which has lower minor complications, but higher rate of tube replacement compared to the pull technique. Use of antibiotics may reduce minor complications following PEG. Early PEG insertion may help to reduce post-PEG major complications.
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Affiliation(s)
- Xia Li
- Endoscopy Center, First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
- Endoscope Room, Changle District Hospital, Fuzhou, People’s Republic of China
| | - Jun-Xi Wang
- Endoscopy Center, First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
| | - Yu-Ping Wang
- Endoscopy Center, First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
| | - Jia-Xin Shen
- Endoscopy Center, First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
| | - Yi-Xing Zheng
- Endoscopy Center, First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
| | - Pei-Hong Zhang
- Endoscopy Center, First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
| | - Jing-Jing Wei
- Endoscopy Center, First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
| | - Ze-Hao Zhuang
- Endoscopy Center, First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
- Correspondence: Ze-Hao Zhuang, Endoscopy Center, First Affiliated Hospital of Fujian Medical University, 20, Chazhong Road, Taijiang District, Fuzhou, 350005, Fujian Province, People’s Republic of China, Tel +860591-87981370, Fax +860591-87981371, Email
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Bloom L, Seckel MA. Placement of Nasogastric Feeding Tube and Postinsertion Care Review. AACN Adv Crit Care 2022; 33:68-84. [PMID: 35259226 DOI: 10.4037/aacnacc2022306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Insertion and postinsertion care of enteral nasogastric feeding tubes are common procedures in the United States, with more than 1.2 million temporary nasogastric feeding tubes inserted annually. Although there are some evidence-based practice guidelines and recommendations for care of these tubes, variation in practice still exists. Additional research is needed to determine the best methodology for insertion and confirmation of nasogastric feeding tubes. Routine competency and training on feeding tube insertion, enteral nutrition, and postinsertion care is crucial to prevent patient safety events. Variable results have been reported with different technologies; however, radiographic confirmation remains the criterion standard. It is important that health care institutions develop standardized procedures for insertion and confirmation on the basis of evidence-based practices to minimize risks and complications from temporary nasogastric feeding tubes.
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Affiliation(s)
- Lindsey Bloom
- Lindsey Bloom is Critical Care Clinical Practice Specialist, Adventist Health, One Adventist Health Way, Roseville, CA 95661
| | - Maureen A Seckel
- Maureen A. Seckel is Critical Care Clinical Nurse Specialist and Sepsis Coordinator, ChristianaCare, Newark, Delaware
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Bond A, Czapran A, Lal S. Small bowel feeding: do you pay the price for bypassing the stomach? Curr Opin Clin Nutr Metab Care 2022; 25:116-121. [PMID: 34966116 DOI: 10.1097/mco.0000000000000804] [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] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Hydration and nutritional support is a vital part of medical care, thus a clear understanding of the optimal approach is vital for medical professionals. This is a particularly pertinent issue for patients admitted to a critical care setting. This article aims to define the advantages and disadvantages of gastric and postpyloric feeding in the critical care setting, thus aiding decision-making for clinicians. RECENT FINDINGS Within the article, the main themes covered are those relating to enteral feeding tube placement, the impact of enteral feeding route on ventilator-associated pneumonia, optimization of enteral tube feeding in critical care and the impact that a chosen route may have upon gastrointestinal function. SUMMARY The value of enteral feeding in critical illness is proven beyond doubt and the simplest approach has long been 'if the gut works, use it'. If gastric feeding is not able to be established or is not tolerated then jejunal feeding should be considered as a preferable alternative to parenteral nutrition. Improving access to service or techniques for postpyloric tube placement would assist in optimizing nutritional support in the critical care setting.
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Affiliation(s)
- Ashley Bond
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford
| | - Adam Czapran
- Department of Critical Care, Kings College NHS Foundation Trust, London
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford
- University of Manchester, Manchester, UK
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Abstract
PURPOSE OF REVIEW To summarize knowledge on the gut function in relation to enteral nutrition. RECENT FINDINGS The gut is certainly suffering during critical illness but our understanding of the exact mechanisms involved is limited. Physicians at bedside are lacking tools to identify how well or bad the gut is doing and whether the gut is responding adequately to critical illness. Sensing nutrition as a signal is important for the gut and microbiome. Enteral nutrition has beneficial effects for the gut perfusion and function. However, early full enteral nutrition in patients with shock was associated with an increased number of rare but serious complications. SUMMARY Whenever synthesizing knowledge in physiology and available evidence in critically ill, we suggest that enteral nutrition has beneficial effects but may turn harmful if provided too aggressively. Contraindications to enteral nutrition are listed in recent guidelines. For patients with gastrointestinal dysfunction but without these contraindications, we suggest considering early enteral nutrition as a signal to the gut and to the body rather than an energy and protein provision. With this rationale, we think that low dose of enteral nutrition could and probably should be provided also when the gut does not feel very good. Understanding the feedback from the gut in response to enteral nutrition would be important, however, monitoring tools are currently limited to clinical assessment only.
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Affiliation(s)
- Annika Reintam Blaser
- Department of Anaesthesiology and Intensive Care, University of Tartu, Puusepa 8, Tartu, Estonia
- Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Michael Hiesmayr
- Division of Cardiac Thoracic and Vascular Anaesthesia and Intensive Care
- Center for Medical Statistics Informatics And Intelligent Systems, Medical University Vienna, Vienna, Austria
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Piton G, Le Gouge A, Boisramé-Helms J, Anguel N, Argaud L, Asfar P, Botoc V, Bretagnol A, Brisard L, Bui HN, Canet E, Chatelier D, Chauvelot L, Darmon M, Das V, Devaquet J, Djibré M, Ganster F, Garrouste-Orgeas M, Gaudry S, Gontier O, Groyer S, Guidet B, Herbrecht JE, Hourmant Y, Lacherade JC, Letocart P, Martino F, Maxime V, Mercier E, Mira JP, Nseir S, Quenot JP, Richecoeur J, Rigaud JP, Roux D, Schnell D, Schwebel C, Silva D, Sirodot M, Souweine B, Thieulot-Rolin N, Tinturier F, Tirot P, Thévenin D, Thiéry G, Lascarrou JB, Reignier J. Factors associated with acute mesenteric ischemia among critically ill ventilated patients with shock: a post hoc analysis of the NUTRIREA2 trial. Intensive Care Med 2022; 48:458-466. [PMID: 35190840 DOI: 10.1007/s00134-022-06637-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/27/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Acute mesenteric ischemia (AMI) is a rare, but life-threatening condition occurring among critically ill patients. Several factors have been associated with AMI, but the causal link is debated, most studies being retrospective. Among these factors, enteral nutrition (EN) could be associated with AMI, in particular among patients with shock. We aimed to study the factors independently associated with AMI in a post hoc analysis of the NUTRIREA-2 trial including 2410 critically ill ventilated patients with shock, randomly assigned to receive EN or parenteral nutrition (PN). METHODS Post hoc analysis of the NUTRIREA-2 trial was conducted. Ventilated adults with shock were randomly assigned to receive EN or PN. AMI was assessed by computed tomography, endoscopy, or laparotomy. Factors associated with AMI were studied by univariate and multivariate analysis. RESULTS 2410 patients from 44 French intensive care units (ICUs) were included in the study: 1202 patients in the enteral group and 1208 patients in the parenteral group. The median age was 67 [58-76] years, with 67% men, a SAPS II score of 59 [46-74], and a medical cause for ICU admission in 92.7%. AMI was diagnosed among 24 (1%) patients, mainly by computed tomography (79%) or endoscopy (38%). The mechanism of AMI was non-occlusive mesenteric ischemia (n = 12), occlusive (n = 4), and indeterminate (n = 8). The median duration between inclusion in the trial and AMI diagnosis was 4 [1-11] days. Patients with AMI were older, had a higher SAPS II score at ICU admission, had higher plasma lactate, creatinine, and ASAT concentrations and lower hemoglobin concentration, had more frequently EN, dobutamine, and CVVHDF at inclusion, developed more frequently bacteremia during ICU stay, and had higher 28-day and 90-day mortality rates compared with patients without AMI. By multivariate analysis, AMI was independently associated with EN, dobutamine use, SAPS II score ≥ 62 and hemoglobin concentration ≤ 10.9 g/dL. CONCLUSION Among critically ill ventilated patients with shock, EN, dobutamine use, SAPS II score ≥ 62 and hemoglobin ≤ 10.9 g/dL were independently associated with AMI. Among critically ill ventilated patients requiring vasopressors, EN should be delayed or introduced cautiously in case of low cardiac output requiring dobutamine and/or in case of multiple organ failure with high SAPS II score.
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Affiliation(s)
- Gaël Piton
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Besançon, Besançon, France. .,Service de Réanimation Médicale, CHRU de Besançon, Boulevard Fleming, 25030, Besançon, France.
| | - Amélie Le Gouge
- Inserm CIC 1415, Tours, France.,Centre Hospitalier Universitaire de Tours, Tours, France
| | - Julie Boisramé-Helms
- EA 7293, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Medical Intensive Care Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Nadia Anguel
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laurent Argaud
- Service de Médecine Intensive Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Pierre Asfar
- 6 Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Angers, Angers, France
| | - Vlad Botoc
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Saint Malo, Saint-Malo, France
| | - Anne Bretagnol
- Service de Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans, Orléans, France
| | - Laurent Brisard
- Service d'Anesthésie Réanimation Chirurgicale, Hopital Laënnec, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Hoang-Nam Bui
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Emmanuel Canet
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France.,Université de Nantes, Nantes, France
| | - Delphine Chatelier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Louis Chauvelot
- Service de Médecine Intensive Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Michael Darmon
- 16 Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Vincent Das
- Service de Médecine Intensive Réanimation, Centre Hospitalier Intercommunal André Grégoire, Montreuil, France
| | - Jérôme Devaquet
- Service de Réanimation Polyvalente, Hôpital Foch, Suresnes, France
| | - Michel Djibré
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | - Stéphane Gaudry
- Service de Médecine Intensive Réanimation, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Olivier Gontier
- 25 Service de Médecine Intensive Réanimation, Centre Hospitalier de Chartres, Chartres, France
| | - Samuel Groyer
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Montauban, Montauban, France
| | - Bertrand Guidet
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins,, 75012, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, 75012, Paris, France
| | - Jean-Etienne Herbrecht
- Service de Médecine Intensive Réanimation, Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Yannick Hourmant
- Centre Hospitalier Universitaire de Nantes, Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation ChirurgicaleHôtel Dieu, 44093, Nantes, France
| | - Jean-Claude Lacherade
- Service de Médecine Intensive Réanimation, Centre Hospitalier Départemental de la Vendée, La Roche sur Yon, France
| | - Philippe Letocart
- Service de Médecine Intensive Réanimation, Centre Hospitalier Jacques Puel, Rodez, France
| | - Frédéric Martino
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Pointe-à-Pitre-Abymes, Pointe-à-Pitre, Guadeloupe, France
| | - Virginie Maxime
- Service de Médecine Intensive Réanimation, Hôpital Raymond Poincaré, Assistance Publique des Hôpitaux de Paris, Garches, France.,Inserm U 1173, Université de Versailles-Saint Quentin en Yvelines, Versailles, France
| | - Emmanuelle Mercier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Bretonneau, CRICS-TRIGGERSEP Network, Tours, France
| | - Jean-Paul Mira
- Service de Médecine Intensive Réanimation, Hôpital Cochin, Groupe Hospitalier Centre-Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Saad Nseir
- CHU de Lille, Médecine Intensive Réanimation, Lille, France.,Université de Lille, Inserm U1285, CNRS, UMR 8576-UGSF, Unité de Glycobiologie Structurale et Fonctionnelle, 59000, Lille, France
| | - Jean-Pierre Quenot
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire François Mitterrand, Dijon, France.,Lipness Team, INSERM, LabExLipSTICUniversité de Bourgogne, Dijon, France.,INSERM Centres d'Investigation Clinique, Département d'épidémiologie clinique, Université de Bourgogne, Dijon, France
| | - Jack Richecoeur
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Beauvais, Beauvais, France
| | - Jean-Philippe Rigaud
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Dieppe, Dieppe, France
| | - Damien Roux
- Service de Médecine Intensive Réanimation, Hôpital Louis-Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France
| | - David Schnell
- Service de Médecine Intensive Réanimation, Centre Hospitalier d'Angoulême, Angoulême, France
| | - Carole Schwebel
- Service de Médecine Intensive Réanimation, Université de Grenoble-Alpes, Grenoble, France.,INSERM 1039, Grenoble, France
| | - Daniel Silva
- Service de Médecine Intensive Réanimation, Hôpital Delafontaine, Saint-Denis, France
| | - Michel Sirodot
- Service de Médecine Intensive Réanimation, Centre Hospitalier Annecy Genevois, Pringy, France
| | - Bertrand Souweine
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Gabriel-Montpied, Clermont-Ferrand, France
| | | | - François Tinturier
- Service de Réanimation Chirurgicale, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - Patrice Tirot
- Service de Médecine Intensive Réanimation, Centre Hospitalier du Mans, Le Mans, France
| | - Didier Thévenin
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Lens, Lens, France
| | - Guillaume Thiéry
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Saint Etienne, Saint Priest en Jarez, France
| | - Jean-Baptiste Lascarrou
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France.,Université de Nantes, Nantes, France
| | - Jean Reignier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France.,Université de Nantes, Nantes, France
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Patel JJ, Shukla A, Heyland DK. Enteral nutrition in septic shock: A pathophysiologic conundrum. JPEN J Parenter Enteral Nutr 2021; 45:74-78. [PMID: 34897735 DOI: 10.1002/jpen.2246] [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: 04/01/2021] [Revised: 08/02/2021] [Accepted: 08/02/2021] [Indexed: 11/07/2022]
Abstract
Septic shock is a public health burden and defined as a subset of sepsis whereby abnormalities in microcirculatory and cellular metabolism manifest as acute circulatory failure. At the level of the gut, septic shock impairs epithelial barrier function (EBF), and the gut initiates proinflammatory responses contributing to multiple organ dysfunction syndrome. The timing and dose of enteral nutrition (EN) in septic shock remains a conundrum. On the one hand, early EN preserves EBF. On the other hand, serious gastrointestinal complications such as bowel necrosis may limit EN initiation in septic shock. We (1) describe the pathophysiologic conundrum septic shock poses for EN initiation, (2) outline guideline-based recommendations for EN in septic shock, (3) identify the role of parenteral nutrition in septic shock, and (4) identify and appraise postguideline literature on the timing, dose, and titration of EN in septic shock.
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Affiliation(s)
- Jayshil J Patel
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anuj Shukla
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Daren K Heyland
- Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
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Pérez-Cordón L, Yébenes J, Martínez de Lagrán I, Campins L. Encuesta sobre la transición de nutrición parenteral total a nutrición enteral en pacientes críticos en los hospitales de España. Med Intensiva 2021. [DOI: 10.1016/j.medin.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wang C, Lin S, Zhang X, Yang C, Li W. Laparoscopic Gastrojejunostomy with Conversion Therapy in Gastric Outlet Obstruction Caused by Incurable Advanced Gastric Cancer. Cancer Manag Res 2021; 13:6847-6857. [PMID: 34512024 PMCID: PMC8420554 DOI: 10.2147/cmar.s322569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/14/2021] [Indexed: 12/27/2022] Open
Abstract
Purpose The benefits of laparoscopic gastrojejunostomy (LGJ) combined with conversion therapy for malignant gastric outlet obstruction (GOO) caused by incurable advanced gastric cancer (AGC) are unclear. This study aimed to examine the feasibility and efficacy of LGJ followed by enteral nutrition and conversion therapy in malignant GOO. Patients and Methods The clinical outcomes for 66 patients with GOO due to incurable AGC were retrospectively evaluated. The patients were classified into multimodal therapy (LGJ, enteral nutrition, and chemotherapy, n = 35) and chemotherapy alone (n = 31) groups. Conversion surgery was defined as surgery aimed at R0 resection in initially incurable tumours. Results Compared to the chemotherapy group, multimodal therapy patients had improved oral intake, more chemotherapy cycles, better nutritional indices, less sarcopenia, and improved quality of life (QOL) post-treatment. Conversion surgery was performed in 17 multimodal therapy patients, with no perioperative mortality, and R0 resection achieved in 15 patients (88.2%). The median survival time of multimodal therapy patients was 16.7 months, compared to 4.5 months for chemotherapy patients. Multimodal therapy patients with conversion surgery had significantly longer overall survival than those without surgery (44.2 vs 8.5 months, respectively, P< 0.001). Multivariate analysis identified multimodal therapy and improved or stable QOL as independent prognostic factors. Conclusion Multimodal therapy was associated with better nutritional and metabolic status, a safely induced high conversion surgery rate with a high R0 resection rate, and a good prognosis. LGJ with enteral nutrition and conversion therapy may improve long-term survival in obstructive incurable AGC.
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Affiliation(s)
- Chuandong Wang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, 350001, People's Republic of China
| | - Shengtao Lin
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, 350001, People's Republic of China
| | - Xiaojuan Zhang
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Department of Radiology, 900th Hospital Logistic Support Forces of PLA, Fuzhou, 350001, People's Republic of China
| | - Changshun Yang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, 350001, People's Republic of China
| | - Weihua Li
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, People's Republic of China
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Graft-versus-host disease: a disorder of tissue regeneration and repair. Blood 2021; 138:1657-1665. [PMID: 34370823 DOI: 10.1182/blood.2021011867] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/27/2021] [Indexed: 11/20/2022] Open
Abstract
Regenerative failure at barrier surfaces and maladaptive repair leading to fibrosis are hallmarks of graft-versus-host disease (GVHD). Although immunosuppressive treatment can control inflammation, impaired tissue homeostasis leads to prolonged organ damage and impaired quality of life. In this Spotlight article, we review recent research that addresses the critical failures in tissue regeneration and repair that underpin treatment-resistant GVHD. We highlight current interventions designed to overcome these defects and provide our assessment of the future therapeutic landscape.
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Green CH, Busch RA, Patel JJ. Fiber in the ICU: Should it Be a Regular Part of Feeding? Curr Gastroenterol Rep 2021; 23:14. [PMID: 34338900 DOI: 10.1007/s11894-021-00814-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW To highlight the controversy of fiber use in the current critical care nutrition guidelines; review the effect of fiber on the gut microbiota in the critically ill; and examine the data on fiber and outcomes in the intensive care setting. RECENT FINDINGS Fiber is increasingly recognized as a necessary component of colonic health and nutrition support. In critical illness there is a shift toward gut dysbiosis and immune dysregulation. Through fermentation and the generation of short-chain fatty acids, fiber has a role in maintaining intestinal homeostasis, immune function, and supporting commensal bacteria. In contrast to fermentable fiber, recent animal models suggest that non-fermentable fiber can also favorably alter intestinal homeostasis in a mechanism distinct from short chain fatty acids. In the critically ill, RCTs and meta-analyses suggest that soluble and mixed fiber supplemented enteral nutrition can reduce diarrhea and is well tolerated. Based on limited data, there may be benefits in reducing length of hospital stay, certain infections, and glucose metabolism. Nonetheless, the role of fiber enriched nutrition in critically ill patients is controversial as evident in the conflicting guidelines. Despite shortcomings in the literature, soluble and mixed fiber supplemented enteral nutrition is safe and beneficial in most hemodynamically stable intensive care patients. More research is necessary to determine optimal fiber composition.
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Affiliation(s)
- Caitlin H Green
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Rebecca A Busch
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jayshil J Patel
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Gao X, Zhang Y, Zhang L, Liu S, Liu H, Zhou D, Li J, Wang X. Effect of Home Enteral Nutrition on Nutritional Status, Body Composition and Quality of Life in Patients With Malnourished Intestinal Failure. Front Nutr 2021; 8:643907. [PMID: 34277678 PMCID: PMC8281236 DOI: 10.3389/fnut.2021.643907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 05/31/2021] [Indexed: 01/01/2023] Open
Abstract
Background: The ultimate goal of intestinal failure (IF) management is to maintain optimal nutritional status, improve the quality of life (QoL), and promote intestinal adaptation. Enteral nutrition support is safe and effective in patients with IF and plays a central role in the management of patients with IF. The purpose of this study was to evaluate the effect of home enteral nutrition on nutritional status, body composition (BC), QoL and other clinical outcomes in malnourished patients with intestinal failure. Methods: This prospective observational study included 166 malnourished patients with intestinal failure presented to Jinling Hospital from January 2016 to October 2018. All patients were supported with home enteral nutrition after discharge. We evaluated clinical outcomes, including nutritional status, BC, phase angle (PhA), QoL, mortality, gastrointestinal complications related to enteral feeding, and other clinical outcomes at 1, 3, and 6 months after discharge. Results: Body weight, BC, and other nutritional parameters were maintained or significantly increased during the period of home enteral nutrition after discharge (p < 0.01). Especially, the quality of skeletal muscle mass in body composition was significantly improved (p < 0.01). SF-36 quality of life scores was significantly improved (discharged at 6 months: reported health transition 40.7 ± 12.1 vs. 69.3 ± 16.3, p < 0.01). There were no differences between hospital and out of hospital with respect to tube-related or gastrointestinal complications. Advanced age, disease type, and poor nutritional status were risk factors for poor clinical outcomes. Conclusions: Home enteral nutrition support is effective for malnourished patients with intestinal failure. It improves nutritional status, BC, PhA, and QoL. Clinical Trial Registration: identifier: ChiCTR2000035145.
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Affiliation(s)
- Xuejin Gao
- Affiliated Jinling Hospital, Research Institute of General Surgery, Medical School of Nanjing University, Nanjing, China
| | - Yupeng Zhang
- Affiliated Jinling Hospital, Research Institute of General Surgery, Medical School of Nanjing University, Nanjing, China
| | - Li Zhang
- Affiliated Jinling Hospital, Research Institute of General Surgery, Medical School of Nanjing University, Nanjing, China
| | - Sitong Liu
- Affiliated Jinling Hospital, Research Institute of General Surgery, Medical School of Nanjing University, Nanjing, China
| | - Hao Liu
- Affiliated Jinling Hospital, Research Institute of General Surgery, Southern Medical University, Guangzhou, China
| | - Da Zhou
- Affiliated Jinling Hospital, Research Institute of General Surgery, Medical School of Nanjing University, Nanjing, China
| | - Jieshou Li
- Affiliated Jinling Hospital, Research Institute of General Surgery, Medical School of Nanjing University, Nanjing, China
| | - Xinying Wang
- Affiliated Jinling Hospital, Research Institute of General Surgery, Medical School of Nanjing University, Nanjing, China
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Kizilates F, Yakupogullari Y, Berk H, Oztoprak N, Otlu B. Risk factors for fecal carriage of extended-spectrum beta-lactamase-producing and carbapenem-resistant Escherichia coli and Klebsiella pneumoniae strains among patients at hospital admission. Am J Infect Control 2021; 49:333-339. [PMID: 32763346 DOI: 10.1016/j.ajic.2020.07.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 12/23/2022]
Abstract
AIM Extended-spectrum beta-lactamase (ESBL)-producing and carbapenem-resistant (CR) Enterobacteriaceae are substantial problems in hospital-acquired infections worldwide. We analyzed the risk factors for fecal carriage of ESBL-positive and/or CR E. coli and K. pneumoniae (EcKp) strains in a hospital in Turkey, an endemic country for both resistances. MATERIALS AND METHODS A prospective cross-sectional study including the rectal swab samples of 168 patients, obtained at the day of admission, was conducted. ESBL-producing and CR EcKp were investigated with phenotypic tests and PCR, and the clonal relatedness of isolates was studied. Risk analysis was performed with logistic regression method. RESULTS A total of 67 (39.8%) and 21 (12.5%) patient samples tested positive for ESBL-producing and CR EcKp, respectively. CTX-M (n = 27) and OXA-48 (n = 12) were the dominant ESBL and carbapenemase types, and 4.5%-10.7% of the isolates were clonally-related. Among 15 potential risk factors studied, longer lengths of hospital stay and antimicrobial use, and receiving total parenteral nutrition in the last 6 months were determined as independent risk factors for fecal carriage of ESBL-producing and/or CR EcKp, while prior antimicrobial treatment was only a risk factor for ESBL producers. CONCLUSION Certain conditions in patients' medical backgrounds may be associated with increased likelihood of resistant bacterial colonization. Notably, questioning these situations at admission can help to identify potential carriers and proactively administer appropriate infection control measures.
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Affiliation(s)
- Filiz Kizilates
- Department of Infectious Diseases and Clinical Microbiology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Yusuf Yakupogullari
- Department of Medical Microbiology, Inonu University Medical Faculty, Malatya, Turkey.
| | - Hande Berk
- Department of Infectious Diseases and Clinical Microbiology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Nefise Oztoprak
- Department of Infectious Diseases and Clinical Microbiology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Baris Otlu
- Department of Medical Microbiology, Inonu University Medical Faculty, Malatya, Turkey
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Abstract
PURPOSE OF REVIEW Circulatory shock is associated with reduced splanchnic blood flow and impaired gut epithelial barrier function (EBF). Early enteral nutrition (EN) has been shown in animal models to preserve EBF. There are limited human data informing early EN in circulatory shock and critical care nutrition guidelines provide disparate recommendations regarding the optimal timing and dose. The purpose of this review is to describe the harms and benefits of early EN in circulatory shock by identifying and appraising recent human data. RECENT FINDINGS The cumulative risk of nonocclusive bowel ischemia and necrosis in patients with circulatory shock is no higher than 0.3% across observational and randomized controlled trial-level data, and whether the risk is increased by EN delivery remains uncertain. Observational data suggest that early EN in circulatory shock is associated with improved clinical outcomes but data from robust randomized controlled trials remain equivocal, so the optimal timing and dose remain unknown. SUMMARY Based on the best available data, initiating restrictive dose EN into the stomach after initial resuscitation in patients with circulatory shock does not appear to be harmful. In fact, early EN may preserve EBF and improve clinical outcomes.
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Affiliation(s)
- Anuj Shukla
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Marianne Chapman
- Intensive Care Unit, Royal Adelaide Hospital; Clinical Professor, School of Medicine, University of Adelaide, Adelaide, Australia
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Deja E, Roper L, Tume LN, Dorling J, Gale C, Arch B, Latten L, Pathan N, Eccleson H, Hickey H, Preston J, Beissel A, Andrzejewska I, Valla FV, Woolfall K. Can they stomach it? Parent and practitioner acceptability of a trial comparing gastric residual volume measurement versus no gastric residual volume in UK NNU and PICUs: a feasibility study. Pilot Feasibility Stud 2021; 7:49. [PMID: 33593416 PMCID: PMC7885383 DOI: 10.1186/s40814-021-00784-5] [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: 05/20/2020] [Accepted: 01/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Routine measurement of gastric residual volume (GRV) to guide feeding in neonatal and paediatric intensive care is widespread. However, this practice is not evidence based and may cause harm. As part of a feasibility study, we explored parent and practitioner views on the acceptability of a trial comparing GRV measurement or no GRV measurement. METHODS A mixed-methods study involving interviews and focus groups with practitioners and interviews with parents with experience of tube feeding in neonatal and/or paediatric intensive care. A voting system recorded closed question responses during practitioner data collection, enabling the collection of quantitative and qualitative data. Data were analysed using thematic analysis and descriptive statistics. RESULTS We interviewed 31 parents and nine practitioners and ran five practitioner focus groups (n=42). Participants described how the research question was logical, and the intervention would not be invasive and potential benefits of not withholding the child's feeds. However, both groups held concerns about the potential risk of not measuring GRV, including delayed diagnosis of infection and gut problems, increased risk of vomiting into lungs and causing discomfort or pain. Parent's views on GRV measurement and consent decision making were influenced by their views on the importance of feeding in the ICU, their child's prognosis and associated comorbidities or complications. CONCLUSIONS The majority of parents and practitioners viewed the proposed trial as acceptable. Potential concerns and preferences were identified that will need careful consideration to inform the development of the proposed trial protocol and staff training.
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Affiliation(s)
- Elizabeth Deja
- Institute of Population Health, University of Liverpool, Liverpool, UK.
| | - Louise Roper
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Lyvonne N Tume
- School of Health & Society, University of Salford, Manchester, M6 6PU, UK
| | - Jon Dorling
- Division of Pediatrics and Neonatal-Perinatal Medicine, Dalhousie University, Halifax, Canada
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital campus, London, UK
| | - Barbara Arch
- Medicines for Children Clinical Trials Unit, Clinical Trials Research Centre, University of Liverpool Institute of Child Health Alder Hey Children's NHS Foundation Trust Liverpool, Liverpool, UK
| | - Lynne Latten
- Department of Dietetics, Alder Hey Children's Hospital, Liverpool, UK
| | - Nazima Pathan
- Paediatric Intensive Care, University of Cambridge, Addenbrooke's Hospital Cambridge, Campbridge, UK
| | - Helen Eccleson
- Medicines for Children Clinical Trials Unit, Clinical Trials Research Centre, University of Liverpool Institute of Child Health Alder Hey Children's NHS Foundation Trust Liverpool, Liverpool, UK
| | - Helen Hickey
- Medicines for Children Clinical Trials Unit, Clinical Trials Research Centre, University of Liverpool Institute of Child Health Alder Hey Children's NHS Foundation Trust Liverpool, Liverpool, UK
| | - Jenny Preston
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Anne Beissel
- Neonatal Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon-Bron, France
| | | | - Frédéric V Valla
- Faculty of Health & Applied Sciences, University of the West of England, Bristol, UK.,Pediatric Intensive Care Unit, CarMEN INSERM UMR 1060 Equipe INFOLIP, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon-Bron, France
| | - Kerry Woolfall
- Institute of Population Health, University of Liverpool, Liverpool, UK
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Wang Y, Zhang T, Liu R, Chang M, Wei W, Jin Q, Wang X. New perspective toward nutritional support for malnourished cancer patients: Role of lipids. Compr Rev Food Sci Food Saf 2021; 20:1381-1421. [PMID: 33533186 DOI: 10.1111/1541-4337.12706] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 12/01/2020] [Accepted: 12/28/2020] [Indexed: 12/13/2022]
Abstract
To improve the difficulties related to malnutrition, nutritional support has become an essential part of multidisciplinary comprehensive treatment for cancer. Lipids are essential nutrient source for the human body, and nowadays in clinical practices, it has a positive interventional effect on patients suffering from cancer. However, contribution of lipids in nutritional support of cancer patients is still poorly understood. Moreover, the sensory and physicochemical properties of lipids can severely restrict their applications in lipid-rich formula foods. In this review article, for the first time, we have presented a summary of the existing studies which were related to the associations between different lipids and improved malnutrition in cancer patients and discussed possible mechanisms. Subsequently, we discussed the challenges and effective solutions during processing of lipids into formula foods. Further, by considering existing problems in current lipid nutritional support, we proposed a novel method for the treatment of malnutrition, including developing individualized lipid nutrition for different patients depending on the individual's genotype and enterotype. Nonetheless, this review study provides a new direction for future research on nutritional support and the development of lipid-rich formula foods for cancer patients, and probably will help to improve the efficacy of lipids in the treatment of cancer malnutrition.
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Affiliation(s)
- Yandan Wang
- National Engineering Research Center for Functional Food, Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, State Key Lab of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi, China
| | - Tao Zhang
- National Engineering Research Center for Functional Food, Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, State Key Lab of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi, China
| | - Ruijie Liu
- National Engineering Research Center for Functional Food, Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, State Key Lab of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi, China
| | - Ming Chang
- National Engineering Research Center for Functional Food, Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, State Key Lab of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi, China
| | - Wei Wei
- National Engineering Research Center for Functional Food, Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, State Key Lab of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi, China
| | - Qingzhe Jin
- National Engineering Research Center for Functional Food, Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, State Key Lab of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi, China
| | - Xingguo Wang
- National Engineering Research Center for Functional Food, Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, State Key Lab of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi, China
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43
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Hu Q, Ren H, Hong Z, Wang C, Zheng T, Ren Y, Chen K, Liu S, Wang G, Gu G, Wu X, Ren J. Early Enteral Nutrition Preserves Intestinal Barrier Function through Reducing the Formation of Neutrophil Extracellular Traps (NETs) in Critically Ill Surgical Patients. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:8815655. [PMID: 33294125 PMCID: PMC7700037 DOI: 10.1155/2020/8815655] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/20/2020] [Accepted: 11/05/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND The gut was suggested as the driver of critical illness and organ injury. Recently, excessive formation of neutrophil extracellular traps (NETs) was associated with mucosal inflammation. Direct investigation of intestinal mucosa is essential to illuminate the potential mechanism of gut barrier in critically ill patients. We hypothesized that early enteral nutrition (EN) could decrease intestinal NETs and maintain the gut barrier. METHODS Intestinal biopsies were obtained using biopsy forceps from critically ill surgical patients complicated with enterocutaneous fistula. Expressions of tight junction (TJ) proteins, mucosal inflammation, and apoptosis were evaluated. Moreover, NET-associated proteins were evaluated in intestinal specimens of patients by Western blot and immunofluorescence analysis. RESULTS The intestinal barrier was significantly impaired in critically ill patients receiving early total parenteral nutrition (TPN), evidenced by intestinal villi atrophy, inflammatory infiltration, increased enterocyte apoptosis, and abnormal TJ expressions. Early EN significantly alleviated these intestinal injuries. In addition, we observed increased formation of the NET structure and elevated expressions of NET-associated proteins in intestines of critically ill surgical patients. Early EN was associated with the diminished presence of NETs and reduced expression of NET-associated proteins. Mechanically, analysis of the TLR4 pathway showed a significant increase in TLR4, NFκB, and MAPK signaling in patients receiving TPN when compared to those receiving early EN. CONCLUSION The intestinal barrier is disrupted in the human gut during critical illness. Our data suggests that an increased NET structure was showed in the gut of critically ill surgical patients, and early EN treatment was associated with the reduction of NET formation and the preservation of mucosal immunity.
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Affiliation(s)
- Qiongyuan Hu
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 210008, China
| | - Huajian Ren
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
| | - Zhiwu Hong
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
| | - Chenyang Wang
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
| | - Tao Zheng
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
| | - Yanhan Ren
- Rosalind Franklin University of Medicine and Sciences, North Chicago, IL, USA
| | - Kai Chen
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 210008, China
| | - Song Liu
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 210008, China
| | - Gefei Wang
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
| | - Guosheng Gu
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
| | - Xiuwen Wu
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
| | - Jianan Ren
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
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Chiconato GC, Campos DJ, Thomaz AC, Moreira Funke VA, Vilela RM. Oral nutritional support to adult patients with acute intestinal Graft Versus Host Disease (GVHD): A proposal for dietary intervention as a model to clinical trials. Clin Nutr ESPEN 2020; 40:369-375. [PMID: 33183565 DOI: 10.1016/j.clnesp.2020.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/01/2020] [Accepted: 07/26/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Acute Graft Versus Host Disease (GVHD) affects about 20%-80% of the patients after the hematopoietic stem cell transplant (HSCT) and it is amongst the main causes of morbidity and mortality both in children and adults. The intestine is one of the most affected organs by GVHD causing important alterations in the nutritional status and quality of life, considering that the dysfunctional intestine could decrease food intake as well as an inappropriate dietary plan could worsen the clinical condition. In addition to GVHD, chemotherapy conditioning regimen suppresses the immune system, promotes mucositis and increases the risk of infectious complications. Taking the above into consideration, when per oral diet is possible; the food choices should be carefully planned and monitored to promote nutritional support and avoid worsening the intestinal function and clinical condition. OBJECTIVE This work was aimed to present a practice guideline proposal, to be validated, based on literature review, regarding to oral dietary recommendations for acute intestinal GVHD after HTSC. METHODS Two research phases were defined: Phase one: evidence-based literature review; Phase 2: Practice Guideline Proposal. 1: Evidence based literature review SEARCH METHODS: A literature review (1997-2019) was performed including PubMed, in English, and Lilacs, in Portuguese electronic database to address the subject of dietary intervention for intestinal GVHD related to the HSCT, with children and adults, whose receiving oral or tube feeding nutrition therapy. SELECTION CRITERIA The study selection was based on the PRISMA method. Controlled clinical trials were searched. Randomization was not possible considering the rare condition. DATA COLLECTION AND ANALYSIS Two independent authors assessed the abstracts of the selected studies to determine the articles feasible to compose the review as the base to elaborate the practice guideline proposal protocol, object of the present study. To determine the level of evidence of the selected article, GRADE criteria were used. MAIN RESULTS One controlled clinical trial study was included. The study was developed in Japan with a total of 35 patients. The dietary plan was characterized by gradual increasing food consistency/density. They found better nutritional parameters in the treated group, however, following GRADE criteria, we rated the quality of evidence as very low. AUTHORS' CONCLUSIONS We could not demonstrate confidence in the effect estimate based on the selected study. However, considering the lack of literature information and the relevance of the topic, we decided to proceed and propose a practice guideline for an oral diet protocol for acute intestinal GVHD as a reference to be a starting point to validate protocols in future clinical trials. 2: Practice Guideline Proposal The criteria to elaborate the protocol were based on the RIGHT Statement. In addition to the literate information about diet and intestinal health, recommendations already adopted in the Service of Bone Marrow Transplant in the Complex Hospital of Clinics of Curitiba, in the state of Paraná, Brazil, were also considered.
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Affiliation(s)
| | - Denise Johnson Campos
- Oncology and Hematology of the Complex Hospital of Clinics UFPR, Curitiba, PR, Brazil
| | - Ana Cláudia Thomaz
- Department of Nutrition of the Federal University of Paraná (UFPR), Curitiba, PR, Brazil
| | - Vaneuza Araújo Moreira Funke
- Bone Marrow Transplant Service of the Complex Hospital of Clinics UFPR, Curitiba, PR, Brazil; Department of Medical Clinic, Hematology Unit, Curitiba, PR, Brazil
| | - Regina Maria Vilela
- Department of Nutrition of the Federal University of Paraná (UFPR), Curitiba, PR, Brazil.
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Mechanick JI, Carbone S, Dickerson RN, Hernandez BJD, Hurt RT, Irving SY, Li DY, McCarthy MS, Mogensen KM, Gautier JBO, Patel JJ, Prewitt TE, Rosenthal M, Warren M, Winkler MF, McKeever L. Clinical Nutrition Research and the COVID-19 Pandemic: A Scoping Review of the ASPEN COVID-19 Task Force on Nutrition Research. JPEN J Parenter Enteral Nutr 2020; 45:13-31. [PMID: 33094848 DOI: 10.1002/jpen.2036] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 10/16/2020] [Indexed: 12/13/2022]
Abstract
The purpose of this scoping review by the American Society for Parenteral and Enteral Nutrition (ASPEN) Coronavirus Disease 2019 (COVID-19) Nutrition Task Force was to examine nutrition research applicable to the COVID-19 pandemic. The rapid pace of emerging scientific information has prompted this activity to discover research/knowledge gaps. This methodology adhered with recommendations from the Joanna Briggs Institute. There were 2301 citations imported. Of these, there were 439 articles fully abstracted, with 23 main topic areas identified across 24 article types and sourced across 61 countries and 51 specialties in 8 settings and among 14 populations. Epidemiological/mechanistic relationships between nutrition and COVID-19 were reviewed and results mapped to the Population, Intervention, Comparator, Outcome, and Time (PICO-T) questions. The aggregated data were analyzed by clinical stage: pre-COVID-19, acute COVID-19, and chronic/post-COVID-19. Research gaps were discovered for all PICO-T questions. Nutrition topics meriting urgent research included food insecurity/societal infrastructure and transcultural factors (pre-COVID-19); cardiometabolic-based chronic disease, pediatrics, nutrition support, and hospital infrastructure (acute COVID-19); registered dietitian nutritionist counseling (chronic/post-COVID-19); and malnutrition and management (all stages). The paucity of randomized controlled trials (RCTs) was particularly glaring. Knowledge gaps were discovered for PICO-T questions on pediatrics, micronutrients, bariatric surgery, and transcultural factors (pre-COVID-19); enteral nutrition, protein-energy requirements, and glycemic control with nutrition (acute COVID-19); and home enteral and parenteral nutrition support (chronic/post-COVID-19). In conclusion, multiple critical areas for urgent nutrition research were identified, particularly using RCT design, to improve nutrition care for patients before, during, and after COVID-19.
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Affiliation(s)
- Jeffrey I Mechanick
- Marie-Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart, and, Metabolic Support, Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Salvatore Carbone
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Roland N Dickerson
- Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Clinical Coordinator and Clinical Pharmacy Specialist, Nutrition Support Service, Regional One Health, Memphis, Tennessee, USA
| | | | - Ryan T Hurt
- Divisions of Gastroenterology and Hepatology, and Endocrinology, Diabetes, Metabolism, Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Sharon Y Irving
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Ding-You Li
- Gastroenterology and Nutrition, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri, USA
| | | | - Kris M Mogensen
- Department of Nutrition, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | | | - Jayshil J Patel
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - T Elaine Prewitt
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Martin Rosenthal
- Acute Care Surgery Team, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Malissa Warren
- VA Portland HealthCare System, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Marion F Winkler
- Department of Surgery and Nutritional Support Service, Rhode Island Hospital, Brown Medical School, Providence, Rhode Island, USA
| | - Liam McKeever
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Bourgault AM, Powers J, Aguirre L, Hines R. Migration of Feeding Tubes Assessed by Using an Electromagnetic Device: A Cohort Study. Am J Crit Care 2020; 29:439-447. [PMID: 33130862 DOI: 10.4037/ajcc2020744] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Bedside methods to verify placement of a feeding tube are not accurate for detecting placement within the gastrointestinal tract, increasing risk of pulmonary aspiration. Current guidelines recommend verifying placement every 4 hours, yet the rationale for this recommendation is unknown. OBJECTIVE To assess spontaneous migration of small-bore feeding tubes in critically ill adults. METHODS A prospective, repeated-measures cohort study was performed in 2 intensive care units. An electromagnetic placement device was used to assess distal feeding tube location every 24 hours for 7 days. Tube migration between zones-esophageal, gastric, and postpyloric- was considered clinically significant. RESULTS Feeding tubes were analyzed in 20 patients. Interrater agreement was substantial for round 2 of a blinded analysis of insertion tracings (g = 0.78); 100% agreement was achieved after unblinding. Among 62 outcomes (migration assessments), 4 feeding tubes migrated 8 times (3 forward and 5 retrograde). All migrations occurred in the postpyloric zone and none were clinically significant. Within 24 hours of insertion, 50% of feeding tubes had migrated forward. Repeated-measures analysis showed a greater likelihood of migration in patients with an endotracheal tube (relative risk, 3.46 [95% CI, 1.14-10.53]; P = .03). CONCLUSIONS No tubes migrated retrograde into the stomach or esophagus, challenging the practice of verifying placement every 4 hours. Verification every 24 hours may be adequate if migration is not suspected. Also, lack of visible anatomical structures on insertion tracings from an electromagnetic placement device make subtle changes in postpyloric placement difficult to identify accurately.
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Affiliation(s)
- Annette M. Bourgault
- Annette M. Bourgault is an associate professor, University of Central Florida College of Nursing, and a nurse scientist, Orlando Health, Orlando, Florida
| | - Jan Powers
- Jan Powers is the director of nursing research and professional practice, Parkview Health System, Fort Wayne, Indiana
| | - Lillian Aguirre
- Lillian Aguirre is a clinical nurse specialist in trauma/burn critical care services, Orlando Regional Medical Center (a part of Orlando Health), Orlando, Florida
| | - Robert Hines
- Robert Hines is an associate professor, University of Central Florida College of Medicine, Orlando, Florida
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47
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Tang QQ, Hong ZW, Ren HJ, Wu L, Wang GF, Gu GS, Chen J, Zheng T, Wu XW, Ren JA, Li JS. Nutritional Management of Patients With Enterocutaneous Fistulas: Practice and Progression. Front Nutr 2020; 7:564379. [PMID: 33123545 PMCID: PMC7573310 DOI: 10.3389/fnut.2020.564379] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/07/2020] [Indexed: 12/14/2022] Open
Abstract
The management of enterocutaneous fistulas (ECF) can be challenging because of massive fluid loss, which can lead to electrolyte imbalance, severe dehydration, malnutrition and sepsis. Nutritional support plays a key role in the management and successful closure of ECF. The principle of nutritional support for patients with ECF should be giving enteral nutrition (EN) priority, supplemented by parenteral nutrition if necessary. Although total parenteral nutrition (TPN) may be indicated, use of enteral feeding should be advocated as early as possible if patients are tolerant to it, which can protect gut mucosal barrier and prevent bacterial translocation. A variety of methods of enteral nutrition have been developed such as fistuloclysis and relay perfusion. ECF can also be occluded by special devices and then EN can be implemented, including fibrin glue application, Over-The-Scope Clip placement and three-dimensional (3D)-printed patient-personalized fistula stent implantation. However, those above should not be conducted in acute fistulas, because tissues are edematous and perforation could easily occur.
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Affiliation(s)
- Qin-Qing Tang
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China.,Department of General Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhi-Wu Hong
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China
| | - Hua-Jian Ren
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China
| | - Lei Wu
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China
| | - Ge-Fei Wang
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China
| | - Guo-Sheng Gu
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China
| | - Jun Chen
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China
| | - Tao Zheng
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China
| | - Xiu-Wen Wu
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China
| | - Jian-An Ren
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China
| | - Jie-Shou Li
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China
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48
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Bechek S, Garcia M, Chiou H. Severe Gastrointestinal Involvement in Pediatric Stevens-Johnson Syndrome: A Case Report and Review of the Literature. Clin Exp Gastroenterol 2020; 13:377-383. [PMID: 33061516 PMCID: PMC7533238 DOI: 10.2147/ceg.s269349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/11/2020] [Indexed: 12/11/2022] Open
Abstract
Stevens-Johnson syndrome and toxic epidermal necrolysis form a rare but severe disease spectrum characterized by widespread epidermal detachment. Gastrointestinal manifestations of the disease, however, are rarely described in the pediatric literature and have a high mortality among adults. There are limited data on the treatment of these cases, with conflicting evidence regarding the benefit of steroids, IVIG, or other immunosuppressive agents. We review previous instances of gastrointestinal involvement in children and report the case of a previously healthy 13-year-old who presented with the typical ocular and skin findings of Stevens-Johnson syndrome, subsequently developed severe life-threatening diarrhea, and was found to have severe esophagitis, duodenitis, and colitis on endoscopic evaluation. Treatment was initiated with an immediate, short course of steroids along with early introduction of an enteral diet via nasogastric tube, and resulted in full gastrointestinal recovery. This case highlights successful medical treatment of the first reported pediatric case of SJS/TEN with both upper and lower gastrointestinal tract involvement.
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Affiliation(s)
- Sophia Bechek
- Stanford University School of Medicine, Stanford, CA, USA
| | - Manuel Garcia
- Division of Pediatric Gastroenterology, Stanford University School of Medicine, Stanford, CA, USA
| | - Howard Chiou
- Department of Medicine, Santa Clara Valley Medical Center, San Jose, CA, USA
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49
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Ding W, Liu J, Zhou X, Miao Q, Zheng H, Zhou B, Dou G, Tong Y, Long Y, Su L. Clinical Multi-Omics Study on the Gut Microbiota in Critically Ill Patients After Cardiovascular Surgery Combined With Cardiopulmonary Bypass With or Without Sepsis (MUL-GM-CSCPB Study): A Prospective Study Protocol. Front Med (Lausanne) 2020; 7:269. [PMID: 32733902 PMCID: PMC7360671 DOI: 10.3389/fmed.2020.00269] [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: 11/03/2019] [Accepted: 05/15/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction: Fever of unknown origin (FUO) and hemodynamic instability are complications that develop after cardiac surgery combined with cardiopulmonary bypass (CPB) for heart disease. Patients who develop fever with hemodynamic instability after cardiac surgery may have systemic inflammatory response syndrome or sepsis. Cardiopulmonary bypass (CPB) is a technique that temporarily takes over the function of the heart and lungs during cardiac surgery. Recent reports suggest that early bloodstream infections of patients undergoing CPB are due to gram-negative bacteria that are present in the intestinal flora. The theory of intestinal flora translocation has growing evidence. Intestinal ischemia-reperfusion that occurs during cardiac surgery with CPB will induce a systemic inflammatory reaction and may cause intestinal flora translocation. Does this systemic reaction cause sepsis? We therefore propose this protocol to determine whether the changes in the intestinal flora in patients after cardiac surgery with CPB are related to sepsis. Methods and Analysis: This study is a prospective observational case-control study to analyze the variation in the intestinal microflora and metabolites in patients undergoing cardiac surgery with CPB and to observe the outcomes of patients with routine clinical interventions. The control group will include healthy people without intestinal illness. Feces and blood samples will be acquired 1 day before cardiac surgery and within 24-72 h after cardiac surgery, and will be used for genomics and metabolomics analyses. Demographic data describing age, sex, main diagnosis, and past medical history and data related to the CPB time and application of antibiotics are available. Sequential (sepsis-related) organ failure assessment, infection-related laboratory items, infection site, and pathogenic microorganisms, and nutrition, and gastrointestinal function assessment are additionally recorded. Group analysis of data will be conducted according to the outcomes (sepsis vs. non-sepsis and survivors vs. non-survivors). Ethics and Dissemination: This protocol has been ethically approved by the Ethics Committee of Peking Union Medical College (ID: ZS-1612). Informed consent will be obtained before subject enrolment, and data will be stored in a secured database. The results will be submitted to international peer-reviewed journals and presented at international conferences. Trial Registration Number: NCT04032938.
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Affiliation(s)
- Wenyan Ding
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jianzhou Liu
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiang Zhou
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Qi Miao
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Haibo Zheng
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Guifang Dou
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing, China
| | - Yigang Tong
- Beijing Advanced Innovation Center for Soft Matter Science and Engineering (BAIC-SM) College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
| | - Yun Long
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Longxiang Su
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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50
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Hamilton LA, Behal ML. Altering Routine Intensive Care Unit Practices to Support Commensalism. Nutr Clin Pract 2020; 35:433-441. [PMID: 32189422 DOI: 10.1002/ncp.10484] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The gastrointestinal (GI) tract consists of trillions of organisms that support multiple functions in the body, from immunity, digestion, and absorption to drug metabolism. These microbes form an overall collection of microorganisms that form the body's microbiome. In critical illness, many of these functions are aberrant, and the microbiome is altered, leading to untoward effects. Some of the most common medications received by patients include antibiotics and proton pump inhibitors, which affect particular changes in the microbiome. In addition, patients receiving prolonged enteral and parenteral nutrition experience changes in the microbiological composition and diversity of their GI tracts. Research is ongoing to characterize the crosstalk between the microbiome and immune function as targets for drug and nutrition therapy.
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Affiliation(s)
- Leslie A Hamilton
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Knoxville, Tennessee, USA
| | - Michael L Behal
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Knoxville, Tennessee, USA
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