1
|
Aadal L, Holst M, Poulsen I, Siig M, Odgaard L. Nutritional interventions and related efforts addressing undernutrition during rehabilitation after acquired brain injury: a scoping review protocol. BMJ Open 2024; 14:e080165. [PMID: 38889937 PMCID: PMC11191809 DOI: 10.1136/bmjopen-2023-080165] [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: 09/22/2023] [Accepted: 05/30/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION Patients with an acquired brain injury (ABI) are at an increased risk of undernutrition due to the disease-related inflammation and other numerous symptoms that impact their nutrition. Unfortunately, recommendations related to nutritional interventions and related efforts vary. The objective of this scoping review is to map the body of literature on nutritional interventions and related efforts provided by health professionals, such as screening or assessments, addressing undernutrition in adults with a moderate to severe ABI during the subacute rehabilitation pathway. METHODS AND ANALYSIS The review follows the Joanna Briggs Institute methodology for scoping reviews. The librarian-assisted search strategy will be conducted in the bibliographical databases: MEDLINE (PubMed), Embase, CINAHL, Web of Science and OpenGrey. Indexed and grey literature in English, German or Scandinavian languages from January 2010 will be considered for inclusion. Two independent reviewers will conduct the iterative process of screening the identified literature, paper selection and data extraction. Disagreements will be resolved by discussion until a consensus is reached. A template will be used to guide the data extraction. This scoping review will include research articles, methodological papers and clinical guidelines reporting on nutritional interventions or related efforts to prevent or address undernutrition in adult patients (≥18 years) with moderate to severe ABI within the first year after admission to rehabilitation hospital. We will map all kinds of nutritional efforts provided by professionals in different settings within high-income countries, including interventions targeting relatives. ETHICS AND DISSEMINATION This review will involve the collection and analysis of secondary sources that have been published and/or are publicly available. Therefore, ethics approval is not required. The results will be published in an international peer-reviewed journal, presented at scientific conferences and disseminated through digital science communication platforms. STUDY REGISTRATION Open Science Framework: https://doi.org/10.17605/OSF.IO/H5GJX.
Collapse
Affiliation(s)
- Lena Aadal
- Department of Research, Hammel Neurorehabilitation and Research Centre, Hammel, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mette Holst
- Centre for Nutrition and Intestinal Failure, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ingrid Poulsen
- Department for People and Technology, Roskilde University and Nursing and Health Care, Health, Aarhus University, Amager Hvidovre Hospital, Hvidovre, Denmark
| | - Margrethe Siig
- Health Care, Ringkøbing Skjern Municipality, Ringkøbing, Denmark
| | - Lene Odgaard
- Hammel Neurorehabilitation and Research Centre, Aarhus Universitet, Hammel, Denmark
| |
Collapse
|
2
|
Fabricius J, Pedersen AR. Subacute prognosis of oral nutrition (SPOON): Development of a multivariable prognostic model for complete oral intake in tube-fed subjects with acquired brain injury. Clin Nutr 2023; 42:1770-1777. [PMID: 37572580 DOI: 10.1016/j.clnu.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/16/2023] [Accepted: 07/10/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND & AIMS Enteral feeding is very common following an acquired brain injury. However, no prognostic models for oral food intake have been developed for subacute rehabilitation. The aim of this study was to develop a prognostic model and online tool, coined "subacute prognosis of oral nutrition" (SPOON), for complete oral intake in tube-fed subjects with acquired brain injury. METHODS The model was developed using routinely gathered clinical data from a cohort of 1233 adult patients who were tube-fed at admission for sub-acute inpatient rehabilitation. Candidate predictors were included based on scientific evidence and their availability in the medical records within the first days following admission. The outcome was time until achieving complete oral food intake without any tube-feeding supplements. Time until complete oral intake was analyzed by discrete time-to-event analysis with logit-link and presented as daily odds ratios (OR) with 95% confidence intervals (CI). RESULTS The following predictors of complete oral intake were included in the model: age, diagnosis, cuffed tracheostomy tube, days from injury to admission for rehabilitation, and the Early Functional Abilities (EFA) sum score. Multiple adjusted analyses were performed stratified by cuffed tracheostomy tube status. Some of the strongest predictors of complete oral intake were age 18-40 years, OR 1.99 (95%CI: 1.53; 2.59); 0-2 weeks since injury, OR 3.75 (95%CI: 2.72; 5.16); and EFA 61-100 (slight/no disturbance in function), OR 5.81 (95%CI: 4.47; 7.55). The online prognostic tool SPOON was evaluated in a usability study. Based on feedback from clinicians, the tool was further refined to enable extraction of data for prediction directly from medical records. CONCLUSIONS The objective of SPOON is to complement the planning of rehabilitation initiatives and inform discussions to determine if a percutaneous endoscopic gastrostomy (PEG) tube should be inserted. SPOON is being implemented locally, but external validation based on appropriate data modeling is warranted before further clinical implementation.
Collapse
Affiliation(s)
- Jesper Fabricius
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Voldbyvej 15, 8450, Hammel, Denmark.
| | - Asger Roer Pedersen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Voldbyvej 15, 8450, Hammel, Denmark; University Research Clinic for Innovative Patient Pathways, Diagnostic Centre, Silkeborg, Denmark
| |
Collapse
|
3
|
Gheri CF, Scalfi L, Biffi B, Pancani S, Madiai S, Di Vincenzo O, Ghaderi M, Celoni R, Dalladonna M, Draghi F, Maccanti D, Macchi C, Romoli AM, Cecchi F, Hakiki B, Luisi MLE. Relationship between Nutritional Risk, Clinical and Demographic Characteristics, and Pressure Ulcers in Patients with Severe Acquired Brain Injuries Attending a Rehabilitative Program. Nutrients 2023; 15:3336. [PMID: 37571274 PMCID: PMC10421108 DOI: 10.3390/nu15153336] [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: 06/23/2023] [Revised: 07/19/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Preliminary evidence in the literature suggests a high prevalence of malnutrition (undernutrition) in patients with severe acquired brain injuries (sABI), with an expected negative impact on clinical outcomes and pressure ulcers (PUs) in particular. In a retrospective cohort study on patients discharged from intensive care units (ICU) and admitted to an intensive rehabilitation unit (IRU), the risk of malnutrition was systematically assessed, in addition to standard clinical procedures (including PUs evaluation), using two different tools: the Malnutrition Universal Screening Tool (MUST) and the Controlling Nutritional Status (CONUT) tool. Eighty-eight patients were included in the analysis. A high proportion (79.5%) of patients with sABI suffered from PUs, being older and more frequently men, with a longer ICU stay between the event and admission to IRU, and a greater MUST score. At discharge, when compared to patients whose PUs had healed, those with persisting PUs were more often men and had the worst cognitive performance at admission. As for nutritional risk, the baseline CONUT score was identified as an independent negative predictor of PUs at discharge by the logistic regression model. In conclusion, the assessment of nutritional risk using simple standard tools may be useful in the clinical evaluation of sABI patients with PUs.
Collapse
Affiliation(s)
- Chiara Francesca Gheri
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Luca Scalfi
- Human Nutrition and Dietetics, Department of Public Health, Federico II University, 80131 Naples, Italy; (L.S.); (O.D.V.)
- Santa Maria del Pozzo Private Hospital, Somma Vesuviana, 80049 Naples, Italy
| | - Barbara Biffi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Silvia Pancani
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Sara Madiai
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Olivia Di Vincenzo
- Human Nutrition and Dietetics, Department of Public Health, Federico II University, 80131 Naples, Italy; (L.S.); (O.D.V.)
| | - Michele Ghaderi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Rebecca Celoni
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Mara Dalladonna
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Francesca Draghi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Daniela Maccanti
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 50134 Florence, Italy
| | - Anna Maria Romoli
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 50134 Florence, Italy
| | - Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Maria Luisa Eliana Luisi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| |
Collapse
|
4
|
Aadal L, Holst M, Rasmussen HH, Nielsen JF, Odgaard L. Malnutrition in Patients With Moderate to Severe Acquired Brain Injury: Prevalence During 4 Weeks of Subacute Rehabilitation. J Neurosci Nurs 2023; 55:38-44. [PMID: 36749958 DOI: 10.1097/jnn.0000000000000688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
ABSTRACT BACKGROUND: Malnutrition is associated with high rates of complication, longer hospital stays, and increased morbidity and mortality. Malnutrition defined as undernutrition is common in patients with acquired brain injury (ABI); however, estimates vary remarkably. This study aimed to describe malnutrition at admission and after 4 weeks of subacute inpatient neurorehabilitation in patients with ABI using the new global consensus definition of malnutrition. METHODS: One hundred thirty-three patients with moderate to severe ABI consecutively admitted to a specialized neurorehabilitation hospital within a period of 4 months were screened for inclusion, of which 92 were included. Malnutrition was defined as at least 1 phenotypic criterion (weight loss, low body mass index, low muscle mass) and at least 1 etiologic criterion (reduced food intake, inflammation). Malnutrition on admission and after 4 weeks was compared using the McNemar test. RESULTS: The proportion of patients with malnutrition at admission was 42%, with more men (46%) than women (36%) fulfilling the criteria for malnutrition. The most frequent phenotypic and etiologic criteria were weight loss (56%) and inflammation (74%), respectively. During the 4 weeks of rehabilitation, the proportion of male patients fulfilling the individual criteria "weight loss" (difference, -21.4%) and "inflammation" (difference, -18.9%) decreased significantly; "low muscle mass" decreased borderline significant (difference, -8.9%), whereas "low body mass index" did not change. The proportion of female patients fulfilling individual criteria for malnutrition was stable or increased nonsignificantly. CONCLUSION: Malnutrition was common at admission to neurorehabilitation in patients with moderate to severe ABI, with more men than women fulfilling the criteria for malnutrition. The nutritional status improved after 4 weeks of rehabilitation in male patients, whereas it was largely unchanged in female patients. The results provide the basis for monitoring high-quality nutritional nursing care.
Collapse
|
5
|
Huppertz V, Guida S, Holdoway A, Strilciuc S, Baijens L, Schols JMGA, van Helvoort A, Lansink M, Muresanu DF. Impaired Nutritional Condition After Stroke From the Hyperacute to the Chronic Phase: A Systematic Review and Meta-Analysis. Front Neurol 2022; 12:780080. [PMID: 35178021 PMCID: PMC8846185 DOI: 10.3389/fneur.2021.780080] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/09/2021] [Indexed: 12/25/2022] Open
Abstract
Background Malnutrition is common after stroke and can affect rehabilitation and healthcare costs. A comprehensive overview of stroke patients' nutritional condition from the hyperacute to the chronic phase is lacking. This systematic review aimed to investigate the prevalence of impaired nutritional condition (INC) across the continuum of care in specific phases after stroke. Methods CAB ABSTRACTS, Embase, MEDLINE, were used to collect studies published between 01-01-1999 and 26-08-2020. Primary and secondary outcomes were prevalence of INC and prevalence of malnutrition, respectively. Exploratory outcomes were prevalence of INC at follow-up, nutritional examination methods, prevalence of dysphagia, stroke severity, adverse events, and continent-specific prevalence of INC. A random-effects meta-analysis model was used to estimate the phase-specific pooled prevalence of INC and malnutrition. Results The dataset consisted of 78 study groups selected over a total of 1,244 identified records. The pooled prevalence of INC and malnutrition were 19% (95%CI:7–31) (N = 4) and 19% (95%CI:9–29) (N = 3), 34% (95%CI:25–43) (N = 34) and 26% (95%CI:18–35) (N = 29), 52% (95%CI:43–61) (N = 34) and 37% (95%CI:28–45) (N = 31), 21% (95%CI:12–31) (N = 3) and 11% (95%CI:0–24) (N = 3) and 72% (95%CI:41–100) (N = 3) and 30% (95%CI:0–76) (N = 2) in the hyperacute, acute, early subacute, late subacute, and chronic phase, respectively. Conclusion INC and malnutrition are highly prevalent in all stages of stroke care. Since malnutrition has been shown to negatively affect clinical outcomes, mortality, and overall healthcare expenditure in stroke survivors, it is essential to examine and monitor the nutritional status of stroke patients throughout their care journey to guide and plan, timely nutritional support and dietary modification.
Collapse
Affiliation(s)
- Viviënne Huppertz
- Department of Respiratory Medicine, Maastricht University, Maastricht, Netherlands
- *Correspondence: Viviënne Huppertz
| | - Sonia Guida
- Danone Nutricia Research, Utrecht, Netherlands
| | - Anne Holdoway
- DHealth, Consultant Dietitian, BMI/Circle Bath Clinic, Education Officer for the British Association for Parenteral and Enteral Nutrition and Chair of the UK Managing Adult Malnutrition in the Community Panel, Bath, United Kingdom
| | - Stefan Strilciuc
- Department of Neurosciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- “RoNeuro” Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Laura Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, and School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Jos M. G. A. Schols
- Department of Health Services Research, Maastricht University, Maastricht, Netherlands
| | - Ardy van Helvoort
- Department of Respiratory Medicine, Maastricht University, Maastricht, Netherlands
- Danone Nutricia Research, Utrecht, Netherlands
| | | | - Dafin F. Muresanu
- Department of Neurosciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- “RoNeuro” Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| |
Collapse
|
6
|
Mathiesen SL, Aadal L, Uldbæk ML, Astrup P, Byrne DV, Wang QJ. Music Is Served: How Acoustic Interventions in Hospital Dining Environments Can Improve Patient Mealtime Wellbeing. Foods 2021; 10:foods10112590. [PMID: 34828871 PMCID: PMC8622365 DOI: 10.3390/foods10112590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/19/2021] [Accepted: 10/23/2021] [Indexed: 11/18/2022] Open
Abstract
Eating-related challenges and discomforts arising from moderately acquired brain injuries (ABI)—including physiological and cognitive difficulties—can interfere with patients’ eating experience and impede the recovery process. At the same time, external environmental factors have been proven to be influential in our mealtime experience. This experimental pilot study investigates whether redesigning the sonic environment in hospital dining areas can positively influence ABI patients’ (n = 17) nutritional state and mealtime experience. Using a three-phase between-subjects interventional design, we investigate the effects of installing sound proofing materials and playing music during the lunch meals at a specialised ABI hospital unit. Comprising both quantitative and qualitative research approaches and data acquisition methods, this project provides multidisciplinary and holistic insights into the importance of attending to sound in hospital surroundings. Our results demonstrate that improved acoustics and music playback during lunch meals might improve the mealtime atmosphere, the patient well-being, and social interaction, which potentially supports patient food intake and nutritional state. The results are discussed in terms of potential future implications for the healthcare sector.
Collapse
Affiliation(s)
- Signe Lund Mathiesen
- Department of Food Science, Faculty of Technical Sciences, Aarhus University, 8200 Aarhus N, Denmark; (D.V.B.); (Q.J.W.)
- Correspondence: ; Tel.: +45-2577-2779
| | - Lena Aadal
- Hammel Neurorehabilitation and Research Center, 8450 Hammel, Denmark;
- Department of Clinical Medicine, Faculty of Health, Aarhus University, 8000 Aarhus C, Denmark
| | | | - Peter Astrup
- Test and Development Center for Welfaretech, 8800 Viborg, Denmark;
| | - Derek Victor Byrne
- Department of Food Science, Faculty of Technical Sciences, Aarhus University, 8200 Aarhus N, Denmark; (D.V.B.); (Q.J.W.)
| | - Qian Janice Wang
- Department of Food Science, Faculty of Technical Sciences, Aarhus University, 8200 Aarhus N, Denmark; (D.V.B.); (Q.J.W.)
| |
Collapse
|
7
|
Aadal L, Odgaard L, Feldbaek Nielsen J, Rasmussen HH, Holst M. Body composition measures may help target fundamental nutritional nursing efforts in rehabilitating patients with acquired brain injury. Nurs Open 2021; 9:2793-2803. [PMID: 34190414 PMCID: PMC9584462 DOI: 10.1002/nop2.981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/19/2021] [Accepted: 06/08/2021] [Indexed: 11/17/2022] Open
Abstract
Aim To illuminate using body composition measurements for malnutrition measured by Bio Impedance Analysis (BIA), as opposed to body mass index (BMI), and discuss benefits and burdens for fundamental nursing care. Design A second analysis of a prospective, descriptive cohort study, targeting fundamental nursing care elements. Methods This postevaluation study explored data from a prospective, descriptive cohort study, which consecutively included 92 patients admitted for neurorehabilitation care. Measures of nutritional status were BMI and FFMI. Chi‐Square test and Multivariable logistic regression were used. Results Body composition measures rather than BMI contributed to target individual nutritional nursing care as this measure detected more patients at potential risk of malnutrition and indicated minor changes in the nutritional state. Transitions from being malnourished to a normal nutritional status occurred in 29% using the BMI definition while it was the case in 40% of individuals with malnutrition defined by the body composition.
Collapse
Affiliation(s)
- Lena Aadal
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lene Odgaard
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
| | - Jørgen Feldbaek Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Henrik Højgaard Rasmussen
- Centre for Nutrition and Intestinal Failure, Aalborg University Hospital and Department of Clinical Sciences, Aalborg University, Aalborg, Denmark
| | - Mette Holst
- Centre for Nutrition and Intestinal Failure, Aalborg University Hospital and Department of Clinical Sciences, Aalborg University, Aalborg, Denmark
| |
Collapse
|
8
|
Singman E. From Provider to Advocate: The Complexities of Traumatic Brain Injury Prompt the Evolution of Provider Engagement. J Clin Med 2021; 10:jcm10122598. [PMID: 34204619 PMCID: PMC8231255 DOI: 10.3390/jcm10122598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 12/18/2022] Open
Abstract
Treating a patient with traumatic brain injury requires an interdisciplinary approach because of the pervasive, profound and protean manifestations of this condition. In this review, key aspects of the medical history and review of systems will be described in order to highlight how the role of any provider must evolve to become a better patient advocate. Although this review is written from the vantage point of a vision care provider, it is hoped that patients, caregivers and providers will recognize the need for a team approach.
Collapse
Affiliation(s)
- Eric Singman
- Wilmer Eye Institute, Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA
| |
Collapse
|
9
|
GÜzel Ş, GÜrÇay E, Karaca Umay E, MercİmekÇİ S, Çakci A. How Does Nutritional Status Affect Outcomes in Patients with Neurological Diseases? IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:1868-1877. [PMID: 33346224 PMCID: PMC7719642 DOI: 10.18502/ijph.v49i10.4689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background: To evaluate the nutritional status of patients with neurological diseases during the rehabilitation process and to investigate the relationships between the nutritional status and disease severity and clinical evaluation outcomes. Methods: In this prospective trial, 109 patients with a disease duration of <6 months, hospitalized for neurological rehabilitation in Physical Medicine and Rehabilitation Clinic, Ankara, Turkey were enrolled from 2014–17. All patients were assessed with the Mini Mental State Examination (MMSE) test, European Quality of Life Scale (Euro-QoL), Hospital Anxiety and Depression Scale (HADS), Pittsburg Rehabilitation Participation Scale (PRPS), and Functional Ambulation Category (FAC). Nutritional status was analyzed by biochemical and anthropometric parameters. The patients received a conventional rehabilitation program and a nutritional support according to clinical and laboratory findings for 4 weeks. The outcome data were evaluated at baseline and at the end of 4-week treatment. Results: Linear regressions analysis revealed that the significant independent predictors that associated positively with baseline insulin (P=0.010) and negatively with baseline cortisol (P=0.020) levels were Brunnstrom upper and hand stages. Additionally, the significant independent predictor that associated positively with baseline insulin (P=0.041) was Brunnstrom lower stage. Conclusion: Insulin and cortisol levels may be predictors in motor function recovery of stroke patients in rehabilitation process. Early detection and treatment of malnutrition both during hospitalization and follow-up might be important for the improvement of outcomes.
Collapse
Affiliation(s)
- Şükran GÜzel
- Physical Medicine and Rehabilitation Clinic, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Eda GÜrÇay
- Physical Medicine and Rehabilitation Clinic, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ebru Karaca Umay
- Physical Medicine and Rehabilitation Clinic, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Serdar MercİmekÇİ
- Physical Medicine and Rehabilitation Clinic, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Aytül Çakci
- Physical Medicine and Rehabilitation Clinic, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| |
Collapse
|
10
|
Tsutsumiuchi K, Wakabayashi H, Maeda K, Shamoto H. Impact of malnutrition on post-stroke cognitive impairment in convalescent rehabilitation ward inpatients. Eur Geriatr Med 2020; 12:167-174. [PMID: 32940865 DOI: 10.1007/s41999-020-00393-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 09/05/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE To investigate the relationship between malnutrition risk on admission and improvement in post-stroke cognitive impairment (PSCI). METHODS This retrospective cohort study included 90 patients with PSCI with a Mini-Mental State Examination (MMSE) score ≤ 23, who were admitted to a rehabilitation hospital between July 2013 and December 2015. We assessed the malnutrition risk using the Mini Nutritional Assessment-Short Form (MNA-SF) and cognitive improvement using the Functional Independence Measure cognitive subscale (cognitive FIM) gain. Participants were classified into the malnourished (MNA-SF score ≤ 7) and adequately nourished groups (≥ 8). The patients' age, modified Rankin Scale score, time to hospitalization, and length of stay were recorded. The relationship between nutritional status and cognitive FIM was determined using a multivariate regression model. RESULTS The study included 47 men and 43 women, with a mean age of 75.0 (standard deviation: 8.7) years. The number of patients in the malnourished and adequately nourished groups were 68 (75.6%) and 22 (24.4%), respectively. The median MMSE score was 19 (interquartile range 15-22), and the median cognitive FIM score at admission was 17 (interquartile range 11-21.8). Univariate analysis showed no significant difference in cognitive FIM gain between the malnourished and adequately nourished groups (P = 0.781). Multivariate regression analysis showed that the MNA-SF score (beta = 0.84, P = 0.009) and cognitive FIM at admission (beta = - 0.347, P < 0.001) were independently related to cognitive FIM gain. CONCLUSION Most patients with PSCI were malnourished; malnutrition on admission for rehabilitation was associated with poor improvement after PSCI.
Collapse
Affiliation(s)
- Keita Tsutsumiuchi
- Department of Rehabilitation, Takarazuka Rehabilitation Hospital, 22-2, Tsurunosou, Takarazuka-shi, Hyogo, 665-0833, Japan. .,Department of Rehabilitation, Ikoma Hospital, 8 Tsukumo, Hirone-aza, Inagawa-chou, Kawabe-gun, Hyogo, 666-0252, Japan.
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Keisuke Maeda
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, 7-430, Morioka, Obu, Aichi, 474-8511, Japan
| | - Hiroshi Shamoto
- Takano Hospital, 214 Higashimachi, Shimokitaba, Hironomachi, Futaba-gun, Fukushima, 979-0402, Japan.,Department of Disaster and Comprehensive Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan
| |
Collapse
|
11
|
Li Y, Liu C, Luo X, He Q, Cheng Y, Shen W, Xie Z. Controlling nutritional status score and prognostic nutrition index predict the outcome after severe traumatic brain injury. Nutr Neurosci 2020; 25:690-697. [PMID: 32778001 DOI: 10.1080/1028415x.2020.1804097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Immune-nutritional status is correlated with a clinical outcome in critical illness. Recently, controlling nutritional status (CONUT) score and prognostic nutrition index (PNI) has been reported to predict prognosis following cancer and other diseases. The aim of this study was to explore the relationship between the CONUT score and PNI and 6-month outcome in patients with severe traumatic brain injury (STBI). METHODS We retrospectively analyzed the clinical data of 78 patients with STBI, including the CONUT score and PNI. Patients were divided into high CONUT group and low CONUT group. Patients were also divided into high PNI and low PNI group respectively. The 6-month outcome was evaluated by the modified Rankin scale (mRS). The unfavorable outcome was defined as mRS score ≥3. RESULTS The unfavorable outcome group had lower Glasgow coma scale (GCS) scores, serum albumin, total cholesterol, PNI, and higher CONUT scores (P < 0.05). Both CONUT scores and PNI were strongly correlated with mRS (r = 0.429, P < 0.05; r = -0.590, P < 0.05, respectively). After adjustment for confounding factors, the odds ratios of CONUT scores and PNI for predicting unfavorable outcome were 10.478 (95% CI: 2.793-39.301) and -0.039 (95% CI: 0.008-0.204), respectively. The area under the curve (AUC) of CONUT scores for predicting unfavorable outcome was 0.777 (95% CI: 0.674-0.880, P < 0.01), which was similar to PNI (0.764, 95% CI: 0.657-0.87, P < 0.01). CONCLUSION Both CONUT scores and PNI might be novel independent predictors of the poor outcome in STBI.
Collapse
Affiliation(s)
- Yuanyou Li
- Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China
| | - Chang Liu
- Department of Neurology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China
| | - Xu Luo
- Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China
| | - Qiuguang He
- Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China
| | - Yuan Cheng
- Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China
| | - Weiwei Shen
- Department of Endocrinology, The First Affiliated Hospital, Chongqing Medical and Pharmaceutical College, Chongqing, People's Republic of China
| | - Zongyi Xie
- Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China
| |
Collapse
|
12
|
Mortensen J, Pedersen AR, Nielsen JF, Kothari M. Construct and content validity of the Functional Oral Intake Scale; Analyses from a cohort of patients with acquired brain injury. Brain Inj 2020; 34:1257-1263. [DOI: 10.1080/02699052.2020.1800094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Jesper Mortensen
- Research Unit, Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
| | - Asger Roer Pedersen
- Research Unit, Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
| | - Jørgen Feldbæk Nielsen
- Research Unit, Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
| | - Mohit Kothari
- Research Unit, Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
- JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| |
Collapse
|
13
|
Reed M, Mullaney K, Ruhmann C, March P, Conte VH, Noyes L, Bleazard M. Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) in the Electronic Health Record: A Validation Study. Nutr Clin Pract 2020; 35:1087-1093. [PMID: 32767391 DOI: 10.1002/ncp.10562] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The impact of malnutrition on pediatric patients in the acute care setting is significant. Hospitalized patients with malnutrition have been shown to have poor clinical outcomes. Nutrition screening is the first critical step in identifying and treating malnutrition. Although several pediatric nutrition screening tools exist, none incorporate both electronic health record (EHR) compatibility and the recommended indicators of pediatric malnutrition, a gap recently identified in a systematic review by the Academy of Nutrition and Dietetics. The aim of this study was to prove the validity of a new version of Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), EHR-STAMP, modified for incorporation into the EHR and inclusion of updated pediatric malnutrition indicators. METHODS An interprofessional team modified the existing STAMP for integration into the EHR. Audits were performed by the research dietitian to assess accuracy and provide feedback for continuous improvement of the tool design. RESULTS A total of 3553 pediatric inpatients were studied from August 2017 to May 2019. Accuracy, sensitivity, and specificity improved with each modification to the EHR-STAMP. The final version of the EHR-STAMP found 85% accuracy, 89% sensitivity, and 97% specificity, with a positive predictive value of 60% and a negative predictive value of 94%. CONCLUSION The EHR-STAMP is a highly reliable tool in the screening of nutrition risk for pediatric hospitalized patients. The tool is easy to use, EHR compatible, and incorporates the current indicators recommended for assessing pediatric malnutrition.
Collapse
Affiliation(s)
- Michelle Reed
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Kathleen Mullaney
- Nemours/Alfred I. duPont Hospital for Children, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Christy Ruhmann
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Peter March
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Virginia H Conte
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Lore Noyes
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Mark Bleazard
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| |
Collapse
|
14
|
Odgaard L, Aadal L, Eskildsen M, Poulsen I. Using clinical quality databases to monitor the quality of fundamental care: Example with weight status after severe traumatic brain injury. J Clin Nurs 2020; 29:2031-2038. [DOI: 10.1111/jocn.15233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 11/19/2019] [Accepted: 02/07/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Lene Odgaard
- Hammel Neurorehabilitation Center and University Research Clinic Aarhus University Aarhus Denmark
| | - Lena Aadal
- Hammel Neurorehabilitation Center and University Research Clinic Aarhus University Aarhus Denmark
| | - Marianne Eskildsen
- Department of Neurorehabilitation TBI Research Unit on Brain Injury Rehabilitation (RUBRIC) Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Ingrid Poulsen
- Department of Neurorehabilitation TBI Research Unit on Brain Injury Rehabilitation (RUBRIC) Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
- Health, Section of Nursing Science Aarhus University Aarhus Denmark
| |
Collapse
|
15
|
Gubari MIM, Norouzy A, Hosseini M, Mohialdeen FA, Hosseinzadeh-Attar MJ. The Relationship between Serum Concentrations of Pro- and Anti-Inflammatory Cytokines and Nutritional Status in Patients with Traumatic Head Injury in the Intensive Care Unit. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E486. [PMID: 31443251 PMCID: PMC6723863 DOI: 10.3390/medicina55080486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/12/2019] [Accepted: 08/12/2019] [Indexed: 01/04/2023]
Abstract
Background and objective: The aim of the present study was to examine the relationship between serum levels of pro-inflammatory cytokines (IL-6, IL-1β, and TNF-α) and anti-inflammatory cytokines (IL-10) measured once at the baseline with changes in nutritional status of patients with traumatic head injury (THI) assessed at three consecutive times (24 h after admission, day 6 and day 13) during hospital stay in the intensive care unit (ICU). Materials and Methods: Sixty-four patients with THI were recruited for the current study (over 10 months). The nutritional status of the patients was determined within 24 h after admission and on days 6 and 13, using actual body weight, body composition analysis, and anthropometric measurements. The APACHE II score and SOFA score were also assessed within 24 h of admission and on days 6 and 13 of patients staying in the ICU. Circulatory serum levels of cytokines (IL-6, IL-1β, TNF-α, and IL-10) were assessed once within 24 h of admission. Results: The current study found a significant reduction in BMI, FBM, LBM, MAUAC, and APM, of THI patients with high serum levels the cytokines, over the course of time from the baseline to day 7 and to day 13 in patients staying in the ICU (p < 0.001). It was also found that patients with low levels of some studied cytokines had significant improvement in their nutritional status and clinical outcomes in term of MAUAC, APM, APACHE II score and SOFA score (p < 0.001 to p < 0.01). Conclusion: THI patients who had high serum levels of studied cytokines were more prone to develop a reduction of nutritional status in terms of BMI, FBM, LBM MAUAC and APM over the course of time from patient admission until day 13 of ICU admission.
Collapse
Affiliation(s)
- Mohammed I M Gubari
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran 1416643931, Iran
| | - Abdolreza Norouzy
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran 1416643931, Iran
| | - Mostafa Hosseini
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran 1417613151, Iran
| | - Fadhil A Mohialdeen
- Community Health Department, Technical College of health, Sulaimani Polytechnic University, Sulaimani 46001, Iraq
| | - Mohammad Javad Hosseinzadeh-Attar
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran 1416643931, Iran.
- Centre of Research Excellence in Translating, Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA 5005, Australia.
| |
Collapse
|
16
|
Yamaki T, Oka N, Odaki M, Kobayashi S. Usability of intravenous thiamine injection test compared with odor stick identification test for Japanese patients with severe traumatic brain injury. Auris Nasus Larynx 2019; 47:233-237. [PMID: 31326161 DOI: 10.1016/j.anl.2019.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 06/03/2019] [Accepted: 07/03/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Olfactory dysfunction is often observed after severe traumatic brain injury (sTBI). Its diagnosis is difficult because patients with sTBI have a communication disability following impaired consciousness and communication disorder. The intravenous thiamine injection (IT) test is one of the representative diagnostic examinations to identify dysfunction, and it is often used in medical certification for liability insurance of automobiles in Japan because it could be judged by a simple reaction. However, the extent of usefulness of the IT test in the diagnosis of olfactory dysfunction in patients with sTBI is unknown. In this study, we validated the usability of the IT test and compared the results with those of the odor stick identification test for the Japanese (OSIT-J) to evaluate the sensitivity of the IT test in patients with sTBI. METHODS The study enrolled 205 subjects, including 10 healthy volunteers and 195 patients with sTBI. First, we examined olfactory dysfunction in sTBI patients using OSIT-J. Subsequently, we performed the IT test among patients with olfactory dysfunction. RESULTS In the first part, 41 subjects, including 10 healthy volunteers, were examined by using the OSIT-J test. As a result, 28 patients were diagnosed with olfactory dysfunction (90.3%, p<0.0001), including anosmia and parosmia, compared with healthy volunteers. Among the 12 odors, garlic odor was easily recognized for patients with olfactory dysfunction. As a consequence of the IT test for 11 patients with olfactory dysfunction, four patients recognized thiamine odor, and seven patients did not. All four patients could recognize the garlic odor of OSIT-J, but 2 of the seven patients could recognize the garlic odor of OSIT-J, suggesting that the thiamine odor is linked to garlic odor (p=0.046), but not always. The detection rate of olfactory dysfunction through the IT test was 36.4%. CONCLUSION Our data showed that garlic odor, which is similar to thiamine odor, was easily recognizable for patients with sTBI. However, the IT test might overlook the diagnosis of olfactory dysfunction because it only identifies one odor. In addition, thiamine frequently induces angialgia. We should pay attention to the overconfidence of the IT test for patients with sTBI.
Collapse
Affiliation(s)
- Tomohiro Yamaki
- Division of Neurosurgery, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Chiba, Japan; Division of PET imaging, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Chiba, Japan.
| | - Nobuo Oka
- Division of Neurosurgery, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Chiba, Japan.
| | - Masaru Odaki
- Division of Neurosurgery, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Chiba, Japan.
| | - Shigeki Kobayashi
- Division of Neurosurgery, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Chiba, Japan.
| |
Collapse
|
17
|
Liu WX, Gong J, Zhao D, Tang ZX, Chen L, Chen ZL, Shen Z. Effect of different early nutritional support programs on serum protein, inflammatory cytokines, and Glasgow Coma Scale score in patients with severe craniocerebral injury. Shijie Huaren Xiaohua Zazhi 2018; 26:803-809. [DOI: 10.11569/wcjd.v26.i13.803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the effect of different nutritional support programs on serum protein, inflammatory cytokines, and Glasgow Coma Scale (GCS) score in patients with severe craniocerebral injury (SCCI).
METHODS The clinical data of 150 patients with SCCI treated from April 2012 to April 2017 were retrospectively analyzed. Among them, 70 patients were given general enteral nutrition support in the early stage (control group), and 80 patients were given early enteral nutrition support program containing probiotics (observation group). The two groups of patients were compared in serum protein levels, inflammatory cytokines, GCS score, and other indicators.
RESULTS At weeks 1 and 2 after treatment, serum protein levels (39.22 ± 2.58 vs 35.03 ± 1.91, 41.31 ± 2.61 vs 36.92 ± 1.93, P < 0.05) and hemoglobin levels (103.68 ± 11.56 vs 94.19 ± 10.81, 107.32 ± 11.41 vs 95.12 ± 10.87, P < 0.05) were significantly higher and the levels of IL-6, TNF-α, D-lactate, and PCT (week 1: 87.33 ± 18.61 vs 113.76 ± 20.35, 6.28 ± 1.06 vs 8.22 ± 1.58, 1.25 ± 0.21 vs 2.39 ± 0.46, 4.15 ± 0.86 vs 7.12 ± 1.01; week 2: 85.35 ± 17.32 vs 110.91 ± 18.93, 5.92 ± 1.01 vs 8.31 ± 1.61, 1.09 ± 0.19 vs 2.28 ± 0.37, 4.105 ± 0.71 vs 7.08 ± 1.22; P < 0.05) were significantly lower in the observation group than in the control group. GCS scores at weeks 1 and 2 were significantly higher in the observation group than in the control group (12.08 ± 1.52 vs 10.28 ± 1.37, 13.26 ± 1.72 vs 11.31 ± 1.41, P < 0.05). The hospitalization time, hospitalization cost, enteral nutrition time, and in-hospital mortality were significantly lower in the observation group than in the control group (21.28 ± 7.16 vs 27.43 ± 8.23, 8.38 ± 1.96 vs 11.65 ± 2.67, 17.66 ± 5.71 vs 23.19 ± 7.33, 16.25% vs 28.57%, P < 0.05). The GOS score at 6 mo after discharge was significantly higher in the observation group than in the control group (4.32 ± 1.25 vs 3.11 ± 0.91, P < 0.05).
CONCLUSION The early use of probiotics-containing enteral nutrition regimens in patients with SCCI can significantly improve nutritional status, reduce inflammatory response, and improve GCS score.
Collapse
Affiliation(s)
- Wei-Xian Liu
- Department of Neurosurgery, Zhejiang Hospital, 12 Lingyin Road, Hangzhou 310013, Zhejiang Province, China
| | - Jie Gong
- Department of Neurosurgery, Zhejiang Hospital, 12 Lingyin Road, Hangzhou 310013, Zhejiang Province, China
| | - Dong Zhao
- Department of Neurosurgery, Zhejiang Hospital, 12 Lingyin Road, Hangzhou 310013, Zhejiang Province, China
| | - Zhu-Xiao Tang
- Department of Neurosurgery, Zhejiang Hospital, 12 Lingyin Road, Hangzhou 310013, Zhejiang Province, China
| | - Liang Chen
- Department of Neurosurgery, Zhejiang Hospital, 12 Lingyin Road, Hangzhou 310013, Zhejiang Province, China
| | - Zhong-Liang Chen
- Department of Neurosurgery, Zhejiang Hospital, 12 Lingyin Road, Hangzhou 310013, Zhejiang Province, China
| | - Zheng Shen
- Department of Neurosurgery, Zhejiang Hospital, 12 Lingyin Road, Hangzhou 310013, Zhejiang Province, China
| |
Collapse
|
18
|
Fan M, Wang Q, Fang W, Jiang Y, Li L, Sun P, Wang Z. Early Enteral Combined with Parenteral Nutrition Treatment for Severe Traumatic Brain Injury: Effects on Immune Function, Nutritional Status and Outcomes. ACTA ACUST UNITED AC 2017; 31:213-220. [PMID: 28065217 DOI: 10.1016/s1001-9294(17)30003-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective To compare the conjoint effect of enteral nutrition (EN) and parenteral nutrition (PN) with single EN or PN on immune function, nutritional status, complications and clinical outcomes of patients with severe traumatic brain injury (STBI). Methods A prospective randomized control trial was carried out from January 2009 to May 2012 in Neurological Intensive Care Unit (NICU). Patients of STBI who met the enrolment criteria (Glasgow Coma Scale score 6~8; Nutritional Risk Screening ≥3) were randomly divided into 3 groups and were admi- nistrated EN, PN or EN+PN treatments respectively. The indexes of nutritional status, immune function, complications and clinical outcomes were examined and compared statistically. Results There were 120 patients enrolled in the study, with 40 pationts in each group. In EN+PN group, T lymthocyte subsets CD3+%, CD4+%, ratio of CD3+/CD25+, ratio of CD4+/CD8+, the plasma levels of IgA, IgM, and IgG at 20 days after nutritional treatment were significantly increased compared to the baseline(t=4.32-30.00, P<0.01), and they were significantly higher than those of PN group (t=2.44-14.70; P<0.05,or P<0.01) with exception of CD4+/CD8+, higher than those of EN group (t=2.49-13.31, P<0.05, or P<0.01) with exceptions of CD3+/CD25+, CD4+/CD8+, IgG and IgM. For the nutritional status, the serum total protein, albumin, prealbumin and hemoglobin were significantly higher in the EN (t=5.87-11.91; P<0.01) and EN+PN groups (t=6.12-13.12; P<0.01) than those in PN group after nutrition treatment. The serum prealbumin was higher in EN+PN group than that in EN group (t=2.08; P<0.05). Compared to the PN group, the complication occurrence rates of EN+PN group were significantly lower in stress ulcer (22.5% vs. 47.5%; χ2= 8.24, P<0.01), intracranial infection (12.5% vs 32.5%;χ2= 6.88, P<0.01) and pyemia (25.0% vs. 47.5%; χ2= 6.57, P<0.05). Compared to the EN group, the complication occurrence rates of EN+PN group were significantly lower in aspirated pneumonia (27.5% vs. 50.0%; χ2= 6.39, P<0.05), hypoproteinemia (17.5% vs. 55.0%; χ2= 18.26, P<0.01) and diarrhea (20.0% vs. 60.0%; χ2= 20.00, P<0.01). The EN+PN group also had significant less length of stay in NICU (t=2.51, 4.82; P<0.05, P<0.01), number of patients receiving assisted mechanical ventilation (χ2= 6.08, 12.88; P<0.05, P<0.01) and its durations (t=3.41, 9.08; P<0.05, P<0.01), and the death rate (χ2=7.50, 16.37; P<0.05, P<0.01) than those of EN or PN group. Conclusion Early EN+PN treatment could promote the recovery of the immune function, enhance nutritional status, decrease complications and improve the clinical outcomes in patients with severe traumatic brain injury.
Collapse
Affiliation(s)
- Mingchao Fan
- Department of Neurological Intensive Care Unit, the Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, China
| | - Qiaoling Wang
- Community Medical Service Center of Shuiqinggou Street, Qingdao, Shandong 266042, China
| | - Wei Fang
- Department of Neurological Intensive Care Unit, the Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, China
| | - Yunxia Jiang
- Nursing School, Medical College of Qingdao University, Qingdao, Shandong 266003, China
| | - Liandi Li
- Department of Neurological Intensive Care Unit, the Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, China
| | - Peng Sun
- Department of Neurosurgery, the Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, China
| | - Zhihong Wang
- Department of Neurosurgery, the Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, China
| |
Collapse
|
19
|
Comparing the measured basal metabolic rates in patients with chronic disorders of consciousness to the estimated basal metabolic rate calculated from common predictive equations. Clin Nutr 2016; 36:1397-1402. [PMID: 27839869 DOI: 10.1016/j.clnu.2016.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 09/09/2016] [Accepted: 09/12/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Accurately predicting the basal metabolic rate (BMR) of patients in a vegetative state (VS) or minimally conscious state (MCS) is critical to proper nutritional therapy, but commonly used equations have not been shown to be accurate. Therefore, we compared the BMR measured by indirect calorimetry (IC) to BMR values estimated using common predictive equations in VS and MCS patients. METHODS Body composition variables were measured using the bioelectric impedance analysis (BIA) technique. BMR was measured by IC in 82 patients (64 men and 18 women) with VS or MCS. Patients were classified by body mass index as underweight (<18.5 kg/m2, n = 34) or normal-weight (18.5 ≤ BMI < 25 kg/m2, n = 48). BMR was estimated for each group using the Harris-Benedict (H-B), Schofield, or Cunningham equations and compared to the measured BMR using Bland-Altman analyses. RESULTS For the underweight group, there was a significant difference between the measured BMR values and the estimated BMR values calculated using the H-B, Schofield, and Cunningham equations (p < 0.05). For the normal-weight group, the BMR values estimated using the H-B and Cunningham equations were different significantly from the measured BMR (p < 0.05 and p < 0.01 respectively). Of the predictive equations, only Schofield was not significantly different from the measured BMR in the normal-weight group. The Schofield equation showed the best concordance (only 41.5%) with the BMR values measured by IC. CONCLUSIONS None of the commonly used equations to estimate BMR were suitable for the VS or MCS populations. Indirect calorimetry is the preferred way to avoid either over or underestimate of BMR values.
Collapse
|