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Mohamed Elfadil O, Velapati SR, Patel J, Hurt RT, Mundi MS. Enteral Nutrition Therapy: Historical Perspective, Utilization, and Complications. Curr Gastroenterol Rep 2024; 26:200-210. [PMID: 38787510 DOI: 10.1007/s11894-024-00934-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE OF REVIEW Enteral nutrition (EN) therapy can provide vital nutrition support for patients with various medical conditions as long as it is indicated and supported by ethical reasoning. This review seeks to offer a detailed account of the history of EN development, highlighting key milestones and recent advances in the field. Additionally, it covers common complications associated with EN and their management. RECENT FINDINGS After years of research and development, we have reached newer generations of enteral feeding formulations, more options for enteral tubes and connectors, and a better understanding of EN therapy challenges. Given the availability of many different formulas, selecting a feeding formula with the best evidence for specific indications for enteral feeding is recommended. Initiation of enteral feeding with standard polymeric formula remains the standard of care. Transition to small-bore connectors remains suboptimal. Evidence-based practices should be followed to recognize and reduce possible enteral feeding complications early.
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Affiliation(s)
- Osman Mohamed Elfadil
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Saketh R Velapati
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Janki Patel
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Ryan T Hurt
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA.
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Sumritpradit P, Shantavasinkul PC, Ungpinitpong W, Noorit P, Gajaseni C. Effect of high-protein peptide-based formula compared with isocaloric isonitrogenous polymeric formula in critically ill surgical patient. World J Gastrointest Surg 2024; 16:1765-1774. [PMID: 38983323 PMCID: PMC11230013 DOI: 10.4240/wjgs.v16.i6.1765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/03/2024] [Accepted: 04/22/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Malnutrition is common in critically ill patients, and it is associated with an increased risk of complications. Early enteral nutrition with adequate caloric and protein intake is critical nevertheless it is difficult to achieve. Peptide-based formulas have been shown to be beneficial in patients with feeding intolerance. However, there are limited studies showing the efficacy and safety of high-protein peptide-based formula in critically ill surgical patients. AIM To determine the effects of a high-protein peptide formulation on gastrointestinal tolerance, nutritional status, biochemical changes, and adverse events in patients in the surgery intensive care unit (SICU) compared to an isocaloric isonitrogenous standard polymeric formulation. METHODS This study was a multi-center double-blind, randomized controlled trial. We enrolled adult patients in the surgical intensive care unit, age ≥ 15 years and expected to receive enteral feeding for at least 5-14 d post-operation. They were randomly assigned to receive either the high-protein peptide-based formula or the isocaloric isonitrogenous standard formula for 14 d. Gastric residual volume (GRV), nutritional status, body composition and biochemical parameters were assessed at baseline and on days 3, 5, 7, 9, 11, and 14. RESULTS A total of 19 patients were enrolled, 9 patients in the peptide-based formula group and 10 patients in the standard formula group. During the study period, there were no differences of the average GRV, body weight, body composition, nutritional status and biochemical parameters in the patients receiving peptide-based formula, compared to the standard regimen. However, participants in the standard formula lost their body weight, body mass index (BMI) and skeletal muscle mass significantly. While body weight, BMI and muscle mass were maintained in the peptide-based formula, from baseline to day 14. Moreover, the participants in the peptide-based formula tended to reach their caloric target faster than the standard formula. CONCLUSION The study emphasizes the importance of early nutritional support in the SICU and showed the efficacy and safety of a high-protein, peptide-based formula in meeting caloric and protein intake targets while maintaining body weight and muscle mass.
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Affiliation(s)
- Preeda Sumritpradit
- Division of Trauma Surgery and Surgical Critical Care, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Prapimporn Chattranukulchai Shantavasinkul
- Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
- Graduate Program in Nutrition, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | | | - Pinit Noorit
- Department of Surgery, Chonburi Hospital, Chonburi 20000, Thailand
| | - Chotip Gajaseni
- Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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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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Raymenants K, Huang IH, Goelen N, Janssen P, Van Tichelen N, Burton D, Tack J. Clinical validation of the VIPUN™ gastric monitoring system versus manometry for the evaluation of gastric motility. Neurogastroenterol Motil 2024; 36:e14783. [PMID: 38488253 DOI: 10.1111/nmo.14783] [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: 10/19/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Gastrointestinal dysmotility is frequently suspected in patients with gastroparesis, functional dyspepsia, and ileus, and in the intensive care unit. Monitoring of gastric motility in clinical practice remains challenging. A novel technology was developed to meet the medical need for a widely available bedside tool to monitor gastric motility continuously. The VIPUN™ Gastric Monitoring System (GMS) comprises a nasogastric feeding tube with intragastric balloon to allow for measuring gastric contractions. AIMS To compare the performance of the VIPUN GMS versus a reference technique (manometry). METHODS In this validation study in healthy subjects, the investigational catheter and a solid-state manometry catheter were placed in the stomach concomitantly. Motility was recorded for 2.5 h: 2 h in a fasting state, followed by a 400-kcal liquid meal, and monitoring of the fed state for the remaining half hour. The performance of both systems was compared by automated recognition and manual identification of the contractile activity. Data are presented as mean (standard deviation). KEY RESULTS The analysis set comprised 13 healthy subjects (6 women, age: 27.5 (8.1) years, BMI: 22.2 (2.46) kg/m2). Automatically-recognized contractility was strongly correlated between the two techniques (endpoint: contraction duration; Spearman ρ = 0.96, p < 0.001). A correlation was also observed between the number of individual contractions identified by expert gastroenterologists on both technologies independently (ρ = 0.71, p = .007) and between the contractions identified by the experts and by the GMS software (ρ = 0.87, p = 0.001). No serious or unanticipated adverse events occurred. CONCLUSIONS & INFERENCES The observed strong correlations with the gold standard, manometry, validate the performance of the VIPUN GMS as a gastric monitoring system.
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Affiliation(s)
- Karlien Raymenants
- Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - I-Hsuan Huang
- Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | | | | | | | | | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
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Lawson CM, Jones C, Herman M, Kim C, Mannino E, Omer E, Venegas C. Does Ileus Represent the Forgotten End Organ Failure in Critical Illness? Curr Gastroenterol Rep 2024; 26:166-171. [PMID: 38558135 DOI: 10.1007/s11894-023-00910-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 04/04/2024]
Abstract
PURPOSE OF REVIEW This review evaluates the current literature on ileus, impaired gastrointestinal transit (IGT), and acute gastrointestinal injury (AGI) and its impact on multiple organ dysfunction syndrome. RECENT FINDINGS Ileus is often under recognized in critically ill patients and is associated with significant morbidity and is potentially a marker of disease severity as seen in other organs like kidneys (ATN).
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Affiliation(s)
- Christy M Lawson
- Department of Trauma Surgery, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA.
| | - Chris Jones
- Department of Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Michael Herman
- Department of Gastroenterology, Borland Groover Clinic, Fleming Island, FL, USA
| | - Cecilia Kim
- Department of Trauma Surgery, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Elizabeth Mannino
- Department of Trauma Surgery, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Endashaw Omer
- Department of Gastroenterology, University of Louisville, Louisville, KY, USA
| | - Carlas Venegas
- Department of Neurology, Mayo Clinc, Jacksonville, FL, USA
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Steel C, Wile H. Dietitian's approach to managing enteral nutrition intolerance when a formula change is indicated: A clinical practice survey. Nutr Clin Pract 2024; 39:641-650. [PMID: 37589316 DOI: 10.1002/ncp.11069] [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: 03/17/2023] [Revised: 06/20/2023] [Accepted: 08/14/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Enteral nutrition intolerance (ENI) is often defined as one or more gastrointestinal (GI) symptoms related to enteral nutrition (EN) and may have significant impact on patient outcomes. There are multiple strategies to help manage ENI, such as changing the EN formula. The objective of this practice survey was to understand prevalence of ENI, management of ENI symptoms, and EN formula features considered when changing formulas to manage ENI. METHODS Canadian clinical dietitians working across care settings (n = 4827) were invited to complete a 28-question online survey if involved in the management of adult and/or pediatric patients receiving EN. RESULTS Five hundred seventeen surveys were analyzed. Significantly more dietitians in adult vs pediatric settings (83.4% and 59.1%, respectively; P = 0.0012), reported ENI in <40% of patients. Assessing medications, elevating the head of the bed, and changing EN infusion rate, volume, or feeding regimen were the highest-ranked strategies to manage ENI symptoms. Most (>90%) respondents change the EN formula <50% of the time to manage ENI. Dietitians consider caloric density and protein form as the most important EN features to manage upper-GI symptoms vs fiber source, osmolality, and form of protein to manage lower-GI symptoms. EN with real-food ingredients was ranked higher in importance for managing upper- and lower-GI symptoms by dietitians in pediatric vs adult settings. CONCLUSION To manage ENI symptoms, dietitians consider multiple strategies before deciding to change the EN formula. When a formula change is indicated, dietitians consider different EN features for the management of upper- and lower-GI symptoms.
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Affiliation(s)
- Cindy Steel
- Nestlé Health Science Canada, North York, Ontario, Canada
| | - Heather Wile
- Nestlé Health Science Canada, North York, Ontario, Canada
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Wittholz K, Hinckfus C, Karahalios A, Panganiban H, Phillips N, Rotherham H, Rechnitzer T, Ali Abdelhamid Y, Deane AM, Fetterplace K. Association between protocol change to a higher-protein formula with lower energy targets and nutrient delivery in critically ill patients with COVID-19: A retrospective cohort study. JPEN J Parenter Enteral Nutr 2024; 48:429-439. [PMID: 38477349 DOI: 10.1002/jpen.2620] [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: 07/03/2023] [Revised: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Guidelines recommend prioritizing protein provision while avoiding excessive energy delivery to critically ill patients with coronavirus disease 2019 (COVID-19), but there are no prospective studies evaluating such a targeted approach in this group. We aimed to evaluate the effect of a "higher-protein formula protocol" on protein, energy, and volume delivery when compared with standard nutrition protocol. METHODS This was a retrospective cohort study of adult patients with COVID-19 who received mechanical ventilation for >72 h and enteral nutrition. Before October 2021, the standard nutrition protocol for patients was 0.7 ml/kg/h ideal body weight (IBW) of a 63 g/L protein and 1250 kcal/L formula. From October 2021, we implemented a higher-protein formula protocol for patients with COVID-19. The initial prescription was 0.5 ml/kg/h IBW of a 100 g/L protein and 1260 kcal/L formula with greater emphasis on energy targets being directed by indirect calorimetry when possible. Measured outcomes included protein, energy, and volume delivered. RESULTS There were 114 participants (standard protocol, 48; higher-protein protocol, 66) with 1324 days of nutrition support. The median (95% CI) differences in protein, energy, and volume delivery between targeted and standard protocol periods were 0.08 g/kg/day (-0.02 to 0.18 g/kg/day), -1.71 kcal/kg/day (-3.64 to 0.21 kcal/kg/day) and -1.5 ml/kg/day (-2.9 to -0.1 ml/kg/day). Thirty-three patients (standard protocol, 7; higher-protein protocol, 26) had 44 indirect calorimetry assessments. There was no difference in measured energy expenditure over time (increased by 0.49 kcal/kg/day [-0.89 to 1.88 kcal/kg/day]). CONCLUSION Implementation of a higher-protein formula protocol to patients with COVID-19 modestly reduced volume administration without impacting protein and energy delivery.
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Affiliation(s)
- Kym Wittholz
- Department of Allied Health (Clinical Nutrition), The Royal Melbourne Hospital, Melbourne, Australia
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Chloe Hinckfus
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
- Department of Intensive Care, The Royal Melbourne Hospital, Melbourne, Australia
| | - Amalia Karahalios
- Centre of Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Haustine Panganiban
- Department of Intensive Care, The Royal Melbourne Hospital, Melbourne, Australia
| | - Nadine Phillips
- Centre of Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Hannah Rotherham
- Department of Intensive Care, The Royal Melbourne Hospital, Melbourne, Australia
| | - Thomas Rechnitzer
- Department of Intensive Care, The Royal Melbourne Hospital, Melbourne, Australia
| | - Yasmine Ali Abdelhamid
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
- Department of Intensive Care, The Royal Melbourne Hospital, Melbourne, Australia
| | - Adam M Deane
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
- Department of Intensive Care, The Royal Melbourne Hospital, Melbourne, Australia
| | - Kate Fetterplace
- Department of Allied Health (Clinical Nutrition), The Royal Melbourne Hospital, Melbourne, Australia
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
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Guan X, Chen D, Xu Y. Clinical practice guidelines for nutritional assessment and monitoring of adult ICU patients in China. JOURNAL OF INTENSIVE MEDICINE 2024; 4:137-159. [PMID: 38681796 PMCID: PMC11043647 DOI: 10.1016/j.jointm.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 05/01/2024]
Abstract
The Chinese Society of Critical Care Medicine (CSCCM) has developed clinical practice guidelines for nutrition assessment and monitoring for patients in adult intensive care units (ICUs) in China. This guideline focuses on nutrition evaluation and metabolic monitoring to achieve optimal and personalized nutrition therapy for critically ill patients. This guideline was developed by experts in critical care medicine and evidence-based medicine methodology and was developed after a thorough review of the system and a summary of relevant trials or studies published from 2000 to July 2023. A total of 18 recommendations were formed and consensus was reached through discussions and reviews by expert groups in critical care medicine, parenteral and enteral nutrition, and surgery. The recommendations are based on currently available evidence and cover several key fields, including screening and assessment, evaluation and assessment of enteral feeding intolerance, metabolic and nutritional measurement and monitoring during nutrition therapy, and organ function evaluation related to nutrition supply. Each question was analyzed according to the Population, Intervention, Comparison, and Outcome (PICO) principle. In addition, interpretations were provided for four questions that did not reach a consensus but may have potential clinical and research value. The plan is to update this nutrition assessment and monitoring guideline using the international guideline update method within 3-5 years.
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Affiliation(s)
- Xiangdong Guan
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dechang Chen
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Xu
- Department of Critical Care Medicine, Beijing Tsinghua Changgung Hospital, Beijing, China
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Nguyen DL, Schott LL, Lowen CC, Desai AM, Baumer DL, Miranowski MK, Cao Z, Torres KA. Characteristics and feeding intolerance in critically ill adult patients receiving peptide-based enteral nutrition: A retrospective cross-sectional study. Clin Nutr ESPEN 2024; 59:270-278. [PMID: 38220386 DOI: 10.1016/j.clnesp.2023.12.007] [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: 07/25/2023] [Revised: 11/17/2023] [Accepted: 12/05/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND & AIMS Patients who experience gastrointestinal (GI) intolerance and hyperglycemia (or glucose intolerance) may not achieve appropriate caloric requirements and experience poor outcomes. The aim was to examine patient characteristics, disease severity, and enteral nutrition (EN) formula use in relation to feeding intolerance and healthcare resource utilization. METHODS A retrospective, cross-sectional design using real-world data from PINC AI™ Healthcare Database, 2015-2019 was used. Critically ill hospitalized adults who required ≥3 days of 100% whey peptide-based EN, other peptide-based diets, or intact-protein standard and diabetic EN formulas were included. Primary outcomes were enteral feeding intolerance, including GI intolerance and hyperglycemia. Pairwise comparisons of other peptide-based and standard intact-protein groups with 100% whey-peptide were completed. Associations between EN group with GI intolerance and hyperglycemia, respectively, were evaluated via multivariable logistic regressions. RESULTS Across 67 US hospitals, 19,679 inpatients (3242,100% whey-peptide, 3121 other peptide-based, and 13,316 standard intact-protein) were included. The 100% whey-peptide group had higher severity of illness and frequencies of comorbidities compared with other peptide-based and standard intact-protein groups. Hospital length of stay, intensive care unit stay, and 30-day readmission were similar across peptide-based cohorts. After controlling for demographic, visit, and severity characteristics, odds of GI intolerance were 18% higher for the other peptide-based group and 15% higher for the standard intact-protein group compared with the 100% whey-peptide group (each P < 0.03). In secondary analysis, odds of hyperglycemia were 81% higher for the other peptide-based group compared with the subgroup of very high-protein/low carbohydrate 100% whey-peptide (P < 0.001). CONCLUSIONS Lower GI intolerance and greater glycemic control were associated with the use of 100% whey-peptide formulas relative to other formulas. Appropriate and optimal delivery of EN using specialized peptide-based formulas is a strategy to minimize feeding intolerance and benefit critically ill patients.
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Affiliation(s)
- Douglas L Nguyen
- Loma Linda University Medical Center, 11234 Anderson St., Loma Linda, CA, 92354, USA.
| | - Laura L Schott
- PINC AI™ Applied Sciences, Premier Inc., 13034 Ballantyne Corporate Pl, Charlotte, NC, 28277, USA.
| | - Cynthia C Lowen
- Nestlé Health Science, 1041 US Highway 202, Bridgewater, NJ, 08807, USA.
| | - Amarsinh M Desai
- Nestlé Health Science, 1041 US Highway 202, Bridgewater, NJ, 08807, USA.
| | - Dorothy L Baumer
- PINC AI™ Applied Sciences, Premier Inc., 13034 Ballantyne Corporate Pl, Charlotte, NC, 28277, USA.
| | - Mary K Miranowski
- Nestlé Health Science, 1041 US Highway 202, Bridgewater, NJ, 08807, USA.
| | - Zhun Cao
- PINC AI™ Applied Sciences, Premier Inc., 13034 Ballantyne Corporate Pl, Charlotte, NC, 28277, USA.
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Yang J, Zou X, Wang R, Kang Y, Ou X, Wang B. MEAN ARTERIAL PRESSURE/NOREPINEPHRINE EQUIVALENT DOSE INDEX AS AN EARLY MEASURE FOR MORTALITY RISK IN PATIENTS WITH SHOCK ON VASOPRESSORS. Shock 2024; 61:253-259. [PMID: 38157472 DOI: 10.1097/shk.0000000000002298] [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: 01/03/2024]
Abstract
ABSTRACT Purpose: We aimed to investigate the association between the early mean arterial pressure (MAP)/norepinephrine equivalent dose (NEQ) index and mortality risk in patients with shock on vasopressors and further identify the breakpoint value of the MAP/NEQ index for high mortality risk. Methods: Based on the Medical Information Mart for Intensive Care IV database, we conducted a retrospective cohort study involving 19,539 eligible intensive care unit records assigned to three groups (first tertile, second tertile, and third tertile) by different MAP/NEQ indexes within 24 h of intensive care unit admission. The study outcomes were 7-, 14-, 21-, and 28-day mortality. A Cox model was used to examine the risk of mortality following different MAP/NEQ indexes. The receiving operating characteristic curve was used to evaluate the predictive ability of the MAP/NEQ index. The restricted cubic spline was applied to fit the flexible correlation between the MAP/NEQ index and risk of mortality, and segmented regression was further used to identify the breakpoint value of the MAP/NEQ index for high mortality risk. Results: Multivariate Cox analysis showed that a high MAP/NEQ index was independently associated with decreased mortality risks. The areas under the receiving operating characteristic curve of the MAP/NEQ index for different mortality outcomes were nearly 0.7. The MAP/NEQ index showed an L-shaped association with mortality outcomes or mortality risks. Exploration of the breakpoint value of the MAP/NEQ index suggested that a MAP/NEQ index less than 183 might be associated with a significantly increased mortality risk. Conclusions: An early low MAP/NEQ index was indicative of poor prognosis in patients with shock on vasopressors.
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Affiliation(s)
- Jie Yang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xia Zou
- Clinical Research Management Department, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Ruoran Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xiaofeng Ou
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Bo Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Matsumoto S, Aoki M, Funabiki T, Shimizu M. Impact of resuscitative endovascular balloon occlusion of the aorta on gastrointestinal function with a matched cohort study. Trauma Surg Acute Care Open 2024; 9:e001239. [PMID: 38298820 PMCID: PMC10828836 DOI: 10.1136/tsaco-2023-001239] [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: 08/30/2023] [Accepted: 12/21/2023] [Indexed: 02/02/2024] Open
Abstract
Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) can temporarily control arterial hemorrhage in torso trauma; however, the abdominal visceral blood flow is also blocked by REBOA. The aim of this study was to evaluate the influence of REBOA on gastrointestinal function. Methods A retrospective review identified all trauma patients admitted to our trauma center between 2008 and 2019. We used propensity score matching analysis to compare the gastrointestinal function between subjects who underwent REBOA and those who did not. Data on demographics, feeding intolerance (FI), time to feeding goal achievement, and complications were retrieved. Results During the study period, 55 patients underwent REBOA. A total of 1694 patients met the inclusion criteria, 27 of whom were a subset of those who underwent REBOA. After 1:1 propensity score matching, the REBOA and no-REBOA groups were assigned 22 patients each. Patients in the REBOA group had a significantly higher incidence of FI (77% vs. 27%; OR, 9.1; 95% CI, 2.31 to 35.7; p=0.002) and longer time to feeding goal achievement (8 vs. 6 days, p=0.022) than patients in the no-REBOA group. Patients in the REBOA group also showed significantly prolonged durations of ventilator use (8 vs. 4 days, p=0.023). Furthermore, there was no difference in the mortality rate between the groups (9% vs. 9%, p=1.000). Conclusions REBOA was associated with gastrointestinal dysfunction. Our study findings can be useful in providing guidance on managing nutrition in trauma patients who undergo REBOA. Level of evidence Level IV. Study type Care management.
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Affiliation(s)
| | - Makoto Aoki
- Maebashi Red Cross Hospital, Maebashi, Gunma, Japan
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Park G, Munley JA, Kelly LS, Kannan KB, Mankowski RT, Sharma A, Upchurch G, Casadesus G, Chakrabarty P, Wallet SM, Maile R, Bible LE, Wang B, Moldawer LL, Mohr AM, Efron PA, Nagpal R. Gut mycobiome dysbiosis after sepsis and trauma. Crit Care 2024; 28:18. [PMID: 38212826 PMCID: PMC10785534 DOI: 10.1186/s13054-023-04780-4] [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: 11/15/2023] [Accepted: 12/14/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Sepsis and trauma are known to disrupt gut bacterial microbiome communities, but the impacts and perturbations in the fungal (mycobiome) community after severe infection or injury, particularly in patients experiencing chronic critical illness (CCI), remain unstudied. METHODS We assess persistence of the gut mycobiome perturbation (dysbiosis) in patients experiencing CCI following sepsis or trauma for up to two-to-three weeks after intensive care unit hospitalization. RESULTS We show that the dysbiotic mycobiome arrays shift toward a pathobiome state, which is more susceptible to infection, in CCI patients compared to age-matched healthy subjects. The fungal community in CCI patients is largely dominated by Candida spp; while, the commensal fungal species are depleted. Additionally, these myco-pathobiome arrays correlate with alterations in micro-ecological niche involving specific gut bacteria and gut-blood metabolites. CONCLUSIONS The findings reveal the persistence of mycobiome dysbiosis in both sepsis and trauma settings, even up to two weeks post-sepsis and trauma, highlighting the need to assess and address the increased risk of fungal infections in CCI patients.
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Affiliation(s)
- Gwoncheol Park
- Department of Health, Nutrition, and Food Sciences, Florida State University, Tallahassee, FL, 32306, USA
| | - Jennifer A Munley
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, FL, 32611, USA
| | - Lauren S Kelly
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, FL, 32611, USA
| | - Kolenkode B Kannan
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, FL, 32611, USA
| | - Robert T Mankowski
- Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, FL, 32611, USA
| | - Ashish Sharma
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, FL, 32611, USA
| | - Gilbert Upchurch
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, FL, 32611, USA
| | - Gemma Casadesus
- Department of Pharmacology and Therapeutics, University of Florida College of Medicine, Gainesville, FL, 32611, USA
| | - Paramita Chakrabarty
- Department of Neuroscience, University of Florida College of Medicine, Gainesville, FL, 32611, USA
| | - Shannon M Wallet
- Department of Oral Biology, University of Florida College of Dentistry, Gainesville, FL, 32611, USA
| | - Robert Maile
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, FL, 32611, USA
| | - Letitia E Bible
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, FL, 32611, USA
| | - Bo Wang
- Department of Biomedical and Chemical Engineering and Sciences, Florida Institute of Technology, Melbourne, FL, 32901, USA
| | - Lyle L Moldawer
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, FL, 32611, USA
| | - Alicia M Mohr
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, FL, 32611, USA
| | - Philip A Efron
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, FL, 32611, USA
| | - Ravinder Nagpal
- Department of Health, Nutrition, and Food Sciences, Florida State University, Tallahassee, FL, 32306, USA.
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13
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Yao Y, Liu J, Xue H, Wang X, Yao W, Liu N, Wang Z, Mi G. Construction of an enteral nutrition evaluation system for critically ill patients based on the Delphi method. Saudi J Gastroenterol 2024; 30:63-70. [PMID: 37721256 PMCID: PMC10852151 DOI: 10.4103/sjg.sjg_205_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/15/2023] [Accepted: 08/25/2022] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND This study aimed to construct an enteral nutrition evaluation system for critically ill patients using the Delphi method to direct the formulation of enteral nutrition support strategies and reduce interruption to enteral feeding. METHODS We used domestic and foreign databases to obtain and analyze the literature and form "The Whole-Proceeding Enteral Nutrition Evaluation System for Critically Ill Patients." The Delphi method was used to conduct two rounds of expert opinion consultation, combined with the suggestions from the research group to finalize the nutrition evaluation content of the system. RESULTS After two rounds of expert consultation, a nutrition evaluation system was formed around three dimensions: before the start, during, and after the end of nutritional support. The effective recovery rates of the two rounds of expert consultation were 90.0% (18/20) and 100.0% (18/18), respectively. Authority coefficients were 0.865 and 0.908, while Kendall coordination coefficients were 0.108 ( P < 0.05) and 0.115 ( P < 0.001), respectively. Finally, the full enteral nutrition evaluation system for critically ill patients was constructed based on the Delphi method, including three primary items and seven secondary and 28 tertiary indicators. CONCLUSION The established "Whole-Proceeding Enteral Nutrition Evaluation System for Critically Ill Patients" has high consistency from expert opinions and reliability, which can provide a practical evaluation tool for the process of enteral nutrition for severe patients.
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Affiliation(s)
- Yanrong Yao
- Department of Hepatobilology, General Hospital of Ningxia Medical University, Yin Chuan, China
| | - Jingli Liu
- Department of Hepatobilology, General Hospital of Ningxia Medical University, Yin Chuan, China
| | - Hongmei Xue
- Department of Hepatobilology, General Hospital of Ningxia Medical University, Yin Chuan, China
| | - Xiaoyan Wang
- Neonatal Intensive Care Unit, General Hospital of Ningxia Medical University, Yin Chuan, China
| | - Weijie Yao
- Department of Hepatobilology, General Hospital of Ningxia Medical University, Yin Chuan, China
| | - Na Liu
- Department of Nursing, General Hospital of Ningxia Medical University, Yin Chuan, China
| | - Zuozheng Wang
- Department of Hepatobilology, General Hospital of Ningxia Medical University, Yin Chuan, China
| | - Guangli Mi
- Department of Nursing, General Hospital of Ningxia Medical University, Yin Chuan, China
- Department of School of Nursing, Ningxia Medical University, Yin Chuan, China
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14
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Wilunda C, Israel‐Ballard K, Wanjohi M, Lang'at N, Mansen K, Waiyego M, Kibore M, Kamande E, Zerfu T, Kithua A, Muganda R, Muiruri J, Maina B, Njuguna E, Njeru F, Kiige LW, Codjia P, Samburu B, Mogusu E, Ngwiri T, Mirie W, Kimani‐Murage EW. Potential effectiveness of integrating human milk banking and lactation support on neonatal outcomes at Pumwani Maternity Hospital, Kenya. MATERNAL & CHILD NUTRITION 2024; 20:e13594. [PMID: 38051296 PMCID: PMC10750015 DOI: 10.1111/mcn.13594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023]
Abstract
We assessed the potential effectiveness of human milk banking and lactation support on provision of human milk to neonates admitted in the newborn unit (NBU) at Pumwani Maternity Hospital, Kenya. This pre-post intervention study collected data from mothers/caregivers and their vulnerable neonates or term babies who lacked sufficient mother's milk for several reasons admitted in the NBU. The intervention included establishing a human milk bank and strengthening lactation support. Preintervention data were collected between 5 October 2018 and 11 November 2018, whereas postintervention data were collected between 4 September 2019 and 6 October 2019. Propensity score-matched analysis was performed to assess the effect of the intervention on exclusive use of human milk, use of human milk as the first feed, feeding intolerance and duration of NBU stay. The surveys included 123 and 116 newborns at preintervention and postintervention, respectively, with 160 newborns (80 in each group) being included in propensity score matched analysis. The proportion of neonates who exclusively used human milk during NBU stay increased from 41.3% preintervention to 63.8% postintervention (adjusted odds ratio [OR]: 2.68; 95% confidence interval [CI]: 1.31, 5.53) and those whose first feed was human milk increased from 55.0% preintervention to 83.3% postintervention (adjusted OR: 5.09; 95% CI: 2.18, 11.88). The mean duration of NBU stay was 27% (95% CI: 5.8%, 44.0%) lower in the postintervention group than in the preintervention group. The intervention did not affect feeding intolerance. Integrating human milk banking and lactation support may improve exclusive use of human milk among vulnerable neonates in a resource limited setting.
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Affiliation(s)
- Calistus Wilunda
- Nutrition and Food Systems UnitAfrican Population and Health Research CenterNairobiKenya
| | | | - Milka Wanjohi
- Nutrition and Food Systems UnitAfrican Population and Health Research CenterNairobiKenya
| | - Nelson Lang'at
- Nutrition and Food Systems UnitAfrican Population and Health Research CenterNairobiKenya
| | - Kimberly Mansen
- Maternal, Newborn, Child Health and Nutrition ProgramPATHSeattleWashingtonUSA
| | | | | | - Eva Kamande
- Nutrition and Food Systems UnitAfrican Population and Health Research CenterNairobiKenya
| | - Taddese Zerfu
- Nutrition and Food Systems UnitAfrican Population and Health Research CenterNairobiKenya
| | | | | | | | | | | | | | - Laura W. Kiige
- Nutrition SectionUNICEF ‐ Kenya Country OfficeNairobiKenya
| | - Patrick Codjia
- Nutrition SectionUNICEF ‐ Kenya Country OfficeNairobiKenya
| | - Betty Samburu
- Nutrition and Dietetics UnitMinistry of HealthNairobiKenya
| | - Esther Mogusu
- Nutrition and Dietetics UnitMinistry of HealthNairobiKenya
| | - Thomas Ngwiri
- Clinical ServicesGertrude's Children's HospitalNairobiKenya
| | - Waithera Mirie
- School of Nursing SciencesUniversity of NairobiNairobiKenya
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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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16
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Lv G, Zhang T, Wang L, Fu X, Wang Y, Yao H, Fang H, Xia X, Yang J, Wang B, Zhang Z, Jin X, Kang Y, Cheng Y, Wu Q. Prediction of prokinetic agents in critically ill patients with feeding intolerance: a prospective observational clinical study. Front Nutr 2023; 10:1244517. [PMID: 37964927 PMCID: PMC10641452 DOI: 10.3389/fnut.2023.1244517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/16/2023] [Indexed: 11/16/2023] Open
Abstract
Background Prokinetic agents are currently considered the first-line therapy to improve gastric emptying when feeding intolerance occurred in critically ill adults. In this study, we developed a technique to assess the feasibility of predicting prokinetic agent efficacy in critically ill patients. Methods The first images of each patient were obtained after EFI had occurred but before the first dose of prokinetic agents was administered and additional images were obtained every morning until the seventh day. The gastric antrum echodensity was recorded based on grayscale values (50th percentile, ED50; 85th percentile, ED85; mean, EDmean) and daily energy and protein intake was collected as the judgment for effective and ineffective group. A receiver operating characteristic curve was analyzed to distinguish the thresholds between the two groups and thus determine the ability of the gastric antrum echodensity to predict the efficacy of prokinetic agents. Results In total, 83 patients were analyzed. Patients in the ineffective group had a higher ED50 (58.13 ± 14.48 vs. 49.88 ± 13.78, p < 0.001, difference 95% CI: 5.68, 10.82), ED85 (74.81 ± 16.41 vs. 65.70 ± 16.05, p < 0.001, difference 95% CI:6.16, 12.05), and EDmean (60.18 ± 14.31 vs. 51.76 ± 14.08, p < 0.001, difference 95% CI: 5.85, 11.00) than those in the effective group. Patients in the effective group more easily reached the target energy 16.21 ± 7.98 kcal/kg vs. 9.17 ± 6.43 kcal/kg (p < 0.001), 0.72 ± 0.38 g/kg vs. 0.42 ± 0.31 g/kg (p < 0.001) than in the ineffective group intake by day. Conclusion The gastric antrum echodensity might serve as a tool for judging the efficacy of prokinetic agents, helping clinicians to decide whether to use prokinetic agents or place a post-pyloric tube when feeding intolerance occurs in critically ill patients.Clinical trial registration:http://www.chictr.org.cn/addproject2.aspx, ChiCTR2200058373. Registered 7 April 2022.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Qin Wu
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
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Xu XY, Xue HP, Yuan MJ, Jin YR, Huang CX. Effects of ultrasound monitoring of gastric residual volume on feeding complications, caloric intake and prognosis of patients with severe mechanical ventilation. World J Gastrointest Surg 2023; 15:1719-1727. [PMID: 37701696 PMCID: PMC10494589 DOI: 10.4240/wjgs.v15.i8.1719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/08/2023] [Accepted: 06/19/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Monitoring of gastric residual is an important approach for assessing gastric emptying in patients with mechanical ventilation. By monitoring gastric contents, the enteral nutrition scheme can be adjusted in time to ensure feeding safety.
AIM To investigate the effects of ultrasound monitoring on the incidence of feeding complications, daily caloric intake and prognosis of patients with severe mechanical ventilation. To analyze the clinical significance of ultrasound monitoring of gastric residual volume (GRV) up to 250 mL to provide a theoretical basis for clinical practice.
METHODS Patients admitted to the department of emergency medicine of the Affiliated Hospital of Nantong University from January 2018 to June 2022 who received invasive mechanical ventilation and continuous enteral nutrition support within 24-48 h after admission were enrolled in this study. Medical records for patients within 7 d of hospitalization were retrospectively analyzed to compare the incidence of feeding complications, daily caloric intake and clinical prognosis between patients with gastric residual ≥ 250 mL and < 250 mL, as monitored by ultrasound on the third day.
RESULTS A total of 513 patients were enrolled in this study. Incidences of abdominal distension, diarrhea, and vomiting in the < 250 mL and ≥ 250 mL groups were: 18.4% vs 21.0%, 23.9% vs 32.3% and 4.0% vs 6.5%, respectively; mortality rates were 20.8% vs 22.65%; mechanical ventilation durations were 18.30 d vs 17.56 d while lengths of stay in the intensive care units (ICU) were 19.87 d vs 19.19 ± 5.19 d. Differences in the above factors between groups were not significant. Gastric residual ≥ 250 mL was not an independent risk factor for death and prolonged ICU stay. However, target feeding time of patients in the ≥ 250 mL group was longer than that of patients in the ≥ 250 mL group, and caloric intake (22.0, 23.6, 24.8, 25.3 kcal/kg/d) for patients in the ≥ 250 mL group from the 4th day to the 7th day of hospitalization was lower than that of patients in the ≥ 250 mL group (23.2, 24.8, 25.7, 25.8 kcal/kg/d). On the 4th day (Z = 4.324, P = 0.013), on the 5th day (Z = 3.376, P = 0.033), while on the 6th day (Z = 3.098, P = 0.04), the differences were statistically significant.
CONCLUSION The use of ultrasound to monitor GRV and undertaking clinical interventions when the monitoring value is ≥ 250 mL has no significant effects on incidences of feeding complications and clinical prognostic outcomes, however, it significantly prolongs the time to reach target feeding, reduces the daily intake of calories during ICU hospitalization, and increases the risk of insufficient nutrition of patients. The accuracy and necessity of monitoring gastric remnants and monitoring frequencies should be investigated further.
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Affiliation(s)
- Xiao-Yan Xu
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Hui-Ping Xue
- Emergency Medical Intensive Care Unit, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Ming-Jun Yuan
- Emergency Medical Intensive Care Unit, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - You-Rong Jin
- Emergency Medical Intensive Care Unit, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Chun-Xia Huang
- Department of Emergency Outpatient, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
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Li J, Wang L, Zhang H, Zou T, Kang Y, He W, Xu Y, Yin W. Different definitions of feeding intolerance and their associations with outcomes of critically ill adults receiving enteral nutrition: a systematic review and meta-analysis. J Intensive Care 2023; 11:29. [PMID: 37408020 DOI: 10.1186/s40560-023-00674-3] [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: 01/20/2023] [Accepted: 06/04/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND A unified clinical definition of feeding intolerance (FI) is urged for better management of enteral nutrition (EN) in critically ill patients. We aimed to identify optimum clinical FI definitions based on reported evidence. METHODS We searched clinical studies comparing FI with non-FI with a clear definition, summarized the evidence by random-effect meta-analyses, and rated the certainty of evidence by the Grading of Recommendations Assessment, Development and Evaluation frameworks. RESULTS Five thousand five hundred twenty-five records were identified, of which 26 eligible studies enrolled 25,189 adult patients. Most patient-centered outcomes were associated with FI overall. Low to very low certainty evidence established FI defined as large gastric residual volume (GRV) ≥ 250 ± 50 mL combined with any other gastrointestinal symptoms (GIS) had a significant association with high mortalities in particular all-cause hospital mortality (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.40-2.57), the incidence of pneumonia (OR 1.54, 95% CI 1.13-2.09) and prolonged length of hospital stay (mean difference 4.20, 95% CI 2.08-6.32), with a moderate hospital prevalence (41.49%, 95% CI 31.61-51.38%). 3-day enteral feeding (EF) delivered percentage < 80% had a moderate hospital prevalence (38.23%, 95% CI 24.88-51.58) but a marginally significant association with all-cause hospital mortality (OR 1.90, 95% CI 1.03-3.50). CONCLUSIONS In critically ill adult patients receiving EN, the large-GRV-centered GIS to define FI seemed to be superior to 3-day EF-insufficiency in terms of both close associations with all-cause hospital mortality and acceptable hospital prevalence (Registered PROSPERO: CRD42022326273). TRIAL REGISTRATION The protocol for this review and meta-analysis was registered with PROSPERO: CRD42022326273. Registered 10 May 2022.
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Affiliation(s)
- Jianbo Li
- Department of Critical Care Medicine, West China Hospital of Sichuan University, 37 Guo Xue Xiang St., Chengdu, 610041, Sichuan, China
| | - Lijie Wang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, 37 Guo Xue Xiang St., Chengdu, 610041, Sichuan, China
| | - Huan Zhang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, 37 Guo Xue Xiang St., Chengdu, 610041, Sichuan, China
| | - Tongjuan Zou
- Department of Critical Care Medicine, West China Hospital of Sichuan University, 37 Guo Xue Xiang St., Chengdu, 610041, Sichuan, China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, 37 Guo Xue Xiang St., Chengdu, 610041, Sichuan, China
| | - Wei He
- Department of Critical Care Medicine, Beijing Tongren Hospital of Capital Medical University, Beijing, 100730, China
| | - Yuan Xu
- Department of Critical Care Medicine, Beijing Tsinghua Chunggung Hospital, Tsinghua University, 168 Litang Rd., Beijing, 102218, China.
| | - Wanhong Yin
- Department of Critical Care Medicine, West China Hospital of Sichuan University, 37 Guo Xue Xiang St., Chengdu, 610041, Sichuan, China.
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19
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Reignier J, Plantefeve G, Mira JP, Argaud L, Asfar P, Aissaoui N, Badie J, Botoc NV, Brisard L, Bui HN, Chatellier D, Chauvelot L, Combes A, Cracco C, Darmon M, Das V, Debarre M, Delbove A, Devaquet J, Dumont LM, Gontier O, Groyer S, Guérin L, Guidet B, Hourmant Y, Jaber S, Lambiotte F, Leroy C, Letocart P, Madeux B, Maizel J, Martinet O, Martino F, Maxime V, Mercier E, Nay MA, Nseir S, Oziel J, Picard W, Piton G, Quenot JP, Reizine F, Renault A, Richecoeur J, Rigaud JP, Schneider F, Silva D, Sirodot M, Souweine B, Tamion F, Terzi N, Thévenin D, Thiery G, Thieulot-Rolin N, Timsit JF, Tinturier F, Tirot P, Vanderlinden T, Vinatier I, Vinsonneau C, Voicu S, Lascarrou JB, Le Gouge A. Low versus standard calorie and protein feeding in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group trial (NUTRIREA-3). THE LANCET. RESPIRATORY MEDICINE 2023; 11:602-612. [PMID: 36958363 DOI: 10.1016/s2213-2600(23)00092-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/10/2023] [Accepted: 02/27/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND The optimal calorie and protein intakes at the acute phase of severe critical illness remain unknown. We hypothesised that early calorie and protein restriction improved outcomes in these patients, compared with standard calorie and protein targets. METHODS The pragmatic, randomised, controlled, multicentre, open-label, parallel-group NUTRIREA-3 trial was performed in 61 French intensive care units (ICUs). Adults (≥18 years) receiving invasive mechanical ventilation and vasopressor support for shock were randomly assigned to early nutrition (started within 24 h after intubation) with either low or standard calorie and protein targets (6 kcal/kg per day and 0·2-0·4 g/kg per day protein vs 25 kcal/kg per day and 1·0-1·3 g/kg per day protein) during the first 7 ICU days. The two primary endpoints were time to readiness for ICU discharge and day 90 all-cause mortality. Key secondary outcomes included secondary infections, gastrointestinal events, and liver dysfunction. The trial is registered on ClinicalTrials.gov, NCT03573739, and is completed. FINDINGS Of 3044 patients randomly assigned between July 5, 2018, and 8 Dec 8, 2020, eight withdrew consent to participation. By day 90, 628 (41·3%) of 1521 patients in the low group and 648 (42·8%) of 1515 patients in the standard group had died (absolute difference -1·5%, 95% CI -5·0 to 2·0; p=0·41). Median time to readiness for ICU discharge was 8·0 days (IQR 5·0-14·0) in the low group and 9·0 days (5·0-17·0) in the standard group (hazard ratio [HR] 1·12, 95% CI 1·02 to 1·22; p=0·015). Proportions of patients with secondary infections did not differ between the groups (HR 0·85, 0·71 to 1·01; p=0·06). The low group had lower proportions of patients with vomiting (HR 0·77, 0·67 to 0·89; p<0·001), diarrhoea (0·83, 0·73 to 0·94; p=0·004), bowel ischaemia (0·50, 0·26 to 0·95; p=0·030), and liver dysfunction (0·92, 0·86-0·99; p=0·032). INTERPRETATION Compared with standard calorie and protein targets, early calorie and protein restriction did not decrease mortality but was associated with faster recovery and fewer complications. FUNDING French Ministry of Health.
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Affiliation(s)
- Jean Reignier
- Movement, Interactions, Performance, UR 4334, Nantes Université, Nantes, France; Médecine Intensive Réanimation, CHU de Nantes, Hôtel-Dieu, Nantes, France.
| | - Gaetan Plantefeve
- Service de Médecine Intensive Réanimation, Centre Hospitalier d'Argenteuil, Argenteuil, France
| | - Jean-Paul Mira
- Service de Médecine Intensive Réanimation, Hôpital Cochin, Groupe Hospitalier Paris Centre-Université Paris Cité, AP-HP, Paris, France
| | - Laurent Argaud
- Service de Médecine Intensive Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Pierre Asfar
- Service de Médecine Intensive Réanimation, CHU Angers, Angers, France
| | - Nadia Aissaoui
- Service de Médecine Intensive Réanimation, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Julio Badie
- Service de Médecine Intensive Réanimation, Hôpital Nord Franche Comté, Trevenans, France
| | - Nicolae-Vlad Botoc
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Saint Malo, Saint-Malo, France
| | - Laurent Brisard
- Service d'Anesthésie RéanimationChirurgicale, Hôpital Laënnec, CHU de Nantes, Nantes, France
| | - Hoang-Nam Bui
- Service de Médecine Intensive Réanimation, CHU de Bordeaux, Bordeaux, France
| | - Delphine Chatellier
- Service de Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France
| | - Louis Chauvelot
- Service de Médecine Intensive Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Alain Combes
- Service de Médecine Intensive Réanimation, Sorbonne Université, Inserm, UMRS 1166-ICAN, Institute of Cardiometabolism and Nutrition, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - Christophe Cracco
- Service de Médecine Intensive Réanimation, Centre Hospitalier d'Angoulême, Angoulême, France
| | - Michael Darmon
- Université Paris Cité, Service de Médecine Intensive Réanimation, CHU Saint Louis, AP-HP, Paris, France
| | - Vincent Das
- Service de Médecine Intensive Réanimation, Centre Hospitalier Intercommunal André Grégoire, Montreuil, France
| | - Matthieu Debarre
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Saint Brieuc, Saint Brieuc, France
| | - Agathe Delbove
- Service de Réanimation Polyvalente, Centre Hospitalier Bretagne-Atlantique, Vannes, France
| | - Jérôme Devaquet
- Service de Réanimation Polyvalente, Hôpital Foch, Suresnes, France
| | - Louis-Marie Dumont
- Service de Médecine Intensive Réanimation, Hôpital Louis-Mourier, AP-HP, Colombes, France
| | - Olivier Gontier
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Chartres, Chartres, France
| | - Samuel Groyer
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Montauban, Montauban, France
| | - Laurent Guérin
- Service de Médecine Intensive Réanimation, CHU Bicêtre, AP-HP, Paris, France
| | - Bertrand Guidet
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Service de Médecine IntensiveRéanimation, Hôpital Saint Antoine, AP-HP, Paris, France
| | - Yannick Hourmant
- CHU de Nantes, Inserm, Nantes Université, Anesthesie Reanimation, CIC 1413, Nantes, France
| | - Samir Jaber
- Service de Réanimation Chirurgicale, Hôpital Saint-Eloi, CHU de Montpellier, Montpellier, France; PhyMedExp, Inserm, CNRS, Montpellier, France
| | - Fabien Lambiotte
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Christophe Leroy
- Service de Médecine Intensive Réanimation, Centre Hospitalier Emile Roux, Le Puy-en-Velay, France
| | - Philippe Letocart
- Service de Médecine Intensive Réanimation, Centre Hospitalier Jacques Puel, Rodez, France
| | - Benjamin Madeux
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Bigorre, Tarbes, France
| | - Julien Maizel
- Service de Médecine Intensive Réanimation, CHU Amiens-Picardie, Amiens, France
| | - Olivier Martinet
- Service de Médecine Intensive Réanimation, CHU de la Réunion, Saint-Denis, La Réunion, France
| | - Frédéric Martino
- Service de Médecine Intensive Réanimation, CHU de la Guadeloupe, Abymes, Guadeloupe, France
| | - Virginie Maxime
- Service de Médecine Intensive Réanimation, Hôpital Raymond Poincaré, AP-HP, Garches, France; Inserm U 1173, Université de Versailles-Saint Quentin en Yvelines, Versailles, France
| | - Emmanuelle Mercier
- Service de Médecine Intensive Réanimation, CHU de Tours, CRICS-TRIGGERSEP Network Tours, France
| | - Mai-Anh Nay
- Service de Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans, Orléans, France
| | - Saad Nseir
- Médecine Intensive-Réanimation, CHU Lille, France; CNRS, Inserm, UMR 8576-U1285, Unité de Glycobiologie Structurale et Fonctionnelle, Université de Lille, France
| | - Johanna Oziel
- Service de Médecine Intensive Réanimation, Hôpital Avicenne, AP-HP, Bobigny, France
| | - Walter Picard
- Service deMédecine Intensive Réanimation, Centre Hospitalier de Pau, Pau, France
| | - Gael Piton
- Service de Médecine Intensive Réanimation, CHU de Besançon, Besançon, France; Université de Franche Comté, Equipe EA 3920, Besançon, France
| | - Jean-Pierre Quenot
- Service de Médecine Intensive Réanimation, CHU François Mitterrand, Dijon, France; Lipness Team, Inserm, LabExLipSTIC France; Inserm Centres d'Investigation Clinique, Département d'Epidémiologie Clinique, Université de Bourgogne, Dijon, France
| | - Florian Reizine
- Service de Médecine Intensive Réanimation, CHU de Rennes, Rennes, France
| | - Anne Renault
- Service de Médecine Intensive Réanimation, CHU la Cavale Blanche, Brest, 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
| | - Francis Schneider
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Daniel Silva
- Service de Médecine Intensive Réanimation, Hôpital Delafontaine, Saint-Denis, France
| | - Michel Sirodot
- Service de Médecine Intensive Réanimation, Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, France
| | - Bertrand Souweine
- Service de Médecine Intensive Réanimation, CHU Gabriel-Montpied, Clermont-Ferrand, France
| | - Fabienne Tamion
- Service de Médecine Intensive Réanimation, Hôpital Charles Nicolle, CHU de Rouen, Normandie Université, UNIROUEN, Inserm U1096, FHU REMOD-VHF, Rouen, France
| | - Nicolas Terzi
- Service de Médecine Intensive Réanimation, Université de Grenoble-Alpes, Inserm U1042, Grenoble, France
| | - Didier Thévenin
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Lens, Lens, France
| | - Guillaume Thiery
- Service de Médecine Intensive Réanimation, CHU de Saint Étienne, Saint Priest en Jarez, France
| | - Nathalie Thieulot-Rolin
- Service de Médecine Intensive Réanimation, Groupe Hospitalier Sud Ile de France, Melun, France
| | - Jean-Francois Timsit
- Service de Médecine Intensive Réanimation, CHU Bichat-Claude Bernard, AP-HP, Paris, France; Université Paris-Cité, Inserm IAME, U1137, Team DesCID, Paris, France
| | - Francois Tinturier
- Service de Réanimation Chirurgicale, CHU Amiens-Picardie, Amiens, France
| | - Patrice Tirot
- Service de Médecine Intensive Réanimation, Centre Hospitalier du Mans, Le Mans, France
| | - Thierry Vanderlinden
- Service de Médecine Intensive Réanimation, Groupement Hospitalier de l'Institut Catholique de Lille, FMMS-ETHICS EA 7446, Université Catholique de Lille, Lille, France
| | - Isabelle Vinatier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Départemental de la Vendée, La Roche sur Yon, France
| | - Christophe Vinsonneau
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Béthune, Béthune, France
| | - Sebastian Voicu
- Service de Médecine Intensive Réanimation, CHU Lariboisière, AP-HP, Paris, France
| | - Jean-Baptiste Lascarrou
- Movement, Interactions, Performance, UR 4334, Nantes Université, Nantes, France; Médecine Intensive Réanimation, CHU de Nantes, Hôtel-Dieu, Nantes, France
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Al-Dorzi HM, Yaqoub R, Alalmaee R, Almutairi G, Almousa A, Aldawsari L. Enteral Nutrition Safety and Outcomes of Patients with COVID-19 on Continuous Infusion of Neuromuscular Blockers: A Retrospective Study. J Nutr Metab 2023; 2023:8566204. [PMID: 37415869 PMCID: PMC10322618 DOI: 10.1155/2023/8566204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/10/2023] [Accepted: 06/17/2023] [Indexed: 07/08/2023] Open
Abstract
Background Intravenous infusions of neuromuscular blocking agents (NMBAs) and prone positioning are recommended for acute respiratory distress syndrome (ARDS) due to COVID-19. The safety of enteral nutrition (EN) during these treatments is unclear. This study assessed EN tolerance and safety during NMBA infusion in proned and nonproned patients with ARDS due to COVID-19. Methods This retrospective study evaluated patients who were admitted to a tertiary-care ICU between March and December 2020, had ARDS due to COVID-19, and received NMBA infusion. We assessed their EN data, gastrointestinal events, and clinical outcomes. The primary outcome was gastrointestinal intolerance, defined as a gastric residual volume (GRV) ≥500 ml or 200-500 ml with vomiting. We compared proned and nonproned patients. Results We studied 181 patients (mean age 61.2 ± 13.7 years, males 71.1%, and median body mass index 31.4 kg/m2). Most (63.5%) patients were proned, and 94.3% received EN in the first 48 hours of NMBA infusion at a median dose <10 kcal/kg/day. GRV was mostly below 100 ml. Gastrointestinal intolerance occurred in 6.1% of patients during NMBA infusion and 10.5% after NMBA discontinuation (similar rates in proned and nonproned patients). Patients who had gastrointestinal intolerance during NMBA infusion had a higher hospital mortality (90.9% versus 60.0%; p=0.05) and longer mechanical ventilation duration and ICU and hospital stays compared with those who did not. Conclusion In COVID-19 patients on NMBA infusion for ARDS, EN was provided early at low doses for most patients, and gastrointestinal intolerance was uncommon in proned and nonproned patients, occurred at a higher rate after discontinuing NMBAs and was associated with worse outcomes. Our study suggests that EN was tolerated and safe in this patient population.
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Affiliation(s)
- Hasan M. Al-Dorzi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center and Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Reem Yaqoub
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Reema Alalmaee
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ghafran Almutairi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Allulu Almousa
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Leen Aldawsari
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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21
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Raphaeli O, Statlender L, Hajaj C, Bendavid I, Goldstein A, Robinson E, Singer P. Using Machine-Learning to Assess the Prognostic Value of Early Enteral Feeding Intolerance in Critically Ill Patients: A Retrospective Study. Nutrients 2023; 15:2705. [PMID: 37375609 DOI: 10.3390/nu15122705] [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: 04/15/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The association between gastrointestinal intolerance during early enteral nutrition (EN) and adverse clinical outcomes in critically ill patients is controversial. We aimed to assess the prognostic value of enteral feeding intolerance (EFI) markers during early ICU stays and to predict early EN failure using a machine learning (ML) approach. METHODS We performed a retrospective analysis of data from adult patients admitted to Beilinson Hospital ICU between January 2011 and December 2018 for more than 48 h and received EN. Clinical data, including demographics, severity scores, EFI markers, and medications, along with 72 h after admission, were analyzed by ML algorithms. Prediction performance was assessed by the area under the receiver operating characteristics (AUCROC) of a ten-fold cross-validation set. RESULTS The datasets comprised 1584 patients. The means of the cross-validation AUCROCs for 90-day mortality and early EN failure were 0.73 (95% CI 0.71-0.75) and 0.71 (95% CI 0.67-0.74), respectively. Gastric residual volume above 250 mL on the second day was an important component of both prediction models. CONCLUSIONS ML underlined the EFI markers that predict poor 90-day outcomes and early EN failure and supports early recognition of at-risk patients. Results have to be confirmed in further prospective and external validation studies.
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Affiliation(s)
- Orit Raphaeli
- Industrial Engineering and Management, Ariel University, Ariel 40700, Israel
- Institute for Nutrition Research, Beilinson Hospital, Rabin Medical Center, Petah Tikva 4941492, Israel
- Data Science and Artificial Intelligence Research Center, Ariel University, Ariel 40700, Israel
| | - Liran Statlender
- Intensive Care Unit, Beilinson Hospital, Rabin Medical Center, Petah Tikva 4941492, Israel
| | - Chen Hajaj
- Industrial Engineering and Management, Ariel University, Ariel 40700, Israel
- Data Science and Artificial Intelligence Research Center, Ariel University, Ariel 40700, Israel
| | - Itai Bendavid
- Intensive Care Unit, Beilinson Hospital, Rabin Medical Center, Petah Tikva 4941492, Israel
| | - Anat Goldstein
- Industrial Engineering and Management, Ariel University, Ariel 40700, Israel
- Data Science and Artificial Intelligence Research Center, Ariel University, Ariel 40700, Israel
| | - Eyal Robinson
- Intensive Care Unit, Beilinson Hospital, Rabin Medical Center, Petah Tikva 4941492, Israel
| | - Pierre Singer
- Institute for Nutrition Research, Beilinson Hospital, Rabin Medical Center, Petah Tikva 4941492, Israel
- Intensive Care Unit, Beilinson Hospital, Rabin Medical Center, Petah Tikva 4941492, Israel
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22
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Kola JB, Turarova B, Csige D, Sipos Á, Varga L, Gergely B, Refai FA, Uray IP, Docsa T, Uray K. Stretch-Induced Down-Regulation of HCN2 Suppresses Contractile Activity. Molecules 2023; 28:molecules28114359. [PMID: 37298834 DOI: 10.3390/molecules28114359] [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: 04/21/2023] [Revised: 05/12/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
Although hyperpolarization-activated and cyclic nucleotide-gated 2 channels (HCN2) are expressed in multiple cell types in the gut, the role of HCN2 in intestinal motility is poorly understood. HCN2 is down-regulated in intestinal smooth muscle in a rodent model of ileus. Thus, the purpose of this study was to determine the effects of HCN inhibition on intestinal motility. HCN inhibition with ZD7288 or zatebradine significantly suppressed both spontaneous and agonist-induced contractile activity in the small intestine in a dose-dependent and tetrodotoxin-independent manner. HCN inhibition significantly suppressed intestinal tone but not contractile amplitude. The calcium sensitivity of contractile activity was significantly suppressed by HCN inhibition. Inflammatory mediators did not affect the suppression of intestinal contractile activity by HCN inhibition but increased stretch of the intestinal tissue partially attenuated the effects of HCN inhibition on agonist-induced intestinal contractile activity. HCN2 protein and mRNA levels in intestinal smooth muscle tissue were significantly down-regulated by increased mechanical stretch compared to unstretched tissue. Increased cyclical stretch down-regulated HCN2 protein and mRNA levels in primary human intestinal smooth muscle cells and macrophages. Overall, our results suggest that decreased HCN2 expression induced by mechanical signals, such as intestinal wall distension or edema development, may contribute to the development of ileus.
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Affiliation(s)
- Job Baffin Kola
- Department of Medical Chemistry, School of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Botagoz Turarova
- Department of Medical Chemistry, School of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Dora Csige
- Department of Medical Chemistry, School of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Ádám Sipos
- Department of Medical Chemistry, School of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Luca Varga
- Department of Medical Chemistry, School of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Bence Gergely
- Department of Medical Chemistry, School of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Farah Al Refai
- Department of Medical Chemistry, School of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Iván P Uray
- Department of Clinical Oncology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Tibor Docsa
- Department of Medical Chemistry, School of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Karen Uray
- Department of Medical Chemistry, School of Medicine, University of Debrecen, 4032 Debrecen, Hungary
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Mohamed Elfadil O, Shah RN, Hurt RT, Mundi MS. Peptide-based formula: Clinical applications and benefits. Nutr Clin Pract 2023; 38:318-328. [PMID: 36802281 DOI: 10.1002/ncp.10961] [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: 11/12/2022] [Revised: 01/08/2023] [Accepted: 01/15/2023] [Indexed: 02/23/2023] Open
Abstract
The use of enteral nutrition (EN) continues to increase given benefits. However, with this increase in use, it is also becoming evident that enteral feeding intolerance (EFI) is also quite prevalent, leading to the inability to meet nutrition needs in many patients. Given the wide variability in the EN population as well as the number of formulas available, there is not a clear consensus regarding the best approach to EFI management. One approach that is emerging to improve EN tolerance is the use of peptide-based formulas (PBFs). PBFs refer to enteral formulas containing proteins that have been enzymatically hydrolyzed to dipeptides and tripeptides. These hydrolyzed proteins are often combined with higher medium-chain triglyceride content to generate an enteral formula that is essentially easier to absorb and utilize. Emerging data demonstrate that the use of PBF in patients with EFI may improve clinical outcomes along with a corresponding reduction in healthcare utilization and potentially the cost of care. This review aims to navigate through key clinical applications and benefits of PBF and to discuss relevant data shared in the literature.
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Affiliation(s)
- Osman Mohamed Elfadil
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Raj N Shah
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan T Hurt
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA.,Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
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Sabino KM, Bridgman E, Deming K, Deming M, Fuller J, Parker K, Mueller J, Nadler E, Wakefield D. Enteral nutrition tolerance in patients receiving neuromuscular blockade. Nutr Clin Pract 2023; 38:340-349. [PMID: 35780473 DOI: 10.1002/ncp.10890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/08/2022] [Accepted: 06/08/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Nutrition support is an essential part of critical care medicine. It is commonly accepted that for the critically ill patient, enteral nutrition (EN) is favored. For the patient who receives neuromuscular blockades, EN may be held, or initiation delayed, because of concerns for EN intolerance. We hypothesized there would be no difference in EN tolerance between groups receiving cisatracurium while receiving EN compared with those not receiving cisatracurium. METHODS This was a retrospective study that included 459 patients from a combined medical and surgical intensive care unit. There were 44 patients who received cisatracurium with EN and 415 who received EN alone. Data collected included gastric residual volume (GRV) and emesis occurrences, new-onset abdominal pain, new or worsening abdominal distention, and bowel ischemia. RESULTS There were more patients with new or worsening abdominal distention in the group receiving cisatracurium (31.82% vs 14.94%; P < 0.01) as well as occurrences of GRV > 300 ml (P < 0.01). There was no statistically significant difference between the groups regarding emesis, new-onset abdominal pain, or bowel ischemia. CONCLUSION Our findings suggest that it is acceptable to provide patients with EN who are receiving cisatracurium.
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Affiliation(s)
- Kim M Sabino
- Department of Food and Nutrition, Trinity Health of New England, Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA
| | - Ellen Bridgman
- Department of Food and Nutrition, Trinity Health of New England, Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA
| | - Kaitlyn Deming
- Department of Food and Nutrition, Trinity Health of New England, Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA
| | - Maria Deming
- Department of Food and Nutrition, Trinity Health of New England, Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA
| | - Julie Fuller
- Department of Food and Nutrition, Trinity Health of New England, Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA
| | - Kristen Parker
- Department of Food and Nutrition, Trinity Health of New England, Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA
| | - Jane Mueller
- Department of Food and Nutrition, Trinity Health of New England, Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA
| | - Evan Nadler
- Department of Food and Nutrition, Trinity Health of New England, Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA
| | - Dotty Wakefield
- Department of Food and Nutrition, Trinity Health of New England, Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA
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Zhang W, Zhou W, Kong Y, Li Q, Huang X, Zhao B, Su H, Chen S, Shen X, Qiu Z. The effect of abdominal massage on enteral nutrition tolerance in patients on mechanical ventilation: A Randomized Controlled Study. Intensive Crit Care Nurs 2023; 75:103371. [PMID: 36528462 DOI: 10.1016/j.iccn.2022.103371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 11/25/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess whether abdominal massage impacts enteral feeding tolerance in mechanically ventilated patients. METHODS Patients were randomized to receive standard or intervention care (standard care plus a 15-minute abdominal massage twice daily) for three days. We recorded the vomiting, reflux, gastric retention, aspiration, diarrhea, abdominal distension, gastric residual volume and abdominal circumference from days one to three. A P-value of less than 0.05 was statistically significant. RESULTS Seventy-four patients (37 per group) were recruited (intervention vs control: age 58.03 ± 10.44 vs 55.33 ± 12.45 years; %M: 69.70 % vs 69.70 %). The aspiration, gastric retention and abdominal distension incidence in the intervention group was 3.03 %, 6.06 % and 9.09 %, whereas in the control group it was 24.24 %, 30.30 % and 27.27 % (P <.05). The vomiting, reflux and diarrhea incidence for patients in the intervention group were all 3.03 %, whereas in the control group they were 3.03 %, 9.09 % and 9.09 % (P >.05). From day 1 to day 3, the gastric residual volume decreased from 87.23 ± 3.29 mL to 72.59 ± 5.40 mL in the intervention group and increased from 91.94 ± 3.45 mL to 105.00 ± 6.94 mL in the control group. Similarly, the abdominal circumference decreased from 84.41 ± 1.73 cm to 82.44 ± 1.73 cm in the intervention group and increased from 87.90 ± 1.60 cm to 88.90 ± 1.75 cm in the control group. The differences in time, group, and interaction effects between the two groups were statistically significant for abdominal circumference and gastric residual volume (P <.05). CONCLUSIONS Abdominal massage can effectively reduce gastric retention, abdominal distension, aspiration, gastric residual volume and abdominal circumference in mechanically ventilated patients, but not the incidence of vomiting, reflux and diarrhea.
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Affiliation(s)
- Weiqin Zhang
- School of Nursing, Fujian Medical University, Fuzhou, Fujian Province 350122, China
| | - Wenguang Zhou
- Chenggong Hospital of Xiamen University (the 73th Group Military Hospital of People's Liberation Army), Xiamen, Fujian Province 361003, China
| | - Yue Kong
- School of Fuzhou General Hospital Clinical Medical, Fujian Medical University, Fuzhou, Fujian Province 350025, China; Education Office, The 900 Hospital of People's Liberation Army, Fuzhou, Fujian Province 350025, China.
| | - Qi Li
- Department of Neurosurgery, The 900 Hospital of People's Liberation Army, Fuzhou, Fujian Province 350025, China
| | - Xiaoqiong Huang
- Department of Neurosurgery, The 900 Hospital of People's Liberation Army, Fuzhou, Fujian Province 350025, China
| | - Binbin Zhao
- Department of Nursing, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province 430071, China
| | - Honghong Su
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian Province 350122, China
| | - Silu Chen
- School of Nursing, Fujian Medical University, Fuzhou, Fujian Province 350122, China
| | - Xianying Shen
- School of Nursing, Fujian Medical University, Fuzhou, Fujian Province 350122, China
| | - Zhaojun Qiu
- School of Nursing, Fujian Medical University, Fuzhou, Fujian Province 350122, China
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Onuk S, Ozer NT, Ozel M, Sipahioglu H, Kahriman G, Baskol G, Temel S, Gundogan K, Akin A. Gastric ultrasound, citrulline, and intestinal fatty acid-binding protein as markers of gastrointestinal dysfunction in critically ill patients: A pilot prospective cohort study. JPEN J Parenter Enteral Nutr 2023; 47:429-436. [PMID: 36609803 DOI: 10.1002/jpen.2473] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 12/23/2022] [Accepted: 12/31/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Gastrointestinal (GI) dysfunction is common in the intensive care unit (ICU), although there is no consensus on biomarkers of GI dysfunction. We aimed to evaluate ultrasound-based gastric antrum measurements and serum intestinal fatty acid-binding protein (IFABP) and citrulline levels in relation to GI dysfunction in critically ill patients. METHODS Adult critically ill patients receiving enteral nutrition and stayed for in the ICU for ≥48 h was included. GI dysfunction was described using Gastrointestinal Dysfunction Score (GIDS). Gastric antrum measurements, including craniocaudal (CC) diameter, anteroposterior diameter, and antral-cross sectional area (CSA), as well as serum levels for IFABP and citrulline, were prospectively recorded at baseline and on day 3 and day 5 of enteral nutrition. The receiver operating characteristic (ROC) analysis was performed to evaluate gastric ultrasound parameters, serum IFABP, and citrulline concentrations in predicting GI dysfunction. RESULTS Thirty-nine participants with a median age of 60 years were recruited and 46.2% of participants had GI dysfunction. ROC analysis revealed that the cutoff value of CSA score to predict GI dysfunction was 4.48 cm2 , which provided 72.7% sensitivity and 77.2% specificity (area under the curve = 0.768, 95% CI: 0.555-0.980). At baseline, gastric residual volume was highly correlated with CC diameter and CSA (r = 0.764, P < 0.001 and r = 0.675, P < 0.001, respectively). Serum IFABP and citrulline levels had no correlation with GI dysfunction or gastric ultrasound parameters (P > 0.05). CONCLUSION CSA was associated with GI dysfunction in critically ill patients. Serum IFABP and citrulline concentrations were poor in predicting GI dysfunction.
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Affiliation(s)
- Sevda Onuk
- Division of Intensive Care Unit, Kayseri City Training and Research Hospital, Kayseri, Turkey
| | - Nurhayat Tugra Ozer
- Department of Clinical Nutrition, Health Science Institute, Erciyes University, Kayseri, Turkey
| | - Merve Ozel
- Department of Clinical Biochemistry, Erciyes University, Kayseri, Turkey
| | - Hilal Sipahioglu
- Division of Intensive Care Unit, Kayseri City Training and Research Hospital, Kayseri, Turkey
| | - Güven Kahriman
- Department of Radiology, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Gulden Baskol
- Department of Clinical Biochemistry, Erciyes University, Kayseri, Turkey
| | - Sahin Temel
- Division of Intensive Care, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Kursat Gundogan
- Division of Intensive Care, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Aynur Akin
- Division of Anestesiology and Reanimation Intensive Care, School of Medicine, Erciyes University, Kayseri, Turkey
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Liu T, Feng P, Wang C, Ojo O, Wang YY, Wang XH. Effects of dietary fibre on enteral feeding intolerance and clinical outcomes in critically ill patients: A meta-analysis. Intensive Crit Care Nurs 2023; 74:103326. [PMID: 36182625 DOI: 10.1016/j.iccn.2022.103326] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 09/08/2022] [Accepted: 09/14/2022] [Indexed: 01/30/2023]
Abstract
BACKGROUND Although some studies have explored the relationships between dietary fibre and enteral feeding intolerance in critically ill patients, the results are equivocal. OBJECTIVE This study aimed to explore the effects of dietary fibre on enteral feeding intolerance and clinical outcomes in critically ill patients. METHODS We searched five databases from inception to July 12, 2021. Data were expressed as mean difference or odds ratio with 95% confidence interval. RESULTS Thirteen studies enrolled 709 critically ill patients included in the study. The results showed the dietary fibre group had a significantly decreased risk of diarrhea (OR: 0.46, 95% CI: 0.30,0.69, P < 0.001), regurgitation (OR: 0.28, 95%CI: 0.13, 0.60, P < 0.05), vomiting (OR: 0.40, 95%CI: 0.17, 0.92, P < 0.05), constipation (OR: 0.21, 95%CI: 0.09, 0.47, P < 0.001) and mortality (OR:0.34; 95%CI:-0.13, 0.91; P < 0.05) compared with the fibre free group. Besides, there was a significant decrease on time to reach full enteral nutrition (MD:-2.08; 95%CI:-4.05, -0.12; P < 0.05), the duration of the intensive care unit stay (MD:-4.62; 95%CI:-6.60, -2.64; P < 0.001) and hospital stay (MD:-6.42; 95%CI:-9.49, -3.36; P < 0.001) in the dietary fibre group. CONCLUSIONS Dietary fibre supplementation may significantly reduce the risk of enteral feeding intolerance and improve the clinical outcomes.
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Affiliation(s)
- Ting Liu
- Department of Intensive Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Ping Feng
- Department of Digestion, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Can Wang
- Department of Intensive Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Omorogieva Ojo
- Department of Adult Nursing and Paramedic Science, University of Greenwich, London, United Kingdom
| | - Yu-Yu Wang
- Department of Intensive Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou 215006, China.
| | - Xiao-Hua Wang
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China.
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Incidence and Risk Factors of Feeding Intolerance in Adult Patients Given Enteral Nutrition Therapy After Liver Transplant. TOP CLIN NUTR 2023. [DOI: 10.1097/tin.0000000000000305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Wang J, Chen Y, Xue H, Chen Z, Wang Q, Zhu M, Yao J, Yuan H, Zhang X. Effect of abdominal massage on feeding intolerance in patients receiving enteral nutrition: A systematic review and meta‐analysis. Nurs Open 2022; 10:2720-2733. [PMID: 36517968 PMCID: PMC10077396 DOI: 10.1002/nop2.1537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 10/26/2022] [Accepted: 11/20/2022] [Indexed: 12/23/2022] Open
Abstract
AIM This study aimed to evaluate the effect of abdominal massage (AM) on feeding intolerance (FI) in patients receiving enteral nutrition (EN). DESIGN A systematic review and meta-analysis. METHODS We searched seven electronic databases to September 2021. STATA and RevMan were used to analyse the data. RESULTS Eleven studies were included. The results revealed that AM could significantly reduce gastric residual volume and abdominal circumference difference, and reduce the incidence of gastric retention, vomiting, abdominal distention (all p < 0.001), diarrhoea (p = 0.02) and constipation (p = 0.002) in the experimental group. One study reported the incidence of aspiration in the control group was higher, but this was not statistically significant (p = 0.07). The meta-regression analysis showed there was a statistically significant correlation between intervention personnel and gastric residual volume (p = 0.035). CONCLUSION AM could reduce the amount and incidence of gastric retention and the changes in abdominal circumference, and significantly reduce the incidence of gastrointestinal symptoms, without increasing the incidence of aspiration for EN patients. No Patient or Public Contribution.
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Affiliation(s)
- Jia Wang
- Department of Fundamental Nursing, School of Nursing Jilin University Changchun China
- Shenzhen hospital of Southern Medical University Shenzhen China
| | - Yahong Chen
- Interventional operating room China‐Japan Union Hospital of Jilin University, Jilin University Changchun China
| | - Hui Xue
- Department of Histology and Embryology, College of Basic Medical Sciences Jilin University Changchun China
| | - Zhiming Chen
- Department of Fundamental Nursing, School of Nursing Jilin University Changchun China
| | - Qiuchen Wang
- Department of Fundamental Nursing, School of Nursing Jilin University Changchun China
| | - Mingyue Zhu
- Department of Fundamental Nursing, School of Nursing Jilin University Changchun China
| | - Jiannan Yao
- Department of Fundamental Nursing, School of Nursing Jilin University Changchun China
| | - Hua Yuan
- Department of Fundamental Nursing, School of Nursing Jilin University Changchun China
| | - Xiuying Zhang
- Department of Fundamental Nursing, School of Nursing Jilin University Changchun China
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Liu R, Paz M, Siraj L, Boyd T, Salamone S, Lite TLV, Leung KM, Chirinos JD, Shang HH, Townsend MJ, Rho J, Ni P, Ranganath K, Violante AD, Zhao Z, Silvernale C, Ahmad I, Krasnow NA, Barnett ES, Harisinghani M, Kuo B, Black KE, Staller K. Feeding intolerance in critically ill patients with COVID-19. Clin Nutr 2022; 41:3069-3076. [PMID: 33934924 PMCID: PMC8007186 DOI: 10.1016/j.clnu.2021.03.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Early reports suggest significant difficulty with enteral feeding in critically ill COVID-19 patients. This study aimed to characterize the prevalence, clinical manifestations, and outcomes of feeding intolerance in critically ill patients with COVID-19. METHODS We examined 323 adult patients with COVID-19 admitted to the intensive care units (ICUs) of Massachusetts General Hospital between March 11 and June 28, 2020 who received enteral nutrition. Systematic chart review determined prevalence, clinical characteristics, and hospital outcomes (ICU complications, length of stay, and mortality) of feeding intolerance. RESULTS Feeding intolerance developed in 56% of the patients and most commonly manifested as large gastric residual volumes (83.9%), abdominal distension (67.2%), and vomiting (63.9%). Length of intubation (OR 1.05, 95% CI 1.03-1.08), ≥1 GI symptom on presentation (OR 0.76, 95% CI 0.59-0.97), and severe obesity (OR 0.29, 95% CI 0.13-0.66) were independently associated with development of feeding intolerance. Compared to feed-tolerant patients, patients with incident feeding intolerance were significantly more likely to suffer cardiac, renal, hepatic, and hematologic complications during their hospitalization. Feeding intolerance was similarly associated with poor outcomes including longer ICU stay (median [IQR] 21.5 [14-30] vs. 15 [9-22] days, P < 0.001), overall hospitalization time (median [IQR] 30.5 [19-42] vs. 24 [15-35], P < 0.001) and in-hospital mortality (33.9% vs. 16.1%, P < 0.001). Feeding intolerance was independently associated with an increased risk of death (HR 3.32; 95% CI 1.97-5.6). CONCLUSIONS Feeding intolerance is a frequently encountered complication in critically ill COVID-19 patients in a large tertiary care experience and is associated with poor outcomes.
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Affiliation(s)
- Rebecca Liu
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Mary Paz
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Layla Siraj
- Harvard Medical School, Boston, MA 02115, USA,Program in Health Sciences & Technology, Harvard Medical School & Massachusetts Institute of Technology, Boston, MA 02115, USA
| | - Taylor Boyd
- Harvard Medical School, Boston, MA 02115, USA
| | | | | | - Krystle M. Leung
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | | | | | | | - Junsung Rho
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Peiyun Ni
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | | | - April D. Violante
- Division of Clinical Nutrition, Department of Nutrition and Food Services, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Zezhou Zhao
- Harvard Medical School, Boston, MA 02115, USA,Program in Health Sciences & Technology, Harvard Medical School & Massachusetts Institute of Technology, Boston, MA 02115, USA
| | - Casey Silvernale
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Imama Ahmad
- Department of Medicine, North Shore Medical Center, Salem, MA 01970, USA
| | | | | | - Mukesh Harisinghani
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Braden Kuo
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Katharine E. Black
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Kyle Staller
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA,Corresponding author. Division of Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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The effects of synbiotic supplementation on enteral feeding tolerance, protein homeostasis, and muscle wasting of critically ill adult patients: a randomized controlled trial. Trials 2022; 23:846. [PMID: 36195945 PMCID: PMC9531380 DOI: 10.1186/s13063-022-06668-0] [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: 08/03/2021] [Accepted: 08/18/2022] [Indexed: 12/03/2022] Open
Abstract
Background Enteral feeding intolerance, energy-protein malnutrition, and muscle wasting are common conditions in the critical care setting. The primary aim of this study was to investigate the effect of synbiotic supplementation on enteral feed volume, energy and protein homeostasis, and muscle mass maintenance in critically ill adult patients. Methods A consecutive of 42 patients admitted to the Edalatian Medical ICU, requiring enteral nutrition (EN), were prospectively randomized to receive the synbiotic capsule (containing a combination of Lactobacillus, Bifidobacterium, Streptococcus, and fructooligosaccharides) or placebo (21 patients in each group) for a maximum of 14 days. Enteral intolerance and energy homeostasis were evaluated on a daily basis. Nitrogen balance and 24-h urine creatinine excretion were recorded on days 1 and 14. Mid-arm circumference was recorded every 3 days. Results Mean EN volume, energy, and protein intake per day were 962.5 ± 533.82 ml, 770 ± 427.05 kcal, and 38.5 ± 21.35 g (fourth day) vs. 590 ± 321.1 ml, 472 ± 256.81 kcal, and 23.6 ± 12.84 g (first day) in the synbiotic group (p < 0.05). Changes in the placebo group were not statistically significant. On day 1, nitrogen balance (NB) was − 19.84 ± 8.03 in the synbiotic vs. − 10.99 ± 9.12 in the placebo group (p = 0.003). On day 14, NB was − 14.18 ± 13.05 in the synbiotic and − 9.59 ± 7.71 in the placebo group (p = 0.41). Mid-arm circumference (MAC), 24-h urine creatinine, and creatinine-height index were almost steady in the synbiotic group, while they decreased in the placebo group. Conclusion Overall, it can be concluded that enteral nutrition supplemented with synbiotics has no statistically significant effect on energy and protein homeostasis and muscle mass maintenance of critically ill patients on day 14, but it can increase enteral feed volume and energy and protein intake during the first 4 days of ICU admission. Trial registration The trial protocol has been approved in Iranian Registry of Clinical Trials on March 17, 2019. The registration reference is IRCT20190227042857N1.
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32
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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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33
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Liu L, Ao D, Cai X, Huang P, Cai N, Lin S, Wu B. Early gut microbiota in very low and extremely low birth weight preterm infants with feeding intolerance: a prospective case-control study. J Microbiol 2022; 60:1021-1031. [PMID: 35984614 PMCID: PMC9390111 DOI: 10.1007/s12275-022-2180-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/30/2022] [Accepted: 07/07/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Ling Liu
- Jinan University, Guangzhou, Guangdong, 510000, China
- Department of Pediatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, 524000, China
| | - Dang Ao
- Department of Pediatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, 524000, China
| | - Xiangsheng Cai
- University of the Chinese Academy of Sciences - Shenzhen Hospital, Shenzhen, Guangdong, 518000, China
| | - Peiyi Huang
- Department of Pediatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, 524000, China
| | - Nali Cai
- Department of Pediatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, 524000, China
| | - Shaozhu Lin
- Department of Pediatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, 524000, China
| | - Benqing Wu
- Jinan University, Guangzhou, Guangdong, 510000, China.
- University of the Chinese Academy of Sciences - Shenzhen Hospital, Shenzhen, Guangdong, 518000, China.
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Hu Y, Chen F, Xiang X, Wang F, Hua Z, Wei H. Early versus delayed enteral nutrition for neonatal hypoxic-ischemic encephalopathy undergoing therapeutic hypothermia: a randomized controlled trial. Ital J Pediatr 2022; 48:146. [PMID: 35971138 PMCID: PMC9380332 DOI: 10.1186/s13052-022-01342-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background The practice of therapeutic hypothermia (TH) is widely used for neonatal hypoxic-ischemic encephalopathy (HIE) despite its corresponding feeding strategies are still controversial. This randomized controlled trial (RCT) demonstrated to evaluate the effect of early vs. delayed enteral nutrition on the incidence of feeding intolerance (FI) and other association during TH. Methods This single center, parallel-group, and no-blinded RCT was processed in a level III, and academic neonatal intensive care unit. Infants who were diagnosed with HIE and undertaken TH from September 2020 to August 2021 were enrolled. Participants were randomized to receive enteral nutrition either during TH/rewarming (early enteral nutrition, EEN) or after TH (delayed enteral nutrition, DEN) according to a recommend enteral feeding protocol. All data were analyzed using SPSS 26.0 software with a p-value< 0.05 was considered statistically significant. Results Ninety-two infants were enrolled after randomization, but 12 (13.04%) cases including 3 (3.26%) deaths were excluded from eventually analyzed, who did not initiate or discontinue the intervention. 80 cases (42 and 38 in the EEN and DEN group, respectively) who completed the interventions were eventually analyzed. Besides initial time of enteral feeds, two groups had processed the same feeding method. Total 23 (25.0%) cases developed FI, and no difference of morbidity was found between two groups (23.4% vs 26.7%, p = 0.595; Log Rank, p = 0.803). There was no case died or developed late-onset bloodstream and no difference of the incidence of hypoglycemia or weight gain was found (p > 0.05). The percentage of infants who had not reaching the goal of full enteral feeding volume between the two groups was similar (21.43% vs 23.68%, p = 0.809). The average time of parenteral nutrition, reaching full enteral feeds and hospital stay were shorter in the EEN group compared with the DEN group with significant differences (8.81 ± 1.67 vs 10.61 ± 2.06 days, p < 0.001; 9.91 ± 1.88 vs 12.24 ± 2.50 days, p < 0.001; 12.55 ± 4.57 vs 16.47 ± 5.27 days, p = 0.001 respectively). Conclusions Compared with delayed enteral nutrition, introduction of early enteral nutrition according to a recommend feeding strategy for neonatal HIE undergoing TH may be feasible and safe.FI is frequent in this high-risk group of infants which should not be ignored during feeding process. Trial registration The Chinese Clinical Trial Registry,ChiCTR2000038193, 2020-9-13, https://www.chictr.org.cn.
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Affiliation(s)
- Ya Hu
- Department of Neonatology, Children's Hospital of Chongqing Medical University (The institution is also validated by Ringgold as 'Chongqing Medical University Affiliated Children's Hospital'), Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Feng Chen
- Department of Neonatology, Children's Hospital of Chongqing Medical University (The institution is also validated by Ringgold as 'Chongqing Medical University Affiliated Children's Hospital'), Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Xinyu Xiang
- Department of Neonatology, Children's Hospital of Chongqing Medical University (The institution is also validated by Ringgold as 'Chongqing Medical University Affiliated Children's Hospital'), Chongqing, China
| | - Fang Wang
- Department of Neonatology, Children's Hospital of Chongqing Medical University (The institution is also validated by Ringgold as 'Chongqing Medical University Affiliated Children's Hospital'), Chongqing, China
| | - Ziyu Hua
- Department of Neonatology, Children's Hospital of Chongqing Medical University (The institution is also validated by Ringgold as 'Chongqing Medical University Affiliated Children's Hospital'), Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hong Wei
- Department of Neonatology, Children's Hospital of Chongqing Medical University (The institution is also validated by Ringgold as 'Chongqing Medical University Affiliated Children's Hospital'), Chongqing, China. .,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China. .,National Clinical Research Center for Child Health and Disorders, Chongqing, China. .,China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
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Prevalence and risk factors of enteral nutrition intolerance in intensive care unit patients: a retrospective study. Chin Med J (Engl) 2022; 135:1814-1820. [PMID: 35833658 PMCID: PMC9521784 DOI: 10.1097/cm9.0000000000001974] [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] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Feeding intolerance (FI) among intensive care unit (ICU) patients undergoing early continuous enteral nutrition (EN) is related to poor outcomes. This study aimed to explore the prevalence and risk factors of FI in ICU patients. METHODS We retrospectively enrolled 1057 patients who received early continuous EN via a nasogastric tube between January 2014 and August 2019. The prevalence of FI during the first 7 days of ICU stay was calculated, and the risk factors were investigated using multivariate logistic regression analysis. RESULTS The prevalence of FI during the first 7 days of ICU stay was 10.95%. FI occurred in 159 of 1057 (15.04%) patients on ICU day 2, 114 of 977 (11.67%) patients on ICU day 3, and 86 of 715 (12.03%) patients on ICU day 7. Mechanical ventilation (MV) (odds ratio [OR]: 1.928, 95% confidence interval [CI]: 1.064-3.493, P = 0.03) was an independent risk factor for FI defined by a gastric residual volume (GRV) of 200 mL and/or vomiting, and acute renal failure (OR: 3.445, 95% CI: 1.115-10.707, P = 0.032) was an independent risk factor of FI defined by a GRV of 500 mL and/or vomiting. Continuous renal replacement therapy (CRRT) was an independent predictor regardless of the FI defined by a GRV of 200 mL (OR: 2.064, 95% CI: 1.233-3.456, P = 0.006) or 500 mL (OR: 6.199, 95% CI: 2.108-18.228, P = 0.001) in the ICU patients. CONCLUSIONS FI occurs frequently in early ICU days, especially in patients receiving MV and CRRT. However, further investigation of a consensus definition of FI and risk factors is still warranted in future studies.
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Lee AE, Munoz E, Al Dabbous T, Harris E, O'Callaghan M, Raman L. Extracorporeal Life Support Organization Guidelines for the Provision and Assessment of Nutritional Support in the Neonatal and Pediatric ECMO Patient. ASAIO J 2022; 68:875-880. [PMID: 35703144 DOI: 10.1097/mat.0000000000001767] [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: 11/26/2022] Open
Abstract
DISCLAIMER This guideline is intended for educational use to build the knowledge of physicians and other health professionals in assessing the conditions and managing the treatment of patients undergoing extracorporeal life support (ECLS)/extracorporeal membrane oxygenation (ECMO) and describe what are believed to be useful and safe practice for extracorporeal life support (ECLS, ECMO) but these are not necessarily consensus recommendations. The aim of clinical guidelines are to help clinicians to make informed decisions about their patients. However, adherence to a guideline does not guarantee a successful outcome. Ultimately, healthcare professionals must make their own treatment decisions about care on a case-by-case basis, after consultation with their patients, using their clinical judgment, knowledge, and expertise. These guidelines do not take the place of physicians' and other health professionals' judgment in diagnosing and treatment of particular patients. These guidelines are not intended to and should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment must be made by the physician and other health professionals and the patient in light of all the circumstances presented by the individual patient, and the known variability and biologic behavior of the clinical condition. These guidelines reflect the data at the time the guidelines were prepared; the results of subsequent studies or other information may cause revisions to the recommendations in these guidelines to be prudent to reflect new data, but Extracorporeal Life Support Organization (ELSO) is under no obligation to provide updates. In no event will ELSO be liable for any decision made or action taken in reliance upon the information provided through these guidelines.
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Affiliation(s)
- Amy E Lee
- From the Section of Pediatric Critical Care, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | | | - Tala Al Dabbous
- Bayt Abdullah Children's Hospice, Al-Adan Hospital, NBK Children's Hospital, Kuwait City, Kuwait
| | | | - Maura O'Callaghan
- ECMO Service Team, Great Ormond Street Hospital, London, United Kingdom
| | - Lakshmi Raman
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
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37
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Ultrasound meal accommodation test in critically ill patients with and without feeding intolerance UMAT-ICU. Clin Nutr ESPEN 2022; 51:424-429. [DOI: 10.1016/j.clnesp.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 04/14/2022] [Accepted: 07/08/2022] [Indexed: 11/19/2022]
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Docsa T, Sipos A, Cox CS, Uray K. The Role of Inflammatory Mediators in the Development of Gastrointestinal Motility Disorders. Int J Mol Sci 2022; 23:ijms23136917. [PMID: 35805922 PMCID: PMC9266627 DOI: 10.3390/ijms23136917] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/20/2022] [Accepted: 06/20/2022] [Indexed: 02/04/2023] Open
Abstract
Feeding intolerance and the development of ileus is a common complication affecting critically ill, surgical, and trauma patients, resulting in prolonged intensive care unit and hospital stays, increased infectious complications, a higher rate of hospital readmission, and higher medical care costs. Medical treatment for ileus is ineffective and many of the available prokinetic drugs have serious side effects that limit their use. Despite the large number of patients affected and the consequences of ileus, little progress has been made in identifying new drug targets for the treatment of ileus. Inflammatory mediators play a critical role in the development of ileus, but surprisingly little is known about the direct effects of inflammatory mediators on cells of the gastrointestinal tract, and many of the studies are conflicting. Understanding the effects of inflammatory cytokines/chemokines on the development of ileus will facilitate the early identification of patients who will develop ileus and the identification of new drug targets to treat ileus. Thus, herein, we review the published literature concerning the effects of inflammatory mediators on gastrointestinal motility.
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Affiliation(s)
- Tibor Docsa
- Department of Medical Chemistry, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (T.D.); (A.S.)
| | - Adám Sipos
- Department of Medical Chemistry, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (T.D.); (A.S.)
| | - Charles S. Cox
- Department of Pediatric Surgery, University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX 77204, USA;
| | - Karen Uray
- Department of Medical Chemistry, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (T.D.); (A.S.)
- Correspondence:
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Hussain Khan Z, Maki Aldulaimi A, Varpaei HA, Mohammadi M. Various Aspects of Non-Invasive Ventilation in COVID-19 Patients: A Narrative Review. IRANIAN JOURNAL OF MEDICAL SCIENCES 2022; 47:194-209. [PMID: 35634520 PMCID: PMC9126903 DOI: 10.30476/ijms.2021.91753.2291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/21/2021] [Accepted: 10/01/2021] [Indexed: 01/08/2023]
Abstract
Non-invasive ventilation (NIV) is primarily used to treat acute respiratory failure. However, it has broad applications to manage a range of other diseases successfully.
The main advantage of NIV lies in its capability to provide the same physiological effects as invasive ventilation while avoiding the placement of an
artificial airway and its associated life-threatening complications. The war on the COVID-19 pandemic is far from over. The present narrative review aimed at identifying various aspects of NIV usage, in COVID-19 and other patients,
such as the onset time, mode, setting, positioning, sedation, and types of interface. A search for articles published from May 2020 to April 2021 was conducted using MEDLINE,
PMC central, Scopus, Web of Science, Cochrane Library, and Embase databases. Of the initially identified 5,450 articles, 73 studies and 24 guidelines on the use of NIV were included.
The search was limited to studies involving human cases and English language articles. Despite several reported benefits of NIV, the evidence on the use of NIV in
COVID-19 patients does not yet fully support its routine use.
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Affiliation(s)
- Zahid Hussain Khan
- Department of Anesthesiology and Critical Care, Imam Khomeini Medical Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmed Maki Aldulaimi
- Al-furat Al-awsat Hospital, Al-furat Al-awsat Technical University, Health and Medical Technical College, Department of Anesthesia and Critical Care, Kufa, Iraq
| | - Hesam Aldin Varpaei
- Department of Nursing and Midwifery, School of Nursing, Islamic Azad University Tehran Medical Sciences, Tehran, Iran
| | - Mostafa Mohammadi
- Department of Anesthesiology and Critical Care, Tehran University of Medical Sciences, Tehran. Iran
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Arunachala Murthy T, Chapple LAS, Lange K, Marathe CS, Horowitz M, Peake SL, Chapman MJ. Gastrointestinal dysfunction during enteral nutrition delivery in intensive care unit (ICU) patients: Risk factors, natural history, and clinical implications. A post-hoc analysis of The Augmented versus Routine approach to Giving Energy Trial (TARGET). Am J Clin Nutr 2022; 116:589-598. [PMID: 35472097 PMCID: PMC9348974 DOI: 10.1093/ajcn/nqac113] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/24/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Slow gastric emptying occurs frequently during critical illness and is roughly quantified at bedside by large gastric residual volumes (GRVs). A previously published trial (The Augmented versus Routine approach to Giving Energy Trial; TARGET) reported larger GRVs with energy-dense (1.5 kcal/mL) compared with standard (1.0 kcal/mL) enteral nutrition (EN), warranting further exploration. OBJECTIVE To assess the incidence, risk factors, duration, and timing of large GRVs (≥250 mL) and its relation to clinical outcomes in mechanically ventilated adults. METHODS A post-hoc analysis of TARGET data in patients with ≥1 GRV recorded. Data are n (%) or median [IQR]. RESULTS Of 3876 included patients, 1777 (46%) had ≥1 GRV ≥250 mL, which was more common in males (50 compared with 39%; P < 0.001) and in patients receiving energy-dense compared with standard EN (52 compared with 40%; RR = 1.27 (95% CI: 1.19, 1.36); P < 0.001) in whom it also lasted longer (1 [0-2] compared with 0 [0-1] d; P < 0.001), with no difference in time of onset after EN initiation (day 1 [0-2] compared with 1 [0-2]; P = 0.970). Patients with GRV ≥250 mL were more likely to have the following: vasopressor administration (88 compared with 76%; RR = 1.15 [1.12, 1.19]; P < 0.001), positive blood cultures (16 compared with 8%; RR = 1.92 [1.60, 2.31]; P < 0.001), intravenous antimicrobials (88 compared with 81%; RR = 1.09 [1.06, 1.12]; P < 0.001), and prolonged intensive care unit (ICU) stay (ICU-free days to day 28; 12.9 [0.0-21.0] compared with 20.0 [3.9-24.0]; P < 0.001), hospital stay (hospital-free days to day 28: 0.0 [0.0-12.0] compared with 7.0 [0.0-17.6] d; P < 0.001), ventilatory support (ventilator-free days to day 28: 16.0 [0.0-23.0] compared with 22.0 [8.0-25.0]; P < 0.001), and a higher 90-d mortality (29 compared with 23%; adjusted: RR = 1.17 [1.05, 1.30]; P = 0.003). CONCLUSION Large GRVs were more common in males and those receiving energy-dense formulae, occurred early and were short-lived, and were associated with a number of negative clinical sequelae, including increased mortality, even when adjusted for illness severity. This trial was registered at clinicaltrials.gov as NCT02306746.
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Affiliation(s)
| | - Lee-anne S Chapple
- Adelaide Medicine School, University of Adelaide, Adelaide, Australia,Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia,Centre for Research Excellence in Nutritional Physiology, Adelaide, Australia
| | - Kylie Lange
- Adelaide Medicine School, University of Adelaide, Adelaide, Australia,Centre for Research Excellence in Nutritional Physiology, Adelaide, Australia
| | - Chinmay S Marathe
- Adelaide Medicine School, University of Adelaide, Adelaide, Australia,Centre for Research Excellence in Nutritional Physiology, Adelaide, Australia,The Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Michael Horowitz
- Adelaide Medicine School, University of Adelaide, Adelaide, Australia,Centre for Research Excellence in Nutritional Physiology, Adelaide, Australia,The Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Sandra L Peake
- Adelaide Medicine School, University of Adelaide, Adelaide, Australia,The Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Adelaide, Australia,School of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Marianne J Chapman
- Adelaide Medicine School, University of Adelaide, Adelaide, Australia,Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia,Centre for Research Excellence in Nutritional Physiology, Adelaide, Australia,School of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
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Deng LX, Lan-Cao, Zhang LN, Dun-Tian, Yang-Sun, Qing-Yang, Yan-Huang. The effects of abdominal-based early progressive mobilisation on gastric motility in endotracheally intubated intensive care patients: A randomised controlled trial. Intensive Crit Care Nurs 2022; 71:103232. [DOI: 10.1016/j.iccn.2022.103232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 02/15/2022] [Accepted: 03/01/2022] [Indexed: 02/08/2023]
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42
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Bowel Dysfunction and Enteral Nutrition in Critically Ill Adult Patients. TOP CLIN NUTR 2022. [DOI: 10.1097/tin.0000000000000276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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43
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A systematic review of the definitions and prevalence of feeding intolerance in critically ill adults. Clin Nutr ESPEN 2022; 49:92-102. [DOI: 10.1016/j.clnesp.2022.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/08/2022] [Accepted: 04/15/2022] [Indexed: 12/12/2022]
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44
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Xavier de Melo V, Mezzomo TR, Aristides Dall'igna AL, de Araújo Marques Dengo V, Stangarlin-Fiori L, Madalozzo Schieferdecker ME, Rodrigues Ferreira SM. Does the nutritional composition and category of administered enteral nutrition affect the nutritional status of patients receiving home nutritional therapy? Clin Nutr ESPEN 2022; 49:270-277. [DOI: 10.1016/j.clnesp.2022.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/10/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
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45
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Chen Y, Tai K, Lai P, Huang Y. Should we believe the benefit of intravenous erythromycin in critically ill adults with gastric feeding intolerance? Reinspecting the pieces of evidence from a series of meta‐analyses. JPEN J Parenter Enteral Nutr 2022; 46:1449-1454. [DOI: 10.1002/jpen.2352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/06/2022] [Accepted: 02/10/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Yi‐Ting Chen
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine National Cheng Kung University Tainan Taiwan
| | - Kuan‐Yu Tai
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine National Cheng Kung University Tainan Taiwan
| | - Pei‐Chun Lai
- Education Center, National Cheng Kung University Hospital, College of Medicine National Cheng Kung University Tainan Taiwan
| | - Yen‐Ta Huang
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine National Cheng Kung University Tainan Taiwan
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46
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Affiliation(s)
- Yaseen M. Arabi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia,Address for correspondence: Dr. Yaseen M. Arabi, Intensive Care Department, King Abdulaziz Medical City, ICU2, Mail Code 1425, PO Box 22490, Riyadh - 11426, Saudi Arabia. E-mail:
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47
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Santos DCD, Ataide CDG, Mota da Costa N, Oliveira Junior VPD, Egea MB. Blenderized formulations in home enteral nutrition: a narrative review about challenges in nutritional security and food safety. Nutr Rev 2022; 80:1580-1598. [PMID: 35026011 DOI: 10.1093/nutrit/nuab121] [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: 11/14/2022] Open
Abstract
Blenderized formulations (BFs) are prepared by homogenization of food that is normally used in oral nutrition. BFs are mainly used in home enteral nutrition (HEN), although their use has also been reported by hospitals when commercial enteral formulas are not available. HEN is applied when the patient has been discharged from the hospital. This nutritional therapy promotes the patient's reintegration into the family nucleus and promotes humanized care, and decreases treatment costs. However, the patient should continue to receive health and nutritional care, ranging from periodic nutritional re-evaluation to adaptation of the dietary plan. HEN provides the patient a greater contact with the family, whereas BFs promote the adaptation of the diet with food, respecting the food diversity and culture, lower cost, and easier access to food. Disadvantages of BFs include more time spent by the professional to calculate the dietary plan, greater difficulty in adjusting daily needs, and less microbiological and chemical stability. In this review, the nutritional, food security, and safety aspects of BF used in HEN are discussed. Technological quality aspects that are essential knowledge in the preparation of the patient's dietary plan also are presented.
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Affiliation(s)
- Daiane Costa Dos Santos
- D.C.d. Santos is with the Goiás Federal University (UFG), Institute of Tropical Pathology and Public Health, IPTSP-UFG, Goiânia, Goiás, Brazil. C.D.G. Ataide is with the Hospital DF Star, Asa Sul, Brasília, Brazil. N.M. da Costa, V.P. de Oliveira Junior, and M.B. Egea are with the Federal Institute of Education, Science, and Technology Goiano, Rio Verde, Goiás, Brazil
| | - Carla Daniela Gomes Ataide
- D.C.d. Santos is with the Goiás Federal University (UFG), Institute of Tropical Pathology and Public Health, IPTSP-UFG, Goiânia, Goiás, Brazil. C.D.G. Ataide is with the Hospital DF Star, Asa Sul, Brasília, Brazil. N.M. da Costa, V.P. de Oliveira Junior, and M.B. Egea are with the Federal Institute of Education, Science, and Technology Goiano, Rio Verde, Goiás, Brazil
| | - Nair Mota da Costa
- D.C.d. Santos is with the Goiás Federal University (UFG), Institute of Tropical Pathology and Public Health, IPTSP-UFG, Goiânia, Goiás, Brazil. C.D.G. Ataide is with the Hospital DF Star, Asa Sul, Brasília, Brazil. N.M. da Costa, V.P. de Oliveira Junior, and M.B. Egea are with the Federal Institute of Education, Science, and Technology Goiano, Rio Verde, Goiás, Brazil
| | - Valtemir Paula de Oliveira Junior
- D.C.d. Santos is with the Goiás Federal University (UFG), Institute of Tropical Pathology and Public Health, IPTSP-UFG, Goiânia, Goiás, Brazil. C.D.G. Ataide is with the Hospital DF Star, Asa Sul, Brasília, Brazil. N.M. da Costa, V.P. de Oliveira Junior, and M.B. Egea are with the Federal Institute of Education, Science, and Technology Goiano, Rio Verde, Goiás, Brazil
| | - Mariana Buranelo Egea
- D.C.d. Santos is with the Goiás Federal University (UFG), Institute of Tropical Pathology and Public Health, IPTSP-UFG, Goiânia, Goiás, Brazil. C.D.G. Ataide is with the Hospital DF Star, Asa Sul, Brasília, Brazil. N.M. da Costa, V.P. de Oliveira Junior, and M.B. Egea are with the Federal Institute of Education, Science, and Technology Goiano, Rio Verde, Goiás, Brazil
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Wang L, Yang H, Cheng Y, Fu X, Yao H, Jin X, Kang Y, Wu Q. Mean Arterial Pressure/Norepinephrine Equivalent Dose Index as an Early Measure of Initiation Time for Enteral Nutrition in Patients with Shock: A Prospective Observational Study. Nutrition 2022; 96:111586. [DOI: 10.1016/j.nut.2021.111586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/07/2021] [Accepted: 12/27/2021] [Indexed: 10/19/2022]
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Vijayaraghavan R, Maiwall R, Arora V, Choudhary A, Benjamin J, Aggarwal P, Jamwal KD, Kumar G, Joshi YK, Sarin SK. Reversal of Feed Intolerance by Prokinetics Improves Survival in Critically Ill Cirrhosis Patients. Dig Dis Sci 2022; 67:4223-4233. [PMID: 34392492 PMCID: PMC8364303 DOI: 10.1007/s10620-021-07185-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/19/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS Feed intolerance (FI) is common in cirrhosis patients in intensive care units (ICU). Prokinetics are the first line treatment for FI but their efficacy and safety in critically ill patient with cirrhosis is unknown. We evaluated the role of prokinetics in reversal of FI and clinical outcomes. METHODS Consecutive patients admitted in ICU developing new-onset FI, were randomized to receive either intravenous metoclopramide (Gr.A, n = 28), erythromycin (Gr.B, n = 27) or placebo (Gr.C, n = 28). FI was defined with the presence of 3 of 5 variables- absence of bowel sounds, gastric residual volume ≥ 500 ml, vomiting, diarrhoea and bowel distension. Primary end-point was complete resolution of FI (≥ 3 variables resolved) within 24-h and secondary end-points included resolution within 72-h and survival at 7-days. RESULTS Of the 1030 ICU patients, 201 (19.5%) developed FI and 83 patients were randomized. Baseline parameters between the groups were comparable. Complete resolution at 24-h was higher in Gr.A (7.14%) and B (22.2%) than C (0%, p = 0.017). Overall, 58 (69.9%) patients achieved resolution within 72 h, more with metoclopramide (n = 24, 85.7%) and erythromycin (n = 25, 92.6%) than with placebo (n = 9, 32.1%, p < 0.001). The 7-day survival was better in patients who achieved resolution within 72-h (65.5 vs. 36%, p = 0.011) than non-responders. High lactate (OR-3.32, CI-1.45-7.70, p = 0.005), shock at baseline (OR-6.34, CI-1.67-24.1, p = 0.007) and resolution of FI within 72 h (OR-0.11, CI, 0.03-0.51, p = 0.04) predicted 7-day mortality. CONCLUSIONS FI is common in critically-ill cirrhosis patients and non-resolution carries high mortality. Early recognition and treatment with prokinetics is recommended to improve short-term survival.
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Affiliation(s)
- Rajan Vijayaraghavan
- grid.418784.60000 0004 1804 4108Department of Hepatology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070 India
| | - Rakhi Maiwall
- grid.418784.60000 0004 1804 4108Department of Hepatology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070 India
| | - Vinod Arora
- grid.418784.60000 0004 1804 4108Department of Hepatology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070 India
| | - Ashok Choudhary
- grid.418784.60000 0004 1804 4108Department of Hepatology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070 India
| | - Jaya Benjamin
- grid.418784.60000 0004 1804 4108Department of Clinical Nutrition, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Prashant Aggarwal
- grid.418784.60000 0004 1804 4108Department of Anaesthesia and Critical Care, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Kapil Dev Jamwal
- grid.464746.30000 0004 1761 4703Department of Gastroenterology, Artemis Hospitals, Gurugram, Haryana India
| | - Guresh Kumar
- grid.418784.60000 0004 1804 4108Department of Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Y. K. Joshi
- grid.418784.60000 0004 1804 4108Department of Clinical Nutrition, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Shiv K. Sarin
- grid.418784.60000 0004 1804 4108Department of Hepatology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070 India
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Thong D, Halim Z, Chia J, Chua F, Wong A. A Systematic Review and Meta-Analysis of the effectiveness of continuous versus intermittent enteral nutrition in critically ill adults. JPEN J Parenter Enteral Nutr 2021; 46:1243-1257. [PMID: 34965317 DOI: 10.1002/jpen.2324] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/09/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Continuous Enteral Nutrition (CEN) remains standard practice in Intensive Care Units (ICUs) worldwide. Intermittent Enteral Nutrition (IEN) may be a suitable alternative method. This meta-analysis aims to investigate the safety, tolerance, and effectiveness of IEN compared to CEN in critically ill adults in the ICU. METHODS Medline, CINAHL, Scopus, Embase and Google Scholar were searched for studies published up until 30th April 2020, along with manual searches in bibliographies. Eligible studies were trials that compared CEN versus IEN feeding in the ICU, and reported on at least one of the relevant outcomes - nutritional intake, gastric residual volume (GRV), aspiration pneumonia, vomiting, diarrhea, abdominal distension, glycemic variability. Secondary outcomes were ICU length of stay (LOS) and mortality. The Cochrane risk-of-bias tool for randomized trials was used to assess methodological quality. RESULTS Ten studies with 664 participants were included in the meta-analysis. The majority of studies had an overall 'High' risk of bias. Incidence of vomiting was significantly higher in CEN as compared to IEN groups (Risk Ratio 2.76; 95% CI, 1.23 - 6.23). There were no significant differences between CEN and IEN groups for nutritional intake, GRV, the incidence of aspiration pneumonia, diarrhea, abdominal distension, ICU LOS, and mortality. Definition and reporting of outcome measures were not standardized across studies, hence this heterogeneity limits generalisability of results. CONCLUSION Overall, the safety, tolerance, and effectiveness of CEN and IEN were found to be comparable. Future studies should explore monitoring larger sample sizes to determine best feeding practices in ICU. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Debbie Thong
- Dietetic and Food Services, Changi General Hospital, Singapore, Singapore
| | - Zakiah Halim
- Dietetic and Food Services, Changi General Hospital, Singapore, Singapore
| | - Joel Chia
- Dietetic and Food Services, Changi General Hospital, Singapore, Singapore
| | - Fionn Chua
- Dietetic and Food Services, Changi General Hospital, Singapore, Singapore
| | - Alvin Wong
- Dietetic and Food Services, Changi General Hospital, Singapore, Singapore
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