1
|
Qin N, Cao Q, Li F, Wang W, Peng X, Wang L. A nomogram based on quantitative EEG to predict the prognosis of nontraumatic coma patients in the neuro-intensive care unit. Intensive Crit Care Nurs 2024; 83:103618. [PMID: 38171953 DOI: 10.1016/j.iccn.2023.103618] [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: 08/07/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE We aimed to establish a quantitative electroencephalography-based prognostic prediction model specifically tailored for nontraumatic coma patients to guide clinical work. METHODS This retrospective study included 126 patients with nontraumatic coma admitted to the First Affiliated Hospital of Chongqing Medical University from December 2020 to December 2022. Six in-hospital deaths were excluded. The Glasgow Outcome Scale assessed the prognosis at 3 months after discharge. The least absolute shrinkage and selection operator regression analysis and stepwise regression method were applied to select the most relevant predictors. We developed a predictive model using binary logistic regression and then presented it as a nomogram. We assessed the predictive effectiveness and clinical utility of the model. RESULTS After excluding six deaths that occurred within the hospital, a total of 120 patients were included in this study. Three predictor variables were identified, including APACHE II score [39.129 (1.4244-1074.9000)], sleep cycle [OR: 0.006 (0.0002-0.1808)], and RAV [0.068 (0.0049-0.9500)]. The prognostic prediction model showed exceptional discriminative ability, with an AUC of 0.939 (95 % CI: 0.899-0.979). CONCLUSION A lack of sleep cycles, smaller relative alpha variants, and higher APACHE II scores were associated with a poor prognosis of nontraumatic coma patients in the neurointensive care unit at 3 months after discharge. CLINICAL IMPLICATION This study presents a novel methodology for the prognostic assessment of nontraumatic coma patients and is anticipated to play a significant role in clinical practice.
Collapse
Affiliation(s)
- Ningxiang Qin
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qingqing Cao
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Department of Neurology, Bishan Hospital of Chongqing Medical University, Chongqing, China
| | - Feng Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xi Peng
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Liang Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| |
Collapse
|
2
|
Loofs TS, Haubrick K. End-of-Life Nutrition Considerations: Attitudes, Beliefs, and Outcomes. Am J Hosp Palliat Care 2020; 38:1028-1041. [PMID: 32945174 DOI: 10.1177/1049909120960124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To assess the physiological outcomes and interpersonal influences that should be considered when making the decision to provide artificial nutrition and hydration (AN&H) for patients in hospice/palliative programs. METHODS A systematic review was conducted using items from the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 checklist. Distinct search strategies were employed to find primary research articles that addressed: General health outcomes of artificial nutrition and hydration interventions and nutrition therapy interventions (n = 16), nutrition-related symptoms in end-of-life care (n = 8), and the attitudes of patients and providers toward artificial nutrition and hydration (n = 21). RESULTS The effect of AN&H on health outcomes, quality-of-life measures and nutrition-related symptoms is limited and may vary by patient setting and diagnosis. In the absence of consistent evidence for specific health outcomes, decisions regarding AN&H should be made in context of the desires and beliefs of a patient, their family, and their medical providers. These beliefs may not be consistent with likely outcomes or may be inconsistent between individuals involved in the decision-making process, and individuals of different cultures or geographic regions may approach AN&H decisions from different perspectives. To help navigate the intersection of nutrition-related health outcomes and patient/provider beliefs, palliative care teams may employ a variety of strategies for approaching the decision-making process, and may benefit from specific involvement of a Registered Dietitian to help contribute to or lead these discussions.
Collapse
Affiliation(s)
- Tyler S Loofs
- St. David's Georgetown Hospital, Georgetown, TX, USA
| | - Kevin Haubrick
- 165982The University of Houston College of Liberal Arts and Social Sciences, TX, USA
| |
Collapse
|
3
|
Changes in Body Mass Index, Energy Intake, and Fluid Intake over 60 Months Premortem as Prognostic Factors in Frail Elderly: A Post-Death Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17061823. [PMID: 32168925 PMCID: PMC7142819 DOI: 10.3390/ijerph17061823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/07/2020] [Accepted: 03/09/2020] [Indexed: 12/11/2022]
Abstract
Survival prediction is considered difficult in elderly individuals with cognitive frailty or dementia that leads to death. The aim of this study was to verify temporal changes in body mass index (BMI), energy intake, and fluid intake measured continuously in frail elderly people as prognostic factors for death. We assessed 106 frail elderly individuals who received >2-year care at an elderly care facility and died at the facility. We analyzed temporal changes in BMI, energy intake, and fluid intake from a maximum of 60 months premortem to death and determined the relationship between these parameters. BMI was significantly below the reference values from 9 months prior to death, but energy intake remained constant from 2 months prior to death to death (p < 0.001). However, the mean fluid intake decreased suddenly immediately prior to death. We compared the changes in each parameter during the year prior to death and during the preceding year and found significant differences in all parameters (p < 0.001). From 60 months prior to death to death, BMI, energy intake, and fluid intake decreased in the same order over time. Therefore, these parameters can be used as prognostic factors for death in frail elderly people.
Collapse
|
4
|
Khadaroo RG, Padwal RS, Wagg AS, Clement F, Warkentin LM, Holroyd-Leduc J. Optimizing senior's surgical care - Elder-friendly Approaches to the Surgical Environment (EASE) study: rationale and objectives. BMC Health Serv Res 2015; 15:338. [PMID: 26293153 PMCID: PMC4546177 DOI: 10.1186/s12913-015-1001-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 08/11/2015] [Indexed: 01/08/2023] Open
Abstract
Background It is estimated that seniors (≥65 years old) account for >50 % of acute inpatient hospital days and are presenting for surgical evaluation of acute illness in increasing numbers. Unfortunately, conventional acute care models rarely take into account needs of the elderly population. The failure to consider these special needs have resulted in poor outcomes, longer lengths of hospital stay and have likely increased the need for institutional care. Acute Care for the Elderly models on medical wards have demonstrated decreased cost, length of hospital stay, readmissions and improved cognition, function and patient/staff satisfaction. We hypothesize that specific Elder-friendly Approaches to the Surgical Environment (EASE) interventions will similarly improve health outcomes in a cost-effective manner. Methods/design Prospective, before-after study with a concurrent control group. Four cohorts of 140 consecutively-screened older patients (≥65 years old) will be enrolled (560 patients in total). The EASE interventions involves co-locating all older surgical patients on a single unit, involving an interdisciplinary care team (including a geriatric specialist) in the development of individual care plans, implementing evidence-informed elder-friendly practices, use of a reconditioning program, and optimizing discharge planning. Subjects will be followed via chart review for their hospital stay, and will then complete in-person or telephone interviews at 6 weeks and 6 months after discharge. Measured outcomes include clinical (postoperative major in-hospital complication or death [primary composite outcome]; death or readmission within 30-days of initial discharge; length of hospital stay), humanistic (quality of life; functional, cognitive, and nutritional status) and economic (health care resource utilization and costs) endpoints. Within-site mean change scores will be computed for the composite primary outcome and the overall covariate-adjusted between-site pre-post difference will be the dependent variable analyzed using generalized linear mixed model procedures including adjustment for clustering. Discussion Our findings will generate new knowledge on outcomes from acute surgical care in older patients and validate a novel elder-friendly surgical model including assessment of both clinical and economic benefits. If effective, we expect the EASE initiatives to be generalizable to other surgical centres. Trial registration Clinicaltrials.govidentifier:NCT02233153
Collapse
Affiliation(s)
- Rachel G Khadaroo
- Department of Surgery, University of Alberta, Edmonton, AB, Canada. .,2D3.77 Walter C. Mackenzie Health Sciences Centre, 8440-112th Street, Edmonton, T6G 2B7, AB, Canada.
| | - Raj S Padwal
- Department of Medicine, University of Alberta, Edmonton, AB, Canada. .,Alberta Diabetes Institute, Edmonton, AB, Canada.
| | - Adrian S Wagg
- Department of Medicine, University of Alberta, Edmonton, AB, Canada. .,Alberta Seniors Health Strategic Clinical Network, Calgary, AB, Canada.
| | - Fiona Clement
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada.
| | | | - Jayna Holroyd-Leduc
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada. .,Alberta Seniors Health Strategic Clinical Network, Calgary, AB, Canada.
| |
Collapse
|
5
|
|
6
|
Aspiration Pneumonia in the Geriatric Population. CURRENT GERIATRICS REPORTS 2015. [DOI: 10.1007/s13670-015-0125-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
7
|
|
8
|
Charles EJ, Petroze RT, Metzger R, Hranjec T, Rosenberger LH, Riccio LM, McLeod MD, Guidry CA, Stukenborg GJ, Swenson BR, Willcutts KF, O'Donnell KB, Sawyer RG. Hypocaloric compared with eucaloric nutritional support and its effect on infection rates in a surgical intensive care unit: a randomized controlled trial. Am J Clin Nutr 2014; 100:1337-43. [PMID: 25332331 PMCID: PMC4196484 DOI: 10.3945/ajcn.114.088609] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Proper caloric intake goals in critically ill surgical patients are unclear. It is possible that overnutrition can lead to hyperglycemia and an increased risk of infection. OBJECTIVE This study was conducted to determine whether surgical infection outcomes in the intensive care unit (ICU) could be improved with the use of hypocaloric nutritional support. DESIGN Eighty-three critically ill patients were randomly allocated to receive either the standard calculated daily caloric requirement of 25-30 kcal · kg(-1) · d(-1) (eucaloric) or 50% of that value (hypocaloric) via enteral tube feeds or parenteral nutrition, with an equal protein allocation in each group (1.5 g · kg(-1) · d(-1)). RESULTS There were 82 infections in the hypocaloric group and 66 in the eucaloric group, with no significant difference in the mean (± SE) number of infections per patient (2.0 ± 0.6 and 1.6 ± 0.2, respectively; P = 0.50), percentage of patients acquiring infection [70.7% (29 of 41) and 76.2% (32 of 42), respectively; P = 0.57], mean ICU length of stay (16.7 ± 2.7 and 13.5 ± 1.1 d, respectively; P = 0.28), mean hospital length of stay (35.2 ± 4.9 and 31.0 ± 2.5 d, respectively; P = 0.45), mean 0600 glucose concentration (132 ± 2.9 and 135 ± 3.1 mg/dL, respectively; P = 0.63), or number of mortalities [3 (7.3%) and 4 (9.5%), respectively; P = 0.72]. Further analyses revealed no differences when analyzed by sex, admission diagnosis, site of infection, or causative organism. CONCLUSIONS Among critically ill surgical patients, caloric provision across a wide acceptable range does not appear to be associated with major outcomes, including infectious complications. The optimum target for caloric provision remains elusive.
Collapse
Affiliation(s)
- Eric J Charles
- From the Department of Surgery, University of Virginia Health System, Charlottesville, VA (EJC, RTP, RM, TH, LHR, LMR, MDM, CAG, BRS, KFW, KBO, and RGS), and the Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA (GJS)
| | - Robin T Petroze
- From the Department of Surgery, University of Virginia Health System, Charlottesville, VA (EJC, RTP, RM, TH, LHR, LMR, MDM, CAG, BRS, KFW, KBO, and RGS), and the Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA (GJS)
| | - Rosemarie Metzger
- From the Department of Surgery, University of Virginia Health System, Charlottesville, VA (EJC, RTP, RM, TH, LHR, LMR, MDM, CAG, BRS, KFW, KBO, and RGS), and the Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA (GJS)
| | - Tjasa Hranjec
- From the Department of Surgery, University of Virginia Health System, Charlottesville, VA (EJC, RTP, RM, TH, LHR, LMR, MDM, CAG, BRS, KFW, KBO, and RGS), and the Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA (GJS)
| | - Laura H Rosenberger
- From the Department of Surgery, University of Virginia Health System, Charlottesville, VA (EJC, RTP, RM, TH, LHR, LMR, MDM, CAG, BRS, KFW, KBO, and RGS), and the Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA (GJS)
| | - Lin M Riccio
- From the Department of Surgery, University of Virginia Health System, Charlottesville, VA (EJC, RTP, RM, TH, LHR, LMR, MDM, CAG, BRS, KFW, KBO, and RGS), and the Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA (GJS)
| | - Matthew D McLeod
- From the Department of Surgery, University of Virginia Health System, Charlottesville, VA (EJC, RTP, RM, TH, LHR, LMR, MDM, CAG, BRS, KFW, KBO, and RGS), and the Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA (GJS)
| | - Christopher A Guidry
- From the Department of Surgery, University of Virginia Health System, Charlottesville, VA (EJC, RTP, RM, TH, LHR, LMR, MDM, CAG, BRS, KFW, KBO, and RGS), and the Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA (GJS)
| | - George J Stukenborg
- From the Department of Surgery, University of Virginia Health System, Charlottesville, VA (EJC, RTP, RM, TH, LHR, LMR, MDM, CAG, BRS, KFW, KBO, and RGS), and the Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA (GJS)
| | - Brian R Swenson
- From the Department of Surgery, University of Virginia Health System, Charlottesville, VA (EJC, RTP, RM, TH, LHR, LMR, MDM, CAG, BRS, KFW, KBO, and RGS), and the Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA (GJS)
| | - Kate F Willcutts
- From the Department of Surgery, University of Virginia Health System, Charlottesville, VA (EJC, RTP, RM, TH, LHR, LMR, MDM, CAG, BRS, KFW, KBO, and RGS), and the Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA (GJS)
| | - Kelly B O'Donnell
- From the Department of Surgery, University of Virginia Health System, Charlottesville, VA (EJC, RTP, RM, TH, LHR, LMR, MDM, CAG, BRS, KFW, KBO, and RGS), and the Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA (GJS)
| | - Robert G Sawyer
- From the Department of Surgery, University of Virginia Health System, Charlottesville, VA (EJC, RTP, RM, TH, LHR, LMR, MDM, CAG, BRS, KFW, KBO, and RGS), and the Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA (GJS)
| |
Collapse
|
9
|
Papavasiliou E, Payne S, Brearley S. Current debates on end-of-life sedation: an international expert elicitation study. Support Care Cancer 2014; 22:2141-9. [DOI: 10.1007/s00520-014-2200-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 03/04/2014] [Indexed: 11/28/2022]
|
10
|
Collins PF, Elia M, Stratton RJ. Nutritional support and functional capacity in chronic obstructive pulmonary disease: A systematic review and meta-analysis. Respirology 2013; 18:616-29. [DOI: 10.1111/resp.12070] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 01/09/2013] [Accepted: 02/07/2013] [Indexed: 12/24/2022]
Affiliation(s)
| | - Marinos Elia
- Faculty of Medicine; Institute of Human Nutrition; Southampton General Hospital, University of Southampton; Southampton; UK
| | - Rebecca J. Stratton
- Faculty of Medicine; Institute of Human Nutrition; Southampton General Hospital, University of Southampton; Southampton; UK
| |
Collapse
|
11
|
Silva MA, Santos SDGFD, Tomasi CD, Luz GD, Paula MMDS, Pizzol FD, Ritter C. Enteral nutrition discontinuation and outcomes in general critically ill patients. Clinics (Sao Paulo) 2013; 68:173-8. [PMID: 23525312 PMCID: PMC3584265 DOI: 10.6061/clinics/2013(02)oa09] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 10/19/2012] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To determine the relationship between enteral nutrition discontinuation and outcome in general critically ill patients. MATERIALS AND METHODS All patients admitted to a mixed intensive care unit in a tertiary care hospital from May-August 2009 were screened for an indication for enteral nutrition. Patients were followed up until leaving the intensive care unit or a maximum of 28 days. The gastrointestinal failure score was calculated daily by adding values of 0 if the enteral nutrition received was identical to the nutrition prescribed, 1 if the enteral nutrition received was at least 75% of that prescribed, 2 if the enteral nutrition received was between 50-75% of that prescribed, 3 if the enteral nutrition received was between 50-25% of that prescribed, and 4 if the enteral nutrition received was less than 25% of that prescribed. RESULTS The mean, worst, and categorical gastrointestinal failure scores were associated with lower survival in these patients. Age, categorical gastrointestinal failure score, type of admission, need for mechanical ventilation, sequential organ failure assessment, and Acute Physiologic and Chronic Health Evaluation II scores were selected for analysis with binary regression. In both models, the categorical gastrointestinal failure score was related to mortality. CONCLUSION The determination of the difference between prescribed and received enteral nutrition seemed to be a useful prognostic marker and is feasible to be incorporated into a gastrointestinal failure score.
Collapse
Affiliation(s)
- Marco Antonio Silva
- Laboratório de Fisiopatologia Experimental, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma/SC, Brazil
| | | | | | | | | | | | | |
Collapse
|
12
|
Collins PF, Stratton RJ, Elia M. Nutritional support in chronic obstructive pulmonary disease: a systematic review and meta-analysis. Am J Clin Nutr 2012; 95:1385-95. [PMID: 22513295 DOI: 10.3945/ajcn.111.023499] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The efficacy of nutritional support in the management of malnutrition in chronic obstructive pulmonary disease (COPD) is controversial. Previous meta-analyses, based on only cross-sectional analysis at the end of intervention trials, found no evidence of improved outcomes. OBJECTIVE The objective was to conduct a meta-analysis of randomized controlled trials (RCTs) to clarify the efficacy of nutritional support in improving intake, anthropometric measures, and grip strength in stable COPD. DESIGN Literature databases were searched to identify RCTs comparing nutritional support with controls in stable COPD. RESULTS Thirteen RCTs (n = 439) of nutritional support [dietary advice (1 RCT), oral nutritional supplements (ONS; 11 RCTs), and enteral tube feeding (1 RCT)] with a control comparison were identified. An analysis of the changes induced by nutritional support and those obtained only at the end of the intervention showed significantly greater increases in mean total protein and energy intakes with nutritional support of 14.8 g and 236 kcal daily. Meta-analyses also showed greater mean (±SE) improvements in favor of nutritional support for body weight (1.94 ± 0.26 kg, P < 0.001; 11 studies, n = 308) and grip strength (5.3%, P < 0.050; 4 studies, n = 156), which was not shown by ANOVA at the end of the intervention, largely because of bias associated with baseline imbalance between groups. CONCLUSION This systematic review and meta-analysis showed that nutritional support, mainly in the form of ONS, improves total intake, anthropometric measures, and grip strength in COPD. These results contrast with the results of previous analyses that were based on only cross-sectional measures at the end of intervention trials.
Collapse
Affiliation(s)
- Peter F Collins
- Institute of Human Nutrition, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | | | | |
Collapse
|
13
|
del Río M, Shand B, Bonati P, Palma A, Maldonado A, Taboada P, Nervi F. Hydration and nutrition at the end of life: a systematic review of emotional impact, perceptions, and decision-making among patients, family, and health care staff. Psychooncology 2011; 21:913-21. [DOI: 10.1002/pon.2099] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 10/13/2011] [Accepted: 10/15/2011] [Indexed: 11/10/2022]
Affiliation(s)
- M. I. del Río
- Programa de Medicina Paliativa y Cuidados Continuos; Departamento de Medicina Interna, Pontificia Universidad Católica de Chile; Santiago Chile
| | - B. Shand
- Departamento de Neurología; Pontificia Universidad Católica de Chile; Santiago Chile
| | - P. Bonati
- Programa de Medicina Paliativa y Cuidados Continuos; Departamento de Medicina Interna, Pontificia Universidad Católica de Chile; Santiago Chile
| | - A. Palma
- Programa de Medicina Paliativa y Cuidados Continuos; Departamento de Medicina Interna, Pontificia Universidad Católica de Chile; Santiago Chile
| | - A. Maldonado
- Programa de Medicina Paliativa y Cuidados Continuos; Departamento de Medicina Interna, Pontificia Universidad Católica de Chile; Santiago Chile
| | - P. Taboada
- Centro de Bioética; Pontificia Universidad Católica de Chile; Santiago Chile
| | - F. Nervi
- Programa de Medicina Paliativa y Cuidados Continuos; Departamento de Medicina Interna, Pontificia Universidad Católica de Chile; Santiago Chile
- División de Medicina, Departamento de Gastroenterología; Pontificia Universidad Católica de Chile; Santiago Chile
| |
Collapse
|
14
|
Anker S, Laviano A, Filippatos G, John M, Paccagnella A, Ponikowski P, Schols A. ESPEN Guidelines on Parenteral Nutrition: On Cardiology and Pneumology. Clin Nutr 2009; 28:455-60. [DOI: 10.1016/j.clnu.2009.04.023] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2009] [Accepted: 04/29/2009] [Indexed: 12/26/2022]
|
15
|
Milne AC, Potter J, Vivanti A, Avenell A. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev 2009; 2009:CD003288. [PMID: 19370584 PMCID: PMC7144819 DOI: 10.1002/14651858.cd003288.pub3] [Citation(s) in RCA: 264] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Evidence for the effectiveness of nutritional supplements containing protein and energy, often prescribed for older people, is limited. Malnutrition is more common in this age group and deterioration of nutritional status can occur during illness. It is important to establish whether supplementing the diet is an effective way of improving outcomes for older people at risk from malnutrition. OBJECTIVES This review examined trials for improvement in nutritional status and clinical outcomes when extra protein and energy were provided, usually as commercial 'sip-feeds'. SEARCH STRATEGY We searched The Cochrane Library, MEDLINE, EMBASE, Healthstar, CINAHL, BIOSIS, CAB abstracts. We also hand searched nutrition journals and reference lists and contacted 'sip-feed' manufacturers. SELECTION CRITERIA Randomised and quasi-randomised controlled trials of oral protein and energy supplementation in older people, with the exception of groups recovering from cancer treatment or in critical care. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed trials prior to inclusion and independently extracted data and assessed trial quality. Authors of trials were contacted for further information as necessary. MAIN RESULTS Sixty-two trials with 10,187 randomised participants have been included in the review. Maximum duration of intervention was 18 months. Most included trials had poor study quality. The pooled weighted mean difference (WMD) for percentage weight change showed a benefit of supplementation of 2.2% (95% confidence interval (CI) 1.8 to 2.5) from 42 trials. There was no significant reduction in mortality in the supplemented compared with control groups (relative risk (RR) 0.92, CI 0.81 to 1.04) from 42 trials. Mortality results were statistically significant when limited to trials in which participants (N = 2461) were defined as undernourished (RR 0.79, 95% CI 0.64 to 0.97).The risk of complications was reduced in 24 trials (RR 0.86, 95% CI 0.75 to 0.99). Few trials were able to suggest any functional benefit from supplementation. The WMD for length of stay from 12 trials also showed no statistically significant effect (-0.8 days, 95% CI -2.8 to 1.3). Adverse effects included nausea or diarrhoea. AUTHORS' CONCLUSIONS Supplementation produces a small but consistent weight gain in older people. Mortality may be reduced in older people who are undernourished. There may also be a beneficial effect on complications which needs to be confirmed. However, this updated review found no evidence of improvement in functional benefit or reduction in length of hospital stay with supplements. Additional data from large-scale multi-centre trials are still required.
Collapse
Affiliation(s)
- Anne C Milne
- Stonelea, Prospect Terrace, Port Elphinstone, InverurieAberdeenAberdeenshire, ScotlandUKAB51 3UN
| | - Jan Potter
- South East Sydney and Illawarra Area Health ServiceAged Care Southern Hospital NetworkLMB 8808South Coast Mail Centre WollongongNew South WalesAustralia2521
| | - Angela Vivanti
- Princess Alexandra HospitalDepartment of Nutrition and DieteticsIpswich RoadWoolloongabbaQueenslandAustralia4103
| | - Alison Avenell
- University of AberdeenHealth Services Research UnitForesterhillAberdeenUKAB25 2ZD
| | | |
Collapse
|
16
|
Servia L, Schoenenberger JA, Trujillano J, Badia M, Rodríguez-Pozo A. [Risk factors of the hepatic dysfunction associated with parenteral nutrition]. Med Clin (Barc) 2009; 132:123-7. [PMID: 19211070 DOI: 10.1016/j.medcli.2008.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Accepted: 02/13/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVE The objective of this study is to describe the incidence of hepatic dysfunction (HD) in our hospital and evaluate the possible risk factors associated with HD development as an improvement of the caring process received by patients treated with parenteral nutrition (PN). PATIENTS AND METHOD A prospective study of patients (n=994) who required PN during the period 2000-2004. HD is the identification of an increase above 1,5 of the top reference value of alkaline phosphatase (40-450U/l) and gamma glutamyl transpeptidase (11-49U/l) associated with an increase of transaminases (5-32U/l) and a total bilirrubin higher than 1,2mg/dl. RESULTS The incidence of HD was 4,9% (n=49). Days with PN were significantly higher in the HD group: median (interquartile range): 30 (20-59) vs 15 (8-25) days (p<0.001). In the univariated HD analysis, the variables that reached significant odds ratio were: the critical patient condition, the PN duration, the total calorie contribution higher than 25kcal/kg, to exceed 3g of carbohydrates/kg, to administer more than 0.8g/kg of lipids and to exceed 0.16g of nitrogen/kg. In the multivariated analysis, the variables selected as independent risk factors were: to exceed 3 weeks of PN, to be a critical patient and a contribution over 0.16g of nitrogen/kg. CONCLUSIONS The present profiles of the patients who will develop HD are those with prolonged PN. These patients undergo processes and critical therapy, where the specialists must monitor, not only calorie contribution, carbohydrates or lipids, but proteins as well.
Collapse
Affiliation(s)
- Luis Servia
- Servicio de Medicina Intensiva, Hospital Universitario Arnau de Vilanova, Lleida, España.
| | | | | | | | | |
Collapse
|
17
|
Dissanaike S, Shelton M, Warner K, O'Keefe GE. The risk for bloodstream infections is associated with increased parenteral caloric intake in patients receiving parenteral nutrition. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 11:R114. [PMID: 17958913 PMCID: PMC2556767 DOI: 10.1186/cc6167] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2007] [Revised: 09/06/2007] [Accepted: 10/24/2007] [Indexed: 01/04/2023]
Abstract
Background Patients receiving total parenteral nutrition (TPN) are at high risk for bloodstream infections (BSI). The notion that intravenous calories and glucose lead to hyperglycemia, which in turn contributes to BSI risk, is widely held but is unproven. We therefore sought to determine the role that hyperglycemia and parenteral calories play in the development of BSI in hospitalized patients receiving TPN. Methods Two hundred consecutive patients initiated on TPN between June 2004 and August 2005 were prospectively studied. Information was collected on patient age, sex, admission diagnosis, baseline laboratory values, intensive care unit (ICU) status and indication for TPN. Patients in the ICU were managed with strict glycemic control, whereas control on the general ward was more liberal. The maximum blood glucose level over each 8-hour period was recorded, as were parenteral daily intake, enteral daily intake and total daily caloric intake. The primary outcome measure was the incidence of BSI. Additional endpoints were ICU length of stay, hospital length of stay and mortality. Results A total of 78 patients (39%) developed at least one BSI, which were more common in ICU patients than in other hospitalized patients (60/122 patients versus 18/78 patients; P < 0.001). Maximum daily blood glucose concentrations were similar in patients with BSI and in patients without BSI (197 mg/dl versus 196 mg/dl, respectively). Patients with BSI received more calories parenterally than patients without BSI (36 kcal/kg/day versus 31 kcal/kg/day, P = 0.003). Increased maximum parenteral calories, increased average parenteral calories, and treatment in the ICU were strong risk factors for developing BSI. There was no difference in mortality between patients with and without BSI. Conclusion Increased parenteral caloric intake is an independent risk factor for BSI in patients receiving TPN. This association appears unrelated to hyperglycemia. Based upon our observations, we suggest that parenteral caloric intake be prescribed and adjusted judiciously with care taken to account for all intravenous caloric sources and to avoid even short periods of increased intake.
Collapse
|
18
|
Hise ME, Halterman K, Gajewski BJ, Parkhurst M, Moncure M, Brown JC. Feeding Practices of Severely Ill Intensive Care Unit Patients: An Evaluation of Energy Sources and Clinical Outcomes. ACTA ACUST UNITED AC 2007; 107:458-65. [PMID: 17324665 DOI: 10.1016/j.jada.2006.12.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2006] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The quantity of nutrition that is provided to intensive care unit (ICU) patients has recently come under more scrutiny in relation to clinical outcomes. The primary objective of this study was to assess energy intake in severely ill ICU patients and to evaluate the relationship of energy intake with clinical outcomes. DESIGN Prospective cohort study. SUBJECTS/SETTINGS Seventy-seven adult surgery and medical ICU patients with length of ICU stay of at least 5 days. STATISTICAL ANALYSES PERFORMED Student's t test and chi2 tests were used to examine ICU populations. To determine the relationship of patient variables to hospital length of stay and ICU, length of stay regression trees were calculated. RESULTS Both groups were underfed with 50% of goal met in surgical ICU and 56% of goal met in medical ICU. Medical ICU patients received less propofol and significantly less dextrose-containing intravenous fluids when compared to surgical ICU patients (P=0.013). From regression analysis, approaching full nutrient requirements during ICU stay was associated with greater hospital length of stay and ICU length of stay. For combined groups, if % goal was > or =82%, the estimated average value for ICU length of stay was 24 days; whereas, if the % goal was <82%, the average ICU length of stay was 12 days. This relationship held true for hospital length of stay. CONCLUSIONS Medical and surgical ICU patients were insufficiently fed during their ICU stay when compared with registered dietitian recommendations. Medical ICU patients received earlier nutrition support, on average more enteral nutrition, with fewer kilocalories supplied from lipid-based sedatives and intravenous fluid relative to surgical ICU patients. Based upon length of stay, the data suggest that the most severely ill patient may not benefit from delivery of full nutrient needs in the ICU.
Collapse
Affiliation(s)
- Mary E Hise
- The University of Kansas Medical Center, Department of Dietetics and Nutrition, Kansas City, KS 66160-7250, USA.
| | | | | | | | | | | |
Collapse
|
19
|
Grau T, Bonet A, Rubio M, Mateo D, Farré M, Acosta JA, Blesa A, Montejo JC, de Lorenzo AG, Mesejo A. Liver dysfunction associated with artificial nutrition in critically ill patients. Crit Care 2007; 11:R10. [PMID: 17254321 PMCID: PMC2147066 DOI: 10.1186/cc5670] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Revised: 11/30/2006] [Accepted: 01/25/2007] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Liver dysfunction associated with artificial nutrition in critically ill patients is a complication that seems to be frequent, but it has not been assessed previously in a large cohort of critically ill patients. METHODS We conducted a prospective cohort study of incidence in 40 intensive care units. Different liver dysfunction patterns were defined: (a) cholestasis: alkaline phosphatase of more than 280 IU/l, gamma-glutamyl-transferase of more than 50 IU/l, or bilirubin of more than 1.2 mg/dl; (b) liver necrosis: aspartate aminotransferase of more than 40 IU/l or alanine aminotransferase of more than 42 IU/l, plus bilirubin of more than 1.2 mg/dl or international normalized ratio of more than 1.4; and (c) mixed pattern: alkaline phosphatase of more than 280 IU/l or gamma-glutamyl-transferase of more than 50 IU/l, plus aspartate aminotransferase of more than 40 IU/l or alanine aminotransferase of more than 42 IU/l. RESULTS Seven hundred and twenty-five of 3,409 patients received artificial nutrition: 303 received total parenteral nutrition (TPN) and 422 received enteral nutrition (EN). Twenty-three percent of patients developed liver dysfunction: 30% in the TPN group and 18% in the EN group. The univariate analysis showed an association between liver dysfunction and TPN (p < 0.001), Multiple Organ Dysfunction Score on admission (p < 0.001), sepsis (p < 0.001), early use of artificial nutrition (p < 0.03), and malnutrition (p < 0.01). In the multivariate analysis, liver dysfunction was associated with TPN (p < 0.001), sepsis (p < 0.02), early use of artificial nutrition (p < 0.03), and calculated energy requirements of more than 25 kcal/kg per day (p < 0.05). CONCLUSION TPN, sepsis, and excessive calculated energy requirements appear as risk factors for developing liver dysfunction. Septic critically ill patients should not be fed with excessive caloric amounts, particularly when TPN is employed. Administering artificial nutrition in the first 24 hours after admission seems to have a protective effect.
Collapse
Affiliation(s)
- Teodoro Grau
- Intensive Care Unit, Hospital Severo Ochoa. Av. Orellana s/n, 28911 Leganés, Madrid, Spain
| | - Alfonso Bonet
- Intensive Care Unit, Hospital Josep Trueta. Av. de Francia s/n, 17007 Girona, Spain
| | - Mercedes Rubio
- Cardiovascular Intensive Care Unit, Hospital Universitario 12 de Octubre. Av. de Córdoba s/n, 28041 Madrid, Spain
| | - Dolores Mateo
- Intensive Care Unit, Newham University Hospital NHS Trust. Glen Road, Plaistow London E13 8SL, UK
| | - Mercé Farré
- Intensive Care Unit, Hospital Universitari Vall d'Hebró. Paseo Vall d'Hebró 119-129, 08035 Barcelona, Spain
| | - José Antonio Acosta
- Intensive Care Unit, General de Alicante. Maestro Alonso 109, 03010 Alicante, Spain
| | - Antonio Blesa
- Intensive Care Unit, Hospital Clínico San Carlos. Profesor Martin Lagos s/n, 28040 Madrid, Spain
| | - Juan Carlos Montejo
- Intensive Care Unit, Hospital Universitario Doce de Octubre.Av. de Córdoba s/n, 28041 Madrid, Spain
| | | | - Alfonso Mesejo
- Intensive Care Unit, Hospital Universitario La Fe. Av. Campanar 21, 46009 Valencia, Spain
| | | |
Collapse
|
20
|
|
21
|
Higgins PA, Daly BJ, Lipson AR, Guo SE. Assessing Nutritional Status in Chronically Critically Ill Adult Patients. Am J Crit Care 2006. [DOI: 10.4037/ajcc2006.15.2.166] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
• Background Numerous methods are used to measure and assess nutritional status of chronically critically ill patients.• Objectives To discuss the multiple methods used to assess nutritional status in chronically critically ill patients, describe the nutritional status of chronically critically ill patients, and assess the relationship between nutritional indicators and outcomes of mechanical ventilation.• Methods A descriptive, longitudinal design was used to collect weekly data on 360 adult patients who required more than 72 hours of mechanical ventilation and had a hospital stay of 7 days or more. Data on body mass index and biochemical markers of nutritional status were collected. Patients’ nutritional intake compared with physicians’ orders, dieticians’ recommendations, and indirect calorimetry and physicians’ orders compared with dieticians’ recommendations were used to assess nutritional status. Relationships between nutritional indicators and variables of mechanical ventilation were determined.• ResultsInconsistencies among nurses’ implementation, physicians’ orders, and dieticians’ recommendations resulted in wide variations in patients’ calculated nutritional adequacy. Patients received a mean of 83% of the energy intake ordered by their physicians (SD 33%, range 0%–200%). Patients who required partial or total ventilator support upon discharge had a lower body mass index at admission than did patients with spontaneous respirations (Mann-Whitney U = 8441, P = .001).• Conclusions In this sample, the variability in weaning progression and outcomes most likely reflects illness severity and complexity rather than nutritional status or nutritional therapies. Further studies are needed to determine the best methods to define nutritional adequacy and to evaluate nutritional status.
Collapse
Affiliation(s)
- Patricia A. Higgins
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio (SEG is now with School of Occupational and Environmental Hygiene, University of British Columbia, Vancouver, British Columbia, Canada)
| | - Barbara J. Daly
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio (SEG is now with School of Occupational and Environmental Hygiene, University of British Columbia, Vancouver, British Columbia, Canada)
| | - Amy R. Lipson
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio (SEG is now with School of Occupational and Environmental Hygiene, University of British Columbia, Vancouver, British Columbia, Canada)
| | - Su-Er Guo
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio (SEG is now with School of Occupational and Environmental Hygiene, University of British Columbia, Vancouver, British Columbia, Canada)
| |
Collapse
|
22
|
Hallenbeck J. Reevaluating PEG tube placement in advanced illness. Gastrointest Endosc 2005; 62:960-2. [PMID: 16301044 DOI: 10.1016/j.gie.2005.06.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Accepted: 06/29/2005] [Indexed: 02/08/2023]
|
23
|
Mallampalli A. Nutritional management of the patient with chronic obstructive pulmonary disease. Nutr Clin Pract 2005; 19:550-6. [PMID: 16215153 DOI: 10.1177/0115426504019006550] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The prevalence and prognostic importance of malnutrition in chronic obstructive pulmonary disease (COPD), the factors that contribute to development of nutritional depletion, and the available evidence regarding effects of nutrition support in these patients are the subjects of this review. Nutritional depletion, as indicated by weight loss and loss of lean body mass, is a common complication of advanced COPD (particularly, but not limited to, the emphysematous type). Low body weight or recent weight loss and in particular depleted lean body mass in patients with COPD have been shown to be independent predictors of mortality, outcomes after acute exacerbations, hospital admission rates, and need for mechanical ventilation. The factors thought to contribute to nutritional depletion in these patients include elevated resting and activity-related energy expenditure, reduced dietary intake relative to resting energy expenditure, accelerated negative nitrogen balance, particularly during acute exacerbations of COPD, medication effects, and perhaps most importantly an elevated systemic inflammatory response. Studies to date suggest that, although it can help limit weight loss and negative energy balance in these patients, the effect of nutritional supplementation alone on clinically significant outcomes such as pulmonary function and exercise capacity is minimal. However, nutritional supplementation may have a role in the management of COPD when provided as part of an integrated rehabilitation program incorporating a structured exercise component as an anabolic stimulus.
Collapse
Affiliation(s)
- Antara Mallampalli
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
| |
Collapse
|
24
|
Campillo B, Richardet JP, Bories PN. Enteral nutrition in severely malnourished and anorectic cirrhotic patients in clinical practice. ACTA ACUST UNITED AC 2005; 29:645-51. [PMID: 16141996 DOI: 10.1016/s0399-8320(05)82150-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To determine among severely malnourished cirrhotic patients remaining anorectic during hospital stay which patients may benefit from enteral nutrition in clinical practice. METHODS A prospective study including malnourished cirrhotic patients fed by enteral nutrition because of inadequate dietary intake after one-month hospitalization was carried out in a department receiving patients from other hospitals. Patients who died during hospital stay (N=35, group I) were compared to surviving patients (N=28, group II). RESULTS Nutritional status and spontaneous dietary intake on admission to our department were in the same range in the two groups, Pugh score was higher in group I (11.1 +/- 1.9 vs 9.1 +/- 2.0, P=0.0001). The delay between previous hospital admission and the outset of enteral nutrition was comparable in the two groups. Its duration and total dietary intake during enteral nutrition were higher in group II (respectively 42.2 +/- 30.9 vs 15.2 +/- 33.1 days, P=0.0016 and 41.1 +/- 13.0 vs 29.9 +/- 10.0 kcal/kg/d, P=0.0004). Prevalence of side effects was higher in group I (54.3 vs 17.9%, P=0.0031). Multivariate analysis showed that Pugh score and septic complications were negatively associated with survival (respectively P=0.0196 and P=0.0078) while duration of enteral nutrition was positively associated (P=0.0435). Eighty six per cent of patients receiving enteral nutrition with bilirubin levels above 74 micromol/L on admission to our department died during hospital stay. Mid-term effects of enteral nutrition in surviving patients were improvement in Pugh score (7.5 +/- 2.0 vs 9.1 +/- 2.0, P<0.0001) and increase in spontaneous caloric and protein intake (29.7 +/- 15.3 vs 18.1 +/- 10.1 kcal/kg/d, P=0.0150 and 1.0 +/- 0.5 vs 0.6 +/- 0.3 g/kg/d, P=0.0049). CONCLUSIONS In severely malnourished cirrhotic patients remaining anorectic after one-month hospitalization, patients with bilirubin level below 74 micromol/L may benefit from six-week enteral nutrition with mid-term improvement in liver function and increase in spontaneous dietary intake.
Collapse
Affiliation(s)
- Bernard Campillo
- Service de Rééducation Digestive, Hôpital Albert Chenevier, Paris, France.
| | | | | |
Collapse
|
25
|
Milne AC, Potter J, Avenell A. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev 2005:CD003288. [PMID: 15846655 DOI: 10.1002/14651858.cd003288.pub2] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Evidence for the effectiveness of nutritional supplements containing protein and energy, which are often prescribed for older people, is limited. Furthermore malnutrition is more common in this age group and deterioration of nutritional status can occur during illness. It is important to establish whether supplementing the diet is an effective way of improving outcomes for older people at risk from malnutrition. OBJECTIVES This review examined the evidence from trials for improvement in nutritional status and clinical outcomes when extra protein and energy were provided, usually in the form of commercial 'sip-feeds'. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Healthstar, CINAHL, BIOSIS, CAB abstracts. We also hand searched nutrition journals and reference lists and contacted 'sip-feed' manufacturers. Date of most recent search: March 2004. SELECTION CRITERIA Randomised controlled trials and quasi-randomised controlled trials of oral protein and energy supplementation in older people with the exception of groups recovering from cancer treatment or in critical care. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed trials prior to inclusion and independently extracted data and assessed trial quality. Authors of trials were contacted for further information as necessary. MAIN RESULTS Forty-nine trials with 4790 randomised participants have been included in the review. Most included trials had poor study quality. The pooled weighted mean difference [WMD] for percentage weight change showed a benefit of supplementation of 2.3% (95% confidence interval (CI) 1.9 to 2.7) from 34 trials. There was a reduced mortality in the supplemented compared with control groups (relative risk (RR) 0.74, CI 0.59 to 0.92) from 32 trials. The risk of complications from 14 trials showed no significant difference (RR 0.95, 95% CI 0.81 to 1.11). Few trials were able to suggest any functional benefit from supplementation. The pooled weighted mean difference (WMD) for length of stay from 10 trials also showed no statistically significant effect (WMD -1.98 days, 95% CI -5.20 to 1.24). AUTHORS' CONCLUSIONS Supplementation produces a small but consistent weight gain in older people. There may also be a beneficial effect on mortality. However, there was no evidence of improvement in clinical outcome, functional benefit or reduction in length of hospital stay with supplements. Additional data from large-scale multi-centre trials are still required.
Collapse
Affiliation(s)
- A C Milne
- Health Services Research Unit (Foresterhill Lea), University of Aberdeen, Foresterhill, Aberdeen, Aberdeenshire, Scotland, UK, AB25 2ZD.
| | | | | |
Collapse
|
26
|
|
27
|
Krishnan JA, Parce PB, Martinez A, Diette GB, Brower RG. Caloric intake in medical ICU patients: consistency of care with guidelines and relationship to clinical outcomes. Chest 2003; 124:297-305. [PMID: 12853537 DOI: 10.1378/chest.124.1.297] [Citation(s) in RCA: 324] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To assess the consistency of caloric intake with American College of Chest Physicians (ACCP) recommendations for critically ill patients and to evaluate the relationship of caloric intake with clinical outcomes. DESIGN Prospective cohort study. SETTING Adult ICUs at two teaching hospitals. PARTICIPANTS Patients with an ICU length of stay of at least 96 h. MEASUREMENTS AND RESULTS On ICU admission, severity of illness (ie, simplified acute physiology score II) and markers of nutritional status (ie, serum albumin level and body mass index) were recorded. The route of feeding (ie, enteral or parenteral), actual caloric intake (ie, percentage of ACCP recommendations: 0 to 32% [tertile I]; 33 to 65% [tertile II]; >/==" BORDER="0"> 66% [tertile III]), and evidence of GI intolerance (ie, gastric aspirate levels, >/==" BORDER="0"> 100 mL) were recorded daily. The following outcomes were assessed: status on hospital discharge (alive vs dead); spontaneous ventilation before ICU discharge (yes vs no); and ICU discharge without developing nosocomial sepsis (yes vs no). The average caloric intake among 187 participants was 50.6% of the ACCP targets and was similar in both hospitals. Caloric intake was inversely related to the mean number of gastric aspirates >/==" BORDER="0"> 100 mL/d (Spearman rho = -0.04; p = 0.06), but not to severity of illness, nutritional status, or route of feeding. After accounting for the number of gastric aspirates >/==" BORDER="0"> 100 mL, severity of illness, nutritional status, and route of feeding, tertile II of caloric intake (vs tertile I) was associated with a significantly greater likelihood of achieving spontaneous ventilation prior to ICU discharge. Tertile III of caloric intake (vs tertile I) was associated with a significantly lower likelihood of both hospital discharge alive and spontaneous ventilation prior to ICU discharge. CONCLUSIONS Study participants were underfed relative to ACCP targets. These targets, however, may overestimate needs, since moderate caloric intake (ie, 33 to 65% of ACCP targets; approximately 9 to 18 kcal/kg per day) was associated with better outcomes than higher levels of caloric intake.
Collapse
Affiliation(s)
- Jerry A Krishnan
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | | | | | | | | |
Collapse
|
28
|
Campillo B, Richardet JP, Scherman E, Bories PN. Evaluation of nutritional practice in hospitalized cirrhotic patients: results of a prospective study. Nutrition 2003; 19:515-21. [PMID: 12781851 DOI: 10.1016/s0899-9007(02)01071-7] [Citation(s) in RCA: 128] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE We evaluated the impact of malnutrition and nutrition practice in 396 hospitalized cirrhotic patients (Child stages A, B, and C: 60, 169, and 167 patients) in a readaptative unit for liver diseases. METHODS Triceps skinfold thickness and mid-arm muscle circumference were measured at admission, and spontaneous dietary intake was evaluated at admission and during hospital stay. RESULTS Ascites was associated with impairment of nutrition status: 49% and 30.4% of non-ascitic patients, 49.1% and 40.5% of patients with mild ascites, and 65.5% and 48.3% of patients with tense ascites had mid-arm muscle circumferences and triceps skinfold thicknesses, respectively, below the fifth percentile of a reference population (P < 0.05 and P = 0.02, respectively). Decrease in dietary intake paralleled worsening of liver failure: 48% and 34% of Child A patients, 51.7% and 35.8% of Child B patients, and 80.3% and 62.9% of Child C patients at admission had caloric intakes below 30 kcal/kg of body weight and protein intakes below 1 g/kg of body weight, respectively (P < 0.001). Mortality rate was 15.4% during hospital stay; Child-Pugh score (P = 0.0014), age (P = 0.0029), severe septic complications (P = 0.0050), and decrease in caloric intake during hospital stay (P = 0.0072) were independently associated with mortality. Twenty-four patients received enteral feeding that was initiated before admission in four patients and after 12.4 +/- 8.3 d of hospitalization in 20 patients because of low caloric intake (<25 kcal/kg) despite oral supplements. Patients receiving enteral feeding were older (P < 0.01), had a higher Child-Pugh score (P < 0.01), and a higher mortality rate (P < 0.001) than other patients. CONCLUSIONS Hospitalized cirrhotic patients have a high prevalence rate of malnutrition, and most do not satisfy their nutritional requirements. Decrease in caloric intake is an independent risk factor of short-term mortality. Enteral nutrition after failure of oral supplementation has no clinical benefit. Tube feeding may be indicated earlier in the course of the disease.
Collapse
Affiliation(s)
- Bernard Campillo
- Service de Rééducation Digestive, Hôpital Albert Chenevier, Assistance Publique-Hôpitaux de Paris, 40 rue de Mesly, 94010 Créteil, France.
| | | | | | | |
Collapse
|
29
|
|
30
|
Affiliation(s)
- Mary Jo Atten
- Department of Internal Medicine, Cook County Hospital, Chicago, Illinois, USA
| | | | | | | | | |
Collapse
|
31
|
Maki DG. Conclusions: drotrecogin alfa (activated)--from bench to practical use at the bedside. Am J Surg 2002; 184:S47-50. [PMID: 12521617 DOI: 10.1016/s0002-9610(02)01136-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Dennis G Maki
- University of Wisconsin Hospital and Clinics, 600 Highland Avenue, H4/572, Madison, WI 53792, USA.
| |
Collapse
|
32
|
Abstract
Patients with chronic obstructive pulmonary disease (COPD) demonstrate classic signs of undernutrition. A low body mass, weight lose, and decrease in lean body mass have been associated with impaired functional status and poor outcome. The nutritional deficiencies accompanying COPD have been refractory to strategies aimed at increasing calorie intake, indicating that the underlying pathophysiology is not a simple nutritional defect amenable to correction. The association of cytokine-induced inflammatory markers in COPD patients suggests that interventions aimed at controlling cytokine production may be required to reverse the cachexia syndrome and improve functional status.
Collapse
Affiliation(s)
- David R Thomas
- Division of Geriatric Medicine, Saint Louis Health Sciences Center, Saint Louis University, 1402 South Grand Boulevard M238, Saint Louis, MO 63104, USA.
| |
Collapse
|
33
|
Somogyi-Zalud E, Zhong Z, Hamel MB, Lynn J. The use of life-sustaining treatments in hospitalized persons aged 80 and older. J Am Geriatr Soc 2002; 50:930-4. [PMID: 12028183 DOI: 10.1046/j.1532-5415.2002.50222.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To characterize the use of life-sustaining treatments in hospitalized patients aged 80 and older. DESIGN A prospective cohort study. SETTING Four teaching hospitals in the United States that participated in the Hospitalized Elderly Longitudinal Project (HELP). PARTICIPANTS Hospitalized patients aged 80 and older. MEASUREMENTS We report the rates of admissions to intensive and coronary care units and the rates of use of cardiopulmonary resuscitation (CPR), ventilators, right heart catheterization, artificial nutrition and hydration, surgical interventions, hemodialysis, and blood transfusions. RESULTS Of the 1,266 patients enrolled in HELP, 72 died during the enrollment hospitalization. The median age of those who died was 86 (range 83-89). Of the patients who died, the median number of activities of daily living impairments was two (range 1-4) before hospitalization, and 70% reported their baseline quality of life as fair or poor. Most patients who died had stated that they did not want aggressive care; 70% wanted their care focused on comfort rather than prolonging life, and 80% had a do-not-resuscitate order. However, the majority (63%) of the patients received one or more life-sustaining treatments before they died. Fifty-four percent were admitted to intensive or coronary care units, 43% were on a ventilator, 18% received CPR, 18% received tube feeding, 17% underwent surgery, 15% had right heart catheterization, 14% received blood transfusions, and 6% had hemodialysis. Intensive care did not affect survival time. CONCLUSION The use of life-sustaining treatments was prevalent in very old patients who died in the course of hospitalization, despite the fact that the majority had a preference for comfort care. This lack of congruence warrants further investigation and efforts to provide care that is more consistent with patients' preferences.
Collapse
Affiliation(s)
- Emese Somogyi-Zalud
- Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817, USA.
| | | | | | | |
Collapse
|
34
|
Amodio P, Caregaro L, Pattenò E, Marcon M, Del Piccolo F, Gatta A. Vegetarian diets in hepatic encephalopathy: facts or fantasies? Dig Liver Dis 2001; 33:492-500. [PMID: 11572577 DOI: 10.1016/s1590-8658(01)80028-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Diet treatment characterized by a reduction in or a selection of food proteins is currently suggested in hepatic encephalopathy. This article is a review of the present knowledge about the characteristics and the rationale of vegetarian diets in cirrhotic patients with overt or latent encephalopathy. In addition, evidence relating diet and encephalopathy and the nutritional features and needs of cirrhotic patients is reported. Finally, the rationale of a diet based on vegetable and milk-derived proteins that may overcome the limits and the possible adverse effects of a strict vegetarian diet is presented.
Collapse
Affiliation(s)
- P Amodio
- Dept Medicine V, Clinical Nutrition, University of Padua, Italy.
| | | | | | | | | | | |
Collapse
|
35
|
|