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Rahman A, Agarwala R, Martin C, Nagpal D, Teitelbaum M, Heyland DK. Nutrition Therapy in Critically Ill Patients Following Cardiac Surgery: Defining and Improving Practice. JPEN J Parenter Enteral Nutr 2016; 41:1188-1194. [DOI: 10.1177/0148607116661839] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Adam Rahman
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
- Gastroenterology, St Joseph’s Healthcare Centre/London Health Sciences Centre, London, Ontario, Canada
| | - Ravi Agarwala
- Critical Care Medicine, Department of Anesthesia, Wake Forest University Medical Center, Winston-Salem, North Carolina, USA
| | - Claudio Martin
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
- Critical Care/Trauma Centre, London Health Sciences Centre, Victoria Campus, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Dave Nagpal
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Michael Teitelbaum
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Daren K. Heyland
- Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada
- Department of Community Health and Epidemiology, Queen’s University, Kingston, Ontario, Canada
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
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Rahman A, Wu T, Bricknell R, Muqtadir Z, Armstrong D. Malnutrition Matters in Canadian Hospitalized Patients. Nutr Clin Pract 2015; 30:709-13. [DOI: 10.1177/0884533615598954] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Adam Rahman
- Department of Medicine, Division of Gastroenterology, Western University, London, Canada
| | - Thomas Wu
- Department of Medicine, Division of Gastroenterology, Western University, London, Canada
| | - Ryan Bricknell
- Department of Medicine, Division of Gastroenterology, Western University, London, Canada
| | - Zack Muqtadir
- Department of Medicine, Division of Gastroenterology, McMaster University, Hamilton, Canada
| | - David Armstrong
- Department of Medicine, Division of Gastroenterology, McMaster University, Hamilton, Canada
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Rahman A, Martin C, Heyland DK. Nutrition therapy for the critically ill surgical patient with aortic aneurysmal rupture: defining and improving current practice. JPEN J Parenter Enteral Nutr 2013; 39:104-13. [PMID: 23976774 DOI: 10.1177/0148607113501695] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Our goal is to define nutrition therapy in critically ill patients after surgical repair of acute ruptured or dissecting aortic aneurysm to identify opportunities for quality improvement. METHODS International, prospective studies in 2007-2009 and 2011 were combined. Sites provided institutional and patient characteristics including from intensive care units (ICUs) admission to ICU discharge for a maximum of 12 days. We selected patients with aortic aneurysmal rupture or acute dissection staying in the ICU for ≥ 3 days. RESULTS There were 104 eligible patients from 72 distinct ICUs analyzed. Overall, 86.5% received artificial nutrition. There were 50.0% patients who received enteral nutrition (EN) only, 29.8% patients received a combination of EN and parenteral nutrition (PN), 6.7% patients received PN only, and 13.5% did not receive any nutrition. The mean time from admission to initiation of EN was 3.0 days (SD ± 2.4 days). The adequacy of calories from nutrition support was 46.8% (range 0%-111%) with a mean of 10.0 kcal/kg/day. Of the total of 83 patients who received EN, 53 patients (63.8%) had interruption of EN. The reasons included fasting, intolerance, patients deemed too sick for enteral feeding, and loss of enteral feeding route. For patients with gastrointestinal intolerance, 3/30 patients (10%) received small bowel feeding and 23/30 patients (76.7%) of patients received motility agents. CONCLUSION Postoperative critically ill patients with aortic aneurysmal rupture or acute dissection are at high risk for inadequate nutrition therapy, and there may be inadequate utilization of strategies to improve nutrition uptake.
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Affiliation(s)
- Adam Rahman
- Department of Medicine, University of Western Ontario, London, Ontario, Canada St. Joseph's Healthcare Centre/London Health Sciences Centre, London, Ontario, Canada
| | - Claudio Martin
- Department of Medicine, University of Western Ontario, London, Ontario, Canada Critical Care/Trauma Centre, London Health Sciences Centre, Victoria Campus, London, Ontario, Canada Lawson Health Research Institute, London, Ontario, Canada
| | - Daren K Heyland
- Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada Department of Medicine, Queen's University, Kingston, Ontario, Canada
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Abstract
The advent of total parenteral nutrition in the late 1960s meant that no situation remained in which a patient could not be fed. Unfortunately, total parenteral nutrition was complicated by serious infective and metabolic side effects that undermined the beneficial effects of nutrient repletion. Consequently, creative ways of restoring upper gut function were designed, based on semielemental diets and novel feeding tube systems. The employment of specific protocols and acceptance of increased gastric residual volumes has allowed most patients in intensive care to be fed safely and early by nasogastric tube. However, nasogastric feeding is unsuitable for patients with severely compromised gastric emptying owing to partial obstruction or ileus. Such patients require postpyloric tube placement with simultaneous gastric decompression via double-lumen nasogastric decompression and jejunal feeding tubes. These tubes can be placed endoscopically 40-60 cm past the ligament of Treitz to enable feeding without pancreatic stimulation. In patients whose disorders last more than 4 weeks, tubes should be repositioned percutaneously, by endoscopic, open or laparoscopic surgery. Together, the advances in enteral access have improved patients' outcomes and led to a 70-90% reduction in the demand for total parenteral nutrition.
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Punnose J, Agarwal MM, Premchandran JS. Transient diabetes insipidus and hypopituitarism after pituitary apoplexy: a rare association with pericardial effusion and painless thyroiditis. Am J Med Sci 2000; 319:261-4. [PMID: 10768614 DOI: 10.1097/00000441-200004000-00012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pituitary apoplexy in a 38-year-old male patient with acromegaly who presented with pericardial effusion, anterior pituitary dysfunction, and diabetes insipidus is described. With corticosteroid therapy, there was good initial recovery of pituitary function and regression of pericardial effusion. On withdrawal of corticosteroids, he developed painless thyroiditis, with transient thyrotoxicosis. Subsequently, the pituitary function tests remained normal for a year, but later he gradually developed hypogonadotropic hypogonadism, hypocortisolism, growth hormone deficiency, and progressive pituitary atrophy, resulting in empty sella syndrome.
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Affiliation(s)
- J Punnose
- Department of Medicine, Al Ain Hospital, Al Ain, United Arab Emirates.
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Abstract
The purpose in this paper is to consider the importance of early nutrition for critically ill patients, briefly reviewing the effects of malnutrition, and the metabolic response to starvation and sepsis. Discussion includes assessment of nutritional status and nutritional requirements, with a suggested enteral feeding regime; and also the combined effect of enteral nutrition and glutamine on gut integrity and its relevance to nosocomial pneumonia, and the ability of the gut to accept food during critical illness.
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Petit J, Kaeffer N, Déchelotte P, Oksenhendler G. [Respective indications of enteral or parenteral nutrition during pre- and post-operative periods]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1995; 14 Suppl 2:127-36. [PMID: 7486329 DOI: 10.1016/s0750-7658(95)80112-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Denutrition is often associated with poor postoperative outcome. However, a large body of evidence, from studies comparing perioperative parenteral (PN) or enteral (EN) nutrition to the absence of perioperative nutrition, suggests that perioperative nutritional support provides significant improvements in both nutritional status and postoperative clinical outcome in selected patients who are or will become malnourished. The aim of this study was to select and review all relevant articles comparing perioperative parenteral and enteral nutritional support, either in terms of clinical outcome, or risks and costs, or in pathophysiological terms. Twelve clinical reports were reviewed. All contained methodological flaws, mainly type II statistical error due to an insufficient number of patients, inaccurate primary diagnosis, absence of blinding, and lack of objective criteria of judgement. These concerns warrant caution in interpreting the results. Moderately strong (grade B) recommendations can only be drawn from these studies: PN (compared to early EN) is associated with a higher rate of sepsis in patients following abdominal trauma; EN is as efficient as PN in patients following surgery; EN is safe and cheaper than PN. PN formulae lack many important nutrients (glutamine, arginine, cysteine, peptides, fibers, n-3 polyunsaturated fatty acids, and nucleotides). Many experimental (animal) and some clinical (in non surgical patients) studies showed that PN (compared to EN) induces gut mucosal atrophy, liver dysfunction, gut bacterial translocation and immune dysfunction. The final aim of PN and EN would therefore strikingly differ. The qualitatively imperfect PN would only supply the fasting patient with quantitative amounts of calories and proteins. Due to initially limited digestive tolerance, EN provides less nutrition than PN does, but would finally lead to the same or even better outcome, due to its ability to counteract stress induced gut and immune dysfunction. Current evidence therefore suggests that early EN is superior to PN in trauma patients, and not different from but cheaper (and therefore more cost-effective) than PN in surgical patients. Further controlled, randomised, and blinded studies including sufficient sizes of groups are required, especially in the surgical setting, to address a large number of still unanswered questions.
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Affiliation(s)
- J Petit
- Service de Réanimation Chirurgicale, Hôpital Charles Nicolle, Rouen
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Badetti C. Comment réaliser et surveiller une nutrition postopératoire ? NUTR CLIN METAB 1995. [DOI: 10.1016/s0985-0562(05)80067-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Petit J, Kaeffer N, Déchelotte P, Oksenhendler G. Indications respectives des voies entérale et parentérale en périodes pré et postopératoire. NUTR CLIN METAB 1995. [DOI: 10.1016/s0985-0562(95)80018-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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