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He M, Wang Y, Wang H, Wang M, Du MJ, Xiong J, Li CL, Huang S, Zhang XY. Reducing Diarrhea in Critically Ill Patients Receiving Enteral Nutrition Support: An Evidence-Based Quality Improvement Project. J Nurs Care Qual 2024; 39:E47-E53. [PMID: 39167924 DOI: 10.1097/ncq.0000000000000795] [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: 08/23/2024]
Abstract
BACKGROUND Diarrhea during enteral nutrition may induce various complications and increase the nursing workload. LOCAL PROBLEM The diarrhea rate in our intensive care units (ICUs) was 37.14% from May to July 2021. Nurses reported a moderate to heavy burden regarding care for those with diarrhea. METHODS A pre-post implementation design was used to evaluate the impact of evidence-based interventions for diarrhea screening and prevention. INTERVENTIONS A diarrhea risk screening tool and countermeasures were developed through an extensive literature review. Tools were integrated into the electronic health record system. RESULTS The rate of diarrhea decreased from 37.14% to 17.33% ( P = .000). Nurse's compliance with practice standards increased for diarrhea assessment, risk factor screening, agent choice, and countermeasures provision ( P < .05). CONCLUSIONS The evidence-based tools developed for this project helped decrease the diarrhea rate in our ICUs.
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Affiliation(s)
- Mei He
- Author Affiliations: Department of Nursing, Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Ms He, Dr Wang, and Mss Wang and Du); Unit of Gerontology, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China (Ms Wang); Intensive Care Unit, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China (Mr Xiong); Neurosurgical Intensive Care Unit, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China (Messrs Li and Huang); and School of Nursing, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China (Mr Zhang)
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Liu C, Wu L, Xu R, Jiang Z, Xiao X, Song N, Jin Q, Dai Z. Development and internal validation of an artificial intelligence-assisted bowel sounds auscultation system to predict early enteral nutrition-associated diarrhoea in acute pancreatitis: a prospective observational study. Br J Hosp Med (Lond) 2024; 85:1-15. [PMID: 39212577 DOI: 10.12968/hmed.2024.0120] [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] [Indexed: 09/04/2024]
Abstract
Aims/Background An artificial intelligence-assisted prediction model for enteral nutrition-associated diarrhoea (ENAD) in acute pancreatitis (AP) was developed utilising data obtained from bowel sounds auscultation. This model underwent validation through a single-centre, prospective observational study. The primary objective of the model was to enhance clinical decision-making by providing a more precise assessment of ENAD risk. Methods The study enrolled patients with AP who underwent early enteral nutrition (EN). Real-time collection and analysis of bowel sounds were conducted using an artificial intelligence bowel sounds auscultation system. Univariate analysis, multicollinearity analysis, and logistic regression analysis were employed to identify risk factors associated with ENAD. The random forest algorithm was utilised to establish the prediction model, and partial dependence plots were generated to analyse the impact of risk factors on ENAD risk. Validation of the model was performed using the optimal model Bootstrap resampling method. Predictive performance was assessed using accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and an area under the receiver operating characteristic (ROC) curve. Results Among the 133 patients included in the study, the incidence of ENAD was 44.4%. Six risk factors were identified, and the model's accuracy was validated through Bootstrap iterations. The prediction accuracy of the model was 81.10%, with a sensitivity of 84.30% and a specificity of 77.80%. The positive predictive value was 82.60%, and the negative predictive value was 80.10%. The area under the ROC curve was 0.904 (95% confidence interval: 0.817-0.997). Conclusion The artificial intelligence bowel sounds auscultation system enhances the assessment of gastrointestinal function in AP patients undergoing EN and facilitates the construction of an ENAD predictive model. The model demonstrates good predictive efficacy, offering an objective basis for precise intervention timing in ENAD management.
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Affiliation(s)
- Chengcheng Liu
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Li Wu
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Rui Xu
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Zhiwei Jiang
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Xiaoping Xiao
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Nian Song
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Qianhong Jin
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Zhengxiang Dai
- Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
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Vandenplas Y, Broekaert I, Domellöf M, Indrio F, Lapillonne A, Pienar C, Ribes-Koninckx C, Shamir R, Szajewska H, Thapar N, Thomassen RA, Verduci E, West C. An ESPGHAN Position Paper on the Diagnosis, Management, and Prevention of Cow's Milk Allergy. J Pediatr Gastroenterol Nutr 2024; 78:386-413. [PMID: 38374567 DOI: 10.1097/mpg.0000000000003897] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 06/25/2023] [Indexed: 07/27/2023]
Abstract
A previous guideline on cow's milk allergy (CMA) developed by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) was published in 2012. This position paper provides an update on the diagnosis, treatment, and prevention of CMA with focus on gastrointestinal manifestations. All systematic reviews and meta-analyses regarding prevalence, pathophysiology, symptoms, and diagnosis of CMA published after the previous ESPGHAN document were considered. Medline was searched from inception until May 2022 for topics that were not covered in the previous document. After reaching consensus on the manuscript, statements were formulated and voted on each of them with a score between 0 and 9. A score of ≥6 was arbitrarily considered as agreement. Available evidence on the role of dietary practice in the prevention, diagnosis, and management of CMA was updated and recommendations formulated. CMA in exclusively breastfed infants exists, but is uncommon and suffers from over-diagnosis. CMA is also over-diagnosed in formula and mixed fed infants. Changes in stool characteristics, feeding aversion, or occasional spots of blood in stool are common and in general should not be considered as diagnostic of CMA, irrespective of preceding consumption of cow's milk. Over-diagnosis of CMA occurs much more frequently than under-diagnosis; both have potentially harmful consequences. Therefore, the necessity of a challenge test after a short diagnostic elimination diet of 2-4 weeks is recommended as the cornerstone of the diagnosis. This position paper contains sections on nutrition, growth, cost, and quality of life.
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Affiliation(s)
- Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
| | - Ilse Broekaert
- Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Flavia Indrio
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Alexandre Lapillonne
- Neonatal Intensive Care Unit, Necker-Enfants Malades Hospital, Paris University, Paris, France
- CNRC, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Corina Pienar
- Department of Pediatrics, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Carmen Ribes-Koninckx
- Gastroenterology and Hepatology & Instituto de Investigacion Sanitaria, La Fe University Hospital, Valencia, Spain
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Lea and Arieh Pickel Chair for Pediatric Research, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hania Szajewska
- Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Nikhil Thapar
- Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
- Woolworths Centre for Child Nutrition Research, Queensland University of Technology, Brisbane, Australia
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Rut Anne Thomassen
- Department of Paediatric Medicine, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Elvira Verduci
- Department of Paediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Christina West
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
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Church A, Zoeller S. Enteral nutrition product formulations: A review of available products and indications for use. Nutr Clin Pract 2023; 38:277-300. [PMID: 36787985 DOI: 10.1002/ncp.10960] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/12/2023] [Accepted: 01/15/2023] [Indexed: 02/16/2023] Open
Abstract
When oral nutrition is not feasible, enteral nutrition (EN) therapy is often considered the preferred route of nutrition support to meet the nutrient needs of individuals with a functional gastrointestinal tract across multiple levels of care (critical care, acute care, and home care). Enteral formulations have progressively evolved over the last 50 years from the simple blending of hospital food thin enough to run through a feeding tube, to the development of commercial standard formulas, followed by specialized formulas with immune-modulating and disease-specific qualities, to the most recent shift to food-based or blenderized EN composed of natural, whole foods with perceived health benefits. With the vast number of enteral formulations on the market, clinicians may be overwhelmed trying to determine proven vs theoretical benefits. This review is intended to explore differences in enteral formulations, identify implications for clinical practice, and review evidenced-based clinical guidelines to assist clinicians in enteral formula selection.
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Affiliation(s)
- April Church
- Nutrition Services, Asante Rogue Regional Medical Center, Medford, Oregon, 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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Lu XM, Jia DS, Wang R, Yang Q, Jin SS, Chen L. Development of a prediction model for enteral feeding intolerance in intensive care unit patients: A prospective cohort study. World J Gastrointest Surg 2022; 14:1363-1374. [PMID: 36632121 PMCID: PMC9827569 DOI: 10.4240/wjgs.v14.i12.1363] [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: 08/27/2022] [Revised: 10/15/2022] [Accepted: 11/16/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Enteral nutrition (EN) is essential for critically ill patients. However, some patients will have enteral feeding intolerance (EFI) in the process of EN.
AIM To develop a clinical prediction model to predict the risk of EFI in patients receiving EN in the intensive care unit.
METHODS A prospective cohort study was performed. The enrolled patients’ basic information, medical status, nutritional support, and gastrointestinal (GI) symptoms were recorded. The baseline data and influencing factors were compared. Logistic regression analysis was used to establish the model, and the bootstrap resampling method was used to conduct internal validation.
RESULTS The sample cohort included 203 patients, and 37.93% of the patients were diagnosed with EFI. After the final regression analysis, age, GI disease, early feeding, mechanical ventilation before EN started, and abnormal serum sodium were identified. In the internal validation, 500 bootstrap resample samples were performed, and the area under the curve was 0.70 (95%CI: 0.63-0.77).
CONCLUSION This clinical prediction model can be applied to predict the risk of EFI.
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Affiliation(s)
- Xue-Mei Lu
- School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Deng-Shuai Jia
- School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Rui Wang
- Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Qing Yang
- Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Shan-Shan Jin
- Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Lan Chen
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
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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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Higher versus lower enteral calorie delivery and gastrointestinal dysfunction in critical illness: A systematic review and meta-analysis. Clin Nutr 2022; 41:2185-2194. [DOI: 10.1016/j.clnu.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 11/20/2022]
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Zhang X, Wang X, Zhao X, Zhang Y. A Structured Skin Care Protocol for Preventing and Treating Incontinence-associated Dermatitis in Critically Ill Patients. Adv Skin Wound Care 2022; 35:335-342. [PMID: 35703853 DOI: 10.1097/01.asw.0000828972.70137.8a] [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]
Abstract
OBJECTIVE To examine the effectiveness of a structured skin care protocol for preventing and treating incontinence-associated dermatitis (IAD) in critically ill patients. METHODS Participants were drawn from the ICUs of three teaching hospitals between January 2016 and December 2017. Patients were eligible if they were ≥18 years old, had idiopathic fecal incontinence, had diarrhea but were unable to sense it, and were expected to stay in the ICU for at least 72 hours after developing incontinence. A total of 143 patients were enrolled: 79 in the experimental group and 64 in the control group. In the first phase of the study, routine skin care measures were used; in the second phase, three ICU caregivers were trained to provide a structured skin care protocol. Trained research team members conducted the data collection and analysis. The TREND (Transparent Reporting of Evaluations with Nonrandomized Designs) Statement Checklist was followed in reporting the study results. RESULTS Application of the structured skin care protocol reduced the incidence of IAD from 35.9% in the control phase to 17.7% in the intervention phase (χ2 = 6.117, P < .05) and also decreased the severity of IAD (z = -2.023, P < .05). Further, IAD developed later (z = -2.116, P < .05) in the intervention group than in the control group. In addition, the nursing times to prevent or manage IAD did not differ significantly between the groups (t = -0.258, P > .05; t = -1.190, P > .05). CONCLUSIONS Use of the developed structured skin care protocol for IAD in critically ill patients lowered the incidence and severity of IAD and delayed IAD development.
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Affiliation(s)
- Xiaoxue Zhang
- In the General Surgery Department at Xuanwu Hospital, Capital Medical University, Beijing, China, Xiaoxue Zhang is Nurse; Xinran Wang is Head Nurse and Professor; and Xiaowei Zhao is Head Nurse. Yu Zhang is Nurse, Urinary Surgery Department, Beijing Hospital. Acknowledgments: This work was supported by the Beijing Municipal Administration of Hospitals Incubating Program (grant PX2016037) and the Chinese Nursing Association Project (grant ZHKY201711). The authors gratefully acknowledge the financial support of the Beijing Municipal Administration of Hospitals Incubating Program and Chinese Nursing Association Project. They also thank the nurses in three ICUs for their effort in the protocol implementation. The authors have disclosed no other financial relationships related to this article. Submitted May 6, 2021; accepted in revised form July 23, 2021
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Jiao J, Chen Y, Yang L, Li W, Zhou Z, Li L, Xiao Y, Zhao J, Li L, Xia Y. Nursing Practice Based on Evidence-Based Concepts to Prevent Enteral Nutrition Complications for Critically Ill Neurosurgical Patients. Front Surg 2022; 9:857877. [PMID: 35372491 PMCID: PMC8971188 DOI: 10.3389/fsurg.2022.857877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To explore the practical value of enteral nutrition care guided by evidence-based concepts in preventing enteral nutritional complications in critically ill neurosurgical patients. Methods Three hundred critically ill patients from March 2020 to October 2021 from our neurosurgery department were included in the study. Patients were divided into a control group (March to December 2020, n = 150) and a study group (January to October 2021, n = 150) according to the order of their admission. The control group received conventional enteral nutrition care, and the study group received enteral nutrition care based on evidence-based concept guidance. The levels of serum nutritional indicators [hemoglobin (Hb), albumin (ALB), and total protein (TP)], feeding compliance rate, the incidence of complications (gastric retention, bloating, diarrhea, reflux, vomiting, aspiration, stress ulcers, etc.), and prognosis during the observation period were compared between the two groups. The scores of the questionnaire of knowledge, attitude, and practice on nutrition among neurosurgical nurses before and after the implementation of evidence-based care were compared among nursing staff in the study group. Results At 1 and 2 weeks after enrollment, Hb, ALB, and TP levels were lower in both groups than before enrollment in the same group (P < 0.05). At 2 weeks after enrollment, Hb, ALB, and TP levels were higher in both groups than at 1 week after enrollment in the same group (P < 0.05). At 1 and 2 weeks after enrollment, Hb, ALB, and TP levels were higher in the study group than in the control group (P < 0.05). At 7 days after feeding, the feeding compliance rate was higher in the study group (94.67%) than in the control group (70.00%) (P < 0.05). The total complication rate was lower in the study group (8.00%) than in the control group (16.00%) (P < 0.05). The percentage of good prognosis was higher in the study group (34.00%) than in the control group (23.33%) (P < 0.05). After the implementation of evidence-based care, caregivers in the study group scored higher on nutrition knowledge, nutrition attitudes, and nutrition practices than those before the implementation (P < 0.05). Conclusion The implementation of evidence-based nursing interventions in critically ill neurosurgical patients based on evidence-based concepts is of great clinical value in correcting their nutritional status, preventing enteral nutritional complications, improving prognosis, and enhancing the nutritional knowledge, attitudes, and practices of nursing staff.
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Affiliation(s)
- Jia Jiao
- Department of Neurosurgery, Changsha First Hospital, Changsha, China
| | - Yu Chen
- Department of Nursing Teaching and Research Office, Changsha First Hospital, Changsha, China
| | - Lijian Yang
- Department of Neurosurgery, Changsha First Hospital, Changsha, China
| | - Wei Li
- Department of Neurosurgery, Changsha First Hospital, Changsha, China
| | - Zhiwei Zhou
- Department of Neurosurgery, Changsha First Hospital, Changsha, China
| | - Lan Li
- Department of Neurosurgery, Changsha First Hospital, Changsha, China
| | - Yinghong Xiao
- Department of Neurosurgery, Changsha First Hospital, Changsha, China
| | - Jiasha Zhao
- Department of Neurosurgery, Changsha First Hospital, Changsha, China
| | - Linzhi Li
- Department of Neurosurgery, Changsha First Hospital, Changsha, China
| | - You Xia
- Department of Nursing Teaching and Research Office, Changsha First Hospital, Changsha, China
- *Correspondence: You Xia
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Verduci E, Salvatore S, Bresesti I, Di Profio E, Pendezza E, Bosetti A, Agosti M, Zuccotti GV, D’Auria E. Semi-Elemental and Elemental Formulas for Enteral Nutrition in Infants and Children with Medical Complexity-Thinking about Cow's Milk Allergy and Beyond. Nutrients 2021; 13:4230. [PMID: 34959782 PMCID: PMC8707725 DOI: 10.3390/nu13124230] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/18/2021] [Accepted: 11/24/2021] [Indexed: 01/24/2023] Open
Abstract
Children with medical complexities, such as multi-system disorders and/or neurological impairments, often experience feeding difficulties and need enteral nutrition. They frequently have impaired motility and digestive-absorbing functions related to their underlying condition. If a cow's milk allergy (CMA) occurs as a comorbidity, it is often misdiagnosed, due to the symptoms' overlap. Many of the commercialized mixtures intended for enteral nutrition are composed of partially hydrolyzed cow's milk proteins, which are not suitable for the treatment of CMA; thus, the exclusion of a concomitant CMA is mandatory in these patients for obtaining symptoms relief. In this review, we focus on the use of elemental and semi-elemental formulas in children with neurological diseases and in preterm infants as clinical "models" of medical complexity. In children with neurodisabilities, when gastrointestinal symptoms persist despite the use of specific enteral formula, or in cases of respiratory and/or dermatological symptoms, CMA should always be considered. If diagnosis is confirmed, only an extensively hydrolyzed or amino-acid based formula, or, as an alternative, extensively hydrolyzed nutritionally adequate formulas derived from rice or soy, should be used. Currently, enteral formulas tailored to the specific needs of preterm infants and children with neurological impairment presenting concomitant CMA have not been marketed yet. For the proper monitoring of the health status of patients with medical complexity, multidisciplinary evaluation and involvement of the nutritional team should be promoted.
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Affiliation(s)
- Elvira Verduci
- Department of Health Sciences, University of Milan, 20146 Milan, Italy
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy; (E.D.P.); (E.P.); (A.B.); (G.V.Z.); (E.D.)
| | - Silvia Salvatore
- Department of Medicine and Surgery, Pediatric and Neonatology Units, Hospital “F. Del Ponte”, University of Insubria, 21100 Varese, Italy; (S.S.); (I.B.); (M.A.)
| | - Ilia Bresesti
- Department of Medicine and Surgery, Pediatric and Neonatology Units, Hospital “F. Del Ponte”, University of Insubria, 21100 Varese, Italy; (S.S.); (I.B.); (M.A.)
| | - Elisabetta Di Profio
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy; (E.D.P.); (E.P.); (A.B.); (G.V.Z.); (E.D.)
- Department of Animal Sciences for Health, Animal Production and Food Safety, University of Milan, 20133 Milan, Italy
| | - Erica Pendezza
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy; (E.D.P.); (E.P.); (A.B.); (G.V.Z.); (E.D.)
| | - Alessandra Bosetti
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy; (E.D.P.); (E.P.); (A.B.); (G.V.Z.); (E.D.)
| | - Massimo Agosti
- Department of Medicine and Surgery, Pediatric and Neonatology Units, Hospital “F. Del Ponte”, University of Insubria, 21100 Varese, Italy; (S.S.); (I.B.); (M.A.)
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy; (E.D.P.); (E.P.); (A.B.); (G.V.Z.); (E.D.)
- Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, 20157 Milan, Italy
- Pediatric Clinical Research Center Fondazione Romeo ed EnricaInvernizzi, University of Milan, 20157 Milan, Italy
| | - Enza D’Auria
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy; (E.D.P.); (E.P.); (A.B.); (G.V.Z.); (E.D.)
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12
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Costa CPD, Gomes DL, Franco MCA. Management of gastrointestinal complications of enteral nutritional therapy in the ICU. Rev Assoc Med Bras (1992) 2021; 67:889-894. [PMID: 34709336 DOI: 10.1590/1806-9282.20201068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 02/20/2021] [Indexed: 11/22/2022] Open
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13
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Chao K, Wang D, Yang H, Ma N, Liu Q, Sun X, Sun R. Beneficial Effect of Immune-Enhanced Enteral Nutrition on Immune Function in Patients With Severe Neurological Diseases: A Single-Center Randomized Controlled Trial. Front Nutr 2021; 8:685422. [PMID: 34497819 PMCID: PMC8419436 DOI: 10.3389/fnut.2021.685422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/26/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Undernutrition is the main reason for the use of artificial nutrition in patients with severe neurological diseases. However, the clinical and immunological outcomes of enteral nutrition supplemented with immunomodulatory nutrients in these patients remain unclear. Methods: In this single-center, randomized controlled study, 57 patients with severe neurological diseases were randomly divided into the following two groups according to the type of enteral nutrition they would receive: immune-enhancing (IE) (n = 27) and non-IE (NIE) (n = 30). The IE and NIE groups received enteral nutrition supplemented with immunomodulatory nutrients and standard enteral nutrition, respectively. We compared the nutritional status and the state of cellular immunity between the patients of the two groups. Clinical and immunological variables were evaluated following nutritional treatment. Results: Feeding intolerance was lower in the IE than that in the NIE group (P = 0.04). However, there were no significant differences between the results of the two groups in terms of length of stay in the intensive care unit or hospital, extubation time, or body mass index (P > 0.05). The CD4+ T-lymphocyte count and CD4+/CD8+ ratio in the peripheral blood increased significantly in the IE group. The expression of CD28 activated cell surface markers was higher in the IE than in the NIE group. In addition, increased plasma interferon-γ levels were recorded in the IE group, whereas the levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-6, IL-8, and IL-10 decreased. Conclusions: Immune-enhanced enteral nutrition could improve the immune status and feeding tolerance in patients with severe neurological diseases. Trial Registration:www.chictr.org.cn/index.aspx, identifier: ChiCTR-IPR-17013909.
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Affiliation(s)
- Ke Chao
- Extracardiac Care Unit, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Dong Wang
- Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongfu Yang
- Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ning Ma
- Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qilong Liu
- Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoge Sun
- Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Rongqing Sun
- Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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14
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Muscaritoli M, Pradelli L. Medium-Chain Triglyceride (MCT) Content of Adult Enteral Tube Feeding Formulas and Clinical Outcomes. A Systematic Review. Front Nutr 2021; 8:697529. [PMID: 34409063 PMCID: PMC8364971 DOI: 10.3389/fnut.2021.697529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/06/2021] [Indexed: 01/03/2023] Open
Abstract
Available data on the effect of lipid composition of enteral formulas on clinical outcomes are controversial. The present systematic review was performed in order to verify whether the presence of specific lipidic substrates, namely medium-chain triglycerides (MCT), in enteral tube feeding formulas is associated to measurable clinical benefits in patients receiving enteral nutrition in different clinical settings, including home enteral nutrition (HEN). The results of this systematic review highlight a lack of robust evidence supporting the use of specific types of lipids in standard or disease-specific formulas. Evidence exists, however, that MCT-containing formulas are safe and well-tolerated. Further, well-designed, adequately powered, randomized controlled trials would be needed in order to assess the superiority of MCT- containing enteral formulas over other standard or disease-specific commercially available enteral products.
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Affiliation(s)
- Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
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15
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Fan H, Yang C, Duan Z, Huo X, Yang Y. Risk factors of enteral feeding intolerance in severe acute pancreatitis patients: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25614. [PMID: 33950939 PMCID: PMC8104290 DOI: 10.1097/md.0000000000025614] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/04/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Patients with severe acute pancreatitis (SAP) have gastrointestinal dysfunction, and enteral nutrition intolerance is easy to occur during the implementation of enteral nutrition, which leads to the suspension or termination of enteral nutrition. Enteral nutrition cannot tolerate the influence of many factors. At present, there is a lack of analysis on the influencing factors of enteral nutrition intolerance in patients with SAP. Therefore, this study analyzed the factors of enteral nutrition intolerance in patients with SAP by meta-analysis, to provide a basis for the protection of enteral nutrition in patients with SAP. METHODS Databases (PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang) were searched using index words to find relevant studies published before March 2021. Meta-analyses of relative risk were performed for the identification of risk factors. RESULTS We will disseminate the findings of this systematic review and meta-analysis via publications in peer-reviewed journals. CONCLUSION This study systematically reviewed the existing evidence and determined the incidence and predictors of enteral nutrition intolerance in patients with SAP.
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Affiliation(s)
- Hongyun Fan
- The First Hospital of Hebei Medical University, Shijiazhuang
| | - Chunchun Yang
- The First Hospital of Hebei Medical University, Shijiazhuang
| | - Zhiying Duan
- The First Hospital of Hebei Medical University, Shijiazhuang
| | - Xiaohui Huo
- The First Hospital of Hebei Medical University, Shijiazhuang
| | - Yang Yang
- Tangshan Hongci Hospital, Tangshan, Hebei Province, China
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16
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Deane AM, Ali Abdelhamid Y, Plummer MP, Fetterplace K, Moore C, Reintam Blaser A. Are Classic Bedside Exam Findings Required to Initiate Enteral Nutrition in Critically Ill Patients: Emphasis on Bowel Sounds and Abdominal Distension. Nutr Clin Pract 2020; 36:67-75. [PMID: 33296117 DOI: 10.1002/ncp.10610] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/05/2020] [Indexed: 02/06/2023] Open
Abstract
The general physical examination of a patient is an axiom of critical care medicine, but evidence to support this practice remains sparse. Given the lack of evidence for a comprehensive physical examination of the entire patient on admission to the intensive care unit, which most clinicians consider an essential part of care, should clinicians continue the practice of a specialized gastrointestinal system physical examination when commencing enteral nutrition in critically ill patients? In this review of literature related to gastrointestinal system examination in critically ill patients, the focus is on gastrointestinal sounds and abdominal distension. There is a summary of what these physical features represent, an evaluation of the evidence regarding use of these physical features in patients after abdominal surgery, exploration of the rationale for and against using the physical findings in routine practice, and detail regarding what is known about each feature in critically ill patients. Based on the available evidence, it is recommended that an isolated symptom, sign, or bedside test does not provide meaningful information. However, it is submitted that a comprehensive physical assessment of the gastrointestinal system still has a role when initiating or administering enteral nutrition: specifically, when multiple features are present, clinicians should consider further investigation or intervention.
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Affiliation(s)
- Adam M Deane
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, The University of Melbourne, Parkville, Victoria, Australia
| | - Yasmine Ali Abdelhamid
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, The University of Melbourne, Parkville, Victoria, Australia
| | - Mark P Plummer
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, The University of Melbourne, Parkville, Victoria, Australia
| | - Kate Fetterplace
- Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, The University of Melbourne, Parkville, Victoria, Australia.,Allied Health (Clinical Nutrition), Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Cara Moore
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Annika Reintam Blaser
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia.,Department of Intensive Care, Lucerne Cantonal Hospital, Lucerne, Switzerland
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17
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Suzuki G, Ichibayashi R, Yamamoto S, Serizawa H, Nakamichi Y, Watanabe M, Honda M. Effect of high-protein nutrition in critically ill patients: A retrospective cohort study. Clin Nutr ESPEN 2020; 38:111-117. [PMID: 32690144 DOI: 10.1016/j.clnesp.2020.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND & AIMS Early provision of a high-protein nutrition improves the prognosis of patients in intensive care units (ICUs). However, high protein intake increases blood urea nitrogen (BUN). No study has compared outcomes according to protein intake, and the clinical significance of changes in BUN (ΔBUN) in ICU patients is unclear. Here, we investigated the association of high protein intake with outcomes and BUN and assessed the clinical significance of ΔBUN. METHODS This was a single-center retrospective cohort study. Between 1 January 2016 and 30 September 2019, 295 ICU patients received enteral nutrition for at least 3 days while undergoing mechanical ventilation. After applying the exclusion criteria of an age of <18 years, gastrointestinal disease, maintenance dialysis, renal replacement therapy after admission, kidney transplantation, and death within 7 days of commencing enteral nutrition, 206 patients remained. INTERVENTIONS Participants were divided into those receiving >1.2 g/kg/day of protein (high-protein group; n = 111) and those receiving ≤1.2 g/kg/day of protein (non-high-protein group; n = 95). The groups were balanced by propensity score matching. The primary endpoint was 28-day mortality, and the secondary endpoints were 90-day mortality, length of ICU stay, number of ventilator-free days in the first 28 days, and ΔBUN. RESULTS The high-protein group had significantly lower 28- and 90-day mortality and significantly greater ΔBUN, including after propensity score matching. ΔBUN might not be associated with outcomes. CONCLUSIONS Provision of >1.2 g/kg/day of protein may be associated with lower mortality of tube-fed and mechanically ventilated patients. Furthermore, while high protein intake may be associated with higher BUN, these changes may not be adversely associated with outcomes.
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Affiliation(s)
- Ginga Suzuki
- Critical Care Center, Toho University Omori Medical Center, Tokyo, Japan.
| | - Ryo Ichibayashi
- Critical Care Center, Toho University Omori Medical Center, Tokyo, Japan.
| | - Saki Yamamoto
- Critical Care Center, Toho University Omori Medical Center, Tokyo, Japan.
| | - Hibiki Serizawa
- Critical Care Center, Toho University Omori Medical Center, Tokyo, Japan.
| | - Yoshimi Nakamichi
- Critical Care Center, Toho University Omori Medical Center, Tokyo, Japan.
| | - Masayuki Watanabe
- Critical Care Center, Toho University Omori Medical Center, Tokyo, Japan.
| | - Mitsuru Honda
- Critical Care Center, Toho University Omori Medical Center, Tokyo, Japan.
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18
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Abstract
PURPOSE OF REVIEW To provide a comprehensive update of diagnosis and treatment of gastrointestinal dysmotility in the critically ill, with a focus on work published in the last 5 years. RECENT FINDINGS Symptoms and clinical features consistent with upper and/or lower gastrointestinal dysmotility occur frequently. Although features of gastrointestinal dysmotility are strongly associated with adverse outcomes, these associations may be because of unmeasured confounders. The use of ultrasonography to identify upper gastrointestinal dysmotility appears promising. Both nonpharmacological and pharmacological approaches to treat gastrointestinal dysmotility have recently been evaluated. These approaches include modification of macronutrient content and administration of promotility drugs, stool softeners or laxatives. Although these approaches may reduce features of gastrointestinal dysmotility, none have translated to patient-centred benefit. SUMMARY 'Off-label' metoclopramide and/or erythromycin administration are effective for upper gastrointestinal dysmotility but have adverse effects. Trials of alternative or novel promotility drugs have not demonstrated superiority over current pharmacotherapies. Prophylactic laxative regimens to prevent non-defecation have been infrequently studied and there is no recent evidence to further inform treatment of established pseudo-obstruction. Further trials of nonpharmacological and pharmacological therapies to treat upper and lower gastrointestinal dysmotility are required and challenges in designing such trials are explored.
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19
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Yamamoto S, Allen K, Jones KR, Cohen SS, Reyes K, Huhmann MB. Meeting Calorie and Protein Needs in the Critical Care Unit: A Prospective Observational Pilot Study. Nutr Metab Insights 2020; 13:1178638820905992. [PMID: 32153344 PMCID: PMC7045298 DOI: 10.1177/1178638820905992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/21/2020] [Indexed: 01/03/2023] Open
Abstract
Background: Inadequate calorie and protein intake during critical illness is associated with poor clinical outcomes. Unfortunately, most critically ill patients do not consume adequate levels of these nutrients. An enteral formula with appropriate macronutrient composition may assist patients in meeting nutritional goals. Design: This study was a single center, prospective, observational study of 29 adults in the medical intensive care unit who required enteral nutrition for at least 3 days. Subjects received a calorically dense, enzymatically hydrolyzed 100% whey peptide-based enteral formula for up to 5 days to assess the ability to achieve 50% of caloric goals within the first 3 days (primary outcome), the daily percentage of protein goals attained and gastrointestinal tolerance (secondary outcomes). Result: A total of 29 subjects consented and began the study. Four subjects dropped out before first day and 25 subjects were included in analyses. Subjects were aged 55.5 ± 16.9 years with mean body mass index (BMI) of 27.9 ± 7.5 kg/m2. Most (92%) subjects were on a mechanical ventilator and experienced organ failure. At least 50% of caloric and protein goals were achieved in 78.9% and 73.7% of the subjects, respectively, during the first 3 days. Overall, 75.0 ± 26.3% and 69.3 ± 26.7% of calorie and protein goals were achieved using the study formula. Conclusions: Subjects fed enterally with a calorically dense, enzymatically hydrolyzed 100% whey peptide-based enteral formula exceeded 50% of caloric and protein goals in most critically ill subjects included in this study. Use of study formula did not lead to severe gastrointestinal intolerance.
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Affiliation(s)
- Shinobu Yamamoto
- Clinical Sciences, Nestlé Health Science, Bridgewater Township, NJ. USA
| | - Karen Allen
- Pulmonary, Critical Care & Sleep Medicine, University of Oklahoma Health Sciences Center, Oklahoma, OK, USA.,Veterans Affairs Hospital, Oklahoma, OK, USA
| | - Kellie R Jones
- Pulmonary, Critical Care & Sleep Medicine, University of Oklahoma Health Sciences Center, Oklahoma, OK, USA.,Veterans Affairs Hospital, Oklahoma, OK, USA
| | - Sarah S Cohen
- Epidemiology Practice, EpidStat Institute, Ann Arbor, MI, USA
| | - Kemuel Reyes
- Clinical Sciences, Nestlé Health Science, Bridgewater Township, NJ. USA
| | - Maureen B Huhmann
- Clinical Sciences, Nestlé Health Science, Bridgewater Township, NJ. USA
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20
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Which Multicenter Randomized Controlled Trials in Critical Care Medicine Have Shown Reduced Mortality? A Systematic Review. Crit Care Med 2019; 47:1680-1691. [DOI: 10.1097/ccm.0000000000004000] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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21
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Fetterplace K, Gill BMT, Chapple LAS, Presneill JJ, MacIsaac C, Deane AM. Systematic Review With Meta-Analysis of Patient-Centered Outcomes, Comparing International Guideline-Recommended Enteral Protein Delivery With Usual Care. JPEN J Parenter Enteral Nutr 2019; 44:610-620. [PMID: 31617220 DOI: 10.1002/jpen.1725] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 09/04/2019] [Accepted: 09/18/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND International guidelines recommend that protein be administered enterally to critically ill patients at doses between 1.2 and 2 g/kg per day Observational data indicate that patients frequently receive less protein. The aim of this systematic review was to evaluate patient-centered outcomes with guideline-recommended enteral protein compared with usual care. METHODS A systematic review was performed of randomized controlled trials including critically ill adult patients provided predominately enteral nutrition with mean protein at ≥1.2 g/kg per day (intervention) and <1.2 g/kg per day (comparator). Random-effects models were applied for outcomes reported in ≥3 trials. RESULTS Of 1375 abstracts, 69 full-text articles were reviewed, and 6 trials meet the inclusion criteria, including 511 patients. The intervention group received a mean (SD) of 1.3 (0.08) g/kg per day, and the comparator group received 0.75 (0.15) g/kg per day protein. Insufficient data were available for meta-analyses on the primary outcome (muscle mass or strength). According to our meta-analyses, mortality at 28 days (5 studies) (risk ratio 0.92 [95% Cl 0.63-1.35], P = .66) and the durations of intensive care unit (6 studies) and hospital admission (4 studies) were similar between the intervention and comparator, with some uncertainty due to sample sizes and heterogeneity. CONCLUSION There are insufficient data to conclude whether protein provision within the current international guideline recommendations improves outcomes. In a limited dataset, enteral protein intakes near the lower level of current recommendations do not appear to reduce admission duration or mortality when compared with usual care in critically ill.
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Affiliation(s)
- Kate Fetterplace
- Allied Health (Clinical Nutrition), Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Parkville, Australia
| | - Benjamin M T Gill
- Allied Health (Clinical Nutrition), Royal Melbourne Hospital, Melbourne, Australia
| | - Lee-Anne S Chapple
- Discipline of Acute Care Medicine, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.,Intensive Care Research, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jeffrey J Presneill
- Department of Medicine, The University of Melbourne, Parkville, Australia.,Intensive Care Unit, Royal Melbourne Hospital, Parkville, Australia
| | - Christopher MacIsaac
- Department of Medicine, The University of Melbourne, Parkville, Australia.,Intensive Care Unit, Royal Melbourne Hospital, Parkville, Australia
| | - Adam M Deane
- Department of Medicine, The University of Melbourne, Parkville, Australia.,Intensive Care Unit, Royal Melbourne Hospital, Parkville, Australia
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22
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Sioson MS, Martindale R, Abayadeera A, Abouchaleh N, Aditianingsih D, Bhurayanontachai R, Chiou WC, Higashibeppu N, Mat Nor MB, Osland E, Palo JE, Ramakrishnan N, Shalabi M, Tam LN, Ern Tan JJ. Nutrition therapy for critically ill patients across the Asia-Pacific and Middle East regions: A consensus statement. Clin Nutr ESPEN 2018; 24:156-164. [PMID: 29576355 DOI: 10.1016/j.clnesp.2017.11.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/05/2017] [Accepted: 11/28/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS Guidance on managing the nutritional requirements of critically ill patients in the intensive care unit (ICU) has been issued by several international bodies. While these guidelines are consulted in ICUs across the Asia-Pacific and Middle East regions, there is little guidance available that is tailored to the unique healthcare environments and demographics across these regions. Furthermore, the lack of consistent data from randomized controlled clinical trials, reliance on expert consensus, and differing recommendations in international guidelines necessitate further expert guidance on regional best practice when providing nutrition therapy for critically ill patients in ICUs in Asia-Pacific and the Middle East. METHODS The Asia-Pacific and Middle East Working Group on Nutrition in the ICU has identified major areas of uncertainty in clinical practice for healthcare professionals providing nutrition therapy in Asia-Pacific and the Middle East and developed a series of consensus statements to guide nutrition therapy in the ICU in these regions. RESULTS Accordingly, consensus statements have been provided on nutrition risk assessment and parenteral and enteral feeding strategies in the ICU, monitoring adequacy of, and tolerance to, nutrition in the ICU and institutional processes for nutrition therapy in the ICU. Furthermore, the Working Group has noted areas requiring additional research, including the most appropriate use of hypocaloric feeding in the ICU. CONCLUSIONS The objective of the Working Group in formulating these statements is to guide healthcare professionals in practicing appropriate clinical nutrition in the ICU, with a focus on improving quality of care, which will translate into improved patient outcomes.
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Affiliation(s)
- Marianna S Sioson
- Section of Nutrition, Department of Medicine, The Medical City, Pasig, Metro Manila, Philippines.
| | - Robert Martindale
- Division of Gastrointestinal and General Surgery, Oregon Health and Sciences University, Portland, OR, USA
| | - Anuja Abayadeera
- Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Nabil Abouchaleh
- Section of Critical Care Medicine, Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Dita Aditianingsih
- Emergency Intensive Care Unit, Cipto Mangunkusumo Hospital, Jakarta, Indonesia; Department of Anaesthesia and Intensive Care, University of Indonesia, Jakarta, Indonesia
| | - Rungsun Bhurayanontachai
- Division of Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Wei-Chin Chiou
- Division of Surgical Critical Care, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Naoki Higashibeppu
- Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Mohd Basri Mat Nor
- Kulliyyah of Medicine, International Islamic University Malaysia, Kuala Lumpur, Malaysia
| | - Emma Osland
- Department of Nutrition and Dietetics, Royal Brisbane Hospital, Brisbane, Australia
| | - Jose Emmanuel Palo
- Section of Adult Critical Care, Department of Medicine, The Medical City, Pasig, Metro Manila, Philippines
| | | | - Medhat Shalabi
- Anesthesiology and Intensive Care Department, Alzahra Hospital, Dubai, United Arab Emirates
| | - Luu Ngan Tam
- Clinical Nutrition Department, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | - Jonathan Jit Ern Tan
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore
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23
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Xiaoyong W, Xuzhao L, Deliang Y, Pengfei Y, Zhenning H, Bin B, Zhengyan L, Fangning P, Shiqi W, Qingchuan Z. Construction of a model predicting the risk of tube feeding intolerance after gastrectomy for gastric cancer based on 225 cases from a single Chinese center. Oncotarget 2017; 8:99940-99949. [PMID: 29245951 PMCID: PMC5725142 DOI: 10.18632/oncotarget.21966] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/20/2017] [Indexed: 12/27/2022] Open
Abstract
Identifying patients at high risk of tube feeding intolerance (TFI) after gastric cancer surgery may prevent the occurrence of TFI; however, a predictive model is lacking. We therefore analyzed the incidence of TFI and its associated risk factors after gastric cancer surgery in 225 gastric cancer patients divided into without-TFI (n = 114) and with-TFI (n = 111) groups. A total of 49.3% of patients experienced TFI after gastric cancer. Multivariate analysis identified a history of functional constipation (FC), a preoperative American Society of Anesthesiologists (ASA) score of III, a high pain score at 6-hour postoperation, and a high white blood cell (WBC) count on the first day after surgery as independent risk factors for TFI. The area under the curve (AUC) was 0.756, with an optimal cut-off value of 0.5410. In order to identify patients at high risk of TFI after gastric cancer surgery, we constructed a predictive nomogram model based on the selected independent risk factors to indicate the probability of developing TFI. Use of our predictive nomogram model in screening, if a probability > 0.5410, indicated a high-risk patients would with a 70.1% likelihood of developing TFI. These high-risk individuals should take measures to prevent TFI before feeding with enteral nutrition.
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Affiliation(s)
- Wu Xiaoyong
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 710032, Xi'an, Shaanxi, China.,Department of Hepatobiliary Surgery, Shanxi Provincial People's Hospital, 030012, Taiyuan, Shanxi, China
| | - Li Xuzhao
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Yu Deliang
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Yu Pengfei
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Hang Zhenning
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Bai Bin
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Li Zhengyan
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Pang Fangning
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Wang Shiqi
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Zhao Qingchuan
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
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Gut microbiota trajectory in patients with severe burn: A time series study. J Crit Care 2017; 42:310-316. [PMID: 28822895 DOI: 10.1016/j.jcrc.2017.08.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/05/2017] [Accepted: 08/11/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE This time series experiments aimed to investigate the dynamic change of gut microbiomes after severe burn and its association with enteral nutrition (EN). MATERIALS AND METHODS Seven severely burned patients who suffered from a severe metal dust explosion injury were recruited in this study. The dynamic changes of gut microbiome of fecal samples at six time points (1-3days, 2, 3, 4, 5 and 6weeks after severe burn) were detected using 16S ribosomal RNA pyrosequencing technology. RESULTS Following the post-burn temporal order, gut microbiota dysbiosis was detected in the gut microbiome after severe burn, then it was gradually resolved. The bio-diversity of gut bacteria was initially decreased, and then returned to normal level. In addition, at the early stage (from 2 to 4weeks), the majority of those patients' gut microbiome were opportunistic pathogen genus, Enterococcus and Escherichia; while at the end of this study, the majority was a beneficial genus, Bacteroides. EN can promote the recovery of gut microbiota, especially in EN well-tolerated patients. CONCLUSIONS Severe burn injury can cause a dramatic dysbiosis of gut microbiota. A trend of enriched beneficial bacteria and diminished opportunistic pathogen bacteria may serve as prognosis microbiome biomarkers of severe burn patients.
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Jakob SM, Bütikofer L, Berger D, Coslovsky M, Takala J. A randomized controlled pilot study to evaluate the effect of an enteral formulation designed to improve gastrointestinal tolerance in the critically ill patient-the SPIRIT trial. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:140. [PMID: 28599662 PMCID: PMC5466775 DOI: 10.1186/s13054-017-1730-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/22/2017] [Indexed: 12/16/2022]
Abstract
Background Diarrhea is frequent in patients in intensive care units (ICU) and is associated with discomfort and complications and may increase the length of stay and nursing workload. Methods This was a prospective, double-blind, randomized, controlled single-center pilot study to assess the incidence and frequency of diarrhea and the respective effects of a modified enteral diet (intervention: Peptamen® AF, rich in proteins, medium chain triglycerides and fish oil) compared to a standard diet (control: Isosource® Energy) in 90 randomized adult patients (intervention, n = 46; control, n = 44) with an ICU stay ≥5 days and tube feeding ≥3 days. Tube feeding was initiated within 72 h of ICU admission and continued up to 10 days. The caloric goal was adjusted to needs by indirect calorimetry. Gastrointestinal function, nutritional intake, and nursing workload were recorded. Follow-up was until 28 days after randomization. Results Median age was 63.3 (interquartile range (IQR) 51.0–73.2) years and Simplified Acute Physiology Score (SAPS) II was 61.0 (IQR 47.8–74). Time to reach caloric goal (intervention: 2.2 (0.8–3.7) days (median, IQR); control: 2.0 (1.3–2.7) days; p = 0.16), length of time on study nutrition (intervention: 5.0 (3.6–6.4) days; control: 7.0 (5.3–8.7) days; p = 0.26), and calorie intake (intervention: 18.0 (12.5–20.9) kcal/kg/day; control 19.7 (17.3–23.1) kcal/kg/day; p = 0.08) did not differ between groups, with a higher protein intake for Peptamen® group (1.13 (0.78–1.31) g/kg/day vs 0.80 (0.70–0.94); p < 0.001). No difference in diarrhea incidence (intervention group: 29 (64%); control group: 31 (70%); p = 0.652), use of fecal collectors (23 (51%) vs. 24 (55%); p = 0.83), or diarrhea-free days (161 (64%) vs 196 (68%); p = 0.65) was found. Nursing workload and cost for diarrhea care were not different between the groups. In a post-hoc analysis, adjusted for treatment group, age, sex, and SAPS II score, diarrhea was associated with length of mechanical ventilation (9.5 (6.0–13.1) vs. 3.9 (3.2–4.6) days; p = 0.006) and length of ICU stay (11.0 (8.9–13.1) vs. 5.0 (3.8–6.2) days; p = 0.001). Conclusions In this pilot study, we found a high incidence of diarrhea, which was not attenuated by Peptamen® AF. Patients with diarrhea stayed longer in the ICU. Trial registration ClinicalTrials.gov identifier, NCT01581957. Registered on 18 April 2012. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1730-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephan M Jakob
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, CH-3010, Switzerland.
| | - Lukas Bütikofer
- CTU Bern, and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - David Berger
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, CH-3010, Switzerland
| | - Michael Coslovsky
- CTU Bern, and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Jukka Takala
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, CH-3010, Switzerland
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