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Lopez-Delgado JC, Patel JJ, Stoppe C, McClave SA. Considerations for medical nutrition therapy management of the critically ill patient with hematological malignancies: A narrative review. Nutr Clin Pract 2024; 39:800-814. [PMID: 38666811 DOI: 10.1002/ncp.11152] [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: 12/19/2023] [Revised: 02/26/2024] [Accepted: 03/21/2024] [Indexed: 07/04/2024] Open
Abstract
Patients with hematological malignancies (HMs) are more frequently admitted now than in the past to the intensive care unit (ICU) due to more aggressive approaches in primary therapy of HMs and the need for critical care support. Pathophysiological alterations derived from HMs and the different hematological therapies, such as chemotherapy, negatively affect gastrointestinal (GI) function, metabolism, and nutrition status. Further, malnutrition strongly influences outcomes and tolerance of the different hematological therapies. In consequence, these critically ill patients frequently present with malnutrition and pathophysiological alterations that create challenges for the delivery of medical nutrition therapy (MNT) in the ICU. Frequent screening, gauging tolerance, and monitoring nutrition status are mandatory to provide individualized MNT and achieve nutrition objectives. The present review discusses how HM impact GI function and nutrition status, the importance of MNT in patients with HM, and specific considerations for guidance in providing adequate MNT to these patients when admitted to the ICU.
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Affiliation(s)
| | - Jayshil J Patel
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Christian Stoppe
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital, Würzburg, Würzburg, Germany
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Charité Berlin, Berlin, Germany
| | - Stephen A McClave
- Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA
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2
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Xu J, Li S, Chen X, Tan B, Chen S, Hu B, Nie Z, Ye H, Sun C, Chi R, Chen C. A Two-Stage Bedside Intubation Method to Improve Success Rate of Post-pyloric Placement of Spiral Nasoenteric Tubes in Critically Ill Patients: A Multi-Center, Prospective Study. Front Med (Lausanne) 2022; 9:875298. [PMID: 35646990 PMCID: PMC9134184 DOI: 10.3389/fmed.2022.875298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/26/2022] [Indexed: 12/03/2022] Open
Abstract
Backgrounds Prokinetic agents could improve the success rate of post-pyloric placement of self-propelled spiral nasoenteric tubes (NETs), and bedside blind technique might apply as a rescue therapy subsequent to spontaneous transpyloric migration failure. The objective of this study was to investigated the validity and safety of these two bedside intubation methods as a sequential procedure for post-pyloric placement of spiral NETs in critically ill patients. Methods The multicenter, prospective study was conducted in intensive care units of four tertiary hospitals (June 2020 to January 2021). Eligible patients received self-propelled spiral NET placements, promoted by prokinetic agents (Stage 1). An abdominal X-ray performed 24 h post-intubation confirmed the position of the tube tip. Patients with a failed transpyloric migration entered Stage 2, where beside blind intubation was conducted (reconfirmed by X-ray). The primary end point was the overall success rate of post-pyloric placement. Results The overall success rate of post-pyloric placement of the spiral NET was 91.1% (73.4% in the third portion of the duodenum [D3] or beyond). The total adverse event rate was 21.0%, without any serious adverse events. In Stage 1, 55.6% of participants achieved transpyloric migration, of these, 44.4% migrated to D3 or beyond. The median time from decision to intubate to the initiation of enteral nutrition (EN) was 25 h. In Stage 2, 83.0% of patients had successful post-pyloric intubation (67.9% in D3 or beyond). The median time from decision to EN initiation after the two-stage process was 36 h. Conclusions Prokinetic agents-assisted self-propelled intubation and remedial bedside blind technique as a sequential procedure for post-pyloric placement of spiral NETs were effective and safe, and this two-stage process did not affect the implementation of early EN in critically ill patients. Trial Registration Chinese Clinical Trial Registry, ChiCTR1900026381. Registered on 6 October 2019.
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Affiliation(s)
- Jing Xu
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Sinian Li
- Neurological Intensive Care Unit, Maoming People's Hospital, Maoming, China
| | - Xiangyin Chen
- Surgical Intensive Care Unit, Maoming People's Hospital, Maoming, China
| | - Bo Tan
- Department of Emergency, Maoming People's Hospital, Maoming, China
| | - Shenglong Chen
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bei Hu
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhiqiang Nie
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Heng Ye
- Department of Critical Care Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Cheng Sun
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ruibin Chi
- Department of Critical Care Medicine, Xiaolan People's Hospital of Zhongshan, Zhongshan, China
| | - Chunbo Chen
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Critical Care Medicine, Maoming People's Hospital, Maoming, China
- *Correspondence: Chunbo Chen
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3
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Al-Dorzi HM, Arabi YM. Nutrition support for critically ill patients. JPEN J Parenter Enteral Nutr 2021; 45:47-59. [PMID: 34897737 DOI: 10.1002/jpen.2228] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/16/2021] [Accepted: 07/16/2021] [Indexed: 12/12/2022]
Abstract
Nutrition support is an important aspect of the management of critically ill patients. This review highlights the emerging evidence on critical care nutrition and focuses on the pathophysiologic interplay between critical illness, the gastrointestinal tract, and nutrition support and the evidence on the best route, dose, and timing of nutrition. Although indirect calorimetry is recommended to measure energy expenditure, predictive equations are commonly used but are limited by their inaccuracy in individual patients. The current evidence supports early enteral nutrition (EN) in most patients, with a gradual increase in the daily dose over the first week. Delayed EN is warranted in patients with severe shock. According to recent trials, parenteral nutrition seems to be as effective as EN and may be started if adequate EN is not achieved by the first week of critical illness. A high protein dose has been recommended, but the best timing is unclear. Immuno-nutrition should not be routinely provided to critically ill patients. Patients receiving artificial nutrition should be monitored for metabolic derangements. Additional adequately powered studies are still needed to resolve many unanswered questions.
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Affiliation(s)
- Hasan M Al-Dorzi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Yaseen M Arabi
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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4
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Wang H, Huang C, Yang Y, Kong L, Zheng X, Shan X. Cost-effectiveness analysis of nasojejunal tube feeding for the prevention of pneumonia in critically ill adults. JPEN J Parenter Enteral Nutr 2021; 46:1167-1175. [PMID: 34751960 DOI: 10.1002/jpen.2302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Nasojejunal tube (NJT) feeding has demonstrated value in reducing pneumonia in critically ill adults who require enteral nutritional (EN) support. This study discusses whether EN support via nasojejunal tube (NJT) feeding is more cost-effective than nasogastric tube (NGT) feeding in reducing pneumonia. METHODS A decision tree model was created. The analysis was based on data from a health care provider in China. Model inputs were derived from published data. The endpoints included incremental cost per pneumonia infection avoided, incremental cost-effectiveness ratio (ICER), net monetary benefit (NMB) and incremental net monetary benefit (INMB) associated with prevention of pneumonia. The uncertainty was assessed through one-way and probabilistic sensitivity analysis. RESULTS The base case analysis showed that EN support via NJT feeding resulted in 0.7453 quality-adjusted life years (QALYs) at a cost of $3018.83 compared to NGT feeding, which resulted in 0.7354 QALYs at a cost of $4788.76. NJT feeding was better than NGT feeding, providing an INMB of $2,075.09 and an ICER of $-178,813.96 per QALY gained, and the cost per pneumonia infection prevented was $16,808.51. The probabilistic sensitivity analysis indicated that NJT feeding was more cost-effective in 83.4% of the cases, with a cost below the WTP threshold. The NMB and INMB estimation for different WTP thresholds also indicated that NJT feeding is the optimal strategy. CONCLUSIONS EN support via NJT feeding was a more cost-effective strategy than NGT feeding in preventing pneumonia in critically ill adults. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Hongmei Wang
- Department of Pharmacy, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Chun Huang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yang Yang
- Operating Room, VIP Department, Jinshan Hospital, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 401122, China
| | - Lingxi Kong
- Department of Pharmacy, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xiaoying Zheng
- Department of Pharmacy, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xuefeng Shan
- Department of Pharmacy, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
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5
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Wei M, Ho E, Hegde P. An overview of percutaneous endoscopic gastrostomy tube placement in the intensive care unit. J Thorac Dis 2021; 13:5277-5296. [PMID: 34527366 PMCID: PMC8411178 DOI: 10.21037/jtd-19-3728] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 05/06/2020] [Indexed: 01/03/2023]
Abstract
Critically ill patients are at increased risk for malnutrition as they often have underlying acute and chronic illness, stress related catabolism, decreased appetite, trauma and ongoing inflammation. Malnutrition is recognized as a leading cause of adverse outcomes, higher mortality, and increased hospital costs. Percutaneous endoscopic gastrostomy (PEG) tubes provide a safe and effective route to provide supplemental enteral nutrition to these patients. PEG placement has essentially replaced surgical gastrostomy as the modality of choice for longer term feeding in patients. This is a highly prevalent procedure with 160,000 to 200,000 PEG procedures performed each year in the United States. The purpose of this review is to provide an overview of current knowledge and practice standards with regards to placement of PEG tube in the Intensive Care Unit (ICU). When a patient is considered for a PEG tube, it is important to evaluate the treatment alternatives and identify the best option for each patient. In this review, we provide the advantages and disadvantages of various feeding modalities and devices. We review the indications and contraindications for PEG tube placement as well as the risks of this procedure. We then describe in detail the per-oral pull, per-oral push, and direct percutaneous techniques for PEG tube placement. Additionally, we review the feasibility of having interventional pulmonologists place PEG tubes in the ICU.
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Affiliation(s)
- Margaret Wei
- Department of Internal Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Elliot Ho
- Division of Advanced Interventional Thoracic Endoscopy/Interventional Pulmonology, University of California San Francisco - Fresno, Fresno, CA, USA
| | - Pravachan Hegde
- Division of Advanced Interventional Thoracic Endoscopy/Interventional Pulmonology, University of California San Francisco - Fresno, Fresno, CA, USA
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Liu Y, Wang Y, Zhang B, Wang J, Sun L, Xiao Q. Gastric-tube versus post-pyloric feeding in critical patients: a systematic review and meta-analysis of pulmonary aspiration- and nutrition-related outcomes. Eur J Clin Nutr 2021; 75:1337-1348. [PMID: 33536570 DOI: 10.1038/s41430-021-00860-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 11/20/2020] [Accepted: 01/07/2021] [Indexed: 01/30/2023]
Abstract
Gastric-tube feeding and post-pyloric feeding are the two most common forms of enteral nutrition, each with advantages and disadvantages. To explore the effects and safety of gastric-tube versus post-pyloric feeding in critical patients by comparing pulmonary aspiration- and nutrition-related outcomes, a meta-analysis was conducted. It was performed by systematically searching the following databases: PubMed, EMBASE, Cochrane library, BMJ best practice, ProQuest dissertations and theses, CINAHL, web of science, SinoMed, WANFANG, CNKI, and the platform of clinical trial registration. The databases were searched through December 31, 2019, and studies were evaluated by two independent researchers. Review Manager software was used for data analysis. We included 41 studies conducted in ten countries and involving 3248 participants. Meta-analysis showed that post-pyloric feeding had a lower incidence rate of pulmonary aspiration, gastric reflux, and pneumonia (P < 0.001, all), less incidence of gastrointestinal complications including vomiting, nausea, diarrhea, abdominal distension, high gastric residual volume, and constipation (P < 0.05, all), more optimal gastrointestinal nutrition including the percentage of total nutrition provided to the patient, the time to tolerate enteral nutrition, the time required to start feeding and the time required to reach nutritional targets (P < 0.05, all), shorter length of mechanical ventilation, stay in ICU and stay in hospital (P < 0.001, all), compared with gastric-tube feeding. No significant differences were shown in the time of gastrointestinal function recovery, mortality, or hospitalization expenses between the two feeding routes. This review provides evidence that post-pyloric feeding appears to be the safer and more effective choice, as compared to gastric-tube feeding among critical patients.
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Affiliation(s)
- Yue Liu
- School of Nursing, Capital Medical University, Beijing, 100069, China
| | - Yanling Wang
- School of Nursing, Capital Medical University, Beijing, 100069, China
| | - Bohan Zhang
- School of Nursing, Capital Medical University, Beijing, 100069, China
| | - Jiani Wang
- School of Nursing, Capital Medical University, Beijing, 100069, China
| | - Liu Sun
- School of Nursing, Capital Medical University, Beijing, 100069, China
| | - Qian Xiao
- School of Nursing, Capital Medical University, Beijing, 100069, China.
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7
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Bing X, Yinshan T, Ying J, Yingchuan S. Efficacy and safety of a modified method for blind bedside placement of post-pyloric feeding tube: a prospective preliminary clinical trial. J Int Med Res 2021; 49:300060521992183. [PMID: 33622069 PMCID: PMC7907950 DOI: 10.1177/0300060521992183] [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] [Indexed: 12/18/2022] Open
Abstract
Objective To compare the efficacy and safety of a new modified method of bedside
post-pyloric feeding tube catheterization with the Corpak protocol versus
electromagnetic-guided catheterization. Materials and Methods We conducted a single-center, single-blinded, prospective clinical trial.
Sixty-three patients were treated with a non-gravity type gastrointestinal
feeding tube using different procedures: modified bedside post-pyloric
feeding tube placement (M group), the conventional Corpak protocol (C
group), and standard electromagnetic-guided tube placement (EM group). Results The success rate in the M group, C group, and EM group was 82.9% (34/41),
70.7% (29/41), and 88.2% (15/17), respectively, with significant differences
among the groups. The time required to pass the pylorus was significantly
shorter in the M group (26.9 minutes) than in the C group (31.9 minutes) and
EM group (42.1 minutes). The proportion of pylorus-passing operations
completed within 30 minutes was significantly higher in the M group than in
the C group and EM group. No severe complications occurred. Conclusion This modified method of bedside post-pyloric feeding tube catheterization
significantly shortened the time required to pass the pylorus with no severe
adverse reactions. This method is effective and safe for enteral nutrition
catheterization of patients with dysphagia and a high risk of aspiration
pneumonia.
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Affiliation(s)
- Xiong Bing
- Department of Rehabilitation, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR China
| | - Tang Yinshan
- Department of Rehabilitation, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR China
| | - Jin Ying
- Department of Rehabilitation, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR China
| | - Shen Yingchuan
- Department of Radiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR China
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8
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Chen MC, Chao HC, Yeh PJ, Lai MW, Chen CC. Therapeutic Efficacy of Nasoenteric Tube Feeding in Children Needing Enteral Nutrition. Front Pediatr 2021; 9:646395. [PMID: 33816405 PMCID: PMC8012528 DOI: 10.3389/fped.2021.646395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/08/2021] [Indexed: 11/24/2022] Open
Abstract
Background: There is limited information on therapeutic benefits and tube-related complications of pediatric nasoenteric (NE) tube feeding. We viewed, from different clinical aspects, NE tube feeding in children who are under intolerable conditions. Methods: A 10-years retrospective study enrolled 77 pediatric patients who underwent an endoscopic-guided placement of the NE tube for enteral nutrition. The evaluated data, including growth parameters, feeding volume, parenteral nutrition (PN) dependence, and nutritional markers [serum hemoglobin (Hb) and albumin] before and after NE tube feeding were compared. Tube-related complications and major adverse events were also recorded. Results: A total of 77 patients (including 50 males) underwent 176 endoscopic-guided placements of the NE tube with an average duration of 133.7 (6.0-1,847.3) days. The gastroesophageal reflux disease-related symptoms (vomiting, desaturations, and aspiration pneumonia) improved in 71.4% of patients. Feeding volume increased significantly after intervention, especially in patients with delayed gastric emptying, from 144.8 ± 28.5 to 1,103.1 ± 524.7 ml/days (p < 0.001). Weaning from PN was successfully achieved in 84.3% of patients with an average of 9.33 ± 7.30 days. About 16 patients (20.8%) were subsequently highly compatible with oral feeding after NE tube placement for an average of 24.7 ± 14.1 days. Patients either without neurologic dysfunction or with no ventilator-dependent status had a higher chance of shifting to oral feeding. Weight-for-age z-scores increased by 0.15 ± 1.33 after NE tube intervention. One NE tube-related adverse event, which caused bowel perforation at 6 days post-insertion, was recorded. No direct tube-related mortality was observed. Conclusions: Endoscopic-guided NE tube placement is a relatively safe, non-invasive procedure for pediatric patients who require enteral nutrition. Feeding via NE tube showed beneficial effects such as improvement in symptoms, PN weaning, and maintenance of body growth without major tube-related complications.
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Affiliation(s)
- Mi-Chi Chen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Hsun-Chin Chao
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Pai-Jui Yeh
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Ming-Wei Lai
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Chien-Chang Chen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,Chang Gung University College of Medicine, Taoyuan City, Taiwan
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9
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Abstract
ZusammenfassungDie Ernährung über eine jejunale Sonde wird immer häufiger bei jenen Kindern notwendig, deren kalorischer Bedarf durch gastrale Ernährung nicht ausreichend gedeckt werden kann. Ursächlich hierfür können die Intoleranz gastral zugeführter Nahrung oder eine ausgeprägte gastroösophageale Refluxkrankheit (GÖRK) sein. Da nach Anlage der Jejunalsonde häufig regelmäßige Sondenwechsel notwendig werden, ist eine jejunale Sonde oft nur eine vorübergehende Lösung bis zur perkutanen Anlage eines Jejunostomas (mit oder ohne Antirefluxoperation) oder als Alternative vor einer etwaigen Antirefluxoperation.Bevor eine jejunale Sonde gelegt wird, sollte eine Nahrungsintoleranz aufgrund anatomischer oder nicht gastrointestinal bedingter Probleme ausgeschlossen werden.Die Versorgung eines Kindes, bei dem die Anlage einer jejunalen Sonde geplant ist, sollte durch ein multidisziplinäres Team, bestehend aus u. a. einem Kindergastroenterologen/einer Kindergastroenterologin, einer Ernährungsfachkraft, einem Psychologen/einer Psychologin und einem Logopäden/einer Logopädin, erfolgen. Das multidisziplinäre Team sollte bereits vor Indikationsstellung die Nahrung anpassen, das Kind logopädisch evaluiert haben und die Familie psychologisch und medizinisch mitbetreuen.Eine adäquate Planung, welche auch ethische Aspekte beinhaltet, garantiert, dass sowohl der Patient/die Patientin, die Eltern und Betreuungspersonen wie auch das behandelnde Team ein klares Verständnis der Indikation und Gründe für die Anlage einer jejunalen Sonde haben. Dabei sollten auch die Fortsetzung einer möglichen oralen Ernährung und eine Sondenentwöhnung diskutiert werden.Diese Übersicht beinhaltet Handlungsempfehlungen zur Indikationsstellung für den Einsatz jejunaler Sonden, gepaart mit praktischen Überlegungen, welche die Verwendung und die Sicherheit der jejunalen Sondenernährung im Kindes- und Jugendalter optimieren sollen.
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10
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Jha P, Rupp L, Bonilla L, Gelfond J, Shah JN, Meyer AD. Electromagnetic Versus Blind Guidance of a Postpyloric Feeding Tube in Critically Ill Children. Pediatrics 2020; 146:peds.2019-3773. [PMID: 32994178 DOI: 10.1542/peds.2019-3773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Postpyloric feeding tube placement is a time-consuming procedure associated with multiple attempts and radiation exposure. Our objective with this study is to compare the time, attempts, and radiation exposure using the electromagnetic versus blind method to place a postpyloric feeding tube in critically ill children. Our hypothesis is that using electromagnetic guidance decreases the procedure time, number of x-rays, and number of attempts, compared to the blind method. METHODS Eleven pediatric nurses participated in a randomized controlled intention-to-treat study at an academic pediatric medical, surgical, and congenital cardiac ICU. University of Texas Health Epidemiology and Biostatistics generated a randomization sequence with sealed envelopes. A standard (2-sided) F-test of association between the electromagnetic and blind method yielded 40 subjects with 86% power. Data were analyzed with Fisher's exact test for categorical variables and the Wilcoxon rank test for continuous variables, with data documented as median (interquartile range [IQR]). RESULTS We randomly assigned 52 patients to either the electromagnetic (n = 28) or blind method (n = 24). The number of attempts and radiographs was at a median of 2 (IQR: 1-2.25) using the blind method, compared to the electromagnetic method at a median of 1 (IQR: 1.0-1.0; P = .001). Successful guidance was 96.4% with the electromagnetic method, compared to only 66.7% with the blind technique (P = .008). The total time required was 2.5 minutes (IQR: 2.0-7.25) with the electromagnetic method, compared to 19 minutes (IQR: 9.25-27.0) for the blind method (P = .001). CONCLUSIONS Electromagnetic guidance is a superior, faster, and overall safer method to place a postpyloric feeding tube in critically ill children.
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Affiliation(s)
- Prashant Jha
- Division of Critical Care, Department of Pediatrics, Children's Hospital of Nevada at University Medical Center, Las Vegas, Nevada; .,Department of Pediatrics, University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada
| | - Lisa Rupp
- Pediatric Services, University Health System, San Antonio, Texas; and
| | - Lorraine Bonilla
- Pediatric Services, University Health System, San Antonio, Texas; and
| | - Jonathan Gelfond
- Department of Epidemiology and Biostatistics, University of Texas Health San Antonio, San Antonio, Texas
| | - Jay N Shah
- Pediatric Services, University Health System, San Antonio, Texas; and.,Divisions of Pediatric Gastroenterology and
| | - Andrew D Meyer
- Pediatric Services, University Health System, San Antonio, Texas; and.,Pediatric Critical Care, Department of Pediatrics and
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11
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Abstract
Sufficient energy and essential nutrients are vital for normal growth and development in childhood. Ideally, nutrition should be provided orally. However, if the gastrointestinal system is functional, enteral tube feeding can be used when nutritional requirements cannot be provided orally, thus providing nutritional benefits and enabling positive disease management in pediatric patients. Postoperative care in children allows monitoring of the position and functionality of the tube; performing nutrition intolerance, growth, hydration, and nutritional assessments; and performing metabolic and complication follow-ups. Tube feeding in pediatric patients is beneficial and has positive effects in controlling and managing diseases and providing appropriate nutrition in children. However, in postoperative patients, it is important to prevent potential complications, which can be classified into 5 groups: mechanical, gastrointestinal, metabolic, infectious, and pulmonary complications. Important points for managing complications include having enteral nutrition practices based on evidence-based guidelines, sharing outcomes with nurses working in clinical settings, creating enteral feeding guides in clinical settings, providing patients/patients' family with training in line with these guides, and maintaining follow-ups at home. This literature review discusses complications and practices regarding the management of complications after percutaneous endoscopic gastrostomy.
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12
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Brown BD, Hoffman SR, Johnson SJ, Nielsen WR, Greenwaldt HJ. Developing and Maintaining an RDN-Led Bedside Feeding Tube Placement Program. Nutr Clin Pract 2019; 34:858-868. [DOI: 10.1002/ncp.10411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
| | | | | | - Wendy R. Nielsen
- University of Minnesota Medical Center; Minneapolis Minnesota USA
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13
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The Use of Jejunal Tube Feeding in Children: A Position Paper by the Gastroenterology and Nutrition Committees of the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition 2019. J Pediatr Gastroenterol Nutr 2019; 69:239-258. [PMID: 31169666 DOI: 10.1097/mpg.0000000000002379] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Jejunal tube feeding (JTF) is increasingly becoming the standard of care for children in whom gastric tube feeding is insufficient to achieve caloric needs. Given a lack of a systematic approach to the care of JTF in paediatric patients, the aim of this position paper is to provide expert guidance regarding the indications for its use and practical considerations to optimize its utility and safety. METHODS A group of members of the Gastroenterology and Nutrition Committees of the European Society of Paediatric Gastroenterology Hepatology and Nutrition and of invited experts in the field was formed in September 2016 to produce this clinical guide. Seventeen clinical questions treating indications and contraindications, investigations before placement, techniques of placement, suitable feeds and feeding regimen, weaning from JTF, complications, long-term care, and ethical considerations were addressed.A systematic literature search was performed from 1982 to November 2018 using PubMed, the MEDLINE, and Cochrane Database of Systematic Reviews. Grading of Recommendations, Assessment, Development, and Evaluation was applied to evaluate the outcomes.During a consensus meeting, all recommendations were discussed and finalized. In the absence of evidence from randomized controlled trials, recommendations reflect the expert opinion of the authors. RESULTS A total of 33 recommendations were voted on using the nominal voting technique. CONCLUSIONS JTF is a safe and effective means of enteral feeding when gastric feeding is insufficient to meet caloric needs or is not possible. The decision to place a jejunal tube has to be made by close cooperation of a multidisciplinary team providing active follow-up and care.
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Yeh DD, Martin M, Sakran JV, Meier K, Mendoza A, Grant AA, Parks J, Byerly S, Lee EE, McKinley WI, McClave SA, Miller K, Mazuski J, Taylor B, Luckhurst C, Fagenholz P. Advances in nutrition for the surgical patient. Curr Probl Surg 2019; 56:343-398. [DOI: 10.1067/j.cpsurg.2019.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Xing J, Zhang Z, Ke L, Zhou J, Qin B, Liang H, Chen X, Liu W, Liu Z, Ai Y, Wang D, Wang Q, Zhou Q, Zhang F, Qian K, Jiang D, Zang B, Li Y, Huang X, Qu Y, Xie Y, Xu D, Zou Z, Zheng X, Liu J, Guo F, Liang Y, Sun Q, Gao H, Liu Y, Chang P, Ceng A, Yang R, Yao G, Sun Y, Wang X, Zhang Y, Wen Y, Yu J, Sun R, Li Z, Yuan S, Song Y, Gao P, Liu H, Zhang Z, Wu Y, Ma B, Guo Q, Shan F, Yang M, Li H, Li Y, Lu W, Wang L, Qian C, Wang Z, Lin J, Zhang R, Wan P, Peng Z, Gong Y, Huang L, Wu G, Sun J, Deng Y, Shi D, Zhou L, Zhou F, Shi Q, Guo X, Liu X, Wu W, Meng X, Li L, Chen W, Li S, Wan X, Chao Z, Zhang A, Gu L, Chen W, Wu J, Zhou L, Zhang Z, Weng Y, Feng Y, Yang C, Feng Y, Zhao S, Tong F, Hao D, Han H, Fu B, Gong C, Li Z, Hu K, Kou Q, Zhang H, Liu J, Fan C, Zhou X, Chen X, Sun J, Zhou X, Song B, Sun C, Zhao L, Dong X, Zhang L, Tong D, Pan Z, Cai C, Wang D, Dong Y, Gong Y, Wu Z, Meng X, Wang P, Li W. Enteral nutrition feeding in Chinese intensive care units: a cross-sectional study involving 116 hospitals. Crit Care 2018; 22:229. [PMID: 30244686 PMCID: PMC6151932 DOI: 10.1186/s13054-018-2159-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 08/10/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There is a lack of large-scale epidemiological data on the clinical practice of enteral nutrition (EN) feeding in China. This study aimed to provide such data on Chinese hospitals and to investigate factors associated with EN delivery. METHODS This cross-sectional study was launched in 118 intensive care units (ICUs) of 116 mainland hospitals and conducted on April 26, 2017. At 00:00 on April 26, all patients in these ICUs were included. Demographic and clinical variables of patients on April 25 were obtained. The dates of hospitalization, ICU admission and nutrition initiation were reviewed. The outcome status 28 days after the day of investigation was obtained. RESULTS A total of 1953 patients were included for analysis, including 1483 survivors and 312 nonsurvivors. The median study day was day 7 (IQR 2-19 days) after ICU entry. The proportions of subjects starting EN within 24, 48 and 72 h after ICU entry was 24.8% (84/352), 32.7% (150/459) and 40.0% (200/541), respectively. The proportion of subjects receiving > 80% estimated energy target within 24, 48, 72 h and 7 days after ICU entry was 10.5% (37/352), 10.9% (50/459), 11.8% (64/541) and 17.8% (162/910), respectively. Using acute gastrointestinal injury (AGI) 1 as the reference in a Cox model, patients with AGI 2-3 were associated with reduced likelihood of EN initiation (HR 0.46, 95% CI 0.353-0.599; p < 0.001). AGI 4 was significantly associated with lower hazard of EN administration (HR 0.056; 95% CI 0.008-0.398; p = 0.004). In a linear regression model, greater Sequential Organ Failure Assessment scores (coefficient - 0.002, 95% CI - 0.008 to - 0.001; p = 0.024) and male gender (coefficient - 0.144, 95% CI - 0.203 to - 0.085; p < 0.001) were found to be associated with lower EN proportion. As compared with AGI 1, AGI 2-3 was associated with lower EN proportion (coefficient - 0.206, 95% CI - 0.273 to - 0.139; p < 0.001). CONCLUSIONS The study showed that EN delivery was suboptimal in Chinese ICUs. More attention should be paid to EN use in the early days after ICU admission.
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Affiliation(s)
- Juan Xing
- Nanjing General Hospital of Nanjing Military Command, No.305 Zhongshan East Road, Nanjing, 210002 China
| | - Zhongheng Zhang
- Department of emergency medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lu Ke
- Nanjing General Hospital of Nanjing Military Command, No.305 Zhongshan East Road, Nanjing, 210002 China
| | - Jing Zhou
- Nanjing General Hospital of Nanjing Military Command, No.305 Zhongshan East Road, Nanjing, 210002 China
| | - Bingyu Qin
- Henan Provincial People’s Hospital, Zhengzhou, China
| | | | | | - Wenming Liu
- Changzhou No.2 People’s Hospital affiliated to Nanjing Medical University, Nanjing, China
| | - Zhongmin Liu
- Jilin University First Hospital, Changchun, China
| | - Yuhang Ai
- Xiangya Hospital Central South University, Changsha, China
| | - Difeng Wang
- Guizhou Medical University affiliated hospital, Guiyang, China
| | | | | | | | - Kejian Qian
- First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Dongpo Jiang
- Third Military Medical University Daping Hospital, Chongqing, China
| | - Bin Zang
- China Medical University Second Affiliated Hospital, Shenyang, China
| | - Yimin Li
- Guangzhou Medical University First Affiliated Hospital, Guangzhou, China
| | - Xiaobo Huang
- Sichuan Provincial People’s Hospital, Chengdu, China
| | - Yan Qu
- Qingdao Municipal Hospital Group, Qingdao, China
| | | | - Donglin Xu
- Guangzhou First Municipal People’s Hospital, Guangzhou, China
| | - Zhiqiang Zou
- Xiehe Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | | | - Jianbo Liu
- Inner Mongolia People’s Hospital, Huhehaote, China
| | - Feng Guo
- Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Yafeng Liang
- Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Qingdao, China
| | - Qiang Sun
- Tianjing People’s Hospital, Tianjin, China
| | - Hongmei Gao
- Tianjing First Central Hospital, Tianjin, China
| | - Yang Liu
- Tangshan Gongren Hospital, Tangshan, China
| | - Ping Chang
- Southern Medical University Zhujiang Hospital, Guangzhou, China
| | - Aibin Ceng
- North China University of Science and Technology Affiliated Hospital, Tangshan, China
| | | | - Gaiqi Yao
- Peking University Third Hospital, Beijing, China
| | - Yun Sun
- Anhui Medical University Second Affiliated Hospital, Hefei, China
| | - Xiaorong Wang
- Wenzhou Medical University First Affiliated Hospital, Wenzhou, China
| | - Yi Zhang
- Shanxi Provincial People’s Hospital, Taiyuan, China
| | - Yichao Wen
- Guangzhou Medical University Second Affiliated Hospital, Guangzhou, China
| | - Jian Yu
- Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Rongqing Sun
- Zhengzhou University First Affiliated Hospital, Zhengzhou, China
| | - Zhiwei Li
- First People’s Hospital of Kunming, Kunming, China
| | - Shiying Yuan
- Union Hospital Affiliated to Tongji Medical College of Huanzhong University of Science and Technology, Wuhan, China
| | - Yunlin Song
- Xinjiang Medical University Affiliated First Hospital, Wulumuqi, China
| | - Peiyang Gao
- Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, China
| | - Haiyan Liu
- First Affiliated Hospital of Anhui Medical University, Hefei, China
| | | | - Yunfu Wu
- Suzhou Municipal Hospital, Suzhou, China
| | - Biao Ma
- Jining Medical College Affiliated Hospital, Jining, China
| | - Qiang Guo
- First Affiliated Hospital of Soochow University, Suzhou, China
| | - Feng Shan
- Qindao University Medical College Affiliated Hospital, Qindao, China
| | - Mingshi Yang
- Central South University Third Xiangya Hospital, Changsha, China
| | - Hailing Li
- 401 Military Hospital of China, Qindao, China
| | - Yuanfei Li
- Changsha Central Hospital, Changsha, China
| | - Weihua Lu
- Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Lei Wang
- Shanxi Medical University First Affiliated Hospital, Taiyuan, China
| | - Chuangyun Qian
- Kuming Medical University First Affiliated Hospital, Kuming, China
| | - Zhiyong Wang
- Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
| | - Jiandong Lin
- First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | | | - Peng Wan
- First People’s Hospital of Yichang, Yichang, China
| | - Zhiyong Peng
- Wuhan University Zhongnan Hospital, Wuhan, China
| | - Yuqiang Gong
- Wenzhou Medical University Second Affiliated Hospital, Wenzhou, China
| | - Linxi Huang
- Shantou University Medical College First Affiliated Hospital, Shantou, China
| | - Guobao Wu
- Zhongnan University Xiangya Second Hospital, Changsha, China
| | - Jie Sun
- Yunnan Second People’s Hospital, Kunming, China
| | - Yijun Deng
- Yancheng First People’s Hospital, Yancheng, China
| | - Dongwu Shi
- Shanxi Provincial People’s Hospital, Taiyuan, China
| | - Lixin Zhou
- First People’s Hospital of Foshan, Foshan, China
| | - Fachun Zhou
- Chongqing Medical University First Affiliated Hospital, Chongqing, China
| | - Qindong Shi
- Xi’an Jiao Tong University First Affiliated Hospital, Xi’an, China
| | | | - Xueyan Liu
- Shenzhen People’s Hospital, Shenzhen, China
| | - Weidong Wu
- Shanxi Dayi Hospital of Shanxi Academy of Medical Science, Taiyuan, China
| | | | - Liandi Li
- Qingdao University Affiliated Hospital, Qingdao, China
| | - Weiwei Chen
- Linhai First People’s Hospital, Linhai, China
| | - Shusheng Li
- Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Xianyao Wan
- First Affiliated Hospital of Dalian Medical University, Dalian, China
| | | | - An Zhang
- Chongqing Medical University Second Affiliated Hospital, Chongqing, China
| | - Liming Gu
- People’s Hospital of Yuxi City, Yuxi, China
| | - Wei Chen
- Shijitan Hospital of Capital Medical University, Beijing, China
| | - Jinglan Wu
- Shenzhen Nanshan People’s Hospital, Shenzhen, China
| | - Lihua Zhou
- Affiliated Hospital of Inner Mongolia Medical College, Huhehaote, China
| | | | | | - Yongshun Feng
- Beijing Jingmei Group General Hospital, Beijing, China
| | - Chunli Yang
- Jiangxi Provincial People’s Hospital, Nanchang, China
| | - Yongjian Feng
- Jinan University First Affiliated Hospital, Jinan, China
| | - Sumin Zhao
- General Hospital of Rocket Army, Beijing, China
| | - Fei Tong
- Hebei Medical University Second Affiliated Hospital, Shijiazhuang, China
| | - Dong Hao
- Binzhou Medical College Affiliated Hospital, Binzhou, China
| | - Hui Han
- Chinese PLA General Hospital, Beijing, China
| | - Baocai Fu
- Yantai Mountain Hospital, Yantai, China
| | - Chuanyong Gong
- Tianjing Hospital of ITCWM Nankai Hospital, Tianjing, China
| | - Zhiping Li
- Hunan Provincial People’s Hospital, Changsha, China
| | - Kunlin Hu
- People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Qiuye Kou
- Sun Yat-sen University Sixth Affiliated Hospital, Guangzhou, China
| | - Han Zhang
- China Academy of Chinese Medical Sciences Xiyuan Hospital, Beijing, China
| | - Jie Liu
- Wuhan General Hospital of Guangzhou Military Region, Wuhan, China
| | - Chuming Fan
- First People’s Hospital of Yunnan, Kunming, China
| | - Xin Zhou
- Xinjiang Military General Hospital, Wulumuqi, China
| | | | - Junli Sun
- Luoyang Central Hospital, Luoyang, China
| | - Xuejun Zhou
- Huairou First Hospital of Beijing, Beijing, China
| | - Bin Song
- Military General Hospital of Beijing PLA, Beijing, China
| | - Cheng Sun
- Guangdong Provincial People’s Hospital, Guangzhou, China
| | - Liyun Zhao
- Guangdong Second TCM Hospital, Guangzhou, China
| | | | | | - Dafei Tong
- Shenyang First People’s Hospital, Shenyang, China
| | - Zhiguo Pan
- Guangzhou Military General Hospital, Guangzhou, China
| | - Chuangjie Cai
- Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | | | | | - Yuanqi Gong
- Nanchang University Second Affiliated Hospital, Nanchang, China
| | - Zhisong Wu
- Beijing University of Chinese Medicine Affiliated Dongfang Hospital, Beijing, China
| | - Xinke Meng
- Shenzhen Second People’s Hospital, Shenzhen, China
| | - Ping Wang
- Chendu Fifth People’s Hospital, Chendu, China
| | - Weiqin Li
- Nanjing General Hospital of Nanjing Military Command, No.305 Zhongshan East Road, Nanjing, 210002 China
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Poveda VDB, Castilho ACBA, Nogueira LDS, Ferretti-Rebustini REL, Silva RDCGE. Assessing gastric residual volume: a description of nurses' clinical practice. Rev Esc Enferm USP 2018; 52:e03352. [PMID: 30088543 DOI: 10.1590/s1980-220x2017038803352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/27/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To analyze the differences in nurses' clinical practice for assessing residual gastric volume and identifying the theoretical framework which supports their practice. METHOD A cross-sectional study carried out by sending an online questionnaire by e-mail to nurses registered at the Regional Nursing Council of the State of São Paulo. RESULTS This study included 598 nursing professionals, with 484 only providing care to adults and 114 exclusively to children. The gastric residual volume test is performed by 83.4% of nursing professionals; in most cases the suspension and prescription of enteral nutritional therapy are performed by the physician. Suspension of enteral nutritional therapy among adults predominantly occurs when the gastric residual volume is equal to 200 ml, and in children when values are less than 100 ml. Procedure after diet suspension involves the return of aspirated gastric contents and maintaining the catheter closed until the next hour in 48.3% of the procedures among adults, and 68.4% among children. 42.9% of the participants in this study were not aware of the theoretical basis that supports the test performance. CONCLUSION We can highlight the need for nurses' training and further studies focused on the practice for assessing gastric residual volume.
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Affiliation(s)
- Vanessa de Brito Poveda
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Médico Cirúrgica, São Paulo, SP, Brasil
| | | | - Lilia de Souza Nogueira
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Médico Cirúrgica, São Paulo, SP, Brasil
| | | | - Rita de Cássia Gengo E Silva
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Médico Cirúrgica, São Paulo, SP, Brasil
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Ruiz RF, Franco MC, Furuya CK, Dos-Santos MEL. Modified technique for percutaneous endoscopic gastrojejunostomy placement. Rev Col Bras Cir 2017; 44:413-415. [PMID: 29019546 DOI: 10.1590/0100-69912017004002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 03/30/2017] [Indexed: 11/22/2022] Open
Abstract
The placement of percutaneous endoscopic gastrojejunostomy (PEG-J) provides diet delivery beyond the angle of Treitz, and it is associated with decrease of complications related to gastroparesis, such as aspiration pneumonia. There are many different techniques to perform a PEG-J described in the literature, with variable degrees of technical success. In this article, we suggest modifications to the technique of PEG-J placement in order to reduce time of procedure and minimize the risk of technical failure.
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Affiliation(s)
- Renzo Feitosa Ruiz
- Hospital Israelita Albert Einstein, Serviço de Endoscopia, São Paulo, SP, Brasil.,Hospital Alemão Oswaldo Cruz, Serviço de Endoscopia, São Paulo, SP, Brasil
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Hirose H, Pitcher HT, Baram M, Cavarocchi NC. Issues in the Intensive Care Unit for Patients with Extracorporeal Membrane Oxygenation. Crit Care Clin 2017; 33:855-862. [DOI: 10.1016/j.ccc.2017.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Omorogieva Ojo, Senior Lecturer in Primary Care at the University of Greenwich, O.Ojo@greenwich.ac.uk , highlights key recommendations on enteral nutrition for patients in critical care.
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Affiliation(s)
- Omorogieva Ojo
- Senior Lecturer in Primary Care at the University of Greenwich
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20
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Abstract
PURPOSE OF REVIEW To summarize recent relevant studies regarding nutrition during critical illness and provide recommendations for clinical practice. RECENT FINDINGS Recently acquired knowledge regarding nutritional status and risk assessment, body composition, gastric residual volume, prokinetics, tube positioning, enteral vs parenteral nutrition, nutritional dose and timing of initiation, pharmaconutrition, dysbiosis and probiotics are discussed. SUMMARY Body composition especially lean body mass is associated with clinical outcomes. The modified NUTrition Risk in the Critically ill score was validated for nutritional risk assessment and identifies patients that benefit from higher nutritional intake; however, caloric restriction decreases mortality in refeeding syndrome. Gastric residual volume monitoring is debated, as abandoning its application doesn't worsen outcome. There is no consensus regarding benefits of gastric vs postpyloric tube placement. Current prokinetics temporarily reduce feeding intolerance, new prokinetics are developed. Enteral remains preferable over parenteral nutrition, although no inferiority of parenteral nutrition is reported in recent studies. Studies imply no harm of hypocaloric feeding when protein requirements are met. Optimal protein provision may be more important than caloric adequacy. Pharmaconutrition confers no superior outcomes and may even confer harm. Dysbiosis is frequently encountered and associated with worse outcomes. Probiotics reduce infectious complications, but not mortality, and may contribute to earlier recovery of gut function.
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Zhang Z, Li Q, Jiang L, Xie B, Ji X, Lu J, Jiang R, Lei S, Mao S, Ying L, Lu D, Si X, He J, Ji M, Zhu J, Chen G, Shao Y, Xu Y, Lin R, Zhang C, Zhang W, Luo J, Lou T, He X, Chen K, Sun R. Effectiveness of enteral feeding protocol on clinical outcomes in critically ill patients: a study protocol for before-and-after design. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:308. [PMID: 27668228 PMCID: PMC5009025 DOI: 10.21037/atm.2016.07.15] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Enteral feed is an important component of nutritional therapy in critically ill patients and underfeeding has been associated with adverse outcomes. The article developed an enteral feeding protocol and planed a before-and-after comparative trial to explore whether implementation of enteral feeding protocol was able to improve clinical outcomes. METHODS AND ANALYSIS The study will be conducted in intensive care units (ICUs) of ten tertiary care academic centers. Critically ill patients expected to stay in ICU for over 3 days and require enteral nutrition (EN) were potentially eligible. This is a before-and-after study comprising three phases: The first phase is the period without enteral feeding protocol; the second phase involves four-week training program, and the last phase is to perform the protocol in participating centers. We plan to enroll a total of 350 patients to provide an 80% power and 0.05 error rate to detect a 15% reduction of mortality. The primary outcome is 28-day mortality. ETHICS AND DISSEMINATION Ethical approval to conduct the research has been obtained from all participating centers. Additionally, the results will be published in peer-reviewed journal. TRIAL REGISTRATION The study was registered at International Standard Registered Clinical/soCial sTudy Number (ISRCTN) registry (ISRCTN10583582).
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Affiliation(s)
- Zhongheng Zhang
- Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua 321000, China
| | - Qian Li
- Department of Critical Care Medicine, Zhejiang Provincial People’s Hospital, Hangzhou 310000, China
| | - Lingzhi Jiang
- Department of Critical Care Medicine, Zhejiang Provincial People’s Hospital, Hangzhou 310000, China
| | - Bo Xie
- Department of Critical Care Medicine, Huzhou Central Hospital, Hangzhou 310000, China
| | - Xiaowei Ji
- Department of Critical Care Medicine, Huzhou Central Hospital, Hangzhou 310000, China
| | - Jiahong Lu
- Department of Critical Care Medicine, Huzhou Central Hospital, Hangzhou 310000, China
| | - Ronglin Jiang
- Department of Critical Care Medicine, Zhejiang Provincial Hospital of TCM, Hangzhou 310000, China
| | - Shu Lei
- Department of Critical Care Medicine, Zhejiang Provincial Hospital of TCM, Hangzhou 310000, China
| | - Shihao Mao
- Department of Critical Care Medicine, Zhejiang Provincial Hospital of TCM, Hangzhou 310000, China
| | - Lijun Ying
- Department of Critical Care Medicine, Shaoxing People’s Hospital, Shaoxing 312000, China
| | - Di Lu
- Department of Critical Care Medicine, Shaoxing People’s Hospital, Shaoxing 312000, China
| | - Xiaoshui Si
- Department of Critical Care Medicine, Yiwu Central Hospital, Yiwu 322000, China
| | - Jianxin He
- Department of Critical Care Medicine, Yiwu Central Hospital, Yiwu 322000, China
| | - Mingxia Ji
- Department of Critical Care Medicine, Yiwu Central Hospital, Yiwu 322000, China
| | - Jianhua Zhu
- Department of Critical Care Medicine, Ningbo First Hospital, Ningbo 315000, China
| | - Guodong Chen
- Department of Critical Care Medicine, Ningbo First Hospital, Ningbo 315000, China
| | - Yadi Shao
- Department of Critical Care Medicine, Ningbo First Hospital, Ningbo 315000, China
| | - Yinghe Xu
- Department of Critical Care Medicine, Taizhou Hospital, Taizhou 318000, China
| | - Ronghai Lin
- Department of Critical Care Medicine, Taizhou Hospital, Taizhou 318000, China
| | - Chao Zhang
- Department of Critical Care Medicine, Taizhou Hospital, Taizhou 318000, China
| | - Weiwen Zhang
- Department of Critical Care Medicine, Quzhou People’s Hospital, Quzhou 324000, China
| | - Jian Luo
- Department of Critical Care Medicine, Quzhou People’s Hospital, Quzhou 324000, China
| | - Tianzheng Lou
- Department of Critical Care Medicine, Lishui People’s Hospital, Lishui 323000, China
| | - Xuwei He
- Department of Critical Care Medicine, Lishui People’s Hospital, Lishui 323000, China
| | - Kun Chen
- Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua 321000, China
| | - Renhua Sun
- Department of Critical Care Medicine, Zhejiang Provincial People’s Hospital, Hangzhou 310000, China
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Toh Yoon EW, Yoneda K, Nakamura S, Nishihara K. Percutaneous endoscopic transgastric jejunostomy (PEG-J): a retrospective analysis on its utility in maintaining enteral nutrition after unsuccessful gastric feeding. BMJ Open Gastroenterol 2016; 3:e000098. [PMID: 27486522 PMCID: PMC4947708 DOI: 10.1136/bmjgast-2016-000098] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 05/19/2016] [Accepted: 05/24/2016] [Indexed: 12/27/2022] Open
Abstract
Background/aims Although percutaneous endoscopic gastrostomy (PEG) is the method of choice for long-term enteral nutrition, feeding-related adverse events such as aspiration pneumonia and peristomal leakage can impede the use of PEG. Percutaneous endoscopic transgastric jejunostomy (PEG-J) using large-bore jejunal tubes may help by circumventing gastric passage during enteral nutrition and improving drainage of gastric secretions. Methods 20 patients (12 males and 8 females) who received PEG-J after unsuccessful PEG feeding during a 6-year period in our institution were analysed retrospectively to evaluate the efficacy of large-bore jejunal feeding tubes in maintaining enteral nutrition. Results The median age was 83.5 (71–96) years. The median period between PEG and PEG-J was 33 (14–280) days. Indications were aspiration due to gastro-oesophageal reflux in 18 patients and severe peristomal leakage in 2 patients. Tube placements were successful in all patients. There were 6 (30%) in-hospital mortalities, with 3 (15%) occurring within 30 days after procedure. Conclusions PEG-J can be performed safely in patients with PEG and may facilitate the maintenance of enteral nutrition in most of the patients. Patients with unsuccessful PEG feeding can be offered the option of jejunal feeding before considering termination of enteral nutrition.
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Affiliation(s)
| | - Kaori Yoneda
- Endoscopy Center, Hiroshima Kyoritsu Hospital , Hiroshima , Japan
| | - Shinya Nakamura
- Department of Internal Medicine , Hiroshima Kyoritsu Hospital , Hiroshima , Japan
| | - Kazuki Nishihara
- Department of Internal Medicine , Hiroshima Kyoritsu Hospital , Hiroshima , Japan
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Santos SCVDO, Woith W, Freitas MIPD, Zeferino EBB. Methods to determine the internal length of nasogastric feeding tubes: An integrative review. Int J Nurs Stud 2016; 61:95-103. [PMID: 27328376 DOI: 10.1016/j.ijnurstu.2016.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 06/08/2016] [Accepted: 06/10/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Improper placement of nasogastric tube used for feeding may lead to serious complications, including death of the patient. There are several different methods used to determine the appropriate length of nasogastric tube for optimal placement in adults. This integrative review of the literature was designed to identify the most accurate method to determine the internal length of nasogastric feeding tube in adults. DESIGN An integrative review of the research literature (1979-2015) using the population-intervention-comparison-outcomes strategy. DATA SOURCES The literature search included the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Joanna Briggs, PubMed (MEDLINE), SCOPUS, and Web of Science electronic databases. REVIEW METHODS Two researchers evaluated the literature to determine if an article met inclusion and exclusion criteria. The quality of the evidence was assessed using the Johns Hopkins Strength of the Evidence critical appraisal tool. RESULTS Twenty studies, published between 1979 and 2014, met inclusion criteria. Of these, nine articles were expert opinion, seven were original research, three were review articles, and one was a guideline. Despite seven original research papers being found, only five reports were about the methods to determine the internal length of nasogastric feeding tube in adults. The literature suggests that four different methods for measuring the tube length are likely to result in proper placement of the tip of the tube in the stomach and all side ports inside it: [nose-to-ear-to-xiphisternum - 50]cm/2+50cm]; [gender-weight and nose-umbilicus-flat]; [xiphisternum-to-ear-to-nose+10cm]; [earlobe to xiphisternum to umbilicus - tip of the nose to earlobe]. Four studies found nose-to-ear-to-xiphisternum was most likely to result in a tube that is positioned incorrectly, either ending in the esophagus, in the stomach but too close to the esophagus, or too far into the stomach or duodenum. CONCLUSIONS The nose-to-ear-to-xiphisternum and Hanson method should no longer be taught in nursing programs or used in practice by the nurse. The [gender-weight and nose-umbilicus-flat] method has been shown to be safer.
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Affiliation(s)
| | - Wendy Woith
- Illinois State University - Mennonite College of Nursing, Edwards Hall, Room 205, Campus Box 5815, Normal, IL 61790-5815, United States.
| | - Maria Isabel Pedreira de Freitas
- School of Nursing (Fenf) - State University of Campinas (Unicamp), Thessaly Vieira de Camargo, 126 - Campus Box: 13083-970, Campinas, SP, Brazil(3).
| | - Eliete Boaventura Bargas Zeferino
- School of Nursing (Fenf) - State University of Campinas (Unicamp), Thessaly Vieira de Camargo, 126 - Campus Box: 13083-970, Campinas, SP, Brazil(3).
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Abstract
Critically ill patients often require enteral feedings as a primary supply of nutrition. Whether enteral nutrition (EN) should be delivered as a gastric versus small bowel feeding in the critically ill patient population remains a contentious topic. The Society of Critical Care Medicine (SCCM)/American Society for Parenteral and Enteral Nutrition (ASPEN), the European Society for Parenteral and Enteral Nutrition (ESPEN), and the Canadian Clinical Practice Guidelines (CCPG) are not in consensus on this topic. No research to date demonstrates a significant difference between the two feeding routes in terms of patient mortality, ventilator days, or length of stay in the intensive care unit (ICU); however, studies provide some evidence that there may be other benefits to using a small bowel feeding route in critically ill patients. The purpose of this paper is to examine both sides of this debate and review advantages and disadvantages of both small bowel and gastric routes of EN. Practical issues and challenges to small bowel feeding tube placement are also addressed. Finally, recommendations are provided to help guide the clinician when selecting a feeding route, and suggestions are made for future research.
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Toh Yoon E, Nishihara K, Murata H. Maintaining Enteral Nutrition in the Severely Ill using a Newly Developed Nasojejunal Feeding Tube with Gastric Decompression Function. Intern Med 2016; 55:2945-2950. [PMID: 27746430 PMCID: PMC5109560 DOI: 10.2169/internalmedicine.55.6915] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
For nutritional support of critically ill patients, the enteral route is preferred over the parenteral route. Although nasojejunal feeding can be superior to gastric feeding when gastrointestinal symptoms occur, it does not necessarily solve the problem of large gastric residual volumes. We report the successful use of a newly developed nasojejunal feeding tube with gastric decompression function in an 84-year-old man with severe pneumonia. After gastric feeding was considered not well tolerated, the use of this tube improved the delivery of nutrition until the patient was stable enough to undergo percutaneous endoscopic gastrostomy.
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Affiliation(s)
- Ezekiel Toh Yoon
- Department of Internal Medicine, Hiroshima Kyoritsu Hospital, Japan
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26
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Japanese Guidelines for Nutrition Support Therapy in the Adult and Pediatric Critically Ill Patients. ACTA ACUST UNITED AC 2016. [DOI: 10.3918/jsicm.23.185] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Malnutrition has been identified as a cause for disease as well as a condition resulting from inflammation associated with acute or chronic disease. Malnutrition is common in acute-care settings, occurring in 30% to 50% of hospitalized patients. Inflammation has been associated with malnutrition and malnutrition has been associated with compromised immune status, infection, and increased intensive care unit (ICU) and hospital length of stay. The ICU nurse is in the best position to advocate for appropriate nutritional therapies and facilitate the safe delivery of nutrition.
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Affiliation(s)
- Jan Powers
- St. Vincent Hospital, 2001 West 86th Street, Indianapolis, IN 46260, USA.
| | - Karen Samaan
- St. Vincent Hospital, 2001 West 86th Street, Indianapolis, IN 46260, USA
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Alkhawaja S, Martin C, Butler RJ, Gwadry‐Sridhar F. Post-pyloric versus gastric tube feeding for preventing pneumonia and improving nutritional outcomes in critically ill adults. Cochrane Database Syst Rev 2015; 2015:CD008875. [PMID: 26241698 PMCID: PMC6516803 DOI: 10.1002/14651858.cd008875.pub2] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Nutritional support is an essential component of critical care. Malnutrition has been associated with poor outcomes among patients in intensive care units (ICUs). Evidence suggests that in patients with a functional gut, nutrition should be administered through the enteral route. One of the main concerns regarding use of the enteral route is the reduction in gastric motility that is often responsible for limited caloric intake. This increases the risk of aspiration pneumonia as well. Post-pyloric feeding, in which the feed is delivered directly into the duodenum or the jejunum, could solve these issues and provide additional benefits over routine gastric administration of the feed. OBJECTIVES To evaluate the effectiveness and safety of post-pyloric feeding versus gastric feeding for critically ill adults who require enteral tube feeding. SEARCH METHODS We searched the following databases: Cochrane Central Register of Controlled Trials (CENTRAL;2013 Issue 10), MEDLINE (Ovid) (1950 to October 2013), EMBASE (Ovid) (1980 to October 2013) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) via EBSCO host (1982 to October 2013). We reran the search on 4 February 2015 and will deal with the one study of interest when we update the review. SELECTION CRITERIA Randomized or quasi-randomized controlled trials comparing post-pyloric versus gastric tube feeding in critically ill adults. DATA COLLECTION AND ANALYSIS We extracted data using the standard methods of the Cochrane Anaesthesia, Critical and Emergency Care Group and separately evaluated trial quality and data extraction as performed by each review author. We contacted trials authors to request missing data. MAIN RESULTS We pooled data from 14 trials of 1109 participants in a meta-analysis. Moderate quality evidence suggests that post-pyloric feeding is associated with low rates of pneumonia compared with gastric tube feeding (risk ratio (RR) 0.65, 95% confidence interval (CI) 0.51 to 0.84). Low-quality evidence shows an increase in the percentage of total nutrient delivered to the patient by post-pyloric feeding (mean difference (MD) 7.8%, 95% CI 1.43 to 14.18).Evidence of moderate quality revealed no differences in duration of mechanical ventilation or in mortality. Intensive care unit (ICU) length of stay was similar between the two groups. The effect on the time required to achieve the full nutrition target was uncertain (MD -1.99 hours 95% CI -10.97 to 6.99) (very low-quality evidence). We found no evidence suggesting an increase in the rate of complications during insertion or maintenance of the tube in the post-pyloric group (RR 0.51, 95% CI 0.19 to 1.364; RR1.63, 95% CI 0.93 to 2.86, respectively); evidence was assessed as being of low quality for both.Risk of bias was generally low in most studies, and review authors expressed concern regarding lack of blinding of the caregiver in most trials. AUTHORS' CONCLUSIONS We found moderate-quality evidence of a 30% lower rate of pneumonia associated with post-pyloric feeding and low-quality evidence suggesting an increase in the amount of nutrition delivered to these participants. We do not have sufficient evidence to show that other clinically important outcomes such as duration of mechanical ventilation, mortality and length of stay were affected by the site of tube feeding.Low-quality evidence suggests that insertion of a post-pyloric feeding tube appears to be safe and was not associated with increased complications when compared with gastric tube insertion. Placement of the post-pyloric tube can present challenges; the procedure is technically difficult, requiring expertise and sophisticated radiological or endoscopic assistance.We recommend that use of a post-pyloric feeding tube may be preferred for ICU patients for whom placement of the post-pyloric feeding tube is feasible. Findings of this review preclude recommendations regarding the best method for placing the post-pyloric feeding tube. The clinician is left with this decision, which should be based on the policies of institutional facilities and should be made on a case-by-case basis. Protocols and training for bedside placement by physicians or nurses should be evaluated.
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Affiliation(s)
- Sana Alkhawaja
- University of Western Ontario, London Health Science CentreDepartment of Critical Care MedicineDivision of Critical Care MedicineLondon, OntarioCanadaN6J 2X7
| | - Claudio Martin
- University of Western Ontario, London Health Science CentreDepartment of Critical Care MedicineDivision of Critical Care MedicineLondon, OntarioCanadaN6J 2X7
| | - Ronald J Butler
- University of Western Ontario, London Health Sciences Centre, University HospitalDepartment of Anesthesia and Critical Care339 Windermere RdLondon, OntarioCanadaN6A 5A5
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29
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Rech MA, Day SA, Kast JM, Donahey EE, Pajoumand M, Kram SJ, Erdman MJ, Peitz GJ, Allen JM, Palmer A, Kram B, Harris SA, Turck CJ. Major publications in the critical care pharmacotherapy literature: January-December 2013. Am J Health Syst Pharm 2015; 72:224-36. [PMID: 25596607 DOI: 10.2146/ajhp140241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Ten recently published articles with important implications for critical care pharmacotherapy are summarized. SUMMARY The Critical Care Pharmacotherapy Literature Update (CCPLU) group is a national assembly of experienced intensive care unit (ICU) pharmacists across the United States. Group members monitor 25 peer-reviewed journals on an ongoing basis to identify literature relevant to pharmacy practice in the critical care setting. After evaluation by CCPLU group members, selected articles are chosen for summarization and distribution to group members nationwide based on (1) applicability to critical care practice, (2) relevance to pharmacy practitioners, and (3) quality of evidence or research methodology. Hundreds of relevant articles were evaluated by the group during the period January-December 2013, of which 98 were summarized and disseminated nationally to CCPLU group members. Among those 98 publications, 10 deemed to be of particularly high utility to critical care practitioners were included in this review. The 10 articles address topics such as rapid lowering of blood pressure in patients with intracranial hemorrhage, adjunctive therapy to prevent renal injury due to acute heart failure, triple-drug therapy to improve neurologic outcomes after cardiac arrest, and continuous versus intermittent infusion of β-lactam antibiotics in severe sepsis. CONCLUSION There were many important additions to the critical care pharmacotherapy literature in 2013, including an updated guideline on the management of myocardial infarction and reports on advances in research focused on improving outcomes in patients with stroke or cardiac arrest and preventing the spread of drug-resistant pathogens in the ICU.
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Affiliation(s)
- Megan A Rech
- Megan A. Rech, Pharm.D., BCPS, is Emergency Medicine Clinical Pharmacist, Loyola University Medical Center, Maywood, IL. Sarah A. Day, Pharm.D., BCPS, is Clinical Pharmacist, Critical Care, Doctors Hospital, Columbus, OH. Jenna M. Kast, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Critical Care, Beaumont Hospital, Royal Oak, MI. Elisabeth E. Donahey, Pharm.D., BCPS, is Neurosciences Intensive Care Pharmacist, Loyola University Medical Center. Mehrnaz Pajoumand, Pharm.D., BCPS, is Clinical Specialist, Trauma Critical Care, University of Maryland Medical Center, Baltimore. Shawn J. Kram, Pharm.D., BCPS, is Clinical Pharmacist, Duke University Hospital, Durham, NC. Michael J. Erdman, Pharm.D., BCPS, is Clinical Pharmacist, Neurocritical Care, University of Florida Health, Jacksonville. Gregory J. Peitz, Pharm.D., BCPS, is Clinical Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha. John M. Allen, Pharm.D., BCPS, is Assistant Professor, University of South Florida College of Pharmacy, Tampa. Allison Palmer, Pharm.D., BCPS, is Critical Care Clinical Pharmacist, John Peter Smith Hospital, Fort Worth, TX. Bridgette Kram, Pharm.D., BCPS, is Clinical Pharmacist, Duke University Hospital. Serena A. Harris, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Trauma and Surgical Critical Care, Eskenazi Health, Indianapolis, IN. Charles J Turck, Pharm.D., BCPS, is President and Chief Executive Officer, ScientiaCME, LLC, Mission Viejo, CA.
| | - Sarah A Day
- Megan A. Rech, Pharm.D., BCPS, is Emergency Medicine Clinical Pharmacist, Loyola University Medical Center, Maywood, IL. Sarah A. Day, Pharm.D., BCPS, is Clinical Pharmacist, Critical Care, Doctors Hospital, Columbus, OH. Jenna M. Kast, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Critical Care, Beaumont Hospital, Royal Oak, MI. Elisabeth E. Donahey, Pharm.D., BCPS, is Neurosciences Intensive Care Pharmacist, Loyola University Medical Center. Mehrnaz Pajoumand, Pharm.D., BCPS, is Clinical Specialist, Trauma Critical Care, University of Maryland Medical Center, Baltimore. Shawn J. Kram, Pharm.D., BCPS, is Clinical Pharmacist, Duke University Hospital, Durham, NC. Michael J. Erdman, Pharm.D., BCPS, is Clinical Pharmacist, Neurocritical Care, University of Florida Health, Jacksonville. Gregory J. Peitz, Pharm.D., BCPS, is Clinical Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha. John M. Allen, Pharm.D., BCPS, is Assistant Professor, University of South Florida College of Pharmacy, Tampa. Allison Palmer, Pharm.D., BCPS, is Critical Care Clinical Pharmacist, John Peter Smith Hospital, Fort Worth, TX. Bridgette Kram, Pharm.D., BCPS, is Clinical Pharmacist, Duke University Hospital. Serena A. Harris, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Trauma and Surgical Critical Care, Eskenazi Health, Indianapolis, IN. Charles J Turck, Pharm.D., BCPS, is President and Chief Executive Officer, ScientiaCME, LLC, Mission Viejo, CA
| | - Jenna M Kast
- Megan A. Rech, Pharm.D., BCPS, is Emergency Medicine Clinical Pharmacist, Loyola University Medical Center, Maywood, IL. Sarah A. Day, Pharm.D., BCPS, is Clinical Pharmacist, Critical Care, Doctors Hospital, Columbus, OH. Jenna M. Kast, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Critical Care, Beaumont Hospital, Royal Oak, MI. Elisabeth E. Donahey, Pharm.D., BCPS, is Neurosciences Intensive Care Pharmacist, Loyola University Medical Center. Mehrnaz Pajoumand, Pharm.D., BCPS, is Clinical Specialist, Trauma Critical Care, University of Maryland Medical Center, Baltimore. Shawn J. Kram, Pharm.D., BCPS, is Clinical Pharmacist, Duke University Hospital, Durham, NC. Michael J. Erdman, Pharm.D., BCPS, is Clinical Pharmacist, Neurocritical Care, University of Florida Health, Jacksonville. Gregory J. Peitz, Pharm.D., BCPS, is Clinical Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha. John M. Allen, Pharm.D., BCPS, is Assistant Professor, University of South Florida College of Pharmacy, Tampa. Allison Palmer, Pharm.D., BCPS, is Critical Care Clinical Pharmacist, John Peter Smith Hospital, Fort Worth, TX. Bridgette Kram, Pharm.D., BCPS, is Clinical Pharmacist, Duke University Hospital. Serena A. Harris, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Trauma and Surgical Critical Care, Eskenazi Health, Indianapolis, IN. Charles J Turck, Pharm.D., BCPS, is President and Chief Executive Officer, ScientiaCME, LLC, Mission Viejo, CA
| | - Elisabeth E Donahey
- Megan A. Rech, Pharm.D., BCPS, is Emergency Medicine Clinical Pharmacist, Loyola University Medical Center, Maywood, IL. Sarah A. Day, Pharm.D., BCPS, is Clinical Pharmacist, Critical Care, Doctors Hospital, Columbus, OH. Jenna M. Kast, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Critical Care, Beaumont Hospital, Royal Oak, MI. Elisabeth E. Donahey, Pharm.D., BCPS, is Neurosciences Intensive Care Pharmacist, Loyola University Medical Center. Mehrnaz Pajoumand, Pharm.D., BCPS, is Clinical Specialist, Trauma Critical Care, University of Maryland Medical Center, Baltimore. Shawn J. Kram, Pharm.D., BCPS, is Clinical Pharmacist, Duke University Hospital, Durham, NC. Michael J. Erdman, Pharm.D., BCPS, is Clinical Pharmacist, Neurocritical Care, University of Florida Health, Jacksonville. Gregory J. Peitz, Pharm.D., BCPS, is Clinical Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha. John M. Allen, Pharm.D., BCPS, is Assistant Professor, University of South Florida College of Pharmacy, Tampa. Allison Palmer, Pharm.D., BCPS, is Critical Care Clinical Pharmacist, John Peter Smith Hospital, Fort Worth, TX. Bridgette Kram, Pharm.D., BCPS, is Clinical Pharmacist, Duke University Hospital. Serena A. Harris, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Trauma and Surgical Critical Care, Eskenazi Health, Indianapolis, IN. Charles J Turck, Pharm.D., BCPS, is President and Chief Executive Officer, ScientiaCME, LLC, Mission Viejo, CA
| | - Mehrnaz Pajoumand
- Megan A. Rech, Pharm.D., BCPS, is Emergency Medicine Clinical Pharmacist, Loyola University Medical Center, Maywood, IL. Sarah A. Day, Pharm.D., BCPS, is Clinical Pharmacist, Critical Care, Doctors Hospital, Columbus, OH. Jenna M. Kast, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Critical Care, Beaumont Hospital, Royal Oak, MI. Elisabeth E. Donahey, Pharm.D., BCPS, is Neurosciences Intensive Care Pharmacist, Loyola University Medical Center. Mehrnaz Pajoumand, Pharm.D., BCPS, is Clinical Specialist, Trauma Critical Care, University of Maryland Medical Center, Baltimore. Shawn J. Kram, Pharm.D., BCPS, is Clinical Pharmacist, Duke University Hospital, Durham, NC. Michael J. Erdman, Pharm.D., BCPS, is Clinical Pharmacist, Neurocritical Care, University of Florida Health, Jacksonville. Gregory J. Peitz, Pharm.D., BCPS, is Clinical Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha. John M. Allen, Pharm.D., BCPS, is Assistant Professor, University of South Florida College of Pharmacy, Tampa. Allison Palmer, Pharm.D., BCPS, is Critical Care Clinical Pharmacist, John Peter Smith Hospital, Fort Worth, TX. Bridgette Kram, Pharm.D., BCPS, is Clinical Pharmacist, Duke University Hospital. Serena A. Harris, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Trauma and Surgical Critical Care, Eskenazi Health, Indianapolis, IN. Charles J Turck, Pharm.D., BCPS, is President and Chief Executive Officer, ScientiaCME, LLC, Mission Viejo, CA
| | - Shawn J Kram
- Megan A. Rech, Pharm.D., BCPS, is Emergency Medicine Clinical Pharmacist, Loyola University Medical Center, Maywood, IL. Sarah A. Day, Pharm.D., BCPS, is Clinical Pharmacist, Critical Care, Doctors Hospital, Columbus, OH. Jenna M. Kast, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Critical Care, Beaumont Hospital, Royal Oak, MI. Elisabeth E. Donahey, Pharm.D., BCPS, is Neurosciences Intensive Care Pharmacist, Loyola University Medical Center. Mehrnaz Pajoumand, Pharm.D., BCPS, is Clinical Specialist, Trauma Critical Care, University of Maryland Medical Center, Baltimore. Shawn J. Kram, Pharm.D., BCPS, is Clinical Pharmacist, Duke University Hospital, Durham, NC. Michael J. Erdman, Pharm.D., BCPS, is Clinical Pharmacist, Neurocritical Care, University of Florida Health, Jacksonville. Gregory J. Peitz, Pharm.D., BCPS, is Clinical Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha. John M. Allen, Pharm.D., BCPS, is Assistant Professor, University of South Florida College of Pharmacy, Tampa. Allison Palmer, Pharm.D., BCPS, is Critical Care Clinical Pharmacist, John Peter Smith Hospital, Fort Worth, TX. Bridgette Kram, Pharm.D., BCPS, is Clinical Pharmacist, Duke University Hospital. Serena A. Harris, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Trauma and Surgical Critical Care, Eskenazi Health, Indianapolis, IN. Charles J Turck, Pharm.D., BCPS, is President and Chief Executive Officer, ScientiaCME, LLC, Mission Viejo, CA
| | - Michael J Erdman
- Megan A. Rech, Pharm.D., BCPS, is Emergency Medicine Clinical Pharmacist, Loyola University Medical Center, Maywood, IL. Sarah A. Day, Pharm.D., BCPS, is Clinical Pharmacist, Critical Care, Doctors Hospital, Columbus, OH. Jenna M. Kast, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Critical Care, Beaumont Hospital, Royal Oak, MI. Elisabeth E. Donahey, Pharm.D., BCPS, is Neurosciences Intensive Care Pharmacist, Loyola University Medical Center. Mehrnaz Pajoumand, Pharm.D., BCPS, is Clinical Specialist, Trauma Critical Care, University of Maryland Medical Center, Baltimore. Shawn J. Kram, Pharm.D., BCPS, is Clinical Pharmacist, Duke University Hospital, Durham, NC. Michael J. Erdman, Pharm.D., BCPS, is Clinical Pharmacist, Neurocritical Care, University of Florida Health, Jacksonville. Gregory J. Peitz, Pharm.D., BCPS, is Clinical Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha. John M. Allen, Pharm.D., BCPS, is Assistant Professor, University of South Florida College of Pharmacy, Tampa. Allison Palmer, Pharm.D., BCPS, is Critical Care Clinical Pharmacist, John Peter Smith Hospital, Fort Worth, TX. Bridgette Kram, Pharm.D., BCPS, is Clinical Pharmacist, Duke University Hospital. Serena A. Harris, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Trauma and Surgical Critical Care, Eskenazi Health, Indianapolis, IN. Charles J Turck, Pharm.D., BCPS, is President and Chief Executive Officer, ScientiaCME, LLC, Mission Viejo, CA
| | - Gregory J Peitz
- Megan A. Rech, Pharm.D., BCPS, is Emergency Medicine Clinical Pharmacist, Loyola University Medical Center, Maywood, IL. Sarah A. Day, Pharm.D., BCPS, is Clinical Pharmacist, Critical Care, Doctors Hospital, Columbus, OH. Jenna M. Kast, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Critical Care, Beaumont Hospital, Royal Oak, MI. Elisabeth E. Donahey, Pharm.D., BCPS, is Neurosciences Intensive Care Pharmacist, Loyola University Medical Center. Mehrnaz Pajoumand, Pharm.D., BCPS, is Clinical Specialist, Trauma Critical Care, University of Maryland Medical Center, Baltimore. Shawn J. Kram, Pharm.D., BCPS, is Clinical Pharmacist, Duke University Hospital, Durham, NC. Michael J. Erdman, Pharm.D., BCPS, is Clinical Pharmacist, Neurocritical Care, University of Florida Health, Jacksonville. Gregory J. Peitz, Pharm.D., BCPS, is Clinical Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha. John M. Allen, Pharm.D., BCPS, is Assistant Professor, University of South Florida College of Pharmacy, Tampa. Allison Palmer, Pharm.D., BCPS, is Critical Care Clinical Pharmacist, John Peter Smith Hospital, Fort Worth, TX. Bridgette Kram, Pharm.D., BCPS, is Clinical Pharmacist, Duke University Hospital. Serena A. Harris, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Trauma and Surgical Critical Care, Eskenazi Health, Indianapolis, IN. Charles J Turck, Pharm.D., BCPS, is President and Chief Executive Officer, ScientiaCME, LLC, Mission Viejo, CA
| | - John M Allen
- Megan A. Rech, Pharm.D., BCPS, is Emergency Medicine Clinical Pharmacist, Loyola University Medical Center, Maywood, IL. Sarah A. Day, Pharm.D., BCPS, is Clinical Pharmacist, Critical Care, Doctors Hospital, Columbus, OH. Jenna M. Kast, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Critical Care, Beaumont Hospital, Royal Oak, MI. Elisabeth E. Donahey, Pharm.D., BCPS, is Neurosciences Intensive Care Pharmacist, Loyola University Medical Center. Mehrnaz Pajoumand, Pharm.D., BCPS, is Clinical Specialist, Trauma Critical Care, University of Maryland Medical Center, Baltimore. Shawn J. Kram, Pharm.D., BCPS, is Clinical Pharmacist, Duke University Hospital, Durham, NC. Michael J. Erdman, Pharm.D., BCPS, is Clinical Pharmacist, Neurocritical Care, University of Florida Health, Jacksonville. Gregory J. Peitz, Pharm.D., BCPS, is Clinical Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha. John M. Allen, Pharm.D., BCPS, is Assistant Professor, University of South Florida College of Pharmacy, Tampa. Allison Palmer, Pharm.D., BCPS, is Critical Care Clinical Pharmacist, John Peter Smith Hospital, Fort Worth, TX. Bridgette Kram, Pharm.D., BCPS, is Clinical Pharmacist, Duke University Hospital. Serena A. Harris, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Trauma and Surgical Critical Care, Eskenazi Health, Indianapolis, IN. Charles J Turck, Pharm.D., BCPS, is President and Chief Executive Officer, ScientiaCME, LLC, Mission Viejo, CA
| | - Allison Palmer
- Megan A. Rech, Pharm.D., BCPS, is Emergency Medicine Clinical Pharmacist, Loyola University Medical Center, Maywood, IL. Sarah A. Day, Pharm.D., BCPS, is Clinical Pharmacist, Critical Care, Doctors Hospital, Columbus, OH. Jenna M. Kast, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Critical Care, Beaumont Hospital, Royal Oak, MI. Elisabeth E. Donahey, Pharm.D., BCPS, is Neurosciences Intensive Care Pharmacist, Loyola University Medical Center. Mehrnaz Pajoumand, Pharm.D., BCPS, is Clinical Specialist, Trauma Critical Care, University of Maryland Medical Center, Baltimore. Shawn J. Kram, Pharm.D., BCPS, is Clinical Pharmacist, Duke University Hospital, Durham, NC. Michael J. Erdman, Pharm.D., BCPS, is Clinical Pharmacist, Neurocritical Care, University of Florida Health, Jacksonville. Gregory J. Peitz, Pharm.D., BCPS, is Clinical Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha. John M. Allen, Pharm.D., BCPS, is Assistant Professor, University of South Florida College of Pharmacy, Tampa. Allison Palmer, Pharm.D., BCPS, is Critical Care Clinical Pharmacist, John Peter Smith Hospital, Fort Worth, TX. Bridgette Kram, Pharm.D., BCPS, is Clinical Pharmacist, Duke University Hospital. Serena A. Harris, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Trauma and Surgical Critical Care, Eskenazi Health, Indianapolis, IN. Charles J Turck, Pharm.D., BCPS, is President and Chief Executive Officer, ScientiaCME, LLC, Mission Viejo, CA
| | - Bridgette Kram
- Megan A. Rech, Pharm.D., BCPS, is Emergency Medicine Clinical Pharmacist, Loyola University Medical Center, Maywood, IL. Sarah A. Day, Pharm.D., BCPS, is Clinical Pharmacist, Critical Care, Doctors Hospital, Columbus, OH. Jenna M. Kast, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Critical Care, Beaumont Hospital, Royal Oak, MI. Elisabeth E. Donahey, Pharm.D., BCPS, is Neurosciences Intensive Care Pharmacist, Loyola University Medical Center. Mehrnaz Pajoumand, Pharm.D., BCPS, is Clinical Specialist, Trauma Critical Care, University of Maryland Medical Center, Baltimore. Shawn J. Kram, Pharm.D., BCPS, is Clinical Pharmacist, Duke University Hospital, Durham, NC. Michael J. Erdman, Pharm.D., BCPS, is Clinical Pharmacist, Neurocritical Care, University of Florida Health, Jacksonville. Gregory J. Peitz, Pharm.D., BCPS, is Clinical Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha. John M. Allen, Pharm.D., BCPS, is Assistant Professor, University of South Florida College of Pharmacy, Tampa. Allison Palmer, Pharm.D., BCPS, is Critical Care Clinical Pharmacist, John Peter Smith Hospital, Fort Worth, TX. Bridgette Kram, Pharm.D., BCPS, is Clinical Pharmacist, Duke University Hospital. Serena A. Harris, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Trauma and Surgical Critical Care, Eskenazi Health, Indianapolis, IN. Charles J Turck, Pharm.D., BCPS, is President and Chief Executive Officer, ScientiaCME, LLC, Mission Viejo, CA
| | - Serena A Harris
- Megan A. Rech, Pharm.D., BCPS, is Emergency Medicine Clinical Pharmacist, Loyola University Medical Center, Maywood, IL. Sarah A. Day, Pharm.D., BCPS, is Clinical Pharmacist, Critical Care, Doctors Hospital, Columbus, OH. Jenna M. Kast, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Critical Care, Beaumont Hospital, Royal Oak, MI. Elisabeth E. Donahey, Pharm.D., BCPS, is Neurosciences Intensive Care Pharmacist, Loyola University Medical Center. Mehrnaz Pajoumand, Pharm.D., BCPS, is Clinical Specialist, Trauma Critical Care, University of Maryland Medical Center, Baltimore. Shawn J. Kram, Pharm.D., BCPS, is Clinical Pharmacist, Duke University Hospital, Durham, NC. Michael J. Erdman, Pharm.D., BCPS, is Clinical Pharmacist, Neurocritical Care, University of Florida Health, Jacksonville. Gregory J. Peitz, Pharm.D., BCPS, is Clinical Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha. John M. Allen, Pharm.D., BCPS, is Assistant Professor, University of South Florida College of Pharmacy, Tampa. Allison Palmer, Pharm.D., BCPS, is Critical Care Clinical Pharmacist, John Peter Smith Hospital, Fort Worth, TX. Bridgette Kram, Pharm.D., BCPS, is Clinical Pharmacist, Duke University Hospital. Serena A. Harris, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Trauma and Surgical Critical Care, Eskenazi Health, Indianapolis, IN. Charles J Turck, Pharm.D., BCPS, is President and Chief Executive Officer, ScientiaCME, LLC, Mission Viejo, CA
| | - Charles J Turck
- Megan A. Rech, Pharm.D., BCPS, is Emergency Medicine Clinical Pharmacist, Loyola University Medical Center, Maywood, IL. Sarah A. Day, Pharm.D., BCPS, is Clinical Pharmacist, Critical Care, Doctors Hospital, Columbus, OH. Jenna M. Kast, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Critical Care, Beaumont Hospital, Royal Oak, MI. Elisabeth E. Donahey, Pharm.D., BCPS, is Neurosciences Intensive Care Pharmacist, Loyola University Medical Center. Mehrnaz Pajoumand, Pharm.D., BCPS, is Clinical Specialist, Trauma Critical Care, University of Maryland Medical Center, Baltimore. Shawn J. Kram, Pharm.D., BCPS, is Clinical Pharmacist, Duke University Hospital, Durham, NC. Michael J. Erdman, Pharm.D., BCPS, is Clinical Pharmacist, Neurocritical Care, University of Florida Health, Jacksonville. Gregory J. Peitz, Pharm.D., BCPS, is Clinical Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha. John M. Allen, Pharm.D., BCPS, is Assistant Professor, University of South Florida College of Pharmacy, Tampa. Allison Palmer, Pharm.D., BCPS, is Critical Care Clinical Pharmacist, John Peter Smith Hospital, Fort Worth, TX. Bridgette Kram, Pharm.D., BCPS, is Clinical Pharmacist, Duke University Hospital. Serena A. Harris, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Trauma and Surgical Critical Care, Eskenazi Health, Indianapolis, IN. Charles J Turck, Pharm.D., BCPS, is President and Chief Executive Officer, ScientiaCME, LLC, Mission Viejo, CA
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Hu B, Ye H, Sun C, Zhang Y, Lao Z, Wu F, Liu Z, Huang L, Qu C, Xian L, Wu H, Jiao Y, Liu J, Cai J, Chen W, Nie Z, Liu Z, Chen C. Metoclopramide or domperidone improves post-pyloric placement of spiral nasojejunal tubes in critically ill patients: a prospective, multicenter, open-label, randomized, controlled clinical trial. Crit Care 2015; 19:61. [PMID: 25880172 PMCID: PMC4367875 DOI: 10.1186/s13054-015-0784-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 02/03/2015] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION The use of prokinetic agents on post-pyloric placement of spiral nasojejunal tubes is controversial. The aim of the present study was to examine if metoclopramide or domperidone can increase the success rate of post-pyloric placement of spiral nasojejunal tubes. METHODS A multicenter, open-label, randomized, controlled trial was conducted in seven hospitals in China between April 2012 and February 2014. Patients admitted to the intensive care unit and requiring enteral nutrition for more than three days were randomly assigned to the metoclopramide, domperidone or control groups (1:1:1 ratio). The primary outcome was defined as the success rate of post-pyloric placement of spiral nasojejunal tubes, assessed 24 hours after initial placement. Secondary outcomes included success rate of post-D1, post-D2, post-D3 and proximal jejunum placement and tube migration distance. Safety of the study drugs and the tubes during the entire study period were recorded. RESULTS In total, 307 patients were allocated to the metoclopramide (n = 103), domperidone (n = 100) or control group (n = 104). The success rate of post-pyloric placement after 24 hours in the metoclopramide, domperidone and control groups was 55.0%, 51.5% and 27.3%, respectively (P = 0.0001). Logistic regression analysis identified the use of prokinetic agents, Acute Physiology and Chronic Health Evaluation (APACHE) II score <20, Sequential Organ Failure Assessment (SOFA) score <12 and without vasopressor as independent factors influencing the success rate of post-pyloric placement. No serious drug-related adverse reaction was observed. CONCLUSIONS Prokinetic agents, such as metoclopramide or domperidone, are effective at improving the success rate of post-pyloric placement of spiral nasojejunal tubes in critically ill patients. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR-TRC-12001956 . Registered 21 February 2012.
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Affiliation(s)
- Bei Hu
- Department of Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, PR China.
| | - Heng Ye
- Department of Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, PR China.
| | - Cheng Sun
- Department of Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, PR China.
| | - Yichen Zhang
- Department of Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, PR China.
| | - Zhigang Lao
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangdong Pharmaceutical University, 19 Nonglinxia Road, Guangzhou, 510080, Guangdong, PR China.
| | - Fanghong Wu
- Department of Critical Care Medicine, Jiangmen Wuyi Traditional Chinese Medicine Hospital, 30 Huayuandong Road, Jiangmen, 529000, Guangdong, PR China.
| | - Zhaohui Liu
- Department of Critical Care Medicine, Guangdong Armed Police Hospital, 106 Yanling Road, Guangzhou, 510507, Guangdong, PR China.
| | - Linxi Huang
- Department of Critical Care Medicine, The First Affiliated Hospital of Shantou University Medical Collage, 57 Changping Road, Shantou, 515041, Guangdong, PR China.
| | - Changchun Qu
- Department of Critical Care Medicine, Guangdong Yunfu People's Hosipital, 120 Huanshidong Road, Yunfu, 527300, Guangdong, PR China.
| | - Lewu Xian
- Department of Critical Care Medicine, Cancer Center of Guangzhou Medical University, 78 Hengzhigang Road, Guangzhou, 510095, Guangdong, PR China.
| | - Hao Wu
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangdong Pharmaceutical University, 19 Nonglinxia Road, Guangzhou, 510080, Guangdong, PR China.
| | - Yingjie Jiao
- Department of Critical Care Medicine, Jiangmen Wuyi Traditional Chinese Medicine Hospital, 30 Huayuandong Road, Jiangmen, 529000, Guangdong, PR China.
| | - Junling Liu
- Department of Critical Care Medicine, Guangdong Armed Police Hospital, 106 Yanling Road, Guangzhou, 510507, Guangdong, PR China.
| | - Juyu Cai
- Department of Critical Care Medicine, The First Affiliated Hospital of Shantou University Medical Collage, 57 Changping Road, Shantou, 515041, Guangdong, PR China.
| | - Weiying Chen
- Department of Critical Care Medicine, Guangdong Yunfu People's Hosipital, 120 Huanshidong Road, Yunfu, 527300, Guangdong, PR China.
| | - Zhiqiang Nie
- Department of Cardiovascular Epidemiology, Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, PR China.
| | - Zaiyi Liu
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, PR China.
| | - Chunbo Chen
- Department of Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, PR China.
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Messinger-Rapport BJ, Gammack JK, Little MO, Morley JE. Clinical Update on Nursing Home Medicine: 2014. J Am Med Dir Assoc 2014; 15:786-801. [DOI: 10.1016/j.jamda.2014.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 09/02/2014] [Indexed: 12/18/2022]
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Silk DBA, Quinn DG. Dual-Purpose Gastric Decompression and Enteral Feeding Tubes Rationale and Design of Novel Nasogastric and Nasogastrojejunal Tubes. JPEN J Parenter Enteral Nutr 2014; 39:531-43. [PMID: 25261414 DOI: 10.1177/0148607114551966] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 08/18/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND The importance of early postoperative nutrition in surgical patients and early institution of enteral nutrition in intensive care unit (ICU) patients have recently been highlighted. Unfortunately, institution of enteral feeding in both groups of patients often has to be postponed due to delayed gastric emptying and the need for gastric decompression. The design of current polyvinylchloride (PVC) gastric decompression tubes (Salem Sump [Covidien, Mansfield, MA] in the United States; Ryles [Penine Health Care Ltd, Derby, UK] in the United Kingdom and Europe) make them unsuitable for their subsequent use as either nasogastric enteral feeding tubes or for continued gastric decompression during postpyloric enteral feeding. To overcome these problems, we have designed a range of polyurethane (PU) dual-purpose gastric decompression and enteral feeding tubes that include 2 nasogastric tubes (double lumen to replace Salem Sump; single lumen to replace Ryles). Two novel multilumen nasogastrojejunal tubes (triple lumen for the United States; double lumen for the United Kingdom and Europe) complete the range. By using PU, a given internal diameter (ID) and flow area can be incorporated into a lower outside diameter (OD) compared with that achieved with PVC. The ID and lumen and flow area of an 18Fr (OD 6.7 mm) PVC Salem Sump can be incorporated into a 14Fr (OD 4.7 mm) PU tube. The design of aspiration/infusion ports of current PVC and PU tubes invites occlusion by gastrointestinal mucosa and clogging by mucus and enteral feed. To overcome this, we have designed long, single, widened, smooth, and curved edge ports with no "dead space" to trap mucus or curdled diet. Involving up to 214° of the circumference, these ports have up to 11 times the flow areas of the aspiration ports of current PVC tubes. CONCLUSION The proposed designs will lead to the development of dual-purpose nasogastric and nasojejunal tubes that will significantly improve the clinical and nutrition care of postoperative and ICU patients.
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Affiliation(s)
- David B A Silk
- Department of Academic Surgery, Imperial College London, United Kingdom
| | - David G Quinn
- Research & Development, Radius International LP, Grayslake, Illinois
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Early versus delayed enteral feeding in patients with abdominal trauma: a retrospective cohort study. Eur J Trauma Emerg Surg 2014; 41:99-105. [PMID: 26038172 DOI: 10.1007/s00068-014-0425-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 06/02/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Early enteral feeding within 24-48 h of intensive care unit admission is recommended for critically ill patients. This study aimed to determine if early enteral feeding could be safely implemented with purported benefits in patients with abdominal trauma. METHODS A retrospective cohort study was performed that included 88 adult patients with abdominal trauma. Patients receiving enteral feeding within 72 h of surgical intensive care unit (SICU) admission (early-initiation group, n = 28) were compared to those receiving enteral feeding later (delayed-initiation group, n = 60). RESULTS The two groups were comparable in demographic characteristics and injury severity. There were no differences in feeding intolerance (53.6 vs. 43.3%, p = 0.37) and mortality at 28 days (0 vs. 5%, p = 0.55) between the early-initiation group and the delayed-initiation group. However, patients in the early-initiation group had fewer infectious complications (17.9 vs. 40 %, p = 0.04) and shorter length of stay in SICU and hospital (p < 0.01) than patients in the delayed-initiation group. CONCLUSIONS Early enteral feeding administered within 72 h of SICU admission was associated with improved clinical outcomes without risk of increasing feeding intolerance in patients with abdominal trauma. Our results support the implementation of early enteral feeding in abdominal trauma management.
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Abstract
The "pancreatic rest" concept is entrenched in the management of acute pancreatitis. As a result, "nonstimulatory" feeding has been widely advocated in patients with this disease, being parenteral nutrition 2-3 decades ago and jejunal tube feeding in the past decade. However, accumulating clinical evidence from the fields of acute pancreatitis and critical care medicine suggests that gastric feeding is as safe and effective as jejunal feeding in most patients. This has paved the way for a new conceptual framework called "gut rousing." Acute pancreatitis management now requires consideration of gut function. Enteral nutrition is a gut-directed therapy, and avoiding stimulation of the pancreas in patients with acute pancreatitis need not overshadow the main goal of maintaining or restoring gut function.
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Affiliation(s)
- Maxim S Petrov
- Department of Surgery, University of Auckland, Auckland, New Zealand
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A Canadian survey of perceived barriers to initiation and continuation of enteral feeding in PICUs. Pediatr Crit Care Med 2014; 15:e49-55. [PMID: 24196008 DOI: 10.1097/pcc.0000000000000016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Clinicians believe nutrition support is important; however, delivery of enteral nutrition may be delayed or interrupted due to a lack of guidelines or perceived contraindications to administration. The aim of this national survey was to examine the knowledge and perceived barriers among clinicians which prevent enteral nutrition administration to PICU patients. DESIGN The survey consisted of 23 questions (19 primary and four branching). The survey was validated using a semistructured pilot test by three pediatric critical care intensivists and two pediatric critical care registered dietitians external to the study team. SETTING The survey was electronically distributed to clinicians in all PICUs across Canada. POPULATION One hundred sixty-two PICU clinicians, including 96 staff intensivists, eight clinical assistants, 36 fellows, and 22 registered dietitians from PICUs across Canada. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The survey was administered from January to March 2013. The response rate was 50% (55 staff intensivists, two clinical assistants, nine fellows, and 15 registered dietitians). There was high variability among clinicians regarding reasons to delay the onset of enteral nutrition or interrupt enteral nutrition administration. High variability (> 70% agreement and < 10% disagreement or vice versa) was found for some reasons to delay or interrupt enteral nutrition, including lactates (rising or > 2 or > 4 mmol/L), high gastric residual volumes, CT/MRI scans, and hypoplastic left heart syndrome. Sixty-eight percent of PICU clinicians reported no written feeding protocol to be in place. CONCLUSIONS Overall, there is high variability among clinicians regarding acceptable procedural and clinical barriers to enteral nutrition administration; this may be improved by a standardized feeding protocol. Therefore, further research must be conducted to provide clinicians with evidence to support their practices for enteral nutrition administration.
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