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ApSimon M, Steel C, Johnston C, Winder B, Cohen S, Reichert H, Armstrong D. Enteral nutrition on discharge from intensive care and 30-day unplanned readmission: An exploratory, retrospective study of association. Clin Nutr ESPEN 2024; 61:15-21. [PMID: 38777427 DOI: 10.1016/j.clnesp.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 01/31/2024] [Accepted: 03/05/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND & AIMS Individuals who survive critical illness are often malnourished with inadequate oral nutrient intake after leaving the intensive care unit (ICU). Enteral nutrition (EN) improves nutrient intake but there is limited evidence on the impact of maintaining EN after discharge from the ICU. The objective of this exploratory study was to understand the association between EN maintenance after ICU and 30-day unplanned hospital re-admission, to inform on future prospective research into the effects of post-ICU nutrition. METHODS This was a single-centre, retrospective study of ICU patients, requiring ventilation, who received EN for at least 3 days in ICU and were discharged to the ward. RESULTS 102 patients met the inclusion criteria; 45 (44.1%) maintained EN and 57 (55.9%) discontinued EN after ICU discharge; there were no significant differences in demographics or clinical measures at ICU admission. Reason for EN discontinuation was documented in 38 (66.7%) patients, with 27 (71%) discontinuing EN due to a routine ward practice of feeding tube removal. Unplanned 30-day hospital re-admission occurred in 17 (16.7%) patients overall, 5 (11.1%) in the EN group and 12 (21.1%) in the non-EN group (crude odds ratio [OR] 0.47, 95% CI 0.15, 1.45, p = 0.188). After adjusting for age, sex, BMI and length of stay, there was a persistent trend to lower re-admission rates in the EN group (OR 0.37, 95% CI 0.09, 1.57, p = 0.176). CONCLUSIONS EN maintenance after ICU discharge was associated with a trend to lower 30-day unplanned hospital re-admission rates. The clinically relevant reduction of about 50% in unplanned re-admission rates in this exploratory study warrants larger, prospective studies of post-ICU nutrition strategies based on clear discontinuation criteria to optimize nutrition and evaluate patient-centred outcomes.
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Affiliation(s)
| | - Cindy Steel
- Nestlé Health Science Canada, North York, ON, Canada.
| | | | - Barb Winder
- Hamilton Health Sciences, Hamilton, ON, Canada
| | - Sarah Cohen
- EpidStrategies, A Division of ToxStrategies, Inc., Katy, TX, USA
| | - Heidi Reichert
- EpidStrategies, A Division of ToxStrategies, Inc., Katy, TX, USA
| | - David Armstrong
- Hamilton Health Sciences, Hamilton, ON, Canada; Division of Gastroenterology & Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
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2
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Hartwell JL, Evans DC, Martin MJ. Nutritional support for the trauma and emergency general surgery patient: What you need to know. J Trauma Acute Care Surg 2024; 96:855-864. [PMID: 38409684 DOI: 10.1097/ta.0000000000004283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
ABSTRACT Decades of research have provided insight into the benefits of nutritional optimization in the elective surgical patient. Patients who are nutritionally prepared for surgery enjoy reduced length of hospital and intensive care unit stays and suffer fewer complications. In the trauma and emergency general surgery patient populations, we are not afforded the preoperative period of optimization and patients often suffer longer lengths of hospital stay, discharge to nonhome destinations, and higher infectious and mortality rates. Nonetheless, ongoing research in this vulnerable and time critical diagnosis population has revealed significant outcomes benefits with the meticulous nutritional support of these patients. However, it is important to note that optimal nutritional support in this challenging patient population is not simply a matter of "feeding more and feeding earlier." In this review, we will address assessing nutritional needs, the provision of optimal nutrition, the timing and route of nutrition, and monitoring outcomes and discuss the management of nutrition in the complex trauma and emergency general surgery patient. LEVEL OF EVIDENCE Literature Synthesis and Expert Opinion; Level V.
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Affiliation(s)
- Jennifer L Hartwell
- From the Division of Acute Care Surgery, Department of Surgery (J.L.H.), University of Kansas Medical Center, Kansas Center, Kansas; Department of Surgery (D.C.E.), Ohio University, OhioHealth Grant Medical Center, Columbus, Ohio; and Division of Trauma and Surgical Critical Care (M.J.M.), Los Angeles County + USC Medical Center, Los Angeles, California
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Im KM, Kim EY. Reducing In-Hospital and 60-Day Mortality in Critically Ill Patients after Surgery with Strict Nutritional Supplementation: A Prospective, Single-Labeled, Randomized Controlled Trial. Nutrients 2023; 15:4684. [PMID: 37960337 PMCID: PMC10648808 DOI: 10.3390/nu15214684] [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: 10/18/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
Malnutrition in critically ill patients is a global concern, especially those who undergo abdominal surgery, as it is associated to higher infectious complications, prolonged hospital stays, and increased morbidity. Despite the importance of proper nutrition, guidelines remain broad, and practical implementation is often inadequate. We aimed to assess the effects of strict nutritional provision and investigate the appropriate target for nutrition support. A prospective, randomized controlled trial was conducted in critically ill patients admitted to intensive care units following abdominal surgery. The intervention group received targeted protein and calories, with consultation from a nutritional support team upon admission. In total, 181 patients in the intervention and 144 in the control group were analyzed. The intervention group demonstrated improved nutrition provision and subsequently better clinical outcomes, including a reduced 60-day mortality (4.4 versus 15.3, p = 0.001), postoperative complications (24.9 versus 47.2, p < 0.001), and in-hospital mortality (5 versus 17.4, p < 0.001). High modified nutrition risk in the critically ill scores [odds ratio (OR) = 2.658, 95% CI = 1.498-4.716] were associated with increased 60-day mortality, while active nutritional intervention (OR = 0.312, 95% CI = 0.111-0.873) was associated with lower mortality rates. Notably, the provision of targeted energy and protein alone did not exhibit a significant association with mortality outcomes.
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Affiliation(s)
- Kyoung Moo Im
- Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul 06591, Republic of Korea;
| | - Eun Young Kim
- Department of Surgery, Division of Trauma and Surgical Critical Care, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul 06591, Republic of Korea
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Singer P, Blaser AR, Berger MM, Calder PC, Casaer M, Hiesmayr M, Mayer K, Montejo-Gonzalez JC, Pichard C, Preiser JC, Szczeklik W, van Zanten ARH, Bischoff SC. ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit. Clin Nutr 2023; 42:1671-1689. [PMID: 37517372 DOI: 10.1016/j.clnu.2023.07.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 06/27/2023] [Accepted: 07/10/2023] [Indexed: 08/01/2023]
Abstract
Following the new ESPEN Standard Operating Procedures, the previous 2019 guideline to provide best medical nutritional therapy to critically ill patients has been shortened and partially revised. Following this update, we propose this publication as a practical guideline based on the published scientific guideline, but shortened and illustrated by flow charts. The main goal of this practical guideline is to increase understanding and allow the practitioner to implement the Nutrition in the ICU guidelines. All the items discussed in the previous guidelines are included as well as special conditions.
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Affiliation(s)
- Pierre Singer
- Intensive Care Unit, Herzlia Medical Center and Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, and Intensive Care Unit, Herzlia Medical Center, Israel.
| | - Annika Reintam Blaser
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia; Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Mette M Berger
- Faculty of Biology and Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Philip C Calder
- School of Human Development and Health, Faculty of Medicine, University of Southampton and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United Kingdom
| | - Michael Casaer
- Clinical Department and Laboratory of Intensive Care Medicine, Catholic University Hospitals (UZLeuven) and Catholic University Leuven, Leuven, Belgium
| | - Michael Hiesmayr
- Division Cardiac-, Thoracic-, Vascular Anaesthesia and Intensive Care, Medical University Vienna, Vienna, Austria
| | - Konstantin Mayer
- Department of Pneumonology, Infectious Diseases and Sleep Medicine, St. Vincentius Kliniken gAG, Karlsruhe, Germany
| | | | - Claude Pichard
- Department of Clinical Nutrition, Geneva University Hospital, Geneva, Switzerland
| | - Jean-Charles Preiser
- Medical Direction, Hopital Universitaire de Bruxelles, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Wojciech Szczeklik
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College & Anesthesia and Intensive Care Department, 5th Military Hospital, Krakow, Poland
| | - Arthur R H van Zanten
- Department of Intensive Care, Gelderse Vallei Hospital, Ede, The Netherlands & Wageningen University & Research, Wageningen, the Netherlands
| | - Stephan C Bischoff
- Department of Nutritional Medicine/Prevention, University of Hohenheim, Stuttgart, Germany
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Lopez-Delgado JC, Servia-Goixart L, Grau-Carmona T, Bordeje-Laguna L, Portugal-Rodriguez E, Lorencio-Cardenas C, Vera-Artazcoz P, Macaya-Redin L, Martinez-Carmona JF, Marin Corral J, Flordelís-Lasierra JL, Seron-Arbeloa C, Alcazar-Espin MDLN, Navas-Moya E, Aldunate-Calvo S, Nieto Martino B, Martinez de Lagran I. Factors associated with the need of parenteral nutrition in critically ill patients after the initiation of enteral nutrition therapy. Front Nutr 2023; 10:1250305. [PMID: 37693244 PMCID: PMC10491892 DOI: 10.3389/fnut.2023.1250305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Background and aims Despite enteral nutrition (EN) is the preferred route of nutrition in patients with critical illness, EN is not always able to provide optimal nutrient provision and parenteral nutrition (PN) is needed. This is strongly associated with gastrointestinal (GI) complications, a feature of gastrointestinal dysfunction and disease severity. The aim of the present study was to investigate factors associated with the need of PN after start of EN, together with the use and complications associated with EN. Methods Adult patients admitted to 38 Spanish intensive care units (ICUs) between April and July 2018, who needed EN therapy were included in a prospective observational study. The characteristics of EN-treated patients and those who required PN after start EN were analyzed (i.e., clinical, laboratory and scores). Results Of a total of 443 patients, 43 (9.7%) received PN. One-third (29.3%) of patients presented GI complications, which were more frequent among those needing PN (26% vs. 60%, p = 0.001). No differences regarding mean energy and protein delivery were found between patients treated only with EN (n = 400) and those needing supplementary or total PN (n = 43). Abnormalities in lipid profile, blood proteins, and inflammatory markers, such as C-Reactive Protein, were shown in those patients needing PN. Sequential Organ Failure Assessment (SOFA) on ICU admission (Hazard ratio [HR]:1.161, 95% confidence interval [CI]:1.053-1.281, p = 0.003) and modified Nutrition Risk in Critically Ill (mNUTRIC) score (HR:1.311, 95% CI:1.098-1.565, p = 0.003) were higher among those who needed PN. In the multivariate analysis, higher SOFA score (HR:1.221, 95% CI:1.057-1.410, p = 0.007) and higher triglyceride levels on ICU admission (HR:1.004, 95% CI:1.001-1.007, p = 0.003) were associated with an increased risk for the need of PN, whereas higher albumin levels on ICU admission (HR:0.424, 95% CI:0.210-0.687, p = 0.016) was associated with lower need of PN. Conclusion A higher SOFA and nutrition-related laboratory parameters on ICU admission may be associated with the need of PN after starting EN therapy. This may be related with a higher occurrence of GI complications, a feature of GI dysfunction. Clinical trial registration ClinicalTrials.gov: NCT03634943.
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Affiliation(s)
- Juan Carlos Lopez-Delgado
- Hospital Clinic of Barcelona, Barcelona, Spain
- Departament d’Infermeria Fonamental i Médico-Quirúrgica, School of Nursing, University of Barcelona, Barcelona, Spain
| | - Lluís Servia-Goixart
- University Hospital Arnau de Vilanova, Lleida, Spain
- Lleida Institute for Biomedical Research (IRBLleida), Lleida, Spain
| | - Teodoro Grau-Carmona
- University Hospital October 12, Madrid, Spain
- Research Institute Hospital 12 de Octubre, Madrid, Spain
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Church A, Zoeller S. Enteral nutrition product formulations: A review of available products and indications for use. Nutr Clin Pract 2023; 38:277-300. [PMID: 36787985 DOI: 10.1002/ncp.10960] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/12/2023] [Accepted: 01/15/2023] [Indexed: 02/16/2023] Open
Abstract
When oral nutrition is not feasible, enteral nutrition (EN) therapy is often considered the preferred route of nutrition support to meet the nutrient needs of individuals with a functional gastrointestinal tract across multiple levels of care (critical care, acute care, and home care). Enteral formulations have progressively evolved over the last 50 years from the simple blending of hospital food thin enough to run through a feeding tube, to the development of commercial standard formulas, followed by specialized formulas with immune-modulating and disease-specific qualities, to the most recent shift to food-based or blenderized EN composed of natural, whole foods with perceived health benefits. With the vast number of enteral formulations on the market, clinicians may be overwhelmed trying to determine proven vs theoretical benefits. This review is intended to explore differences in enteral formulations, identify implications for clinical practice, and review evidenced-based clinical guidelines to assist clinicians in enteral formula selection.
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Affiliation(s)
- April Church
- Nutrition Services, Asante Rogue Regional Medical Center, Medford, Oregon, USA
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Zhang W, Zhou W, Kong Y, Li Q, Huang X, Zhao B, Su H, Chen S, Shen X, Qiu Z. The effect of abdominal massage on enteral nutrition tolerance in patients on mechanical ventilation: A Randomized Controlled Study. Intensive Crit Care Nurs 2023; 75:103371. [PMID: 36528462 DOI: 10.1016/j.iccn.2022.103371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 11/25/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess whether abdominal massage impacts enteral feeding tolerance in mechanically ventilated patients. METHODS Patients were randomized to receive standard or intervention care (standard care plus a 15-minute abdominal massage twice daily) for three days. We recorded the vomiting, reflux, gastric retention, aspiration, diarrhea, abdominal distension, gastric residual volume and abdominal circumference from days one to three. A P-value of less than 0.05 was statistically significant. RESULTS Seventy-four patients (37 per group) were recruited (intervention vs control: age 58.03 ± 10.44 vs 55.33 ± 12.45 years; %M: 69.70 % vs 69.70 %). The aspiration, gastric retention and abdominal distension incidence in the intervention group was 3.03 %, 6.06 % and 9.09 %, whereas in the control group it was 24.24 %, 30.30 % and 27.27 % (P <.05). The vomiting, reflux and diarrhea incidence for patients in the intervention group were all 3.03 %, whereas in the control group they were 3.03 %, 9.09 % and 9.09 % (P >.05). From day 1 to day 3, the gastric residual volume decreased from 87.23 ± 3.29 mL to 72.59 ± 5.40 mL in the intervention group and increased from 91.94 ± 3.45 mL to 105.00 ± 6.94 mL in the control group. Similarly, the abdominal circumference decreased from 84.41 ± 1.73 cm to 82.44 ± 1.73 cm in the intervention group and increased from 87.90 ± 1.60 cm to 88.90 ± 1.75 cm in the control group. The differences in time, group, and interaction effects between the two groups were statistically significant for abdominal circumference and gastric residual volume (P <.05). CONCLUSIONS Abdominal massage can effectively reduce gastric retention, abdominal distension, aspiration, gastric residual volume and abdominal circumference in mechanically ventilated patients, but not the incidence of vomiting, reflux and diarrhea.
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Affiliation(s)
- Weiqin Zhang
- School of Nursing, Fujian Medical University, Fuzhou, Fujian Province 350122, China
| | - Wenguang Zhou
- Chenggong Hospital of Xiamen University (the 73th Group Military Hospital of People's Liberation Army), Xiamen, Fujian Province 361003, China
| | - Yue Kong
- School of Fuzhou General Hospital Clinical Medical, Fujian Medical University, Fuzhou, Fujian Province 350025, China; Education Office, The 900 Hospital of People's Liberation Army, Fuzhou, Fujian Province 350025, China.
| | - Qi Li
- Department of Neurosurgery, The 900 Hospital of People's Liberation Army, Fuzhou, Fujian Province 350025, China
| | - Xiaoqiong Huang
- Department of Neurosurgery, The 900 Hospital of People's Liberation Army, Fuzhou, Fujian Province 350025, China
| | - Binbin Zhao
- Department of Nursing, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province 430071, China
| | - Honghong Su
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian Province 350122, China
| | - Silu Chen
- School of Nursing, Fujian Medical University, Fuzhou, Fujian Province 350122, China
| | - Xianying Shen
- School of Nursing, Fujian Medical University, Fuzhou, Fujian Province 350122, China
| | - Zhaojun Qiu
- School of Nursing, Fujian Medical University, Fuzhou, Fujian Province 350122, China
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Li Y, Liu H. Application strategy and effect analysis of nutritional support nursing for critically ill patients in intensive care units. Medicine (Baltimore) 2022; 101:e30396. [PMID: 36197233 PMCID: PMC9509121 DOI: 10.1097/md.0000000000030396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We investigate nutritional support and nursing status of critical patients in intensive care units (ICUs) to understand the latest nutritional support guidelines' implementation by clinical medical staff; identify problems in nutritional support and nursing for these patients, analyze causes, and present suggestions; and provide a clinical/theoretical bases to improve nutritional support implementation and nursing strategies for them. Clinical case information of 304 critically ill ICU patients admitted from July 2017 to July 2021 was analyzed. They were divided into the experimental (nutritional support) and control (no nutritional support) groups to compare their laboratory indicators, 28-day case fatality rate, and infection incidence. Least significant difference was used for postanalysis of statistically significant items to obtain pairwise comparisons. Nutrition support strategies for ICU patients are consistent with guidelines but have an implementation gap. No statistically significant differences were found in hemoglobin (HB), total serum protein (TP), serum albumin (ALB), transferrin (TF), prealbumin (PA), and total lymphocyte count (TLC) in experimental group patients compared with the control group within 24 hours (before nutritional support, P > .05). No statistically significant differences were also found in HB, TP, TLC, and ALB between the enteral nutrition + parenteral nutrition (EN + PN), total EN (TEN), total PN (TPN), and control groups on admission day 7 (after nutritional support, P > .05), while statistically significant differences existed between PA and TF (P < .05). TF of patients supported by TEN was higher (statistically significant difference, P < .05). PA in patients receiving TEN and EN + PN support was higher than in control group patients (statistically significant difference, P < .05). Compared with the control group, in experimental group patients, infection incidence was significantly lower (40.2% vs 62.9%, P < .05); incidence of complications was lower, but not statistically significant (40.2% vs 57.1%, P > .05); and 28-day mortalities were significantly lower (26.7% vs 45.7%, P < .05). Nutritional support can reduce hospitalization complications and 28-day mortality in critical patients, but its implementation must be standardized. Especially for patients with gastrointestinal dysfunction, personalized/standardized nutrition strategies and nursing procedures are needed when PN support is applied, and training of clinical medical staff should be strengthened to improve nutrition support's efficiency.
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Affiliation(s)
- Yunting Li
- Department of Emergency Medicine, The Second Affiliated Hospital of Hainan Medical University, Haikou, 570311, China
| | - Haitang Liu
- Department of Critical Care Unit 2, The Second Affiliated Hospital of Hainan Medical University, Haikou, 570311, China
- *Correspondence: Haitang Liu, Department of Critical Care Unit 2, The Second Affiliated Hospital of Hainan Medical University, Haikou, 570311, China (e-mail: )
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Casting Light on the Necessary, Expansive, and Evolving Role of the Critical Care Dietitian: An Essential Member of the Critical Care Team. Crit Care Med 2022; 50:1289-1295. [PMID: 35984051 DOI: 10.1097/ccm.0000000000005607] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Park H, Lim SY, Kim S, Kim HS, Kim S, Yoon HI, Cho YJ. Effect of a nutritional support protocol on enteral nutrition and clinical outcomes of critically ill patients: a retrospective cohort study. Acute Crit Care 2022; 37:382-390. [PMID: 35977898 PMCID: PMC9475161 DOI: 10.4266/acc.2022.00220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/03/2022] [Indexed: 11/30/2022] Open
Abstract
Background Enteral nutrition (EN) supply within 48 hours after intensive care unit (ICU) admission improves clinical outcomes. The “new ICU evaluation & development of nutritional support protocol (NICE-NST)” was introduced in an ICU of tertiary academic hospital. This study showed that early EN through protocolized nutritional support would supply more nutrition to improve clinical outcomes. Methods This study screened 170 patients and 62 patients were finally enrolled; patients who were supplied nutrition without the protocol were classified as the control group (n=40), while those who were supplied according to the protocol were classified as the test group (n=22). Results In the test group, EN started significantly earlier (3.7±0.4 days vs. 2.4±0.5 days, P=0.010). EN calorie (4.0±1.0 kcal/kg vs. 6.7±0.9 kcal/kg, P=0.006) and protein (0.17±0.04 g/kg vs. 0.32±0.04 g/kg, P=0.002) supplied were significantly higher in the test group. Although EN was supplied through continuous feeding in the test group, there was no difference in complications such as feeding hold due to excessive gastric residual volume or vomit, and hyper- or hypo-glycemia between the two groups. Hospital mortality was significantly lower in the group that started EN within 1.5 days (42.9% vs. 11.8%, P=0.018). The proportion of patients who started EN within 1.5 days was higher in the test group (40.9% vs. 17.5%, P=0.044). Conclusions The NICE-NST may improve EN supply and mortality of critically ill patients without increasing complications.
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Bechtold ML, Brown PM, Escuro A, Grenda B, Johnston T, Kozeniecki M, Limketkai BN, Nelson KK, Powers J, Ronan A, Schober N, Strang BJ, Swartz C, Turner J, Tweel L, Walker R, Epp L, Malone A. When is enteral nutrition indicated? JPEN J Parenter Enteral Nutr 2022; 46:1470-1496. [PMID: 35838308 DOI: 10.1002/jpen.2364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 11/07/2022]
Abstract
Enteral nutrition (EN) is a vital component of nutrition around the world. EN allows for delivery of nutrients to those who cannot maintain adequate nutrition by oral intake alone. Common questions regarding EN are when to initiate and in what scenarios it is safe. The answers to these questions are often complex and require an evidence-based approach. The Board of Directors of the American Society for Parenteral and Enteral Nutrition (ASPEN) established an Enteral Nutrition Committtee to address the important questions surrounding the indications for EN. Consensus recommendations were established based on eight extremely clinically relevant questions regarding EN indications as deemed by the Enteral Nutrition Committee. These consensus recommendations may act as a guide for clinicians and stakeholders on difficult questions pertaining to indications for EN. This paper was approved by the ASPEN Board of Directors.
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Affiliation(s)
| | | | | | - Brandee Grenda
- Morrison Healthcare at Atrium Health Navicant, Charlotte, North Carolina, USA
| | - Theresa Johnston
- Nutrition Support Team, Christiana Care Health System, Newark, Delaware, USA
| | | | | | | | - Jan Powers
- Nursing Research and Professional Practice, Parkview Health System, Fort Wayne, Indiana, USA
| | - Andrea Ronan
- Fanconi Anemia Research Fund, Eugene, Oregon, USA
| | - Nathan Schober
- Cancer Treatment Centers of America - Atlanta, Newnan, Georgia, USA
| | | | - Cristina Swartz
- Northwestern Medicine Delnor Cancer Center, Chicago, Illinois, USA
| | - Justine Turner
- Department of Pediatrics, Division of Gastroenterology and Nutrition, University of Alberta, Edmonton, Canada
| | | | - Renee Walker
- Michael E. DeBakey Veteran Affairs Medical Center, Houston, Texas, USA
| | - Lisa Epp
- Mayo Clinic, Rochester, Minnesota, USA
| | - Ainsley Malone
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
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Ramuada L, Veldsman L, Livhuwani N, Blaauw R. Assessment of knowledge, attitude and practice of nurses regarding enteral nutrition at a military hospital. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2022. [DOI: 10.1080/16070658.2022.2076970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Londolani Ramuada
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Military Hospital, Thaba Tshwane, Pretoria, South Africa
| | - Lizl Veldsman
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | | | - Renée Blaauw
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Gao X, Liu Y, Zhang L, Zhou D, Tian F, Gao T, Tian H, Hu H, Gong F, Guo D, Zhou J, Gu Y, Lian B, Xue Z, Jia Z, Chen Z, Wang Y, Jin G, Wang K, Zhou Y, Chi Q, Yang H, Li M, Yu J, Qin H, Tang Y, Wu X, Li G, Li N, Li J, Pichard C, Wang X. Effect of Early vs Late Supplemental Parenteral Nutrition in Patients Undergoing Abdominal Surgery: A Randomized Clinical Trial. JAMA Surg 2022; 157:384-393. [PMID: 35293973 PMCID: PMC8928091 DOI: 10.1001/jamasurg.2022.0269] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Importance The effect of and optimal timing for initiating supplemental parenteral nutrition (SPN) remain unclear after major abdominal surgery for patients in whom energy targets cannot be met by enteral nutrition (EN) alone. Objective To examine the effect of early supplemental parenteral nutrition (E-SPN) (day 3 after surgery) or late supplemental parenteral nutrition (L-SPN) (day 8 after surgery) on the incidence of nosocomial infections in patients undergoing major abdominal surgery who are at high nutritional risk and have poor tolerance to EN. Design, Setting, and Participants A multicenter randomized clinical trial was conducted from April 1, 2017, to December 31, 2018, in the general surgery department of 11 tertiary hospitals in China. Participants were those undergoing major abdominal surgery with high nutritional risk and poor tolerance to EN (≤30% of energy targets from EN on postoperative day 2, calculated as 25 and 30 kcal/kg of ideal body weight daily for women and men, respectively) and an expected postoperative hospital stay longer than 7 days. Data analysis was performed from February 1 to October 31, 2020. Interventions Random allocation to E-SPN (starting on day 3 after surgery) or L-SPN (starting on day 8 after surgery). Main Outcomes and Measures The primary outcome was the incidence of nosocomial infections between postoperative day 3 and hospital discharge. Results A total of 230 patients (mean [SD] age, 60.1 [11.2] years; 140 men [61.1%]; all patients were of Han race and Asian ethnicity) were randomized (115 to the E-SPN group and 115 to the L-SPN group). One patient in the L-SPN group withdrew informed consent before the intervention. The E-SPN group received more mean (SD) energy delivery between days 3 and 7 compared with the L-SPN group (26.5 [7.4] vs 15.1 [4.8] kcal/kg daily; P < .001). The E-SPN group had significantly fewer nosocomial infections compared with the L-SPN group (10/115 [8.7%] vs 21/114 [18.4%]; risk difference, 9.7%; 95% CI, 0.9%-18.5%; P = .04). No significant differences were found between the E-SPN group and the L-SPN group in the mean (SD) number of noninfectious complications (31/115 [27.0%] vs 38/114 [33.3%]; risk difference, 6.4%; 95% CI, -5.5% to 18.2%; P = .32), total adverse events (75/115 [65.2%] vs 82/114 [71.9%]; risk difference, 6.7%; 95% CI, -5.3% to 18.7%; P = .32), and rates of other secondary outcomes. A significant difference was found in the mean (SD) number of therapeutic antibiotic days between the E-SPN group and the L-SPN group (6.0 [0.8] vs 7.0 [1.1] days; mean difference, 1.0 days; 95% CI, 0.2-1.9 days; P = .01). Conclusion and Relevance In this randomized clinical trial, E-SPN was associated with reduced nosocomial infections in patients undergoing abdominal surgery and seems to be a favorable strategy for patients with high nutritional risk and poor tolerance to EN after major abdominal surgery. Trial Registration ClinicalTrials.gov Identifier: NCT03115957.
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Affiliation(s)
- Xuejin Gao
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yuxiu Liu
- Department of Medical Statistics, Jinling Hospital, Nanjing Medical University, Nanjing, China.,Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Li Zhang
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Da Zhou
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Feng Tian
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Tingting Gao
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Hao Tian
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Hao Hu
- Department of Hepatobiliary Pancreatic Surgery, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Fangyou Gong
- Department of General Surgery, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Dong Guo
- Department of Gastrointestinal Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Junde Zhou
- Department of General Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yingchao Gu
- Department of General Surgery, the Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Bo Lian
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Zhigang Xue
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhenyi Jia
- Department of General Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhida Chen
- Department of General Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yong Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Gang Jin
- Department of Hepatobiliary Pancreatic Surgery, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Kunhua Wang
- Department of General Surgery, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yanbing Zhou
- Department of Gastrointestinal Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qiang Chi
- Department of General Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hua Yang
- Department of General Surgery, the Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Mengbin Li
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Jianchun Yu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Huanlong Qin
- Department of General Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yun Tang
- Department of General Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiaoting Wu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Guoli Li
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ning Li
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jieshou Li
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Claude Pichard
- Nutrition Unit, Geneva University Hospital, Lausanne, Switzerland
| | - Xinying Wang
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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Naseri A, Seyedi-Sahebari S, Mahmoodpoor A, Sanaie S. Probiotics in Critically Ill Patients: An Umbrella Review. Indian J Crit Care Med 2022; 26:339-360. [PMID: 35519905 PMCID: PMC9015916 DOI: 10.5005/jp-journals-10071-24129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives Data sources Study selection Data extraction Data synthesis Conclusion How to cite this article
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Affiliation(s)
- Amirreza Naseri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Research Center for Evidence-based-Medicine, Iranian EBM Center: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sepideh Seyedi-Sahebari
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Research Center for Evidence-based-Medicine, Iranian EBM Center: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ata Mahmoodpoor
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sarvin Sanaie
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Sarvin Sanaie, Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran, Phone: +98 9143116744, e-mail:
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15
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Kang H, Woo M, Park E, Park YK. The Status of Enteral Nutrition Formula Use by Dietitians in Hospitals Within Busan and Gyeongnam Area. Clin Nutr Res 2022; 11:9-19. [PMID: 35223677 PMCID: PMC8844530 DOI: 10.7762/cnr.2022.11.1.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 01/07/2022] [Accepted: 01/09/2022] [Indexed: 12/05/2022] Open
Abstract
This study was conducted to analyze the status of medical food selection process in hospitals within Busan and Gyeongnam area. The survey was distributed to 396 hospitals (general, tertiary and long-term care hospitals) and finally 68 surveys were used for analysis. The questionnaire consisted of 9 general items and 10 items related to enteral nutrition (EN). From the survey we found out that general hospitals and tertiary hospitals normally hire clinical dietitian, while long-term care hospitals hire dietitians with no further qualifications (χ2 = 27.918, p < 0.001). A significant relationship was found between hospital size and the priority for choosing medical foods for patients (χ2 = 11.852, p < 0.05). In general and tertiary hospitals, medical foods were provided exactly according to the doctor's prescription, whereas in long-term care hospitals, only half followed the doctor’s direction and half of them provided the products that has been conventionally used. There was also a significant relationship between hospital size and the method for determination of nutrition requirements (χ2 = 20.496, p < 0.001). Finally, the priority of considerations when developing a ‘medical food guidelines’ was shown in the following order; 1) the type of medical food that can be selected according to the disease state, 2) the nutrient content and comparison table for commercial products, and 3) how to manage complications that may occur when supplying medical food for patients. Developing an EN practice guideline for making a sensible selection of medical foods will provide a valuable information for better patient care.
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Affiliation(s)
- Haejin Kang
- Department of Medical Nutrition (AgeTech-Service Convergence Major), Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Korea
| | - Minji Woo
- Department of Food and Nutrition, Kyungnam University, Changwon 51767, Korea
| | - Eunju Park
- Department of Food and Nutrition, Kyungnam University, Changwon 51767, Korea
| | - Yoo Kyoung Park
- Department of Medical Nutrition (AgeTech-Service Convergence Major), Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Korea
- Department of Food Innovation and Health, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Korea
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Patel JJ, Shukla A, Heyland DK. Enteral nutrition in septic shock: A pathophysiologic conundrum. JPEN J Parenter Enteral Nutr 2021; 45:74-78. [PMID: 34897735 DOI: 10.1002/jpen.2246] [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: 04/01/2021] [Revised: 08/02/2021] [Accepted: 08/02/2021] [Indexed: 11/07/2022]
Abstract
Septic shock is a public health burden and defined as a subset of sepsis whereby abnormalities in microcirculatory and cellular metabolism manifest as acute circulatory failure. At the level of the gut, septic shock impairs epithelial barrier function (EBF), and the gut initiates proinflammatory responses contributing to multiple organ dysfunction syndrome. The timing and dose of enteral nutrition (EN) in septic shock remains a conundrum. On the one hand, early EN preserves EBF. On the other hand, serious gastrointestinal complications such as bowel necrosis may limit EN initiation in septic shock. We (1) describe the pathophysiologic conundrum septic shock poses for EN initiation, (2) outline guideline-based recommendations for EN in septic shock, (3) identify the role of parenteral nutrition in septic shock, and (4) identify and appraise postguideline literature on the timing, dose, and titration of EN in septic shock.
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Affiliation(s)
- Jayshil J Patel
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anuj Shukla
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Daren K Heyland
- Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
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17
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Al-Kalaldeh M, Shosha GA, Shoqirat N, Alsaraireh M, Haddadin R. Estimating the time point for nutritional failure in patients suffering from acute brain attacks in the intensive care unit. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:S12-S19. [PMID: 34839686 DOI: 10.12968/bjon.2021.30.21.s12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Severe brain attack patients demonstrate hypermetabolic state and gastrointestinal dysfunction, leading to faster onset of nutritional failure. AIM To estimate the time point where the development of nutritional failure is more probable among patients with acute brain attacks in the intensive care unit (ICU). METHODS Direct bedside observation for selected nutritional parameters was performed. When enteral nutrition was initiated, observation was performed at five points over 9 days. FINDINGS 84 patients with 55% mortality risk and on mechanical ventilation were included. Over the observation period, gastric residual volume increased (144 ml vs 196 ml), body weight decreased (79.4 kg vs 74.3 kg), and serum albumin reduced (3.6 g/dl to 3.1 g/dl). Caloric attainment and malnutrition score deteriorated, and feeding-related complications increased. Nutritional failure was evidently prevalent between the third and fifth day of observation. CONCLUSION An earlier period of enteral nutrition entails higher probability of nutritional failure among severe brain attack patients in the ICU.
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Affiliation(s)
- Mahmoud Al-Kalaldeh
- Associate Professor, Faculty of Nursing, The University of Jordan - Aqaba Campus, Jordan
| | - Ghada Abu Shosha
- Associate Professor, Faculty of Nursing, Zarqa University, Jordan
| | | | | | - Rawan Haddadin
- Head of Nursing Department, Marka Military Medical Center, Jordan
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18
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Recovery Focused Nutritional Therapy across the Continuum of Care: Learning from COVID-19. Nutrients 2021; 13:nu13093293. [PMID: 34579171 PMCID: PMC8472175 DOI: 10.3390/nu13093293] [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: 08/23/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 02/07/2023] Open
Abstract
Targeted nutritional therapy should be started early in severe illness and sustained through to recovery if clinical and patient-centred outcomes are to be optimised. The coronavirus disease 2019 (COVID-19) pandemic has shone a light on this need. The literature on nutrition and COVID-19 mainly focuses on the importance of nutrition to preserve life and prevent clinical deterioration during the acute phase of illness. However, there is a lack of information guiding practice across the whole patient journey (e.g., hospital to home) with a focus on targeting recovery (e.g., long COVID). This review paper is of relevance to doctors and other healthcare professionals in acute care and primary care worldwide, since it addresses early, multi-modal individualised nutrition interventions across the continuum of care to improve COVID-19 patient outcomes. It is of relevance to nutrition experts and non-nutrition experts and can be used to promote inter-professional and inter-organisational knowledge transfer on the topic. The primary goal is to prevent complications and support recovery to enable COVID-19 patients to achieve the best possible nutritional, physical, functional and mental health status and to apply the learning to date from the COVID-19 pandemic to other patient groups experiencing acute severe illness.
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19
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Caloric Intake with High Ratio of Enteral Nutrition Associated with Lower Hospital Mortality for Patients with Acute Respiratory Distress Syndrome Using Prone Position Therapy. Nutrients 2021; 13:nu13093259. [PMID: 34579135 PMCID: PMC8469711 DOI: 10.3390/nu13093259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/12/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022] Open
Abstract
Positioning patients in the prone position leads to reduced hospital mortality rates for those with severe acute respiratory distress syndrome (ARDS). What constitutes the optimal feeding strategy for prone patients with ARDS is controversial. We conducted a retrospective study that enrolled 110 prone patients with ARDS in two medical intensive care units (ICUs) from September 2015 to November 2018. Inclusion criteria were as follows: age ≥20 years, diagnosis of respiratory failure requiring mechanical ventilation, diagnosis of ARDS within 72 h of ICU admission, placement in a prone position within the first 7 days of ICU admission, and ICU stay of more than 7 days. Exclusion criteria were as follows: nil per os orders because of gastrointestinal bleeding or hemodynamic instability, and ventilator dependency because of chronic respiratory failure. The consecutive daily enteral nutrition(EN)/EN + parenteral nutrition(PN) ratio could predict hospital mortality rates within the first 7 days of admission when using generalized estimating equations (p = 0.013). A higher average EN/EN + PN ratio within the first 7 days predicted (hazard ratio: 0.97, confidence interval: 0.96-0.99) lower hospital mortality rates. To reduce hospital mortality rates, caloric intake with a higher EN ratio may be considered for patients in prone positions with ARDS.
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20
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Koontalay A, Suksatan W, Teranuch A. Early Enteral Nutrition Met Calories Goals Led by Nurse on Improve Clinical Outcome: A Systematic Scoping Review. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:392-398. [PMID: 34703776 PMCID: PMC8491827 DOI: 10.4103/ijnmr.ijnmr_421_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/24/2021] [Accepted: 05/08/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Critically ill patients face challenges in hypercatabolism due to crisis states, as it may lead to malnutrition. An early Enteral Nutrition (EN) within 24-48 h is recommended to use in order to improve clinical outcomes. This systematic scoping review is examined recently with the evidence of the early EN protocol led by nurses to drive and achieve the daily calorie target and improve clinical outcomes. MATERIALS AND METHODS The database of CINAHL, MEDLINE via PubMed and Scopus, Web of Science, and Embase through Ovid from January 2019 to September 2020, comprised of 221 articles which four articles are chosen and entered into the final analysis. RESULTS The findings show the benefits of the early EN to guide nurses to start the EN as soon as possible after admitted to the Intensive Care Unit or when hemodynamic is stable in order to achieve a daily calorie target regarding the reduced hospitalization, duration of mechanical ventilation, morbidity, and mortality. CONCLUSIONS The synthesized results show the early EN led by a nurse to address the specific needs and the vital role of nutritional support, and also drive the enteral feeding for critically ill patients to reach the calorie target goals in short times to enhance clinical outcomes.
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Affiliation(s)
| | - Wanich Suksatan
- Faculty of Nursing, HRH Princess Chulabron College of Medical Science, Chulaborn Royal Academy, Thailand
- Saint Louis University, Trudy Busch.Valentine School of Nursing, St.Louis, Missouri, USA
| | - Aumpornpun Teranuch
- Adult Nursing, Faculty of Nursing, Khon Kaen University, Acting Director, Research and Training Center for Enhancing Quality of Life of Working Age People, Thailand
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21
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Gastrointestinal Tolerance and Protein Absorption Markers with a New Peptide Enteral Formula Compared to a Standard Intact Protein Enteral Formula in Critically Ill Patients. Nutrients 2021; 13:nu13072362. [PMID: 34371872 PMCID: PMC8308653 DOI: 10.3390/nu13072362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/04/2021] [Accepted: 07/08/2021] [Indexed: 11/18/2022] Open
Abstract
The aim of this exploratory study was to investigate gastrointestinal tolerance and protein absorption markers with a new enteral peptide formula (PF) compared to an isocaloric enteral intact protein standard formula (SF) containing the same amount of protein in ICU patients. Patients admitted to a cardio-thoracic intensive care unit expected to receive tube feeding for ≥5 days were randomized to receive either PF (1.5 kcal/mL) or SF in a double-blind manner for ≤14 days. Twenty-six patients were randomized (13 SF and 13 PF) and 23 (12 SF and 11 PF) completed at least 5 days of product administration. There were no statistically significant differences between the feeds during the first 5 days of intervention for diarrhea (SF:3 (23%); PF:5 (39%), p = 0.388), vomiting (SF:1 (8%); PF:2 (15%), p = 0.549), constipation (SF:7 (54%), PF:3 (23%), p = 0.115), and high gastric residual volume (>500 mL: SF:1 (8%); PF: 2 (15%), p = 0.535). There were no differences in plasma amino acids or urinary markers of protein absorption and metabolism. In conclusion, no major differences were found in tolerability and protein absorption markers between the standard intact protein formula and the peptide formula.
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22
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Tedeschi-Jockers F, Reinhold S, Hollinger A, Tuchscherer D, Kiss C, Gantner L, Ledergerber K, Zimmermann S, Scheuzger J, Huber J, Siegemund M. A new high protein-to-energy enteral formula with a whey protein hydrolysate to achieve protein targets in critically ill patients: a prospective observational tolerability study. Eur J Clin Nutr 2021; 76:419-427. [PMID: 34168292 PMCID: PMC8223230 DOI: 10.1038/s41430-021-00956-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 05/16/2021] [Accepted: 05/28/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Current guidelines and expert recommendations stress the need to implement enteral feeds with a higher protein-to-energy ratio to meet protein requirements as recommended while avoiding gastrointestinal side effects and energy overfeeding in ICU patients. MATERIALS AND METHODS Prospective tolerability study in 18 critically ill patients with a high protein formula (high protein-to-energy (HP:E) formula = Fresubin® Intensive; HPG) compared to a contemporary matched conventional therapy group (CTG). The primary outcome was GI intolerance defined as ≥300 ml daily gastric residual volume (GRV), vomiting, or diarrhea on days 1 and 2. Secondary outcomes were the percentage of patients reaching their protein target on day 4 and overall protein intake. RESULTS Groups were comparable regarding demographic characteristics, disease severity, organ failures, mechanical ventilation, and NUTRIC score at baseline. Eighteen patients completed the 4-day feeding period. The number of events of GRV of ≥300 ml/day was equal in both groups (33.3%). The incidence of diarrhea and vomiting was low in the HPG (two patients concerned). EN did not need to be discontinued due to intolerance in any group. Seventy-two percent of patients reached protein targets ≥1.3 g/kgBW/d within 4 days after initiation of enteral feeding, which was superior to the CTG (33%). Post-hoc testing showed group differences of protein intake between HPG and CTG were significant at t = 72 h and t = 96 h. Energy targets were met in both groups. CONCLUSION The HP:E formula containing 33% whey protein hydrolysate is well tolerated in this tolerability study. Due to the HP:E ratio protein targets can be reached faster. Larger randomized trials are needed to confirm preliminary results. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02678325. Registered 2 May 2016.
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Affiliation(s)
| | - Simona Reinhold
- Intensive Care Unit, University Hospital Basel, Basel, Switzerland
| | - Alexa Hollinger
- Intensive Care Unit, University Hospital Basel, Basel, Switzerland.
| | | | - Caroline Kiss
- Department of Clinical Nutrition, University Department of Geriatric Medicine Felix Platter, Basel, Switzerland
| | - Lukas Gantner
- Intensive Care Unit, University Hospital Basel, Basel, Switzerland
| | | | | | - Jonas Scheuzger
- Intensive Care Unit, University Hospital Basel, Basel, Switzerland
| | - Jan Huber
- Intensive Care Unit, University Hospital Basel, Basel, Switzerland
| | - Martin Siegemund
- Intensive Care Unit, University Hospital Basel, Basel, Switzerland
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23
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Dixit SB, Tiwari NR, Zirpe KG, Tolat AG, Khatib KI, Kulkarni AP, Mehta Y, Mishra RC, Govil D, Chaudhry D, Ahsina Jahan L. How Have Nutrition Practices in the ICU Changed in the Last Decade (2011-2020): A Scoping Review. Cureus 2021; 13:e15422. [PMID: 34249568 PMCID: PMC8253490 DOI: 10.7759/cureus.15422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 01/03/2023] Open
Abstract
Malnutrition is more prevalent in the critically ill than ambulatory patients due to a variety of factors. Strategies employed in the optimization of nutrition practices rely largely on the review of published literature and guidelines. While the last decade was marked by some landmark large randomized controlled trials taking place and some high-quality systematic reviews, it still has left us with many unanswered questions. The evidence generated by these trials can, to a good extent, extrapolate to the developed countries. However, its implementation in developing and third-world countries needs further elaboration and logistical considerations. With this scoping review, we attempt to provide insights into the landmark developments in the decade 2011-2020. Solutions to employ and implement the results of these developments and ways for their corroboration into a larger population are also discussed.
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Affiliation(s)
| | - Nishant R Tiwari
- Internal Medicine, Byramjee Jeejeebhoy Medical College, Pune, IND
| | - Kapil G Zirpe
- Neurocritical Care, Ruby Hall Clinic, Grant Medical Foundation, Pune, IND
| | - Aditya G Tolat
- General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Khalid I Khatib
- Critical Care Medicine, Smt Kashibai Navale Medical College and General Hospital, Pune, IND
| | - Atul P Kulkarni
- Anaesthesiology and Critical Care Medicine, Tata Memorial Hospital, Mumbai, IND
| | - Yatin Mehta
- Anaesthesiology and Critical Care Medicine, Medanta-The Medicity, Gurugram, IND
| | - Rajesh C Mishra
- Critical Care Medicine, Sanjivani Super Speciality Hospital, Ahmedabad, IND
| | - Deepak Govil
- Anaesthesiology and Critical Care Medicine, Medanta-The Medicity, Gurugram, IND
| | - Dhruva Chaudhry
- Pulmonary and Critical Care Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Lopa Ahsina Jahan
- Critical Care Medicine, MH Samorita Hospital and Medical College, Dhaka, BGD
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Xu XT, Huang H, Tian MX, Hu RC, Dai Z, Jin X. A four-oil intravenous lipid emulsion improves markers of liver function, triglyceride levels and shortens length of hospital stay in adults: a systematic review and meta-analysis. Nutr Res 2021; 92:1-11. [PMID: 34157593 DOI: 10.1016/j.nutres.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/25/2021] [Accepted: 05/07/2021] [Indexed: 11/30/2022]
Abstract
Clinical trials have reported that a four-oil intravenous lipid emulsion (SMOFlipid) play a positive role in immune function, but showed inconsistent outcomes compared to other lipid emulsions. A systematic review and meta-analysis was conducted to evaluate the effect of SMOFlipid on liver function, triglycerides (TG), inflammatory markers, and clinical outcomes in hospitalized adults after short-term use compared to others. A search of the PubMed, Medline, Embase, China National Knowledge Infrastructure, and Wanfang databases was performed to identify the included randomized controlled trials. Trials with adults who were administrated a short-term course of SMOFlipid were included. A meta-analysis on liver function markers, TG, inflammatory markers, and clinical outcomes was conducted. A total of 18 randomized controlled trials with 1188 patients were included. Compared to other lipid emulsions, SMOFlipid was associated with a significant reduction in ALT, AST, γ-glutamyltransferase, total bilirubin, TG, C-reactive protein and length of hospital stay. No effect on serum interleukin-6 levels or adverse events were observed. For adult patients, our meta-analysis indicated that SMOFlipid may be beneficial to the liver and prone to prevent hyperlipidemia. The SMOFlipid also shortened length of hospital stay.
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Affiliation(s)
- Xin-Tian Xu
- Department of Pharmacy, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hui Huang
- Department of Pharmacy, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Meng-Xing Tian
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ren-Chong Hu
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhu Dai
- Department of Pharmacy, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xin Jin
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Chada RR, Chidrawar S, Goud BA, Maska A, Medanki R, Nagalla B. Association between nutrition delivery, modified Nutrition Risk in Critically Ill score, and 28-day mortality. Nutr Clin Pract 2021; 36:1020-1033. [PMID: 33964049 DOI: 10.1002/ncp.10673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 03/16/2021] [Accepted: 04/04/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Nutrition delivery, is a key component in the management of critical illness. Traditional scoring systems are inadequate in the intensive care unit (ICU), as patients are sedated. Our study examines the associations between calorie and protein adequacy, 28-day mortality, and modified Nutrition Risk in Critically Ill (mNUTRIC) score and identify at-risk ICU patients who may benefit more from nutrition intervention. METHODS Prospective observational study of adults admitted for >24h to the ICU of a tertiary care hospital during a period of 7 months. Data were collected on nutrition delivery, mNUTRIC score, use of mechanical ventilation, and ICU/hospital length of stay (LOS). Multivariate logistic regression analysis was done with 28-day mortality as the primary outcome. RESULTS Two hundred forty-eight patients were recruited for the study with 60% male, 40% female, mean age 60.8 ± 14.7, and body mass index of 24.2 ± 4.8. Patients with inadequate calorie and protein delivery had significantly higher 28-day mortality than those with adequate provision (P=.032 and P =. 017). In bivariate logistic regression analysis, mNUTRIC score (odds ratio [OR], 1.802; 95% CI, 1.042-3.117; P = .035) and adequacy of energy (OR, 1.92) and protein (OR, 2.49) correlate with 28-day mortality. The Kaplan-Meier survival curve showed a survival benefit in the ≥80% energy and protein group among the total patients and was also significantly associated with lower hospital and ICU LOS, even after matching (log-rank test, P < 0.001). CONCLUSION Adequacy of energy and protein to ≥80% may shorten ICU/hospital LOS and reduce 28-day mortality among both high and low nutrition risk patients.
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Affiliation(s)
- Radha Reddy Chada
- Department of Clinical Nutrition and Dietetics, AIG Hospitals, Gachibowli, Hyderabad, Telangana, India
| | - Sachin Chidrawar
- Department of Intensive Care, Sunshine Hospitals, Secunderabad, Telangana, India.,Bathurst Hospital, NSW, Australia
| | - Bhagyasri A Goud
- Senior dietician, Dept. of Clinical Nutrition & Dietetics, Sunshine Hospitals, Secunderabad, India
| | - Anita Maska
- Senior dietician, Dept. of Clinical Nutrition & Dietetics, Sunshine Hospitals, Secunderabad, India
| | - Rajiv Medanki
- Department of Nephrology, Sunshine Hospitals, Secunderabad, Telangana, India
| | - Balakrishna Nagalla
- Division of Biostatistics, National Institute of Nutrition, Hyderabad, Telangana, India
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Hill A, Heyland DK, Ortiz Reyes LA, Laaf E, Wendt S, Elke G, Stoppe C. Combination of enteral and parenteral nutrition in the acute phase of critical illness: An updated systematic review and meta-analysis. JPEN J Parenter Enteral Nutr 2021; 46:395-410. [PMID: 33899951 DOI: 10.1002/jpen.2125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Uncertainty remains about the best route and timing of medical nutrition therapy in the acute phase of critical illness. Early combined enteral nutrition (EN) and parenteral nutrition (PN) may represent an attractive option to achieve recommended energy and protein goals in select patient groups. This meta-analysis aims to update and summarize the current evidence. METHODS This systematic review and meta-analysis includes randomized controlled trials (RCTs) targeting the effect of EN alone vs a combination of EN with PN in the acute phase of critical illness in adult patients. Assessed outcomes include mortality, intensive care unit (ICU) and hospital length of stay (LOS), ventilation days, infectious complications, physical recovery, and quality-of-life outcomes. RESULTS Twelve RCTs with 5543 patients were included. Treatment with a combination of EN with PN led to increased delivery of macronutrients. No statistically significant effect of a combination of EN with PN vs EN alone on any of the parameters was observed: mortality (risk ratio = 1.0; 95% CI, 0.79-1.28; P = .99), hospital LOS (mean difference, -1.44; CI, -5.59 to 2.71; P = .50), ICU LOS, and ventilation days. Trends toward improved physical outcomes were observed in two of four trials. CONCLUSION A combination of EN with PN improved nutrition intake in the acute phase of critical illness in adults and was not inferior regarding the patients' outcomes. Large, adequately designed trials in select patient groups are needed to answer the question of whether this nutrition strategy has a clinically relevant treatment effect.
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Affiliation(s)
- Aileen Hill
- Department of Intensive Care Medicine, Medical Faculty RWTH Aachen, Aachen, Germany.,Department of Anesthesiology, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Daren K Heyland
- Clinical Evaluation Research Unit, Department of Critical Care Medicine, Queen's University, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Luis A Ortiz Reyes
- Clinical Evaluation Research Unit, Department of Critical Care Medicine, Queen's University, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Elena Laaf
- Department of Intensive Care Medicine, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Sebastian Wendt
- Department of Intensive Care Medicine, Medical Faculty RWTH Aachen, Aachen, Germany.,Department of Anesthesiology, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Gunnar Elke
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Christian Stoppe
- Department of Anesthesiology, Würzburg University, Würzburg, Germany
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27
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Zheng C, Xie K, Li XK, Wang GM, Luo J, Zhang C, Jiang ZS, Wang YL, Luo C, Qiang Y, Hu LW, Wang YQ, Shen Y. The prognostic value of modified NUTRIC score for patients in cardiothoracic surgery recovery unit: A retrospective cohort study. J Hum Nutr Diet 2021; 34:926-934. [PMID: 33788349 DOI: 10.1111/jhn.12899] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Malnutrition is highly prevalent in critically ill patients. The modified Nutrition Risk in the Critically ill (mNUTRIC) score has been introduced to evaluate the nutritional risk of patients in an intensive care unit (ICU). The mNUTRIC score is a predictive factor of mortality for patients in a medical or mixed ICU, whereas the relationship between mNUTRIC and prognosis of patients in a cardiothoracic surgery recovery unit (CSRU) is unclear and related researches are limited. METHODS We conducted this retrospective cohort study to explore the value of mNUTRIC score in CSRU patients. We identified totally 4059 patients from the Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC III) database. RESULTS The optimal cut-off value of mNUTRIC score was 4 and a total of 1498 (36.9%) patients were considered to be at high nutritional risk (mNUTRIC ≥ 4). A multivariate logistic regression model indicated that patients at high nutritional risk have higher hospital mortality compared to those at low nutritional risk (odds ratio = 2.49, 95% confidence interval (CI) = 1.32-4.70, p = 0.005]. Furthermore, a Cox regression model was established adjusted for age, white blood cell and body mass index. The Kaplan-Meier curve indicated that patients at high nutritional risk have poorer 365-days [hazard ratio (HR) = 1.76, 95% CI = 1.30-2.37, p < 0.001] and 1000-days (HR = 2.30, 95% CI = 1.87-2.83, p < 0.001) overall survival. CONCLUSIONS The mNUTRIC score could not only predict hospital mortality, but also be an independent prognostic factor for long-term survival in CSRU patients. More well-designed clinical trials are needed to verify and update our findings.
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Affiliation(s)
- Chao Zheng
- Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Kai Xie
- Department of Cardiothoracic Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Xiao-Kun Li
- Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Gao-Ming Wang
- Department of Thoracic Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China
| | - Jing Luo
- Department of Cardiothoracic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Chi Zhang
- Department of Cardiothoracic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhi-Sheng Jiang
- Department of Cardiothoracic Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Yi-Lin Wang
- St. Robert Catholic High School, Thornhill, Canada
| | - Chao Luo
- Department of Cardiothoracic Surgery, Jinling Hospital, Southern Medical University, Guangzhou, China
| | - Yong Qiang
- Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Li-Wen Hu
- Department of Cardiothoracic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yan-Qing Wang
- Department of Cardiology, School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China
| | - Yi Shen
- Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China.,Department of Cardiothoracic Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, China.,Department of Cardiothoracic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.,Department of Cardiothoracic Surgery, Jinling Hospital, Southern Medical University, Guangzhou, China
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28
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KAÇMAZ M, ŞAHİN KOCAÖZ F, DESTEGÜL D, YÜKSEL TURHAN Z, BAYRAKTAR M. The Relationship of Gastrointestinal Complications and Ventilator Related Status with Gastric Residual Volume in Intensive Care Patients. ACTA MEDICA ALANYA 2021. [DOI: 10.30565/medalanya.868948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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29
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LaVallee C, Seelam P, Balakrishnan S, Lowen C, Henrikson A, Kesting B, Perugini M, Araujo Torres K. Real-World Evidence of Treatment, Tolerance, Healthcare Utilization, and Costs Among Postacute Care Adult Patients Receiving Enteral Peptide-Based Diets in the United States. JPEN J Parenter Enteral Nutr 2021; 45:1729-1735. [PMID: 33734462 PMCID: PMC9292286 DOI: 10.1002/jpen.2074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/17/2020] [Accepted: 01/07/2021] [Indexed: 11/13/2022]
Abstract
Objective Peptide ‐based (PB) enteral tube feeding (ETF) formulas have been shown to reduce gastrointestinal (GI) intolerance in patients receiving enteral nutrition. However, limited data exist in relation to their use in the postacute/home care setting. We sought to assess the real‐world GI tolerance, healthcare utilization, and resource use costs of 100% whey‐protein PB ETF in adults in a postacute care setting and describe their demographic, clinical, and treatment characteristics. Method Using medical claims data from the United States, we analyzed GI intolerance events occurring in adults receiving 100% whey‐protein PB ETF (Peptamen® adult formulas) for one year before and after initiation of ETF. Resource use costs were subsequently estimated using a multivariate general linearized model and adjusted for age, gender, and Charlson Comorbidity Index score. Results The proportion of adults experiencing no GI intolerance events increased from 41% (418/1022) to 59% (601/1022) in the one‐year period after initiation of 100% whey PB ETF (P < .001). The proportion of patients with at least one hospital inpatient visit also decreased from 100% (1022/1022) to 72% (737/1022) over the same period, and the mean number of inpatient visits per patient decreased from 15.6 to 13.0. Cost modeling revealed that outpatient visits accounted for 42% ($1174/$2820) of total estimated healthcare resource costs in the first 30 days after 100% whey PB ETF initiation, with only 9% ($255/$2820) due to emergency room visits. Conclusion These 100% whey‐protein PB ETF formulas are a valuable nutrition treatment option for patients with or at risk of malnutrition who show intolerance to standard ETF formulas and may reduce hospital inpatient visits and associated costs.
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Affiliation(s)
- Chris LaVallee
- Health Outcomes Research, Decision Resources Group, Burlington, Massachusetts, USA
| | | | | | - Cynthia Lowen
- Medical Affairs, Nestlé Health Science, Bridgewater Township, New Jersey, USA
| | - Aimee Henrikson
- Medical Affairs, Nestlé Health Science, Bridgewater Township, New Jersey, USA
| | - Bill Kesting
- Market Access, Nestlé Health Science, Bridgewater Township, New Jersey, USA
| | - Moreno Perugini
- Medical Affairs, Nestlé Health Science, Bridgewater Township, New Jersey, USA.,Market Access, Nestlé Health Science, Bridgewater Township, New Jersey, USA
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30
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Litton E, Anstey M, Broadhurst D, Chapman A, Currie A, Ferrier J, Gummer J, Higgins A, Lim J, Manning L, Myers E, Orr K, Palermo AM, Paparini A, Pellicano S, Raby E, Rammohan A, Regli A, Richter B, Salman S, Strunk T, Waterson S, Weight D, Wibrow B, Wood F. Early and sustained Lactobacillus plantarum probiotic therapy in critical illness: the randomised, placebo-controlled, restoration of gut microflora in critical illness trial (ROCIT). Intensive Care Med 2021; 47:307-315. [PMID: 33566129 PMCID: PMC7873510 DOI: 10.1007/s00134-020-06322-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 11/07/2020] [Indexed: 12/16/2022]
Abstract
Purpose In adults requiring treatment in an intensive care unit, probiotic therapy using Lactobacillus plantarum 299v may reduce nosocomial infection. The aim of this study was to determine whether early and sustained L. plantarum 299v therapy administered to adult ICU patients increased days alive and at home. Methods A multicentre, parallel group, placebo-controlled, randomised clinical trial was conducted. Adult patients within 48 h of intensive care admission and expected to require intensive care beyond the day after recruitment were eligible to participate. L plantarum 299v or placebo were administered immediately after enrolment and continued for 60 days. The primary outcome was days alive and out of hospital to Day 60 (DAOH60). Secondary outcomes included nosocomial infections. Results The median [interquartile range (IQR)] number of DAOH60 in the probiotic (n = 110) and placebo group (n = 108) was 49.5 (IQR 37.0–53.0) and 49.0 (IQR 43.8–53.0) respectively, between-group difference of 0.0 [95% confidence interval (CI) − 6.10 to 7.1, P = 0.55]. Nosocomial infection occurred in 8 (7.3%) and 5 (4.6%) of the probiotic and placebo group participants, respectively, odds ratio 1.62 (95% CI 0.51–5.10), P = 0.57. There were no serious, or probiotic-associated adverse events. Conclusion Early and sustained untargeted administration of probiotic therapy with Lactobacillus plantarum 299v to adult patients admitted to the ICU is safe, but not associated with improved patient outcomes. Electronic supplementary material The online version of this article (10.1007/s00134-020-06322-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Edward Litton
- Intensive Care Unit, Fiona Stanley Hospital, Murdoch, 6150, Australia.
- Intensive Care Unit, St John of God Hospital, Subiaco, 6009, Australia.
- School of Medicine, University of Western Australia, Crawley, 6009, Australia.
| | - Matt Anstey
- School of Medicine, University of Western Australia, Crawley, 6009, Australia
- Intensive Care Unit, Sir Charles Gairdner Hospital, Nedlands, 6009, Australia
| | - David Broadhurst
- School of Science, Edith Cowan University, Joondalup, 6027, Australia
| | - Andy Chapman
- Intensive Care Unit, Royal Perth Hospital, Perth, 6000, Australia
| | - Andrew Currie
- Molecular and Forensic Sciences, Murdoch University, Perth, 6150, Australia
| | - Janet Ferrier
- Intensive Care Unit, St John of God Hospital, Subiaco, 6009, Australia
| | - Joel Gummer
- Health Futures Institute, Murdoch University, Perth, 6150, Australia
| | - Alisa Higgins
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, 3800, Australia
| | - Jolene Lim
- Intensive Care Unit, Fiona Stanley Hospital, Murdoch, 6150, Australia
| | - Laurens Manning
- Infectious Diseases, Fiona Stanley Hospital, Murdoch, 6150, Australia
| | - Erina Myers
- Intensive Care Unit, Sir Charles Gairdner Hospital, Nedlands, 6009, Australia
| | - Katrina Orr
- Pharmacy, Fiona Stanley Hospital, Murdoch, 6150, Australia
| | | | | | - Susan Pellicano
- Intensive Care Unit, Fiona Stanley Hospital, Murdoch, 6150, Australia
| | - Edward Raby
- Infectious Diseases, Fiona Stanley Hospital, Murdoch, 6150, Australia
| | - Anu Rammohan
- Department of Economics, University of Western Australia, Crawley, 6009, Australia
| | - Adrian Regli
- Intensive Care Unit, Fiona Stanley Hospital, Murdoch, 6150, Australia
- Intensive Care Unit, St John of God Hospital Murdoch, Murdoch, 6150, Australia
| | - Bernhard Richter
- Intensive Care Unit, Fiona Stanley Hospital, Murdoch, 6150, Australia
- Medical University of Vienna, Waehringer Guertel, Vienna, Austria
| | - Sam Salman
- School of Medicine, University of Western Australia, Crawley, 6009, Australia
| | - Tobias Strunk
- Neonatal Directorate, King Edward Memorial Hospital, Subiaco, 6009, Australia
| | - Sharon Waterson
- Intensive Care Unit, Royal Perth Hospital, Perth, 6000, Australia
| | - David Weight
- Intensive Care Unit, Fiona Stanley Hospital, Murdoch, 6150, Australia
| | - Bradley Wibrow
- Intensive Care Unit, Sir Charles Gairdner Hospital, Nedlands, 6009, Australia
| | - Fiona Wood
- Burns Service, Fiona Stanley Hospital, Murdoch, 6150, Australia
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Ohbe H, Matsui H, Fushimi K, Yasunaga H. Small-bore feeding tube versus large-bore sump tube for early enteral nutrition in mechanically ventilated patients: A nationwide inpatient database study. Clin Nutr 2021; 40:4113-4119. [PMID: 33610423 DOI: 10.1016/j.clnu.2021.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/13/2021] [Accepted: 02/01/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND & AIMS When physicians start nasogastric tube feeding in mechanically ventilated patients, they have two choices of feeding tube device: a large-bore sump tube or a small-bore feeding tube. Some physicians may prefer to initiate enteral nutrition via the large-bore sump tube that is already in place, and others may prefer to use the small-bore feeding tube. However, it remains unknown whether small-bore feeding tubes or large-bore sump tubes are better for early enteral nutrition. The present study aimed to compare outcomes between these two types of feeding tubes in mechanically ventilated patients. METHODS Using the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2018, we identified adult patients who underwent invasive mechanical ventilation for ≥2 days in intensive care units and received nasogastric tube feeding within 2 days of starting mechanical ventilation. We categorized these patients as receiving early enteral nutrition via small-bore feeding tube (8- to 12-Fr single-lumen tubes) or via large-bore sump tube. Propensity score-matched analyses were performed to compare 28-day in-hospital mortality and hospital-acquired pneumonia between the two groups. RESULTS A total of 79,656 patients were included. Of these patients, 20,178 (25%) were in the small-bore feeding tube group. One-to-one propensity score matching created 20,061 matched pairs. Compared with those in the large-bore sump tube group, patients in the small-bore feeding tube group had significantly higher 28-day in-hospital mortality (17.0% versus 15.6%; hazard ratio, 1.08; 95% confidence interval, 1.03 to 1.14) and a significantly higher prevalence of hospital-acquired pneumonia (9.3% versus 8.5%; odds ratio, 1.11; 95% confidence interval, 1.02 to 1.21). CONCLUSIONS This nationwide observational study suggests that small-bore feeding tubes may not be associated with better clinical outcomes but rather with increased mortality and hospital-acquired pneumonia. Because of the uncertainty regarding the mechanism of our findings, further studies are warranted.
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Affiliation(s)
- Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan.
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan.
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 1138510, Japan.
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan.
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[Benefits of an education program and a clinical algorithm in mixed nutritional support to improve nutrition for the critically ill patient: a before-and-after study]. NUTR HOSP 2021; 38:436-445. [PMID: 33899491 DOI: 10.20960/nh.03415] [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: 11/02/2022] Open
Abstract
Introduction Introduction: optimal nutrition in the critically ill patient is a key aspect for recovery. Objectives: to promote training in and knowledge of mixed nutrition support (MNS) by means of a clinical algorithm among intensivists for improving the nutritional status of critically ill patients. Methods: a before-and-after study with the participation of 19 polyvalent intensive care units (ICUs) in 10 autonomous communities. Five members of the scientific committee trained the trainers by means of oral presentations and a clinical algorithm on MNS. Then, trainers were responsible for explaining the algorithm to local intensivists in their ICUs. The 30-item study questionnaire was completed before and after the intervention by 179 and 105 intensivists, respectively. Results: a clear improvement of knowledge was found in six (20 %) specific MNS-related questions. In 11 items (36.6 %), adequate knowledge on different aspects of nutritional support that were already present before the intervention were maintained, and in five items (16.7 %) an improvement in the rate of correct responses was recorded. There were no improvements in correct responses for four items (13.3 %), and for four (13.3 %) additional items the percentage of correct responses decreased. Conclusions: the use of the MNS algorithm has achieved a solid consolidation of the main concepts of MNS. Some aspects regarding how to manage the malnourished patient, how to identify them and what type of nutrition to guide from the beginning of admission to the ICU, nutritional contributions in special situations, and the monitoring of possible complications such as refeeding are areas for which further training strategies are needed.
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De Waele E, Jakubowski JR, Stocker R, Wischmeyer PE. Review of evolution and current status of protein requirements and provision in acute illness and critical care. Clin Nutr 2020; 40:2958-2973. [PMID: 33451860 DOI: 10.1016/j.clnu.2020.12.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 11/20/2020] [Accepted: 12/21/2020] [Indexed: 12/12/2022]
Abstract
Nutrition therapy, by enteral, parenteral, or both routes combined, is a key component of the management of critically ill, surgical, burns, and oncology patients. Established evidence indicates overfeeding (provision of excessive calories) results in increased risk of infection, morbidity, and mortality. This has led to the practice of "permissive underfeeding" of calories; however, this can often lead to inadequate provision of guideline-recommended protein intakes. Acutely ill patients requiring nutritional therapy have high protein requirements, and studies demonstrate that provision of adequate protein can result in reduced mortality and improvement in quality of life. However, a significant challenge to adequate protein delivery is the current lack of concentrated protein solutions. Patients often have fluid administration restrictions and existing protein solutions are frequently not sufficiently concentrated to deliver a patient's protein requirements. This has led to the development of new enteral and parenteral nutrition solutions incorporating higher levels of protein in smaller volumes. This review article summarizes current evidence supporting the role of higher protein intakes, especially during the early phases of nutrition therapy in acute illness, methods for assessing protein requirements, as well as, the currently available high-protein enteral and parenteral nutrition solutions. There is sufficient evidence (albeit limited from true randomized, controlled studies) to indicate that earlier provision of guideline-recommended protein intakes may be key to improving patient outcomes and that nutritional therapy that tailors caloric and protein intake to the patients' needs should be considered a desired standard of care.
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Affiliation(s)
- Elisabeth De Waele
- Department of Intensive Care Medicine and Department of Nutrition, UZ Brussel, Vrije Unversiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium.
| | - Julie Roth Jakubowski
- Medical Affairs, Baxter Healthcare Corporation, One Baxter Parkway, Deerfield, IL 60015, USA.
| | - Reto Stocker
- Institute for Anesthesiology and Intensive Care Medicine, Klinik Hirslanden, 8032, Zurich, Switzerland.
| | - Paul E Wischmeyer
- Department of Anesthesiology and Surgery Duke University School of Medicine, 200 Morris Street, #7600-H, P.O. Box 17969, Durham, NC 27701, USA.
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Kuwajima V, Bechtold ML. Should I Start With A Postpyloric Enteral Nutrition Modality? Nutr Clin Pract 2020; 36:76-79. [PMID: 33326156 DOI: 10.1002/ncp.10607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Nutrition therapy is a key element in the management of malnourished and critically ill patients. Although many aspects of enteral nutrition (EN) have been well defined by research, with clear recommendations by 3 major society guidelines, EN delivery method remains a topic for debate. The goal of this manuscript is to concisely review gastric vs postpyloric enteral feeding in critically ill adult patients and provide a set of recommendations to individualize EN delivery method based on patient characteristics and specific needs.
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Affiliation(s)
- Vanessa Kuwajima
- Division of Gastroenterology, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Matthew L Bechtold
- Division of Gastroenterology, University of Missouri School of Medicine, Columbia, Missouri, USA
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35
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Israfilov E, Kir S. Comparison of Energy Expenditure in Mechanically Ventilated Septic Shock Patients in Acute and Recovery Periods via Indirect Calorimetry. JPEN J Parenter Enteral Nutr 2020; 45:1523-1531. [PMID: 33314315 DOI: 10.1002/jpen.2063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Nutrition in intensive care units (ICUs) affects morbidity and mortality. We aimed to evaluate the energy expenditure of mechanically ventilated patients in early and late septic shock periods. METHODS This study retrospectively evaluated 28 mechanically ventilated septic shock patients (11 female/17 male) in a medical ICU. Indirect calorimetry (IC) measurement was performed for 24 hours during the acute and recovery periods of septic shock. The energy values calculated by Harris-Benedict equation (predicted resting energy expenditure [PREE]), measured by IC (measured resting energy expenditure [MREE]), and given to each patient were obtained in the acute and recovery periods. RESULTS The mean age was 67.46 ± 14.92 (36-91) years. The MREE was 2741.1 ± 706.3 kcal/d (38.61 ± 11.44 kcal/kg/d) and 2332.8 ± 426.6 kcal/d (32.65 ± 7.8 kcal/kg/d) in the acute and recovery periods, respectively, and showed significant differences (P = 0.001). The patients' energy intake was 1152.7 ± 207.1 kcal/d and 1542.7 ± 433.3 kcal/d in the acute and recovery periods, respectively. A significant difference existed between energy intake and MREE during the acute and recovery periods (P < 0.001 for both). CONCLUSION Our findings showed that energy expenditure increases in septic shock. Significant differences existed between MREE, PREE, and energy intake, which were not correlated. The MREE was higher in the acute period. Despite the increasing energy requirement, the PREE and energy intake were well below MREE. For better clinical outcomes, each patient's energy expenditure must be closely monitored and evaluated using intermittent IC measurements.
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Affiliation(s)
- Elmir Israfilov
- Department of Internal Medicine, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Seher Kir
- Department of Internal Medicine, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
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36
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Pearcy J, Agarwal E, Isenring E, Somani A, Wright C, Shankar B. Ward-based nutrition care practices and a snapshot of patient care: Results from nutritionDay in the ICU. Clin Nutr ESPEN 2020; 41:340-345. [PMID: 33487287 DOI: 10.1016/j.clnesp.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Poor adherence to intensive care unit (ICU) guidelines is common, leading to suboptimal nutritional care. This study determined current ward-based nutrition care practices in the Indian ICU setting, comparing them to international best-practice guidelines and provided patient demographic, clinical and nutritional information to serve as baseline data for future benchmarking. METHODS This multi-site cross-sectional retrospective study analysed data collected from nutritionDay worldwide audits (2012-2016) across ICUs from a chain of urban private hospitals in India. Additional guideline-specific data were collected through questionnaires and phone interviews with the Head of Dietetics Departments in the participating hospitals. RESULTS Overall, 10 ICUs and 457 participants were included. It was common practice to use modified versions of the Mini Nutritional Assessment-Short Form (MNA-SF) and Subjective Global Assessment (SGA) for nutrition screening and assessment. Nearly half the participants (n = 222, 49%) received nutrition orally. A majority of the remaining participants received enteral nutrition (n = 163, 36%) or no nutrition (n = 60, 13%) at the time of data collection. The calories prescribed for most participants were between 1500 and 1999 kilocalories per day (n = 207, 45%), with no nutrition planned for 115 (25%) participants. Three-quarters (n = 129, 74%) of participants on EN received the planned calories, while 24% (n = 42) were given less than planned. CONCLUSION Overall, most participants received the calories planned for enteral nutrition. The use of modified screening and assessment tools and suboptimal delivery of EN remains a global problem for critical care, possibly requiring a more pragmatic approach to nutritional therapy.
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Affiliation(s)
- Joshua Pearcy
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, 4229, Australia.
| | - Ekta Agarwal
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, 4229, Australia
| | - Elizabeth Isenring
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, 4229, Australia
| | - Ananya Somani
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, 4229, Australia
| | - Charlene Wright
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, 4229, Australia
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Joung SY, Lee CW, Choi YS, Kim SM, Park SW, Mo ES, Park JH, Shin J, Lee HJ, Park HS. Analysis of the Time Interval between the Physician Order for Life-Sustaining Treatment Completion and Death. Korean J Fam Med 2020; 41:392-397. [PMID: 32429012 PMCID: PMC7700825 DOI: 10.4082/kjfm.19.0077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/11/2019] [Accepted: 10/04/2019] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND This study aimed to explore the time interval distribution pattern between the Physicians Order for Life-Sustaining Treatment (POLST) form completion and death at a tertiary hospital in South Korea. It also examined the association between various independent parameters and POLST form completion timing. METHODS A total of 150 critically ill patients admitted to Korea University Guro Hospital between June 1, 2018 and December 31, 2018 who completed the POLST form were retrospectively analyzed and included in this study. Data were analyzed with descriptive statistics, and group comparisons were performed using the chi-square test for categorical variables. Fisher's exact test was also used to compare cancer versus non-cancer groups. RESULTS More than half the decedents (54.7%) completed their POLST within 15 days of death and 73.4% within 30 days. The non-cancer group had the highest percentage of patients (77.8%) who died within 15 days of POLST form completion while the colorectal (39.1%) and other cancer (37.5%) groups had the lowest (P=0.336). CONCLUSION Our findings demonstrated a current need for more explicit guidance to assist physicians with initiating more timely, proactive end-of-life discussions.
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Affiliation(s)
- Sung Yoon Joung
- Department of Family Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Chung-woo Lee
- Department of Family Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Youn Seon Choi
- Department of Family Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Seon Mee Kim
- Department of Family Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Seok Won Park
- Department of Family Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Eun Shik Mo
- Department of Family Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Jae Hyun Park
- Department of Family Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Jean Shin
- Department of Family Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Hyun Jin Lee
- Department of Family Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Hong Seok Park
- Department of Urology, Korea University Guro Hospital, Seoul, Korea
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Santos HO, Tinsley GM, da Silva GAR, Bueno AA. Pharmaconutrition in the Clinical Management of COVID-19: A Lack of Evidence-Based Research But Clues to Personalized Prescription. J Pers Med 2020; 10:jpm10040145. [PMID: 32992693 PMCID: PMC7712662 DOI: 10.3390/jpm10040145] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 02/06/2023] Open
Abstract
A scientific interest has emerged to identify pharmaceutical and nutritional strategies in the clinical management of coronavirus disease 2019 (COVID-19). The purpose of this narrative review is to critically assess and discuss pharmaconutrition strategies that, secondary to accepted treatment methods, could be candidates in the current context of COVID-19. Oral medicinal doses of vitamin C (1–3 g/d) and zinc (80 mg/d elemental zinc) could be promising at the first signs and symptoms of COVID-19 as well as for general colds. In critical care situations requiring parenteral nutrition, vitamin C (3–10 g/d) and glutamine (0.3–0.5 g/kg/d) administration could be considered, whereas vitamin D3 administration (100,000 IU administered intramuscularly as a one-time dose) could possess benefits for patients with severe deficiency. Considering the presence of n-3 polyunsaturated fatty acids and arginine in immune-enhancing diets, their co-administration may also occur in clinical conditions where these formulations are recommended. However, despite the use of the aforementioned strategies in prior contexts, there is currently no evidence of the utility of any nutritional strategies in the management of SARS-CoV-2 infection and COVID-19. Nevertheless, ongoing and future clinical research is imperative to determine if any pharmaconutrition strategies can halt the progression of COVID-19.
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Affiliation(s)
- Heitor O. Santos
- School of Medicine, Federal University of Uberlandia (UFU), Uberlandia 38408-100, Brazil
- Correspondence: ; Tel.: +55-34-992112948; Fax: +55-34-3225-8628
| | - Grant M. Tinsley
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX 79409, USA;
| | - Guilherme A. R. da Silva
- Hospital Universitário Gaffrée e Guinle, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro 21941-901, Brazil;
| | - Allain A. Bueno
- College of Health, Life and Environmental Sciences, University of Worcester, Worcester WR2 6AJ, UK;
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Zhang P, Bian Y, Tang Z, Wang F. Use of Nutrition Risk in Critically Ill (NUTRIC) Scoring System for Nutrition Risk Assessment and Prognosis Prediction in Critically Ill Neurological Patients: A Prospective Observational Study. JPEN J Parenter Enteral Nutr 2020; 45:1032-1041. [PMID: 32729938 DOI: 10.1002/jpen.1977] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 06/23/2020] [Accepted: 07/27/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Critically ill patients who are hospitalized in a neurological intensive care unit (NICU) are largely susceptible to nutrition risk. However, only a limited number of studies have investigated the applicable assessment tool in NICUs. METHODS This was a prospective observational study conducted at a single-center NICU. A total of 140 adult patients who were hospitalized for >24 hours were enrolled. The Nutritional Risk Screening 2002, Nutrition Risk in the Critically ill (NUTRIC), and modified NUTRIC (mNUTRIC) scores were applied for the assessment of nutrition risk. Analyses of multivariable logistic regression were performed by considering a 28-day mortality as the outcome of interest. RESULTS Nutrition risk was commonly identified in NICU patients. Multivariate analysis revealed that age ≥60 years, hospital infection, mechanical ventilation, and high nutrition risk (mNUTRIC score ≥ 5) independently increased 28-day mortality in NICU patients. For subgroups of patients with a prolonged length of stay, high nutrition risk (mNUTRIC score ≥ 5) has always been an independent risk factor of 28-day mortality. Both NUTRIC and mNUTRIC scores were able to predict 28-day mortality, with area under the receiver operating characteristic curves of 0.857 (95% CI, 0.786-0.928) and 0.856 (95% CI, 0.786-0.927), respectively. CONCLUSION The mNUTRIC scoring system is not only a useful tool for nutrition risk assessment but also, and more importantly, it is independently related to the risk of 28-day mortality in NICU patients. Therefore, mNUTRIC scoring is an appropriate tool for nutrition risk assessment and prognosis prediction of NICU patients.
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Affiliation(s)
- Ping Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Bian
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhouping Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Furong Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Mitochondrial Dysfunction in Critical Illness: Implications for Nutritional Therapy. Curr Nutr Rep 2020; 8:363-373. [PMID: 31713718 DOI: 10.1007/s13668-019-00296-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF THE REVIEW This paper will review the evidence for mitochondrial dysfunction in critical illness, describe the mechanisms which lead to multiple organ failure, and detail the implications of this pathophysiologic process on nutritional therapy. RECENT FINDINGS Mitochondria are particularly sensitive to increased oxidative stress in critical illness. The functional and structural abnormalities which occur in this organelle contribute further to the excessive production of reactive oxygen species and the reduction in generation of adenosine triphosphate (ATP). To reduce metabolic demand, mitochondrial dysfunction develops (a process likened to hibernation), which helps sustain the life of the cell at a cost of organ system failure. Aggressive feeding in the early phases of critical illness might inappropriately increase demand at a time when ATP production is limited, further jeopardizing cell survival and potentiating the processes leading to multiple organ failure. Several potential therapies exist which would promote mitochondrial function in the intensive care setting through support of autophagy, antioxidant defense systems, and the biogenesis and recovery of the organelle itself. Nutritional therapy should supplement micronutrients required in the mitochondrial metabolic pathways and provide reduced delivery of macronutrients through slower advancement of feeding in the early phases of critical illness. A better understanding of mitochondrial dysfunction in the critically ill patient should lead to more innovative therapies in the future.
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Alshimemeri A, Alenezi F, Alyamani L, Alsumari O, Alsulaiman F, Basham K, Alnafisah F. Impact of critical care medicine publications from intensive care department at King Abdulaziz Medical City, Riyadh in the last two decades. J Family Med Prim Care 2020; 9:3669-3672. [PMID: 33102348 PMCID: PMC7567232 DOI: 10.4103/jfmpc.jfmpc_440_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/25/2020] [Accepted: 05/20/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction : The volume and quality of biomedical research publications from an institution are considered adequate indicators of the quality of medical care in that institute. King Abdulaziz Medical City (KAMC), Riyadh, Kingdom of Saudi Arabia (KSA), is one of the oldest and most distinguished medical centers in the country. Methods: In this study, we analyzed the number of publications from the Critical Care Unit of the hospital in the past two decades, from 1996 to 2016. The research publications were evaluated on various parameters. Moreover, the impact of their study on global medicine was determined. Results: Our results indicate a steady progression in the number of publications from the institute in the past two decades. An average of 17.3 papers was published each year during this time. Out of the 283 publications from KAMC included in this study, the majority of the publications were original articles, 61 were review articles, 66 were multicenter trial studies and 28 were randomized control trials. The citation profile of the publications was good indicating global impact of the studies. Conclusion: The global impact of research as evaluated through published manuscripts in KAMC is overall good. This was deduced from both the increase in the number of publications each year and also the quality of papers as evidenced by the citation index of the papers published between 1996 and 2016.
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Affiliation(s)
- Abdullah Alshimemeri
- Intensive Care Department, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Farhan Alenezi
- Intensive Care Department, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Luay Alyamani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Osama Alsumari
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Feras Alsulaiman
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Karam Basham
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Fahad Alnafisah
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
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Moisey LL, Pikul J, Keller H, Yeung CYE, Rahman A, Heyland DK, Mourtzakis M. Adequacy of Protein and Energy Intake in Critically Ill Adults Following Liberation From Mechanical Ventilation Is Dependent on Route of Nutrition Delivery. Nutr Clin Pract 2020; 36:201-212. [PMID: 32717141 DOI: 10.1002/ncp.10558] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Studies examining nutrition intake of critically ill patients following liberation from mechanical ventilation (LMV) are scarce. The objectives of this prospective, observational feasibility study were to quantify and assess protein and energy intake in hospitalized, critically ill patients following LMV, to determine barriers to optimal intake, and to report on the feasibility of recruiting and retaining patients into this study. METHODS Adult patients requiring MV for >72 hours in a medical/surgical intensive care unit (ICU) were recruited. Protein and energy intakes were quantified up to 14 days following LMV. Patients also identified barriers to eating. RESULTS Nineteen patients (mean age, 60 years [SD, 12 years]) were studied over 125 days. Over all study days, the median amounts of protein and energy consumed in comparison with amounts prescribed by dietitians were 46% (interquartile range [IQR], 26-100) and 71% (IQR, 38-100), respectively. When stratified by route of nutrition delivery, on days (n = 54) when patients consumed an oral diet as the sole nutrition source, median amounts of protein and energy consumed in comparison with those prescribed were only 27% (IQR, 15-41) and 47% (IQR, 29-66), respectively. The most frequently reported barriers to eating were poor appetite, early satiety, and taste changes. CONCLUSIONS Protein and calorie intake is below prescribed amounts for patients whose enteral nutrition is discontinued and an oral diet prescribed as sole nutrition source following LMV. Acceptable strategies to enhance nutrition intake in post-ICU patients during the recovery stages of critical illness are needed.
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Affiliation(s)
- Lesley L Moisey
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.,College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jill Pikul
- Department of Critical Care, London Health Sciences Centre, University Hospital, London, Ontario, Canada.,Clinical Nutrition Services, London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - Heather Keller
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.,Schlegel-UW Research Institute for Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Chi Yan Emily Yeung
- School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada
| | - Adam Rahman
- Department of Medicine, Western University, London, Ontario, Canada.,Gastroenterology, St. Joseph's Healthcare Centre, London Health Sciences Centre, London, Ontario, Canada
| | - Daren K Heyland
- Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada.,Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada
| | - Marina Mourtzakis
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
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Meeting nutritional targets of critically ill patients by combined enteral and parenteral nutrition: review and rationale for the EFFORTcombo trial. Nutr Res Rev 2020; 33:312-320. [PMID: 32669140 DOI: 10.1017/s0954422420000165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
While medical nutrition therapy is an essential part of the care for critically ill patients, uncertainty exists about the right form, dosage, timing and route in relation to the phases of critical illness. As enteral nutrition (EN) is often withheld or interrupted during the intensive care unit (ICU) stay, combined EN and parenteral nutrition (PN) may represent an effective and safe option to achieve energy and protein goals as recommended by international guidelines. We hypothesise that critically ill patients at high nutritional risk may benefit from such a combined approach during their stay on the ICU. Therefore, we aim to test if an early combination of EN and high-protein PN (EN+PN) is effective in reaching energy and protein goals in patients at high nutritional risk, while avoiding overfeeding. This approach will be tested in the here-presented EFFORTcombo trial. Nutritionally high-risk ICU patients will be randomised to either high (≥2·2 g/kg per d) or low protein (≤1·2 g/kg per d). In the high protein group, the patients will receive EN+PN; in the low protein group, patients will be given EN alone. EN will be started in accordance with international guidelines in both groups. Efforts will be made to reach nutrition goals within 48-96 h. The efficacy of the proposed nutritional strategy will be tested as an innovative approach by functional outcomes at ICU and hospital discharge, as well as at a 6-month follow-up.
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Yamamoto K, Tsuchihashi-Makaya M, Kinugasa Y, Iida Y, Kamiya K, Kihara Y, Kono Y, Sato Y, Suzuki N, Takeuchi H, Higo T, Miyazawa Y, Miyajima I, Yamashina A, Yoshita K, Washida K, Kuzuya M, Takahashi T, Nakaya Y, Hasebe N, Tsutsui H. Japanese Heart Failure Society 2018 Scientific Statement on Nutritional Assessment and Management in Heart Failure Patients. Circ J 2020; 84:1408-1444. [PMID: 32655089 DOI: 10.1253/circj.cj-20-0322] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | | | - Yoshiharu Kinugasa
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | - Yuki Iida
- Department of Rehabilitation Medicine, Kainan Hospital
| | | | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences
| | - Yuji Kono
- Department of Rehabilitation, Fujita Health University Bantane Hospital
| | - Yukihito Sato
- Department of Cardiovascular Medicine, Hyogo Prefectural Amagasaki General Medical Center
| | - Norio Suzuki
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital
| | - Harumi Takeuchi
- Department of Clinical Nutrition, Nagoya University Hospital
| | - Taiki Higo
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Yasushi Miyazawa
- Department of Clinical Nutrition, Tokyo Medical University Hospital
| | - Isao Miyajima
- Department of Clinical Nutrition, Chikamori Hospital
| | | | - Katsushi Yoshita
- Department of Food and Human Health Science, Osaka City University Graduate School of Human Life Science
| | - Koichi Washida
- Faculty of Nursing, Kobe Women's University.,Department of Nursing, Hyogo Prefectural Amagasaki General Medical Center
| | - Masafumi Kuzuya
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine
| | - Tetsuya Takahashi
- Department of Physical Therapy, Faculty of Health Science, Juntendo University.,Department of Rehabilitation, Juntendo University Hospital
| | - Yutaka Nakaya
- Department of Internal Medicine, Touto Kasukabe Hospital
| | - Naoyuki Hasebe
- Division of Cardiology, Nephrology, Pulmonology and Neurology, Department of Internal Medicine, Asahikawa Medical University
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
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Litton E, Anstey M, Broadhurst D, Chapman AR, Currie A, Ferrier J, Gummer J, Higgins A, Lim J, Manning L, Myers E, Orr K, Palermo AM, Paparini A, Pellicano S, Raby E, Rammohan A, Regli A, Richter B, Salman S, Strunk T, Waterson S, Wibrow B, Wood FM. Study protocol for the safety and efficacy of probiotic therapy on days alive and out of hospital in adult ICU patients: the multicentre, randomised, placebo-controlled Restoration Of gut microflora in Critical Illness Trial (ROCIT). BMJ Open 2020; 10:e035930. [PMID: 32565465 PMCID: PMC7311035 DOI: 10.1136/bmjopen-2019-035930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION The effect of early and sustained administration of daily probiotic therapy on patients admitted to the intensive care unit (ICU) remains uncertain. METHODS AND ANALYSIS The Restoration Of gut microflora in Critical Illness Trial (ROCIT) study is a multicentre, randomised, placebo-controlled, parallel-group, two-sided superiority trial that will enrol 220 patients in five ICUs. Adult patients who are within 48 hours of admission to an ICU and are expected to require intensive care beyond the next calendar day will be randomised in a 1:1 ratio to receive early and sustained Lactobacillus plantarum 299v probiotic therapy in addition to usual care or placebo in addition to usual care. The primary endpoint is days alive and out of hospital to day 60. ETHICS AND DISSEMINATION ROCIT has been approved by the South Metropolitan Health Service Human Research Ethics Committee (ref: RGS00000004) and the St John of God Health Care Human Research Ethics Committee (ref: 1183). The trial results will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER Australian and New Zealand Clinical Trials Registry (ANZCTR12617000783325); Pre-results.
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Affiliation(s)
- Edward Litton
- Intensive Care Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Intensive Care Unit, St John of God Hospital, Subiaco, Western Australia, Australia
| | - Matthew Anstey
- Intensive Care Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - David Broadhurst
- School of Science, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Andy R Chapman
- Intensive Care Unit, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Andrew Currie
- Murdoch University, Murdoch, Western Australia, Australia
| | - Janet Ferrier
- Intensive Care Unit, St John of God Hospital, Subiaco, Western Australia, Australia
| | - Joel Gummer
- Murdoch University, Murdoch, Western Australia, Australia
| | - Alisa Higgins
- Australian and New Zealand Intensive Care Research Centre, Monash University, Clayton, Victoria, Australia
| | - Jolene Lim
- Intensive Care Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Laurens Manning
- University of Western Australia, Perth, Western Australia, Australia
| | - Erina Myers
- Intensive Care Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Katrina Orr
- Pharmacy, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Anne-Marie Palermo
- Intensive Care Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | | | - Susan Pellicano
- Intensive Care Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Edward Raby
- Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Anu Rammohan
- Department of Economics, University of Western Australia, Crawley, Western Australia, Australia
| | - Adrian Regli
- Intensive Care Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Intensive Care Unit, St John of God Hospital, Murdoch, Western Australia, Australia
| | - Bernhard Richter
- Intensive Care Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Division of Cardiology, Medical University of Vienna, Wien, Wien, Austria
| | - Sam Salman
- University of Western Australia, Perth, Western Australia, Australia
| | - Tobias Strunk
- Neonatal Directorate, King Edward Memorial Hospital for Women Perth, Subiaco, Western Australia, Australia
| | - Sharon Waterson
- Intensive Care Unit, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Brad Wibrow
- Intensive Care Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Fiona M Wood
- University of Western Australia, Perth, Western Australia, Australia
- Burns Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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Peng J, Liu G, Li F, Yuan M, Xiang Y, Qin D. The correlation between feeding intolerance and poor prognosis of patients with severe neurological conditions: a case-control study. Expert Rev Neurother 2020; 20:415-416. [PMID: 32275458 DOI: 10.1080/14737175.2020.1750372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Jingjing Peng
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Guangwei Liu
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Feng Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Meizhen Yuan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing People’s Republic of China
| | - Yanling Xiang
- Department of Surgical Anesthesia, University-Town Hospital of Chongqing Medical University, People’s Republic of China
| | - Deyu Qin
- Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
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BEDSIDE SONOGRAPHIC CONFIRMATION OF THE PLACEMENT OF A NASOENTERAL TUBE IN A CRITICALLY ILL PATIENT: A CASE REPORT. Gastroenterol Nurs 2020; 42:392-396. [PMID: 31365428 DOI: 10.1097/sga.0000000000000400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Jiang L, Huang X, Wu C, Tang J, Li Q, Feng X, He T, Wang Z, Gao J, Ruan Z, Hong W, Lai D, Zhao F, Huang Z, Lu Z, Tang W, Zhu L, Zhang B, Wang Z, Shen X, Lai J, Ji Z, Fu K, Hong Y, Dai J, Hong G, Xu W, Wang Y, Xie Y, Chen Y, Zhu X, Ding G, Gu L, Zhang M. The effects of an enteral nutrition feeding protocol on critically ill patients: A prospective multi-center, before-after study. J Crit Care 2020; 56:249-256. [PMID: 31986368 DOI: 10.1016/j.jcrc.2020.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 01/05/2020] [Accepted: 01/16/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim of this study was to explore the effects of an enteral nutrition (EN) feeding protocol in critically ill patients. METHODS This was a prospective multi-center before-after study. We compared energy related and prognostic indicators between the control group (pre-implementation stage) and intervention group (post-implementation stage). The primary endpoint was the percentage of patients receiving EN within 7 days after ICU admission. RESULTS 209 patients in the control group and 230 patients in the intervention group were enrolled. The implementation of the EN protocol increased the percentage of target energy reached from day 3 to day 7, and the difference between two groups reached statistical significance in day 6 (P = .01) and day 7 (P = .002). But it had no effects on proportion of patient receiving EN (P = .65) and start time of EN (P = .90). The protocol application might be associated with better hospital survival (89.1% vs 82.8%, P = .055) and reduce the incidence of EN related adverse (P = .004). There was no difference in ICU length of stay, duration of mechanical ventilation and ICU cost. CONCLUSION The implementation of the enteral feeding protocol is associated with improved energy intake and a decreased incidence of enteral nutrition related adverse events for critically ill patients, but it had no statistically beneficial effects on reducing the hospital mortality rate. Trial registration ClinicalTrials.gov, NCT02976155. Registered November 29, 2016- Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02976155.
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Affiliation(s)
- Libing Jiang
- Department of Emergency Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, No 88, Jiefang Rd, Hangzhou, China
| | - Xiaoxia Huang
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, No 88, Jiefang Rd, Hangzhou, China
| | - Chunshuang Wu
- Department of Emergency Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, No 88, Jiefang Rd, Hangzhou, China
| | - Jiaying Tang
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, No 88, Jiefang Rd, Hangzhou, China
| | - Qiang Li
- Department of Emergency Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, No 88, Jiefang Rd, Hangzhou, China
| | - Xiuqin Feng
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, No 88, Jiefang Rd, Hangzhou, China
| | - Tao He
- Department of Emergency Intensive Care Unit, The Second Hospital of Jiaxing, No 1518, Huanchengbei Rd, Jiaxing, China
| | - Zhengquan Wang
- Department of Emergency Medicine, Yuyao People's Hospital, Medical School of Ningbo University, Ningbo, China
| | - Jindan Gao
- Department of Emergency Medicine, Yuyao People's Hospital, Medical School of Ningbo University, Ningbo, China
| | - Zhanwei Ruan
- Department of Emergency Intensive Care Unit, Ruian people's Hospital, Ruian, China
| | - Weili Hong
- Department of Emergency Intensive Care Unit, Ruian people's Hospital, Ruian, China
| | - Dengpan Lai
- Emergency Department, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Fei Zhao
- Emergency Department, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Zhiping Huang
- Department of Critical Care Medicine, Beilun District People's Hospital, Ningbo, China
| | - Zhifeng Lu
- Department of Critical Care Medicine, Beilun District People's Hospital, Ningbo, China
| | - Weidong Tang
- Department of Critical Care Medicine, The First People's Hospital of Fuyang district, Hangzhou, China
| | - Lijun Zhu
- Department of Critical Care Medicine, The First People's Hospital of Fuyang district, Hangzhou, China
| | - Bingwen Zhang
- Emergency Department, Jinhua Hospital of Zhejiang University, Jinhua, China
| | - Zhi Wang
- Emergency Department, Jinhua Hospital of Zhejiang University, Jinhua, China
| | - Xiaoyuan Shen
- Department of Critical Care Medicine, The First People's Hospital of Xiaoshan District, Hangzhou, China
| | - Jiawei Lai
- Department of Critical Care Medicine, The First People's Hospital of Xiaoshan District, Hangzhou, China
| | - Zhaohui Ji
- Emergency Department, The First People's Hospital of Huzhou, Huzhou, China
| | - Kai Fu
- Emergency Department, The First People's Hospital of Huzhou, Huzhou, China
| | - Yucai Hong
- Department of Emergency Medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Junru Dai
- Department of Emergency Medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guangliang Hong
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenqing Xu
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yi Wang
- Department of Emergency Medicine, The First People's Hospital of Hangzhou, Hangzhou, China
| | - Yun Xie
- Department of Emergency Medicine, The First People's Hospital of Hangzhou, Hangzhou, China
| | - Yuxi Chen
- Department of Emergency Medicine, Wenzhou Central Hospital, Wenzhou, China
| | - Xiuhua Zhu
- Department of Emergency Medicine, Wenzhou Central Hospital, Wenzhou, China
| | - Guojuan Ding
- Department of Emergency Medicine, People's Hospital of Shaoxing, Shaoxing, China
| | - Lanru Gu
- Department of Emergency Medicine, People's Hospital of Shaoxing, Shaoxing, China
| | - Mao Zhang
- Department of Emergency Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, No 88, Jiefang Rd, Hangzhou, China.
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Sinha S, Lath G, Rao S. Safety of Enteral Nutrition Practices: Overcoming the Contamination Challenges. Indian J Crit Care Med 2020; 24:709-712. [PMID: 33024380 PMCID: PMC7519612 DOI: 10.5005/jp-journals-10071-23530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Enteral nutrition (EN) has host of benefits to offer to critically ill patients and is the preferred route of feeding over parenteral nutrition. But along with the many outcome benefits of enteral feeding come the potential for adverse effects that includes gastrointestinal (GI) disturbances mainly attributed to contaminated feeds. Currently, EN is practiced using blenderized/kitchen prepared feeds or scientifically developed commercial feeds. Commercial feeds based on their formulation may be divided as ready-to-mix powder formulas or ready-to-hang sterile liquid formulas. A holistic view on potential sterility of EN from preparation to patient delivery would be looked upon. These sterility issues may potentially result in clinical complications, and hence process-related errors need to be eliminated in hospital practice, since immunocompromised intensive care unit patients are at high risk of infection. This review intends to discuss the various EN practices, risk of contamination, and ways to overcome the same for better nutrition delivery to the patients. Among the various types of enteral formulas and delivery methods, this article tries to summarize several benefits and risks associated with each delivery system using the currently available literature. How to cite this article Sinha S, Lath G, Rao S. Safety of Enteral Nutrition Practices: Overcoming the Contamination Challenges. Indian J Crit Care Med 2020;24(8):709-712.
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Affiliation(s)
- Saswati Sinha
- Department of Critical Care, AMRI Hospital, Kolkata, West Bengal, India
| | - Gunjan Lath
- Department of Scientific and Medical Affairs, Abbott Nutrition International, Kolkata, West Bengal, India
| | - Sameer Rao
- Department of Scientific and Medical Affairs, Abbott Nutrition International, Kolkata, West Bengal, India
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Koontalay A, Sangsaikaew A, Khamrassame A. Effect of a Clinical Nursing Practice Guideline of Enteral Nutrition Care on the Duration of Mechanical Ventilator for Critically Ill Patients. Asian Nurs Res (Korean Soc Nurs Sci) 2019; 14:17-23. [PMID: 31899383 DOI: 10.1016/j.anr.2019.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Early enteral nutrition (EN) can improve clinical outcomes in critically ill patients. This study aimed to evaluate the effects of this clinical nursing practice guideline (CNPG) of EN care on the duration of mechanical ventilator in critically ill patients to investigate whether it was able to improve clinical outcomes. METHODS This study compares a pretest-posttest design for the two groups, which was done before and after to determine the effects of a CNPG of EN care on the duration of a mechanical ventilator in critically ill patients. This study was performed on 44 critically ill patients admitted to the intensive care unit (ICU). The patients were divided into two groups according to EN. For the intervention group, CNPG started within the first 48 hours of admission to the ICU, and for the control group, they received standard nursing care. RESULTS After the implementation, it showed significant associations between the duration of mechanical ventilator in ICU. The intervention group who received the CNPG had significantly shorter starting time of EN and a reduced duration of mechanical ventilator than those in the control group (p < .001). CONCLUSION A CNPG for EN care reduced the duration of mechanical ventilator. This could possibly improve the delivery of target calories when compared with current standard practice and improve the outcome of critically ill patients.
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Affiliation(s)
- Apinya Koontalay
- College of Nursing and Health, Suan Sunandha Rajabhat University, Bangkok, Thailand.
| | - Amornrat Sangsaikaew
- Boromarajonani College of Nursing NakhonPhanom, Nakhon Phanom University, Nakhon Phanom, Thailand
| | - Arunee Khamrassame
- Intensive Care Unit, Kuchinarai Crown Prince Hospital, Kalasin, Thailand
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