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Sun C, Yuan K, Gao Q, Liu F, Long Y, Wang L. Blind versus endoscopy-guided postpyloric feeding tube placement in adults with ischemic stroke: A retrospective cohort study. JPEN J Parenter Enteral Nutr 2024; 48:597-604. [PMID: 38806291 DOI: 10.1002/jpen.2645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 05/06/2024] [Accepted: 05/06/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND This study compared the one-time success rate of blind and endoscopy-guided postpyloric feeding tube placement after implementing a comprehensive nursing scheme of intestinal blind placement for patients with ischemic stroke. METHODS This retrospective cohort study included 179 patients with blind bedside placement and 118 with endoscopy-guided placement. The primary outcome was the one-time success rate of radiologically confirmed postpyloric placement. The secondary endpoints included the position of the tube tip, length of insertion, time of placement, and expenses. The safety endpoints were the incidence of complications caused by placement. RESULTS The results showed that the method of tube placement did not significantly affect the outcome of the first tube placement (odds ratio [OR] = 0.41; 95% CI = 0.137-1.207; P = 0.105). Compared with endoscopy-guided placement, blind placement was half the cost. We also found that a history of abdominal surgery (OR = 0.003; 95% CI = 0.000-0.059; P < 0.001) and longer intensive care unit (ICU) days (OR = 0.94; 95% CI = 0.903-0.981; P = 0.004) were inversely associated with the one-time success rate. CONCLUSION Our study suggested that blind intestinal feeding tube placement has an equivalent one-time success rate compared with endoscopy-guided placement in hospitalized patients with ischemic stroke if operators can be trained well. However, the expenses of endoscopy-guided placement were twice those of blind bedside methods. We also found that patients with abdominal surgery history and longer ICU stay were more likely to fail at the first placement. Further research is needed to replicate our single-center observations in a larger population of patients.
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Affiliation(s)
- Chun Sun
- Neurology Intensive Care Unit, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, China
- Neurology Intensive Care Unit, Wuhan No 1 Hospital, Wuhan, China
| | - Kangyi Yuan
- The College of Post and Telecommunication, Wuhan Institute of Technology, Wuhan, China
| | - Qiyuan Gao
- Manchester Metropolitan Joint Institute, Hubei University, Wuhan, China
| | - Fang Liu
- Neurology Intensive Care Unit, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, China
- Neurology Intensive Care Unit, Wuhan No 1 Hospital, Wuhan, China
| | - Yuanxi Long
- Neurology Intensive Care Unit, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, China
- Neurology Intensive Care Unit, Wuhan No 1 Hospital, Wuhan, China
| | - Li Wang
- Nursing Department, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, China
- Nursing Department, Wuhan No 1 Hospital, Wuhan, China
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Wang C, Yang D. Effect of different preoperative nutritional treatments on postoperative recovery and clinical outcomes in patients with gastric cancer and early gastric outlet obstruction. Oncol Lett 2024; 27:214. [PMID: 38572061 PMCID: PMC10988191 DOI: 10.3892/ol.2024.14348] [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: 10/15/2023] [Accepted: 02/20/2024] [Indexed: 04/05/2024] Open
Abstract
Patients with gastric cancer and early gastric outlet obstruction often experience malnutrition and require various nutritional support strategies. This study aimed to evaluate the impact of different preoperative nutritional treatments on their postoperative recovery and prognosis. The present retrospective study collected data from 467 patients with gastric cancer and early gastric outlet obstruction who underwent surgery at Harbin Medical University Cancer Hospital (Harbin, China) between January 2016 and December 2018. All patients received preoperative nutritional treatment, with a mean treatment duration of 8.23±2.33 days. The present study analyzed associations and survival in different groups using χ2, independent-samples t-test, ANOVA and log-rank tests. Furthermore, single- and multi-factor survival analyses were conducted and nomograms and calibration curves constructed to investigate factors influencing patient survival. In this study, 230 patients (49.3%) received only parenteral nutrition (PN; Group 1), 162 patients (34.7%) received PN combined with enteral nutrition (EN; Group 2) and 75 patients (16.0%) received PN combined with a full- or semi-liquid diet (Group 3). No significant differences in clinical and pathological parameters were observed among the groups. However, Group 2 showed significant advantages in postoperative recovery, including faster time to first postoperative bowel sounds, flatus and bowel movement. Survival analysis indicated that Group 3 had shorter progression-free survival (χ2=30.485) and overall survival (χ2=31.249). Preoperative nutritional treatment was identified as an independent prognostic factor. Preoperative PN combined with EN proved advantageous for postoperative recovery of patients with gastric cancer and early gastric outlet obstruction. Furthermore, PN combined with full- or semi-liquid diets may not have fully met the nutritional needs of these patients, resulting in less favorable clinical outcomes.
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Affiliation(s)
- Caixia Wang
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Dameng Yang
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
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Haines KL, Ohnuma T, Grisel B, Krishnamoorthy V, Raghunathan K, Sulo S, Kerr KW, Besecker B, Cassady BA, Wischmeyer PE. Early enteral nutrition is associated with improved outcomes in critically ill mechanically ventilated medical and surgical patients. Clin Nutr ESPEN 2023; 57:311-317. [PMID: 37739674 DOI: 10.1016/j.clnesp.2023.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND AIMS Data suggest that guidelines for enteral nutrition (EN) initiation are not closely followed in clinical practice. In addition, critically ill mechanically ventilated (MV) patients have varying metabolic needs, which often increase and persist over time, requiring personalized nutrition intervention. While both over- and under-nutrition can impact patient outcomes, recent data suggest that targeted early EN delivery may reduce mortality and improve clinical outcomes. This study examined if early EN improves clinical outcomes and decreases costs in critically ill patients on MV. METHODS Data from a nationwide administrative-financial database between 2018 and 2020 was utilized to identify eligible adult critical care patients. Patients who received EN within 3 days after intubation (early EN) were compared to patients who started EN after 3 days of intubation (late EN). Outcomes of interest included hospital mortality, discharge disposition, hospital and intensive care unit (ICU) length of stay (LOS), MV days, and total cost. After inverse-probability-of-treatment weighting, outcomes were modeled using a nominal logistic regression model for hospital mortality and discharge disposition, a linear regression model for cost, and Cox proportional-hazards model for MV days, hospital and ICU LOS. RESULTS A total of 27,887 adult patients with early MV were identified, of which 16,772 (60.1%) received early EN. Regression analyses showed that the early EN group had lower hospital mortality (OR = 0.88, 95% CI, 0.82 to 0.94), were more likely to be discharged home (OR = 1.47, 95% CI 1.38 to 1.56), had fewer MV days (HR = 1.23, 95% CI, 1.11 to 1.37), shorter hospital LOS (HR = 1.43, 95% CI, 1.33 to 1.54) and ICU LOS (HR = 1.36, 95% CI, 1.27 to 1.46), and lower cost (-$21,226; 95% CI, -$23,605 to -$18,848) compared to the late EN group. CONCLUSIONS Early EN within 3 days of MV initiation in real-world practice demonstrated improved clinical and economic outcomes. These data suggest that early EN is associated with decreased hospital mortality, increased discharge to home, and decreased hospital and ICU LOS, time on MV, and cost compared to delayed initiation of EN; highlighting the importance of early EN to optimize utcomes ando support the recovery of critically ill patients on MV.
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Affiliation(s)
- Krista L Haines
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA; The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
| | - Tetsu Ohnuma
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA; Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
| | - Braylee Grisel
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
| | - Vijay Krishnamoorthy
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA; Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA
| | - Karthik Raghunathan
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA; Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
| | - Suela Sulo
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
| | - Kirk W Kerr
- Scientific and Medical Affairs, Abbott Nutrition, Columbus, OH, USA.
| | - Beth Besecker
- Scientific and Medical Affairs, Abbott Nutrition, Columbus, OH, USA.
| | - Bridget A Cassady
- Scientific and Medical Affairs, Abbott Nutrition, Columbus, OH, USA.
| | - Paul E Wischmeyer
- Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
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Chinnery G, du Toit AL, Robinson C, Kippie I, Jonas E, Scriba M. Early economic benefits of perioperative nasojejunal tube feeding in non-critical care adult surgical patients with gastric feed intolerance. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2023. [DOI: 10.1080/16070658.2022.2154535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Galya Chinnery
- Department of Surgical Gastroenterology, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | | | - Chanel Robinson
- Department of Surgery, Mitchell’s Plain District Hospital, Cape Town, South Africa
| | - Ilhaam Kippie
- Department of Surgery, Khayelitsha District Hospital, Cape Town, South Africa
| | - Eduard Jonas
- Department of Surgery, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Matthias Scriba
- Department of Surgical Gastroenterology, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
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Exploration of the Curative Effect of Early Enteral Nutrition Nursing on Patients with Severe Acute Pancreatitis and the Improvement of Patients' Mental Health and Inflammation Level. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:8784905. [PMID: 34552708 PMCID: PMC8452422 DOI: 10.1155/2021/8784905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/20/2021] [Accepted: 08/25/2021] [Indexed: 02/07/2023]
Abstract
In order to explore the curative effect of early enteral nutrition nursing on patients with severe acute pancreatitis and the improvement of patients' mental health and inflammation levels, this paper compares the curative effect of early enteral nutrition nursing and traditional care on patients with severe acute pancreatitis and the improvement effects of patients' mental health and inflammation levels through controlled trials. Moreover, this paper combines statistical methods for data processing and visually expresses data through statistical graphs and statistical tables. Through the comparison of experiments, it can be seen that the improvement effect in all aspects of patients in the test group is significantly higher than that in the control group. Finally, through the analysis of the test results, it can be known that the use of early enteral nutrition nursing for patients with acute severe acute pancreatitis has a certain effect in improving their nutritional status, regulating immune function, and promoting mental health.
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Abstract
PURPOSE OF REVIEW The current review summarizes recent evolutions in knowledge and discusses the concept of whom and when parenteral nutrition should be considered in critically ill patients as a total form of nutrition, in a supplemental form, or never. RECENT FINDINGS Recent developments in our understanding of the application of parenteral nutrition in critical care include the phases of illness, avoidance of overfeeding and the population in whom parenteral nutrition may be appropriate for. Importantly, one of the greatest lessons of recent times may be who not to provide parenteral nutrition to; however, a blanket approach of increased risk with parenteral nutrition is too simple for the modern context. SUMMARY When providing total or supplemental parenteral nutrition, avoidance of overfeeding with total calories and/or glucose alone is critical, as is consideration to the phase of illness the patient is in, the population in whom it is to be applied, premorbid nutrition status and the setting (including adequacy of line management and expertise in parenteral nutrition provision). The appropriateness of parenteral nutrition should be considered in those where death is imminent or who are well nourished, likely to commence oral and/or enteral nutrition imminently and have a short-stay in intensive care, or are in a high-risk setting.
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Affiliation(s)
- Emma J Ridley
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University
- Nutrition Department, Alfred Hospital, Melbourne, Victoria, Australia
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Zheng Z, Ding YX, Qu YX, Cao F, Li F. A narrative review of acute pancreatitis and its diagnosis, pathogenetic mechanism, and management. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:69. [PMID: 33553362 PMCID: PMC7859757 DOI: 10.21037/atm-20-4802] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Acute pancreatitis (AP) is an inflammatory disease that can progress to severe acute pancreatitis (SAP), which increases the risk of death. AP is characterized by inappropriate activation of trypsinogen, infiltration of inflammatory cells, and destruction of secretory cells. Other contributing factors may include calcium (Ca2+) overload, mitochondrial dysfunction, impaired autophagy, and endoplasmic reticulum (ER) stress. In addition, exosomes are also associated with pathophysiological processes of many human diseases and may play a biological role in AP. However, the pathogenic mechanism has not been fully elucidated and needs to be further explored to inform treatment. Recently, the treatment guidelines have changed; minimally invasive therapy is advocated more as the core multidisciplinary participation and "step-up" approach. The surgical procedures have gradually changed from open surgery to minimally invasive surgery that primarily includes percutaneous catheter drainage (PCD), endoscopy, small incision surgery, and video-assisted surgery. The current guidelines for the management of AP have been updated and revised in many aspects. The type of fluid to be used, the timing, volume, and speed of administration for fluid resuscitation has been controversial. In addition, the timing and role of nutritional support and prophylactic antibiotic therapy, as well as the timing of the surgical or endoscopic intervention, and the management of complications still have many uncertainties that could negatively impact the prognosis and patients' quality of life. Consequently, to inform clinicians about optimal treatment, we aimed to review recent advances in the understanding of the pathogenesis of AP and its diagnosis and management.
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Affiliation(s)
- Zhi Zheng
- Department of General Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Yi-Xuan Ding
- Department of General Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Yuan-Xu Qu
- Department of General Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Feng Cao
- Department of General Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Fei Li
- Department of General Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
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Ochoa JB, Cárdenas D, Goiburu ME, Bermúdez C, Carrasco F, Correia MITD. Lessons Learned in Nutrition Therapy in Patients With Severe COVID-19. JPEN J Parenter Enteral Nutr 2020; 44:1369-1375. [PMID: 32833241 PMCID: PMC7461365 DOI: 10.1002/jpen.2005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/12/2020] [Indexed: 12/18/2022]
Abstract
The coronavirus disease 2019 (COVID‐19) pandemic has reached worldwide, and until a vaccine is found, it will continue to cause significant morbidity and mortality. The clinical presentation of COVID‐19 ranges from that of being asymptomatic to developing a fatal illness characterized by multiple organ involvement. Approximately 20% of the patients will require hospitalization; one‐quarter of hospitalized patients will develop severe COVID‐19 requiring admission to the intensive care unit, most frequently, with acute respiratory failure. An ongoing effort is being made to identify the patients that will develop severe COVID‐19. Overall, patients present with 3 different phenotypes of nutrition risk: (1) the frail older patient, (2) the patient with severe ongoing chronic illness, and (3) the patient with severe and morbid obesity. These 3 phenotypes represent different nutrition risks and diverse nutrition interventions. This article explores the different potential approaches to nutrition intervention in patients with COVID‐19, evaluating, in this process, the challenges faced in the implementation of guidelines written by different societies.
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Affiliation(s)
- Juan B Ochoa
- Department of Surgery, Ochsner Medical Center-New Orleans, New Orleans, Louisiana, USA
| | - Diana Cárdenas
- Department of Medicine, Universidad El Bosque, Bogota, Bogota, Colombia
| | - María E Goiburu
- Facultad de Ciencias Medicas, Universidad Nacional de Asuncion, Asuncion, Paraguay
| | | | | | - M Isabel T D Correia
- Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, Brazil
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