1
|
Farrar JE, Swanson JM, Hudson JQ, Byerly S, Filiberto DM, Dickerson RN. Validation of Two Scoring Tools to Predict Risk of Augmented Renal Clearance in Trauma Patients. J Surg Res 2024; 300:526-533. [PMID: 38875951 DOI: 10.1016/j.jss.2024.05.026] [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: 02/21/2024] [Revised: 05/07/2024] [Accepted: 05/17/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Augmented renal clearance (ARC) is prevalent in trauma populations. Identification is underrecognized by calculated creatinine clearance or estimated glomerular filtration rate equations. Predictive scores may assist with ARC identification. The goal of this study was to evaluate validity of the ARCTIC score and ARC Predictor to predict ARC in critically ill trauma patients. METHODS This single center, retrospective study was performed at an academic level 1 trauma center. Critically ill adult trauma patients undergoing 24-h urine-collection were included. Patients with serum creatinine >1.5 mg/dL, kidney replacement therapy, suspected rhabdomyolysis, chronic kidney disease, or inaccurate urine collection were excluded. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for ARCTIC Score and ARC Predictor were calculated. Receiver operating characteristic curves were created for ARCTIC score and ARC Predictor models. RESULTS One-hundred and twenty-two patients with ARC and 78 patients without ARC were included. The ARCTIC score sensitivity, specificity, PPV, and NPV were 89%, 54%, 75%, and 75%, respectively. The ARC Predictor demonstrated sensitivity, specificity, PPV, and NPV of 77%, 88%, 91%, and 71%, respectively. Regression analyses revealed both ARCTIC score ≥6 and ARC Predictor threshold >0.5 as significant risk factors for ARC in presence of traumatic brain injury, obesity, injury severity score, and negative nitrogen balance (ARCTIC ≥6: odds ratio 8.59 [95% confidence interval 3.90-18.92], P < 0.001; ARC Predictor >0.5: odds ratio 20.07 [95% confidence interval 8.53-47.19], P < 0.001). CONCLUSIONS These findings corroborate validity of two pragmatic prediction tools to identify patients at high risk of ARC. Future studies evaluating correlations between ARCTIC score, ARC Predictor, and clinical outcomes are warranted.
Collapse
Affiliation(s)
- Julie E Farrar
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, Tennessee.
| | - Joseph M Swanson
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, Tennessee
| | - Joanna Q Hudson
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, Tennessee
| | - Saskya Byerly
- Department of Surgery, Division of Trauma/Surgical Critical Care, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee; Regional One Health, Memphis, Tennessee
| | - Dina M Filiberto
- Department of Surgery, Division of Trauma/Surgical Critical Care, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee; Regional One Health, Memphis, Tennessee
| | - Roland N Dickerson
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, Tennessee
| |
Collapse
|
2
|
Varghese JA, Keegan S, Nicholson C, Drummond KJ, Kaul N, Fetterplace K. Volume-based enteral feeding for ward patients with acute neurological conditions: a pilot prospective cohort study. J Hum Nutr Diet 2024; 37:1040-1049. [PMID: 38752463 DOI: 10.1111/jhn.13319] [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: 01/02/2024] [Accepted: 04/27/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Patients requiring enteral nutrition (EN) after neurological insults experience feeding interruptions, contributing to inadequate nutrition delivery. This prospective cohort study investigated if volume-based enteral feeding (VBF) improved the delivery of prescribed EN volume in ward patients with acute neurological conditions. METHODS Over two sequential periods, the usual care group received standard continuous rate-based feeding, and the intervention group received VBF with bi-daily EN rate adjustments to achieve target daily volume. The primary outcome was percentage of prescribed daily EN formula volume delivered. Differences in energy and protein provision, weight, malnutrition and safety were explored. An evaluation survey captured nurse acceptability of the protocol. RESULTS The intervention group (n = 32) achieved greater median interquartile range (IQR) EN adequacy of prescribed volume at 92% (88-97) compared to 67% (54-78) for usual care (n = 35) (p < 0.001). VBF compared to rate-based feeding resulted in patients receiving more kilojoules (131 [121-138] kJ/kg vs. 84 [64-99] kJ/kg; p < 0.001) and protein (1.3 [1.2-1.5] g/kg vs. 0.9 [0.6-1.1] g/kg; p < 0.001). There were no differences in gastrointestinal intolerance between groups. Compliance to the VBF protocol was 90%, and 78% of staff reported high confidence using the protocol. The intervention group had less median weight loss at discharge (-1.4 [0.1 to -4.3] kg) than usual care (-3.6 [-1.3 to 8.4] kg; p < 0.011), but no differences in malnutrition status were observed. CONCLUSION A VBF protocol delivered greater EN volume, energy and protein following neurological injury. The VBF protocol was feasible with high acceptability from nursing staff.
Collapse
Affiliation(s)
- Jessie A Varghese
- Department of Allied Health (Clinical Nutrition), The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Simone Keegan
- Department of Allied Health (Clinical Nutrition), The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Christine Nicholson
- Departments of Neurosciences and Nursing Education, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Katharine J Drummond
- Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Neha Kaul
- Department of Allied Health (Clinical Nutrition), The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Nutrition and Dietetics, Alfred Health, Melbourne, Victoria, Australia
| | - Kate Fetterplace
- Department of Allied Health (Clinical Nutrition), The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
3
|
Kittrell HD, Shaikh A, Adintori PA, McCarthy P, Kohli-Seth R, Nadkarni GN, Sakhuja A. Role of artificial intelligence in critical care nutrition support and research. Nutr Clin Pract 2024. [PMID: 39073166 DOI: 10.1002/ncp.11194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 06/06/2024] [Accepted: 06/28/2024] [Indexed: 07/30/2024] Open
Abstract
Nutrition plays a key role in the comprehensive care of critically ill patients. Determining optimal nutrition strategy, however, remains a subject of intense debate. Artificial intelligence (AI) applications are becoming increasingly common in medicine, and specifically in critical care, driven by the data-rich environment of intensive care units. In this review, we will examine the evidence regarding the application of AI in critical care nutrition. As of now, the use of AI in critical care nutrition is relatively limited, with its primary emphasis on malnutrition screening and tolerance of enteral nutrition. Despite the current scarcity of evidence, the potential for AI for more personalized nutrition management for critically ill patients is substantial. This stems from the ability of AI to integrate multiple data streams reflecting patients' changing needs while addressing inherent heterogeneity. The application of AI in critical care nutrition holds promise for optimizing patient outcomes through tailored and adaptive nutrition interventions. A successful implementation of AI, however, necessitates a multidisciplinary approach, coupled with careful consideration of challenges related to data management, financial aspects, and patient privacy.
Collapse
Affiliation(s)
- Hannah D Kittrell
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Division of Data Driven and Digital Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ahmed Shaikh
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Peter A Adintori
- Food and Nutrition Services Department, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Program in Rehabilitation Sciences, New York University Steinhardt, New York, New York, USA
| | - Paul McCarthy
- Department of Cardiovascular and Thoracic Surgery, Division of Cardiovascular Critical Care, West Virginia University, Morgantown, West Virginia, USA
| | - Roopa Kohli-Seth
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Girish N Nadkarni
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Division of Data Driven and Digital Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ankit Sakhuja
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Division of Data Driven and Digital Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
4
|
Wang Q, Tang J, Li Y, Lu J, Yang D, He C, Li T, Fu K, Liu R. EFFECT OF STRATIFIED DOSE OF NOREPINEPHRINE ON CELLULAR IMMUNE RESPONSE IN PATIENTS WITH SEPTIC SHOCK AND THE CONSTRUCTION OF A PROGNOSTIC RISK MODEL. Shock 2024; 62:32-43. [PMID: 38517239 DOI: 10.1097/shk.0000000000002363] [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: 03/23/2024]
Abstract
ABSTRACT Objective: To explore the effect of a stratified dose of norepinephrine (NE) on cellular immune response in patients with septic shock, and to construct a prognostic model of septic shock. Methods: A total of 160 patients with septic shock (B group) and 58 patients with sepsis (A group) were given standard cluster therapy. Patients with septic shock were divided into four groups (B1-B4 groups: 0.01-0.2, 0.2-0.5, 0.5-1.0, and >1 μg/kg/min) according to the quartile method of the early (72 h) time-weighted average dose of NE and clinical application. The cellular immune indexes at 24 h (T0) and 4-7 days (T1) after admission were collected. The difference method was used to explore the effect of NE stratified dose on cellular immune effect in patients with septic shock. A multivariate COX proportional risk regression model was used to analyze the independent prognostic risk factors, and a prognostic risk model was constructed. Results: The differences of ΔIL-1β, ΔIL-6, ΔIL-10, absolute value difference of T lymphocyte (ΔCD3+/CD45+#) and Th helper T cell (ΔCD3+ CD4+/CD45+#), CD64 infection index difference, ΔmHLA-DR, regulatory T lymphocyte ratio difference (ΔTregs%) between group A, B1, B2, B3, and B4 were statistically significant ( P < 0.05). There was a nonlinear relation between the stratified dose of NE and ΔIL-6, ΔIL-10, ΔCD3+/CD45+#, ΔmHLA-DR%. The threshold periods of NE-induced proinflammatory and anti-inflammatory immune changes were 0.3-0.5 μg/kg/min. Multivariate COX model regression analysis showed that age, nutritional patterns, weighted average dose of norepinephrine, IL-6, absolute value of T lymphocytes, and mHLA-DR were independent risk factors affecting the prognosis of patients with septic shock ( P < 0.05). The prognostic risk model was constructed (AUC value = 0.813, 95% CI: 0.752-0.901). Conclusion: NE has a certain inhibitory effect on cellular immune function in patients with septic shock. A prognostic risk model was constructed with stronger prediction efficiency for the prognosis of patients with septic shock.
Collapse
Affiliation(s)
- Qiang Wang
- Department of Geriatric Intensive Care Medicine, the First Affiliated Hospital of Kunming Medical University, Yunnan Geriatric Medicine Center, Kunming, China
| | - Jiefu Tang
- Department of Geriatric Intensive Care Medicine, the First Affiliated Hospital of Kunming Medical University, Yunnan Geriatric Medicine Center, Kunming, China
| | - Yao Li
- Stomatology Research Center, The First People's Hospital of Yunnan Province, Kunming, China
| | - Jiafei Lu
- Department of Geriatric Intensive Care Medicine, the First Affiliated Hospital of Kunming Medical University, Yunnan Geriatric Medicine Center, Kunming, China
| | - Dexing Yang
- Department of Emergency Medicine, Yunnan First People's Hospital, Kunming, China
| | - Chen He
- Department of Geriatric Intensive Care Medicine, the First Affiliated Hospital of Kunming Medical University, Yunnan Geriatric Medicine Center, Kunming, China
| | - Ting Li
- Department of Geriatric Intensive Care Medicine, the First Affiliated Hospital of Kunming Medical University, Yunnan Geriatric Medicine Center, Kunming, China
| | - Kai Fu
- Department of Geriatric Intensive Care Medicine, the First Affiliated Hospital of Kunming Medical University, Yunnan Geriatric Medicine Center, Kunming, China
| | - Rong Liu
- Department of Geriatric Intensive Care Medicine, the First Affiliated Hospital of Kunming Medical University, Yunnan Geriatric Medicine Center, Kunming, China
| |
Collapse
|
5
|
Cogle SV, Ayers P, Berger MM, Berlana D, Wischmeyer PE, Ybarra J, Zeraschi S, De Cloet J. Parenteral nutrition in the hospital setting/short-term parenteral nutrition. Am J Health Syst Pharm 2024; 81:S102-S111. [PMID: 38869256 PMCID: PMC11170504 DOI: 10.1093/ajhp/zxae080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
PURPOSE This article is based on presentations and discussions held at the International Safety and Quality of Parenteral Nutrition (PN) Summit concerning the acute care setting. Some European practices presented in this article do not conform with USP general chapter <797> requirements. Nevertheless, the purpose is to cover the challenges experienced in delivering high-quality PN within hospitals in the United States and Europe, in order to share best practices and experiences more widely. SUMMARY Core issues regarding the PN process within an acute care setting are largely the same everywhere: There are ongoing pressures for greater efficiency, optimization, and also concurrent commitments to make PN safer for patients. Within Europe, in recent years, the use of market-authorized multi-chamber bags (MCBs) has increased greatly, mainly for safety, cost-effectiveness, and efficiency purposes. However, in the US, hospitals with low PN volumes may face particular challenges, as automated compounding equipment is often unaffordable in this setting and the variety of available MCBs is limited. This can result in the need to operate several PN systems in parallel, adding to the complexity of the PN use process. Ongoing PN quality and safety initiatives from US institutions with various PN volumes are presented. In the future, the availability of a greater selection of MCBs in the US may increase, leading to a reduction in dependence on compounded PN, as has been seen in many European countries. CONCLUSION The examples presented may encourage improvements in the safety and quality of PN within the acute care setting worldwide.
Collapse
Affiliation(s)
- Sarah V Cogle
- Department of Pharmacy, Clinical Programs, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Phil Ayers
- Clinical Pharmacy Services, Department of Pharmacy, Baptist Medical Center, Jackson, MS, USA
| | - Mette M Berger
- Service of Adult Intensive Care, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - David Berlana
- Pharmacy Service, Vall d'Hebron Barcelona Hospital Campus and Department of Pharmacology, Toxicology and Therapeutic Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain
| | - Paul E Wischmeyer
- Department of Anesthesiology and Surgery, Duke University School of Medicine, Durham, NC, USA
| | | | - Sarah Zeraschi
- Pharmacy Department and Nutrition and Intestinal Failure Services, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Joeri De Cloet
- Pharmacy Department, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
6
|
Karvellas CJ, Bajaj JS, Kamath PS, Napolitano L, O'Leary JG, Solà E, Subramanian R, Wong F, Asrani SK. AASLD Practice Guidance on Acute-on-chronic liver failure and the management of critically ill patients with cirrhosis. Hepatology 2024; 79:1463-1502. [PMID: 37939273 DOI: 10.1097/hep.0000000000000671] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/01/2023] [Indexed: 11/10/2023]
Affiliation(s)
- Constantine J Karvellas
- Division of Gastroenterology (Liver Unit), Department of Critical Care Medicine, University of Alberta, Edmonton, Canada
| | - Jasmohan S Bajaj
- Virginia Commonwealth University, Central Virginia Veterans Healthcare System, Richmond, Virginia, USA
| | - Patrick S Kamath
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | | | - Jacqueline G O'Leary
- Department of Medicine, Dallas Veterans Medical Center, University of Texas Southwestern Medical Center Dallas, Texas, USA
| | - Elsa Solà
- Institute for Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, California, USA
| | | | | | | |
Collapse
|
7
|
Fernández J, Blasi A, Hidalgo E, Karvellas CJ. Bridging the critically ill patient with acute to chronic liver failure to liver transplantation. Am J Transplant 2024:S1600-6135(24)00223-5. [PMID: 38548058 DOI: 10.1016/j.ajt.2024.03.026] [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: 12/21/2023] [Revised: 03/16/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024]
Abstract
Liver transplantation (LT) has emerged as an effective therapy for severe forms of acute-on-chronic liver failure (ACLF), an entity characterized by the development of multiorgan failure and high short-term mortality. The aim of critical care management of ACLF patients is to rapidly treat precipitating events and aggressively support failing organs to ensure that patients may successfully undergo LT or, less frequently, recover. Malnutrition and sarcopenia are frequently present, adversely impacting the prognosis of these patients. Management of critical care patients with ACLF is complex and requires the participation of different specialties. Once the patient is stabilized, a rapid evaluation for salvage LT should be performed because the time window for LT is often narrow. The development of sepsis and prolonged organ support may preclude LT or diminish its chances of success. The current review describes strategies to bridge severe ACLF patients to LT, highlights the minimal evaluation required for listing and the currently suggested contraindications to proceed with LT, and addresses different aspects of management during the perioperative and early posttransplant period.
Collapse
Affiliation(s)
- Javier Fernández
- Liver ICU, Liver Unit, Hospital Clinic, University of Barcelona, IDIBAPS and CIBERehd, Spain; EF Clif, EASL-CLIF Consortium, Barcelona, Spain.
| | - Annabel Blasi
- Anesthesiology Department, Hospital Clínic, and University of Barcelona, Spain
| | - Ernest Hidalgo
- Hepatolobiliary Surgery Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Constantine J Karvellas
- Department of Critical Care Medicine, University of Alberta, Edmonton, Canada; Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Canada
| |
Collapse
|
8
|
Gu BD, Wang Y, Ding R. Impact of a multidisciplinary collaborative nutritional treatment model in patients who are critically ill with neurological disorders: A randomized controlled trial. Technol Health Care 2024; 32:1767-1780. [PMID: 38073348 DOI: 10.3233/thc-230791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND Malnutrition is a widespread problem in critically ill patients with neurological disorders. OBJECTIVE The purpose of this study is to investigate the effect of a multidisciplinary collaborative nutritional treatment mode based on a standardized unit for nutritional support on the outcome metrics in patients with neurological disorders who are critically ill. METHODS We enrolled 84 participants who were hospitalized in the intensive care unit (ICU) of Yancheng No. 1 People's Hospital for neurological disorders between June 2018 and December 2021. The participants were randomly assigned to the control group and the test group. The control group received traditional nutritional support, while the test group was treated with a multidisciplinary collaborative nutritional treatment mode based on a standardized unit for nutritional support. We collected the general information, feeding tolerance (FT), nutritional risk score, and laboratory indicators before intervention, after intervention for one week, and after intervention for 2 weeks, and other data of the participants. RESULTS After the intervention, the test group scored significantly lower than the control group in the incidence of gastroparesis and diarrhea, as well as the NUTRIC score, with statistically significant differences (P< 0.001). The prealbumin levels in the test group increased progressively prior to intervention, after intervention for one week, and after intervention for two weeks. Compared to the control group, the test group had higher prealbumin levels prior to intervention, after intervention for one week, and after intervention for two weeks, with statistically significant differences (P< 0.001). CONCLUSION We developed a multidisciplinary collaborative nutritional treatment model based on a standard unit for nutritional support. This model can improve neural function, FT, and pertinent outcome indicators and is generally applicable.
Collapse
Affiliation(s)
- Bao-Di Gu
- Department of Critical Care Medicine, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School, The First People's Hospital of Yancheng, Yancheng, Jiangsu, China
| | - Yun Wang
- Department of Neurology, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School, The First People's Hospital of Yancheng, Yancheng, Jiangsu, China
| | - Rong Ding
- Department of Nursing, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School, The First People's Hospital of Yancheng, Yancheng, Jiangsu, China
| |
Collapse
|
9
|
Wang Y, Li Y, Li Y, Li H, Zhang D. Enteral feeding strategies in patients with acute gastrointestinal injury: From limited to progressive to open feeding. Nutrition 2024; 117:112255. [PMID: 37897987 DOI: 10.1016/j.nut.2023.112255] [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: 07/19/2023] [Revised: 09/21/2023] [Accepted: 09/29/2023] [Indexed: 10/30/2023]
Abstract
Acute gastrointestinal injury (AGI) is very common in critically ill patients, and its severity is positively correlated with mortality. Critically ill patients with digestive and absorption dysfunction caused by AGI face higher nutritional risks, making nutritional support particularly important. Early enteral nutrition (EN) support is extremely important because it can promote the recovery of intestinal function, protect the intestinal mucosal barrier, reduce microbiota translocation, reduce postoperative complications, shorten hospital stay, and improve clinical prognosis. In recent years, many nutritional guidelines have been proposed for critically ill patients; however, there are few recommendations for the implementation of EN in patients with AGI, and their quality of evidence is low. The use of EN feeding strategies in critically ill patients with AGI remains controversial. The aim of this review was to elaborate on how EN feeding strategies should transition from limited to progressive to open feeding and explain the time window for this transition.
Collapse
Affiliation(s)
- Youquan Wang
- Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, China.
| | - Yanhua Li
- Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, China.
| | - Yuting Li
- Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, China.
| | - Hongxiang Li
- Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, China.
| | - Dong Zhang
- Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, China.
| |
Collapse
|
10
|
Slingerland-Boot R, Kummerow M, Arbous SM, van Zanten ARH. Association between first-week propofol administration and long-term outcomes of critically ill mechanically ventilated patients: A retrospective cohort study. Clin Nutr 2024; 43:42-51. [PMID: 38000194 DOI: 10.1016/j.clnu.2023.10.029] [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: 06/20/2023] [Revised: 09/21/2023] [Accepted: 10/29/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND & AIM Propofol is commonly used in ICUs, but its long-term effects have not been thoroughly studied. In vitro studies suggest it may harm mitochondrial function, potentially affecting clinical outcomes. This study aimed to investigate the association between substantial propofol sedation and clinical outcomes in critically ill patients. METHODS We conducted a single-centre cohort study of critically ill, mechanically ventilated (≥7 days) adults to compare patients who received a substantial dose of propofol (cumulative >500 mg) during the first week of ICU admission with those who did not. The primary outcome was the association between substantial propofol administration and 6-month mortality, adjusted for relevant covariates. Subanalyses were performed for administration in the early (day 1-3) and late (day 4-7) acute phases of critical illness due to the metabolic changes in this period. Secondary outcomes included tracheostomy need and duration, length of ICU and hospital stay (LOS), discharge destinations, ICU, hospital, and 3-month mortality. RESULTS A total of 839 patients were enrolled, with 73.7 % receiving substantial propofol administration (substantial propofol dose group). Six-month all-cause mortality was 32.4 %. After adjusting for relevant variables, we found no statistically significant difference in 6-month mortality between both groups. There were also no significant differences in secondary outcomes. CONCLUSION Our study suggests that substantial propofol administration during the first week of ICU stay in the least sick critically ill, mechanically ventilated adult patients is safe, with no significant associations found with 6-month mortality, ICU or hospital LOS, differences in discharge destinations or need for tracheostomy.
Collapse
Affiliation(s)
- Rianne Slingerland-Boot
- Department of Intensive Care Medicine, Gelderse Vallei Hospital, Ede, the Netherlands; Wageningen University & Research, Division of Human Nutrition and Health, Wageningen, the Netherlands
| | - Maren Kummerow
- Department of Intensive Care Medicine, Gelderse Vallei Hospital, Ede, the Netherlands
| | - Sesmu M Arbous
- Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Arthur R H van Zanten
- Department of Intensive Care Medicine, Gelderse Vallei Hospital, Ede, the Netherlands; Wageningen University & Research, Division of Human Nutrition and Health, Wageningen, the Netherlands.
| |
Collapse
|
11
|
Rivas García F, Martínez RJG, Camarasa FJH, Cerdá JCM, Messeguer FL, Gallardo MLV. A Narrative Review: Analysis of Supplemental Parenteral Nutrition in Adults at the End of Life. Pharmaceuticals (Basel) 2023; 17:65. [PMID: 38256898 PMCID: PMC10820363 DOI: 10.3390/ph17010065] [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: 11/06/2023] [Revised: 12/15/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024] Open
Abstract
"End of life" is a stage defined by the existence of an irreversible prognosis that ends with a person's death. One of the aspects of interest regarding end of life focuses on parenteral nutrition, which is usually administered in order to avoid malnutrition and associated complications. However, parenteral nutrition can be adapted to specific circumstances and evolve in its functionality through supplementation with certain nutrients that can have a beneficial effect. This narrative review aims to carry out a situation analysis of the role that could be adopted by supplemental parenteral nutrition in attenuating alterations typical of end of life and potential improvement in quality of life.
Collapse
|
12
|
Moonen HPFX, Hermans AJH, Bos AE, Snaterse I, Stikkelman E, van Zanten FJL, van Exter SH, van de Poll MCG, van Zanten ARH. Resting energy expenditure measured by indirect calorimetry in mechanically ventilated patients during ICU stay and post-ICU hospitalization: A prospective observational study. J Crit Care 2023; 78:154361. [PMID: 37451114 DOI: 10.1016/j.jcrc.2023.154361] [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: 03/01/2023] [Revised: 06/12/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE The metabolic course during and after critical illness is unclear. We performed repeated indirect calorimetry (IC) measurements during ICU- and post-ICU hospitalization to determine resting energy expenditure (REE). METHODS Prospective observational design. In ventilated ICU patients, IC measurements were performed every three days until hospital discharge. Measured REE as predicted by the Harris-Benedict equation (HBE-REE) and 25 kcal/adjusted body weight/day (25-REE) were compared. RESULTS In 56 patients (38% females, 71[13]years, BMI 29(27;31)kg/m2), 189 ICU IC measurements were performed. Measured REE did not differ from HBE-REE at ICU admission, but was lower than 25-REE. Measured REE was increased compared to baseline on ICU-admission-day four (29(29-30)kcal/kg/day; mean difference 3.1(1.4-4.9)kcal/kg/day, p < 0.001) and thereafter during ICU admission. During post-ICU ward stay, 44 measurements were performed in 23 patients, showing a higher mean REE than during ICU stay (33(31-35)kcal/kg/day; mean difference 2.6(1.2-3.9)kcal/kg/day, p < 0.001). The REE in the ICU and ward was >110% of HBE-REE from day four onwards. CONCLUSIONS Critically ill mechanically ventilated patients were shown to have a resting energy expenditure (REE) > 110% of predicted REE on ICU admission day four and thereafter. Indirect calorimetry measurements suggest that the mean energy requirements during post-ICU hospitalization are higher than those in the ICU.
Collapse
Affiliation(s)
- Hanneke P F X Moonen
- Department of Intensive Care Medicine, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP Ede, the Netherlands; Wageningen University & Research, Division of Human Nutrition and Health, Stippeneng 4, 6708 WE Wageningen, the Netherlands
| | - Anoek J H Hermans
- Department of Intensive Care Medicine, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP Ede, the Netherlands; Wageningen University & Research, Division of Human Nutrition and Health, Stippeneng 4, 6708 WE Wageningen, the Netherlands
| | - Anneloes E Bos
- Department of Intensive Care Medicine, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP Ede, the Netherlands
| | - Ilana Snaterse
- Department of Intensive Care Medicine, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP Ede, the Netherlands
| | - Eline Stikkelman
- Department of Intensive Care Medicine, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP Ede, the Netherlands
| | - Florianne J L van Zanten
- Department of Intensive Care Medicine, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP Ede, the Netherlands
| | - Sabien H van Exter
- Department of Intensive Care Medicine, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP Ede, the Netherlands; Wageningen University & Research, Division of Human Nutrition and Health, Stippeneng 4, 6708 WE Wageningen, the Netherlands
| | - Marcel C G van de Poll
- Department of Intensive Care Medicine, Department of Surgery, School for Nutrition and Translantional Research in Metabolism (NUTRIM) Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Arthur R H van Zanten
- Department of Intensive Care Medicine, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP Ede, the Netherlands; Wageningen University & Research, Division of Human Nutrition and Health, Stippeneng 4, 6708 WE Wageningen, the Netherlands.
| |
Collapse
|
13
|
Feng L, Chen J, Xu Q. Is monitoring of gastric residual volume for critically ill patients with enteral nutrition necessary? A meta-analysis and systematic review. Int J Nurs Pract 2023; 29:e13124. [PMID: 36540042 DOI: 10.1111/ijn.13124] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/16/2022] [Accepted: 11/13/2022] [Indexed: 12/18/2023]
Abstract
BACKGROUND There are many controversies over the necessity of monitoring gastric residual volume in the nursing care of enteral nutrition. We aimed to conduct an updated meta-analysis to evaluate the effects of monitoring or not monitoring gastric residual volume on patients' outcomes and complications. METHODS We searched the Cochrane Library database to 15 April 2021 for randomized controlled trials (RCTs) on the effects of gastric residual volume and no gastric residual volume monitoring. Review Manager software was used for data analysis. RESULTS A total of seven RCTs involving 1240 enteral nutrition patients were included. Gastric residual volume monitoring was associated with reduced incidence of vomiting (OR2.33, 95% CI:1.68-3.24), whereas no gastric residual volume monitoring was associated with reduced incidence of unnecessary interruptions of enteral nutrition (OR0.38,95% CI:0.26-0.55). There were no significant differences on the incidence of abdominal distention (OR1.87, 95% CI:0.82-4.28), diarrhoea (OR1.03,95% CI:0.74-1.43), VAP (OR0.83, 95%CI:0.37-1.89), duration of mechanical ventilation (MD -0.06,95% CI:-1.22-1.10), length of ICU stay (MD -1.33, 95% CI:-3.58-0.91) and mortality (OR0.90,95% CI:0.61-1.34). CONCLUSIONS Not monitoring gastric residual volume is associated with reduced unnecessary interruptions of enteral nutrition related to inadequate feeding and increased risk of vomiting.
Collapse
Affiliation(s)
- Limei Feng
- Department of Nursing, Wuxi No. 5 Affiliated Hospital of Jiangnan University, Wuxi No. 5 People's Hospital, Jiangsu, China
| | - Judi Chen
- Department of Nursing, Wuxi No. 5 Affiliated Hospital of Jiangnan University, Wuxi No. 5 People's Hospital, Jiangsu, China
| | - Qin Xu
- School of Nursing, Nanjing Medical University, Nanjing, China
| |
Collapse
|
14
|
Shen Y, Wang X, Yao Y, Zhou X. Acute fatty liver of pregnancy causing multiple organ dysfunction syndrome in a Chinese intensive care unit. Nurs Crit Care 2023; 28:1170-1175. [PMID: 37114863 DOI: 10.1111/nicc.12916] [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: 06/25/2022] [Revised: 03/29/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023]
Abstract
Acute fatty liver of pregnancy (AFLP) is a rare but severe condition associated with high rates of maternal and foetal morbidity and mortality. Timely discontinuation of pregnancy, professional supervision and appropriate management are helpful for a successful discharge. This article reports the presentation and nursing care of a pregnant woman who was diagnosed with AFLP and discharged from the intensive care unit (ICU) after a prolonged hospitalization. The patient was admitted to the ICU on the first day after a caesarean section, with deterioration of liver, kidney and coagulation function. On day 1 of ICU admission, she underwent transnasal high-flow oxygen therapy. Owing to worsening respiratory status and oxygen saturation <85%, the patient was intubated on day 3 in the ICU. Her urine output decreased significantly, her bilirubin level progressively increased, and she was treated with bilirubin adsorption and haemodialysis. Multiple organ dysfunction syndrome occurred, along with many other complications, including subarachnoid haemorrhage and lower extremity venous thrombosis. The patient was finally extubated on day 7, and haemodialysis was discontinued on day 42, with a daily urine output of approximately 2000 mL. The patient was discharged from the ICU 43 days after admission. Treatment and care activities under qualified nursing care, including managing haemorrhage and anticoagulation in haemodialysis, pain care based on psychological support, early rehabilitation and nutrition and providing appropriate care for respiratory support, contributed to the successful discharge of the patient from the ICU. During the patient's 43-day stay in the ICU, strict monitoring and personalized nursing care were implemented.
Collapse
Affiliation(s)
- Yan Shen
- Department of Nursing, Shanghai General Hospital, Shanghai, China
| | - Xujuan Wang
- Department of Nursing, Shanghai General Hospital, Shanghai, China
| | - Yeying Yao
- Department of Nursing, Shanghai General Hospital, Shanghai, China
| | - Xingmei Zhou
- Department of Nursing, Shanghai General Hospital, Shanghai, China
| |
Collapse
|
15
|
Li P, Li S, Liu S, Li M. Modified Nutrition Risk in the Critically ill score and mortality in critically ill patients with traumatic brain injury. Nutr Clin Pract 2023; 38:1032-1044. [PMID: 37255501 DOI: 10.1002/ncp.11014] [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: 12/09/2022] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Understanding the relationship between nutrition risk at admission to the intensive care unit (ICU) and the prognosis of patients with traumatic brain injury (TBI) may aid early recognition of high-risk patients. METHODS We extracted data from the Medical Information Mart for Intensive Care III and the electronic ICU Collaborative Research Databases. Using modified Nutrition Risk in the Critically ill score (mNUTRIC) within the first 24 h of ICU admission, 5153 patients were divided into three groups: low (≤1, n = 1765), moderate (2-4, n = 2574), and high (≥5, n = 814). The primary outcome was 28-day in-hospital mortality, and the secondary outcomes were 7-day in-hospital mortality, length of ICU stay, and duration of mechanical ventilation. RESULTS During the median follow-up time of 6.69 days, 647 deaths occurred in total. After adjustment for potential confounding factors, setting the low mNUTRIC group as a reference, the risk of 28-day mortality was increased in the high and moderate mNUTRIC groups (hazard ratio [HR]high vs low [95% CI]: 4.21 [2.70-6.58] and 2.84 [1.95-4.14], respectively). Similarly, high and moderate mNUTRIC scores are linked to a higher risk of 7-day mortality (PTrend < 0.001) and a longer duration of mechanical ventilation (PTrend < 0.001). The effect of mNUTRIC on mortality varied by serum glucose level (PInteraction = 0.01). Lastly, those whose mNUTRIC scores deteriorated within the first 3 days have a 1.46 times greater risk of dying compared with patients with improved mNUTRIC scores. CONCLUSIONS Nutrition risk screening by mNUTRIC score at the time of admission to the ICU may improve mortality prediction.
Collapse
Affiliation(s)
- Ping Li
- Key Laboratory of Biomedical Imaging of Guangdong Province, Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital at Sun Yat-sen University, Zhuhai, Guangdong, China
- Center for Interventional Medicine, The Fifth Affiliated Hospital at Sun Yat-Sen University, Zhuhai, Guangdong, China
| | - Sikai Li
- Key Laboratory of Biomedical Imaging of Guangdong Province, Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital at Sun Yat-sen University, Zhuhai, Guangdong, China
- Center for Interventional Medicine, The Fifth Affiliated Hospital at Sun Yat-Sen University, Zhuhai, Guangdong, China
| | - Shanshan Liu
- Department of Critical Illness, The Fifth Affiliated Hospital at Sun Yat-sen University, Zhuhai, Guangdong, China
| | - Man Li
- Key Laboratory of Biomedical Imaging of Guangdong Province, Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital at Sun Yat-sen University, Zhuhai, Guangdong, China
- Center for Interventional Medicine, The Fifth Affiliated Hospital at Sun Yat-Sen University, Zhuhai, Guangdong, China
| |
Collapse
|
16
|
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.
Collapse
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
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Alós Zaragozá L, Cobo Del Prado Ciurlizza I, Solis Albamonte P, Gandía Llopis J, Rosselló Chornet M, Romero García CS. The clinical impact of implementation of a nutritional treatment protocol in critically ill adults with SARS-CoV-2 infection. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:387-394. [PMID: 37553014 DOI: 10.1016/j.redare.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 11/27/2022] [Indexed: 08/10/2023]
Abstract
INTRODUCTION The critical patient affected by SARS-CoV-2 is at risk of malnutrition. The need to avoid volume overload and manoeuvres that delay reaching nutritional requirements such as pronation make the nutritional approach to these patients complex. To ensure adequate treatment, a nutritional support protocol was developed as a clinical practice guideline adapted to the COVID-19 patient. OBJECTIVE To describe and analyse the results of introducing a nutritional support protocol aimed at SARS-CoV-2 patients admitted to the intensive care unit (ICU) of the Consorcio Hospital General Universitario de Valencia (CHGUV) from March to May 2020. MATERIAL AND METHODS Observational, descriptive, retrospective and longitudinal design to evaluate compliance with a nutritional support protocol. RESULTS Thirty-one consecutive patients were included but nutritional follow-up could not be performed in eight. Of the remaining 23 patients, only eight reached 80% of caloric requirements before the tenth day after starting treatment (good compliance group) and 15 after the eleventh day (poor compliance group). In the group with «good compliance» 75% (n=6) were discharged and 25% died (n=2), compared to the group with «bad compliance» where 53% (n=8) were discharged and 47% (n=7) died (Chi square test, p-value=0.019). Those patients who reached 80% of caloric needs during ICU stay had a shorter length of stay compared to those who did not (median days of admission=14, IQR=10-16 and median days of admission=22, IQR=13-39, p-value=0.025). CONCLUSIONS Introducing a nutritional protocol during the first weeks of the SARS-CoV-2 pandemic could improve clinical outcomes by promoting healing and reducing associated complications.
Collapse
Affiliation(s)
- L Alós Zaragozá
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
| | - I Cobo Del Prado Ciurlizza
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - P Solis Albamonte
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - J Gandía Llopis
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - M Rosselló Chornet
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - C S Romero García
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| |
Collapse
|
18
|
Alós Zaragozá L, Cobo Del Prado Ciurlizza I, Solis Albamonte P, Gandía Llopis J, Rosselló Chornet M, Romero García CS. [The clinical impact of implementation of a nutritional treatment protocol in critically ill adults with SARS-CoV-2 infection]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023:S0034-9356(23)00108-1. [PMID: 37363692 PMCID: PMC10208262 DOI: 10.1016/j.redar.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 11/27/2022] [Indexed: 06/28/2023]
Abstract
Introduction The critical patient affected by SARS-CoV-2 is at risk of malnutrition. The need to avoid volume overload and manoeuvres that delay reaching nutritional requirements such as pronation make the nutritional approach to these patients complex. To ensure adequate treatment, a nutritional support protocol was developed as a clinical practice guideline adapted to the COVID-19 patient. Objective To describe and analyse the results of introducing a nutritional support protocol aimed at SARS-CoV-2 patients admitted to the intensive care unit (ICU) of the Consorcio Hospital General Universitario de Valencia (CHGUV) from March to May 2020. Material and methods Observational, descriptive, retrospective and longitudinal design to evaluate compliance with a nutritional support protocol. Results Thirty-one consecutive patients were included but nutritional follow-up could not be performed in eight. Of the remaining 23 patients, only eight reached 80% of caloric requirements before the tenth day after starting treatment (good compliance group) and 15 after the eleventh day (poor compliance group). In the group with «good compliance» 75% (n = 6) were discharged and 25% died (n = 2), compared to the group with «bad compliance» where 53% (n = 8) were discharged and 47% (n = 7) died (Chi square test, p-value = 0.019). Those patients who reached 80% of caloric needs during ICU stay had a shorter length of stay compared to those who did not (median days of admission = 14, IQR = 10-16 and median days of admission = 22, IQR = 13-39, p-value = 0.025). Conclusions Introducing a nutritional protocol during the first weeks of the SARS-CoV-2 pandemic could improve clinical outcomes by promoting healing and reducing associated complications.
Collapse
Affiliation(s)
- L Alós Zaragozá
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - I Cobo Del Prado Ciurlizza
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - P Solis Albamonte
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - J Gandía Llopis
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - M Rosselló Chornet
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - C S Romero García
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, España
| |
Collapse
|
19
|
Mahmoodpoor A, Sanaie S, Sarfaraz T, Shadvar K, Fattahi V, Hamishekar H, Vahedian-Azimi A, Samim A, Rahimi-Bashar F. Prognostic values of modified NUTRIC score to assess outcomes in critically ill patients admitted to the intensive care units: prospective observational study. BMC Anesthesiol 2023; 23:131. [PMID: 37081414 PMCID: PMC10116464 DOI: 10.1186/s12871-023-02086-0] [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: 01/01/2023] [Accepted: 04/08/2023] [Indexed: 04/22/2023] Open
Abstract
PURPOSE Modified Nutrition Risk in the Critically Ill (NUTRIC) score (mNUTRIC score) have been validated as screening tool for quantifying risk of adverse outcome critically ill patients admitted to the intensive care units (ICUs). The aim of this study was to evaluate the prognostic value of mNUTRIC score to assess outcomes in this population. MATERIALS AND METHODS This prospective, observational study was conducted on adult patients admitted to the general ICUs of two university affiliated hospital in northwest of Iran. The association between the mNUTRIC score and outcomes was assessed using the univariate and multivariate binary logistic regression. The performance of mNUTRIC score to predict outcomes was assessed using the receiver operating characteristic (ROC)-curve. RESULTS In total 445 ICU patients were enrolled. Based on mNUTRIC score, 62 (13.9%) and 383 (86.1%) individuals were identified at high and low nutritional risk, respectively. The area under the curve (AUC) for predicting ICU mortality, using vasopressor, duration of vasopressor, and mechanical ventilation (MV) duration were (AUC: 0.973, 95% CI: 0.954-0.986, P < 0.001), (AUC: 0.807, 95% CI: 0.767-0.843, P < 0.001), (AUC: 0.726, 95% CI: 0.680-0.769, P < 0.001) and (AUC: 0.710, 95% CI: 0.666-0.752, P < 0.001), respectively. CONCLUSIONS An excellent and good predictive performance of the mNUTRIC score was found regarding ICU mortality and using vasopressor, respectively. However, this predictive was fair for MV and vasopressor duration and poor for ICU and hospital length of stay.
Collapse
Affiliation(s)
- Ata Mahmoodpoor
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
- Evidence Based Research center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Sarvin Sanaie
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Tohid Sarfaraz
- Department of Anesthesiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kamran Shadvar
- Department of Anesthesiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Fattahi
- Department of Anesthesiology, Faculty of Medicine, Tabriz Islamic Azad Uniersity, Tabriz, Iran
| | - Hadi Hamishekar
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Vahedian-Azimi
- Trauma research center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Abbas Samim
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Farshid Rahimi-Bashar
- Anesthesia and Critical Care Department, Hamadan University of Medical Sciences, Ayatolah Motahari BLVD Resalat Square, Hamadan, 6514845411, Iran.
| |
Collapse
|
20
|
Singh K, Carvalho R, Tinne A, Bahall V, De Barry L, Sankar S. Perioperative challenges following management of spontaneous hepatic rupture in a parturient with severe pre-eclampsia – A case report. Case Rep Womens Health 2023; 37:e00499. [PMID: 36968549 PMCID: PMC10033934 DOI: 10.1016/j.crwh.2023.e00499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Spontaneous hepatic rupture in pregnancy (SHRP) is a rare but often fatal condition associated with pre-eclampsia or HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome. SHRP is linked to significant maternal and perinatal morbidity and mortality, and maternal complications can extend past the initial intraoperative period. This case report describes the challenging perioperative course of a 35-year-old woman with SHRP. She underwent five laparotomies during a prolonged and complicated course in the intensive care unit. Despite these challenges, maternal and fetal outcomes were good. This case report serves to highlight key perioperative multidisciplinary issues in the care of these patients.
Collapse
Affiliation(s)
- Keevan Singh
- Department of Anaesthesia and Intensive Care, San Fernando General Hospital, Trinidad and Tobago
| | - Randall Carvalho
- Department of Anaesthesia and Intensive Care, San Fernando General Hospital, Trinidad and Tobago
| | - Allan Tinne
- Department of Surgery, San Fernando General Hospital, Trinidad and Tobago
| | - Vishal Bahall
- Department of Obstetrics and Gynecology, San Fernando General Hospital, Trinidad and Tobago
| | - Lance De Barry
- Department of Obstetrics and Gynecology, San Fernando General Hospital, Trinidad and Tobago
- Corresponding author.
| | - Steven Sankar
- Department of Radiology, San Fernando General Hospital, Trinidad and Tobago
| |
Collapse
|
21
|
Pohlenz-Saw JAE, Merriweather JL, Wandrag L. (Mal)nutrition in critical illness and beyond: a narrative review. Anaesthesia 2023; 78:770-778. [PMID: 36644786 DOI: 10.1111/anae.15951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 01/17/2023]
Abstract
Close liaison with ICU-trained dietitians and early initiation of nutrition is a fundamental principle of care of critically ill patients- this should be done while monitoring closely for refeeding syndrome. Enteral nutrition delivered by volumetric pumps should be used where possible, though parenteral nutrition should be started early in patients with high nutritional risk factors. Malnutrition and loss of muscle mass are common in patients who are admitted to ICUs and are prognostic for patient-centred outcomes including complications and mortality. Obesity is part of that story, and isocaloric and high-protein provision of nutrition is important in this group of patients who comprise a growing proportion of people treated. Assessing protein stores and appropriate dosing is, however, challenging in all groups of patients. It would be beneficial to develop strategies to reduce muscle wasting as well; various strategies including amino acid supplementation, ketogenic nutrition and exercise have been trialled, but the quality of data has been inadequate to address this phenomenon. Nutritional targets are rarely achieved in practice, and all ICUs should incorporate clear guidelines to help address this. These should include local nutritional and fasting guidelines and for the management of feed intolerance, early access to post-pyloric feeding and a multidisciplinary framework to support the importance of nutritional education.
Collapse
Affiliation(s)
| | | | - L Wandrag
- Department of Nutrition & Dietetics, King's College Hospital, London, UK.,Department of Critical Care Medicine, King's College Hospital, London, UK
| |
Collapse
|
22
|
Smith LO, Olieman JF, Berk KA, Ligthart-Melis GC, Earthman CP. Clinical applications of body composition and functional status tools for nutrition assessment of hospitalized adults: A systematic review. JPEN J Parenter Enteral Nutr 2023; 47:11-29. [PMID: 36036239 DOI: 10.1002/jpen.2444] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND No global consensus exists on diagnostic criteria for malnutrition. Muscular deficits and functional impairments are major components of available malnutrition diagnostic frameworks because these facets of nutrition status significantly impact outcomes. The purpose of this review is to explore which body composition assessment (BCA) and functional status assessment (FSA) tools are being used for nutrition assessment (NA) and monitoring the response to nutrition interventions (RNIs) in adult inpatients. METHODS A literature search of Embase, Medline (Ovid), Web of Science, and Cochrane Central was performed to identify studies that used BCA and/or FSA tools for NA (along with an accepted NA diagnostic framework) and/or for monitoring RNI in adult inpatients. RESULTS The search yielded 3667 articles; 94 were included in the review. The number of studies using BCA and/or FSA tools for NA was 47 and also 47 for monitoring RNI. Seventy-nine percent of studies used bioimpedance for BCA, and 97% that included FSA utilized handgrip strength. When compared against sets of diagnostic criteria, many of the BCA and FSA tools showed promising associations with nutrition status. CONCLUSION Bioimpedance methods are the most widely used bedside BCA tools, and handgrip strength is the most widely used FSA tool; however, these methods are being used with a variety of protocols, algorithms, and interpretation practices in heterogeneous populations. To create a standardized nutrition status assessment process there is a need for validation studies on bedside methods and the development of globally standardized assessment protocols in clinical inpatient settings.
Collapse
Affiliation(s)
- Luke O Smith
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware, USA
| | - Joanne F Olieman
- Division of Dietetics, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Kirsten A Berk
- Division of Dietetics, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Gerdien C Ligthart-Melis
- Division of Dietetics, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Carrie P Earthman
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware, USA
| |
Collapse
|
23
|
Fasting practices of enteral nutrition delivery for airway procedures in critically ill adult patients: A scoping review. J Crit Care 2022; 72:154144. [PMID: 36115335 DOI: 10.1016/j.jcrc.2022.154144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/09/2022] [Accepted: 08/25/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is limited understanding of fasting practices and reported safety concerns for airway procedures in critically ill adults. OBJECTIVE To describe fasting practices including safety concerns for airway procedures in critically ill adult patients in the reported literature. INCLUSION CRITERIA Studies conducted in adult critically ill patients receiving enteral nutrition (EN) and undergoing an airway procedure (endotracheal intubation, endotracheal extubation, and tracheostomy) were included if EN fasting practices and/or prespecified nutrition and clinical outcomes were reported. METHODS A scoping review using the Joanna Briggs Institute methodology was conducted. MEDLINE, Embase, and CINAHL were searched from 2000 to January 19, 2022. Results are presented via narrative synthesis. RESULTS Fourteen studies were included, with only one randomised control trial (RCT). Twelve studies reported on fasting practices with varied EN fasting durations (0-34 h) and two reported data on nutrition adequacy. Three studies investigated continued EN in one study arm and four studies minimised fasting duration by including gastric suctioning prior to the airway procedure. Safety concerns primarily related to aspiration events (61%) were reported in nine studies. CONCLUSION In the reported literature, there is wide variation in EN fasting practices for airway procedures in critically ill patients with limited evidence to inform practice.
Collapse
|
24
|
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.
Collapse
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: )
| |
Collapse
|
25
|
Ramirez-Vega D, Salinas-Cortes M, Melendez-Coral M, Cordell GA, Rodriguez-Garcia A. The evolution of nutrition intervention during the COVID-19 pandemic. CIENCIA & SAUDE COLETIVA 2022; 27:3053-3061. [PMID: 35894318 DOI: 10.1590/1413-81232022278.04082021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 10/20/2021] [Indexed: 11/22/2022] Open
Abstract
COVID-19 has challenged health professionals in widely divergent areas, including innovation of practice, communication, multidisciplinary activities, broader use of technology, and adaptability. The role of the dietitian and other health professionals in dealing with the evolving crisis might be considered essential in treating patients. Given the limited access to various food options, nutrition screening and assessment deserves a high priority to complete a comprehensive nutrition evaluation, identify nutrition risks, prioritize care, and provide early nutrition intervention and support to all patients with or who have had, COVID-19 and are experiencing ongoing symptoms. Such an intervention would benefit the patients and the health system by reducing the length of hospital stay, ameliorating further complications, limiting hospital readmission, enhancing recovery, and assisting in the management of comorbidities and their metabolic alterations. This brief overview outlines the essential role of nutrition intervention and support as part of an integrated, multidisciplinary treatment program for the care of COVID-19 patients during the pandemic. Restrictive movements have changed consultative approaches, and the importance of Telenutrition for the effective communication of health status and recommendations.
Collapse
Affiliation(s)
- Dixia Ramirez-Vega
- School of Nutrition, Tecnológico de Monterrey. Av. Morones Prieto 3000, Col. Sertoma. 64710 Monterrey NL Mexico.
| | - Monica Salinas-Cortes
- Steinhardt Department of Nutrition and Food Studies, New York University. New York NY USA.,Clinical Nutrition Department, Moses Division, Montefiore Medical Center. New York NY USA
| | - Melissa Melendez-Coral
- School of Nutrition, Tecnológico de Monterrey. Av. Morones Prieto 3000, Col. Sertoma. 64710 Monterrey NL Mexico.
| | - Geoffrey A Cordell
- Natural Products Inc, USA and College of Pharmacy, University of Florida. Gainesville FL USA
| | - Aida Rodriguez-Garcia
- School of Nutrition, Tecnológico de Monterrey. Av. Morones Prieto 3000, Col. Sertoma. 64710 Monterrey NL Mexico. .,Facultad de Ciencias Biológicas, Instituto de Biotecnología, Universidad Autónoma de Nuevo León. San Nicolás de los Garza NL México
| |
Collapse
|
26
|
Ong CS, Brown P, Shou BL, Wilcox C, Cho SM, Mendez-Tellez PA, Kim BS, Whitman GJR. Resting Energy Expenditure of Patients on Venovenous Extracorporeal Membrane Oxygenation for Adult Respiratory Distress Syndrome: A Pilot Study. Crit Care Explor 2022; 4:e0730. [PMID: 35923588 PMCID: PMC9296180 DOI: 10.1097/cce.0000000000000730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The objectives of this study were to 1) in patients without pulmonary function, determine resting energy expenditure (REE) in venovenous extracorporeal membrane oxygenation (ECMO) acute respiratory distress syndrome (ARDS) patients by paralysis status and 2) determine the threshold tidal volume (TV) associated with meaningful gas exchange as determined by measurable end-tidal carbon dioxide elimination (etV̇co2). DESIGN Retrospective observational study. SETTING A tertiary high ECMO volume academic institution. PATIENTS/SUBJECTS Ten adult ARDS patients on venovenous ECMO. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The modified Weir equation, Fick principle, Henderson-Hasselbalch equation, ECMO flow, hemoglobin, and pre and post oxygenator blood gases were used to determine ECMO carbon dioxide production (V̇co2), ECMO oxygen consumption, and REE. REE values were matched to patients' paralysis status based on medication flowsheets and compared using a paired t test. Linear regression was performed to determine the threshold TV normalized to ideal body weight (IBW) associated with measurable ventilator etV̇co2, above which meaningful ventilation occurs. When lungs were not functioning, patients had significantly lower mean REE when paralyzed (23.4 ± 2.8 kcal/kg/d) than when not paralyzed (29.2 ± 5.8 kcal/kg/d) (p = 0.02). Furthermore, mean REE was not similar between patients and varied as much as 1.7 times between patients when paralyzed and as much as 1.4 times when not paralyzed. Linear regression showed that ventilator V̇co2 was measurable and increased linearly when TV was greater than or equal to 0.7 mL/kg. CONCLUSIONS REE is patient-specific and varies significantly with and without patient paralysis. When TV exceeds 0.7 mL/kg IBW, ventilator V̇co2 increases measurably and must be considered in determining total REE.
Collapse
Affiliation(s)
- Chin Siang Ong
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Division of Surgical Outcomes, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Patricia Brown
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Benjamin L Shou
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christopher Wilcox
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sung-Min Cho
- Division of Neuroscience Critical Care, Departments of Neurology, Neurosurgery, Anesthesia and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD
| | | | - Bo Soo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Glenn J R Whitman
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
27
|
Loss SH, Teichmann PDV, Pedroso de Paula T, Gross LDA, Costa VL, Lisboa BO, Sperb LF, Viana MV, Viana LV. LOSS et al.Nutrition as a risk for mortality and functionality in critically ill older adultsNutrition as a risk for mortality and functionality in critically ill older adults. JPEN J Parenter Enteral Nutr 2022; 46:1867-1874. [PMID: 35770828 DOI: 10.1002/jpen.2431] [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: 02/22/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND & AIMS There is no specific recommendation for nutrition therapy for critically ill older adults. However, targeting caloric and protein balance and avoiding fasting could improve outcomes in this high-risk nutritional population. This study aimed to evaluate the associations between nutrition and mortality/functionality in critically ill older patients. METHODS Single-center retrospective observational study of critically ill patients aged 65 years or older. We extracted data from the dietician evaluations about calories, proteins, and the type of diet (fasting, oral, enteral, parenteral) prescribed in the first week of intensive care unit admission. Primary outcomes were intrahospital mortality and independence and functional capacity evaluated after hospital discharge. RESULTS Out of the 2,043 patients screened, 533 were included in the study. Most patients were men (52.1%), with a median age of 73 (68-78) years. Overall, the intrahospital mortality rate was 53.8%. SAPS-3, albumin, C-reactive protein, and surgical patients were independently associated with fasting in a multivariate analysis. The multivariate regression analyses showed that SAPS-3, albumin, and fasting were independently associated with mortality. Each fasting day increases the risk of mortality by 16.7%. Also, independence and functional capacity were not related to nutritional prescription. CONCLUSION Older adults (65 years or older) constitute a fragile population in which nutritional breaks were associated with increased hospital mortality. Furthermore, a prospective clinical trial is necessary to establish the best strategy to feed this population. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Sergio Henrique Loss
- Hospital de Clínica de Porto Alegre (HCPA) and Universidade Federal do Rio Grande do Sul (UFRGS)
| | - Pedro do Valle Teichmann
- Hospital de Clínica de Porto Alegre (HCPA) and Universidade Federal do Rio Grande do Sul (UFRGS)
| | - Tatiana Pedroso de Paula
- Hospital de Clínica de Porto Alegre (HCPA) and Universidade Federal do Rio Grande do Sul (UFRGS)
| | - Luiza de Azevedo Gross
- Hospital de Clínica de Porto Alegre (HCPA) and Universidade Federal do Rio Grande do Sul (UFRGS)
| | - Vicente Lobato Costa
- Hospital de Clínica de Porto Alegre (HCPA) and Universidade Federal do Rio Grande do Sul (UFRGS)
| | | | - Luiza Ferreira Sperb
- Hospital de Clínica de Porto Alegre (HCPA) and Universidade Federal do Rio Grande do Sul (UFRGS)
| | - Marina Verçoza Viana
- Hospital de Clínica de Porto Alegre (HCPA) and Universidade Federal do Rio Grande do Sul (UFRGS)
| | - Luciana Verçoza Viana
- Hospital de Clínica de Porto Alegre (HCPA) and Universidade Federal do Rio Grande do Sul (UFRGS)
| |
Collapse
|
28
|
Lederer AK, Huber R. The Relation of Diet and Health: You Are What You Eat. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137774. [PMID: 35805428 PMCID: PMC9266141 DOI: 10.3390/ijerph19137774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 12/10/2022]
Affiliation(s)
- Ann-Kathrin Lederer
- Center for Complementary Medicine, Department of Medicine II, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
- Department of General, Visceral and Transplantation Surgery, University Medical Center, 55131 Mainz, Germany
- Correspondence:
| | - Roman Huber
- Center for Complementary Medicine, Department of Medicine II, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| |
Collapse
|
29
|
Methodological Rigor and Transparency in Clinical Practice Guidelines for Nutrition Care in Critically Ill Adults: A Systematic Review Using the AGREE II and AGREE-REX Tools. Nutrients 2022; 14:nu14132603. [PMID: 35807784 PMCID: PMC9268338 DOI: 10.3390/nu14132603] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 02/07/2023] Open
Abstract
Background: To evaluate the methodological quality of (1) clinical practice guidelines (CPGs) that inform nutrition care in critically ill adults using the AGREE II tool and (2) CPG recommendations for determining energy expenditure using the AGREE-REX tool. Methods: CPGs by a professional society or academic group, intended to guide nutrition care in critically ill adults, that used a systematic literature search and rated the evidence were included. Four databases and grey literature were searched from January 2011 to 19 January 2022. Five investigators assessed the methodological quality of CPGs and recommendations specific to energy expenditure determination. Scaled domain scores were calculated for AGREE II and a scaled total score for AGREE-REX. Data are presented as medians (interquartile range). Results: Eleven CPGs were included. Highest scoring domains for AGREE II were clarity of presentation (82% [76–87%]) and scope and purpose (78% [66–83%]). Lowest scoring domains were applicability (37% [32–42%]) and stakeholder involvement (46% [33–51%]). Eight (73%) CPGs provided recommendations relating to energy expenditure determination; scores were low overall (37% [36–40%]) and across individual domains. Conclusions: Nutrition CPGs for critically ill patients are developed using systematic methods but lack engagement with key stakeholders and guidance to support application. The quality of energy expenditure determination recommendations is low.
Collapse
|
30
|
Kangalgil M, Ulusoy H, Turan S, Oncu K. Association between skeletal muscle changes, anthropometric measurements, and clinical outcomes in critically ill trauma and surgical patients: A prospective observational study. Nutr Clin Pract 2022; 37:1326-1335. [PMID: 35594361 DOI: 10.1002/ncp.10865] [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: 12/23/2021] [Revised: 04/06/2022] [Accepted: 04/21/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Acute skeletal muscle wasting may predict clinical outcomes in critically ill patients. This study aimed to assess acute muscle loss, changes in anthropometric measurements, and the relationship between muscle loss and clinical outcomes in critically ill trauma and surgical patients. METHODS This single-center, prospective observational study was conducted in critically ill trauma and surgical patients who were expected to stay in the intensive care unit (ICU) for at least 7 days. Rectus femoris cross-sectional area muscle measurements were performed by bedside ultrasound, and anthropometric measurements were obtained at baseline and 7 days after the first assessment. Length of mechanical ventilation, ICU and hospital stay, and mortality were recorded. RESULTS Thirty-five patients with a mean age of 49.6 ± 18.6 years and 74.1% male were enrolled. The rectus femoris cross-sectional area, mid-arm circumference, and calf circumference were reduced at second assessment from baseline (P < 0.05). In univariate analysis, muscle loss and changes in anthropometric measurements were not associated with 90-day mortality (P > 0.05). CONCLUSION Muscle loss in critical trauma and surgical patients occurred rapidly during the first week of critical illness. Rectus femoris muscle cross-sectional area assessment can be used to detect skeletal muscle changes in critically ill patients. Further investigations on the skeletal muscle changes and clinical outcomes need to be conducted.
Collapse
Affiliation(s)
- Melda Kangalgil
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Karadeniz Technical University, Trabzon, Turkey
| | - Hülya Ulusoy
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Sekine Turan
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Kıvanç Oncu
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| |
Collapse
|
31
|
Roudi F, Saghi E, Ayoubi SS, Pouryazdanpanah M. Clinical nutrition approach in medical management of COVID-19 hospitalized patients: A narrative review. Nutr Health 2022; 28:357-368. [PMID: 35581719 PMCID: PMC9117992 DOI: 10.1177/02601060221101696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: Malnutrition in COVID-19 hospitalized patients is associated with a high-risk
condition to increase disease severity and prolonging the recovery period.
Therefore, nutritional therapy, including supplements plays a critical role
to reduce disease-related complications and the length of hospital stay. Aim: To review the latest evidence on nutritional management options in COVID-19
hospitalized patients, as well as possibly prescribed supplements.
Methods: This review was conducted by considering the
latest recommendations, using the guidelines of the American Society of
Enteral and Parenteral (ASPEN) and the European Society of Enteral and
Parenteral (ESPEN), and searching Web of Science, PubMed/Medline, ISI, and
Medline databases. The relevant articles were found using a mix of related
mesh terms and keywords. We attempted to cover all elements of COVID-19
hospitalized patients’ dietary management. Results: Energy
demand in COVID-19 patients is a vital issue. Indirect Calorimetry (IC) is
the recommended method to measure resting energy expenditure. However, in
the absence of IC, predictive equations may be used. The ratio of
administered diet for the macronutrients could be based on the phase and
severity of Covid-19 disease. Moreover, there are recommendations for taking
micronutrient supplements with known effects on improving the immune system
or reducing inflammation. Conclusions: Nutritional treatment of
COVID-19 patients in hospitals seems to be an important element of their
medical care. Enteral nutrition would be the recommended feeding method for
early nutrition support. However, data in the COVID-19 nutritional domain
relating to micronutrient supplementation are still fragmentary and
disputed, and further study is required.
Collapse
Affiliation(s)
- Fatemeh Roudi
- Department of Nutrition, Faculty of Medicine, 37552Mashhad University of Medical Sciences, Mashhad, Iran
| | - Effat Saghi
- Department of Nutrition, Faculty of Medicine, 37552Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samaneh Sadat Ayoubi
- Department of Nutrition, Faculty of Medicine, 37552Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdieh Pouryazdanpanah
- Department of Nutrition, Public Health School, Kerman University of Medical Sciences, Kerman, Iran
| |
Collapse
|
32
|
Macronutrients and fatty acids of enteral diets: A comparison between labels and analytical findings. J Food Compost Anal 2022. [DOI: 10.1016/j.jfca.2021.104273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
33
|
How much underfeeding can the critically ill adult patient tolerate? JOURNAL OF INTENSIVE MEDICINE 2022; 2:69-77. [PMID: 36789187 PMCID: PMC9923975 DOI: 10.1016/j.jointm.2022.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/26/2021] [Accepted: 01/06/2022] [Indexed: 12/13/2022]
Abstract
Critical illness leads to significant metabolic alterations that should be considered when providing nutritional support. Findings from key randomized controlled trials (RCTs) indicate that underfeeding (<70% of energy expenditure [EE]) during the acute phase of critical illness (first 7 days of intensive care unit [ICU] admission) may not be harmful and could instead promote autophagy and prevent overfeeding in light of endogenous energy production. However, the optimal energy target during this period is unclear and full starvation is unlikely to be beneficial. There are limited data regarding the effects of prolonged underfeeding on clinical outcomes in critically ill patients, but recent studies show that oral food intake is suboptimal both in the ICU and following discharge to the acute care setting. It is hypothesized that provision of full nutrition (70-100% of EE) may be important in the recovery phase of critical illness (>7 days of ICU admission) for promoting recovery and rehabilitation; however, studies on nutritional intervention delivered from ICU admission through hospital discharge are needed. The aim of this review is to provide a narrative synthesis of the existing literature on metabolic alterations experienced during critical illness and the impact of underfeeding on clinical outcomes in the critically ill adult patient.
Collapse
|
34
|
Servia-Goixart L, Lopez-Delgado JC, Grau-Carmona T, Trujillano-Cabello J, Bordeje-Laguna ML, Mor-Marco E, Portugal-Rodriguez E, Lorencio-Cardenas C, Montejo-Gonzalez JC, Vera-Artazcoz P, Macaya-Redin L, Martinez-Carmona JF, Iglesias-Rodriguez R, Monge-Donaire D, Flordelis-Lasierra JL, Llorente-Ruiz B, Menor-Fernández EM, Martínez de Lagrán I, Yebenes-Reyes JC, Servia-Goixart L, Trujillano-Cabello J, Escobar-Ortiz J, Montserrat-Ortiz N, Zapata-Rojas A, Grau-Carmona T, Bautista-Redondo I, Cruz-Ramos A, Diaz-Castellanos L, Morales-Cifuentes M, Bono MP, Montejo-Gonzalez JC, Temprano-Vazquez S, Arjona-Diaz V, Garcia-Fuentes C, Mudarra-Reche C, Orejana-Martin M, Lopez-Delgado JC, Lores-Obradors A, Anguela-Calvet L, Muñoz-Del Río G, Revelo-Esquibel PA, Alanez-Saavedra H, Serra-Paya P, Luna-Solis SM, Salinas-Canovas A, De Frutos-Seminario F, Rodriguez-Queralto O, Gonzalez-Iglesias C, Zamora-Elson M, Fuente-O'Connor EDL, Arbeloa CS, Bueno-Vidales N, Iglesias-Rodriguez R, Martin-Luengo A, Sanchez-Miralles A, Marmol-Peis E, Ruiz-Miralles M, Gonzalez-Sanz M, Server-Martinez A, Vila-Garcia B, Lorencio-Cardenas C, Macaya-Redin L, Flecha-Viguera R, Aldunate-Calvo S, Flordelis-Lasierra JL, Rio IJD, Mampaso-Recio JR, Rodriguez-Roldan JM, Gastaldo-Simeon R, Gimenez-Castellanos J, Fernandez-Ortega JF, Martinez-Carmona JF, Lopez-Luque E, Ortega-Ordiales A, Crespo-Gomez M, Ramirez-Montero V, Lopez-García E, Navarro-Lacalle A, Martinez-Garcia P, Dominguez-Fernandez MI, Vera-Artazcoz P, Izura-Gomez M, Hernandez-Duran S, Bordeje-Laguna ML, Mor-Marco E, Rovira-Valles Y, Philibert V, Alcazar-Espin MDLN, Higon-Cañigral A, Calvo-Herranz E, Manzano-Moratinos D, Portugal-Rodriguez E, Andaluz-Ojeda D, Parra-Morais L, Citores-Gonzalez R, Garcia-Gonzalez MT, Sanchez-Giron GR, Navas-Moya E, Ferrer-Pereto C, Lluch-Candal C, Ruiz-Izquierdo J, Castor-Bekari S, Leon-Cinto C, Martinez de Lagran I, Yebenes-Reyes JC, Nieto-Martino B, Vaquerizo-Alonso C, Almanza-Lopez S, Perez-Quesada S, Anton-Pascual JL, Marin-Corral J, Sistachs-Baquedano M, Hacer-Puig M, Picornell-Noguera M, Mateu-Campos L, Martinez-Valero C, Ortiz-Suñer A, Llorente-Ruiz B, Martinez-Diaz MC, Muñoz De La Peña MT, Rodriguez-Serrano DA, Fernandez-Salvatierra L, Barcelo-Castello M, Millan-Taratiel P, Tejada-Artigas A, Martinez-Arroyo I, Araujo-Aguilar P, Fuster-Cabre M, Andres-Gines L, Soldado-Olmo S, Menor-Fernandez EM, Lage-Cendon L, Touceda-Bravo A, Sanchez-Ales L, Almorin-Gonzalvez L, Gero-Escapa M, Martinez-Barrio E, Ossa-Echeverri S, Monge-Donaire D. Evaluation of Nutritional Practices in the Critical Care patient (The ENPIC study): Does nutrition really affect ICU mortality? Clin Nutr ESPEN 2022; 47:325-332. [DOI: 10.1016/j.clnesp.2021.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
|
35
|
Slingerland-Boot H, Adhikari S, Mensink M, van Zanten A. Comparison of the Beacon and Quark indirect calorimetry devices to measure resting energy expenditure in ventilated ICU patients. Clin Nutr ESPEN 2022; 48:370-377. [DOI: 10.1016/j.clnesp.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 01/12/2022] [Indexed: 11/17/2022]
|
36
|
Formenti P, Coppola S, Umbrello M, Froio S, Caccioppola A, De Giorgis V, Galanti V, Lusardi AC, Ferrari E, Noè D, Carnier S, Folli F, Chiumello D. Time course of the Bioelectrical Impedance Vector Analysis and muscular ultrasound in critically ill patients. J Crit Care 2021; 68:89-95. [PMID: 34952476 DOI: 10.1016/j.jcrc.2021.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 11/11/2021] [Accepted: 11/27/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE Several different tools have been developed to integrate the clinical and biochemical nutritional evaluations in critical care patients. Aims of this study were to evaluate the changes in the Bioelectrical Impedance Vector Analysis (BIVA) and ultrasonographic features of the diaphragm (DTee) and rectus femoris (RFCSA) during the first week of ICU stay. MATERIALS AND METHODS Ninety-six adult mechanically ventilated patients enrolled within 24 h after the admission to the ICU (T1). RFCSA and diaphragm end-expiratory thickness were measured, as well as BIVA parameters. Anthropometric data and biochemical parameters were collected. The measurements were repeated on the 3rd (T3) and 7th (T7) days of ICU stay. RESULTS During the study period, the phase angle significantly decreased by 21%, reactance by 27%, and resistance by 11%. Both RFCSA and DTee significantly decreased, while neither were correlated to any BIVA parameter. DTee was considerably higher in survivors vs. non-survivors. CONCLUSIONS Body composition is significantly modified after one week of ICU stay. BIVA may be useful in the definition of hydration state, while it does not seem to track muscle mass. Different temporal trends of specific BIVA and muscle ultrasound parameters were found in patients with high or low severity of illness.
Collapse
Affiliation(s)
- Paolo Formenti
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy.
| | - Silvia Coppola
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy
| | - Michele Umbrello
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy
| | - Sara Froio
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy
| | - Alessio Caccioppola
- Dipartimento di fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Valentina De Giorgis
- Dipartimento di fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Valentina Galanti
- Dipartimento di fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Andrea Clarissa Lusardi
- Dipartimento di fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Erica Ferrari
- Dipartimento di fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Donatella Noè
- SSD Servizio Dietetico e Nutrizione Clinica- ASST Santi Paolo e Carlo, Ospedali San Paolo e San Carlo Borromeo, Milan, Italy
| | - Simone Carnier
- Endocrinology and Metabolism, Department of Health Science, University of Milan - ASST Santi Paolo e Carlo, Ospedali San Paolo e San Carlo Borromeo, Milan, Italy
| | - Franco Folli
- Endocrinology and Metabolism, Department of Health Science, University of Milan - ASST Santi Paolo e Carlo, Ospedali San Paolo e San Carlo Borromeo, Milan, Italy; Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Davide Chiumello
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy; Centro Ricerca Coordinata di Insufficienza Respiratoria, Università degli Studi di Milano, Milan, Italy; Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
37
|
Burgdorf L. Nutritional management of a polytrauma patient in an intensive care unit. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2021. [DOI: 10.1080/16070658.2021.2003969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Lisa Burgdorf
- Dietetics, Harry Gwala Regional Hospital, Pietermaritzburg, South Africa
| |
Collapse
|
38
|
Breik L, Tatucu-Babet OA, Ridley EJ. Micronutrient intake from enteral nutrition in critically ill adults: A systematic review of randomised controlled trials. Aust Crit Care 2021; 35:564-574. [PMID: 34756550 DOI: 10.1016/j.aucc.2021.09.001] [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: 09/30/2020] [Revised: 08/29/2021] [Accepted: 09/03/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES The primary objective was to compare the intake of important micronutrients provided from enteral nutrition to critically ill patients with the Australia and New Zealand recommended dietary intakes. A secondary objective was to compare the upper levels of intake and investigate prespecified subgroups. REVIEW METHOD USED A systematic literature review was performed. DATA SOURCES MEDLINE, EMBASE, CINAHL, and CENTRAL were used. REVIEW METHODS Databases were searched for randomised controlled trials that investigated an enteral nutrition intervention as the sole source of nutrition, were published in English between January 2000 and January 8th, 2021, and provided data to calculate micronutrient intake. The primary outcome was the % recommended dietary intake. The quality of individual trials was assessed using the Cochrane Risk of Bias Tool. Outcomes are presented as either mean ± standard deviation or median [interquartile range], with a p < 0.05 considered statistically significant. RESULTS Thirteen trials were included (n = 1538 patients). Trials investigating hypocaloric nutrition were excluded from the primary outcome assessment (conducted in nine trials (n = 1220)). All nine trials delivered ≥104% of the recommended dietary intakes and <100% of the upper level of intakes of all micronutrients. In subgroup analyses, trials with ≥80% target energy delivered a higher % of the recommended dietary intake of vitamin B12, thiamine, zinc, and vitamin C. Acute Physiology and Chronic Health Evaluation scores ≥20 delivered a higher % of the recommended dietary intake of vitamin B12 and vitamin A. Antioxidant formulas compared with standard formulas delivered a higher % recommended dietary intake of vitamin C and thiamine. In the four trials that investigated hypocaloric feeding compared with control, there was no difference in micronutrient intake. The quality was low. CONCLUSIONS Enteral nutrition delivery frequently met the recommended dietary intakes for all micronutrients investigated and did not exceed the upper levels of intake set for health. PROSPERO REGISTRATION CRD42020178333.
Collapse
Affiliation(s)
- Lina Breik
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Level 3, 555 St Kilda Rd, Melbourne, VIC, 3004, Australia; Nutrition and Dietetics Department, Box Hill Hospital, Eastern Health, 8 Arnold Street, Box Hill, Melbourne, VIC, 3128, Australia
| | - Oana A Tatucu-Babet
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Level 3, 555 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - Emma J Ridley
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Level 3, 555 St Kilda Rd, Melbourne, VIC, 3004, Australia; Nutrition Department, Alfred Hospital, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia.
| |
Collapse
|
39
|
Pisani D, Navalesi P, De Rosa S. Do we need a 6D's Framework of Nutritional Stewardship in critical care? JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE (ONLINE) 2021; 1:5. [PMID: 37386525 DOI: 10.1186/s44158-021-00009-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 09/13/2021] [Indexed: 07/01/2023]
Abstract
Recent European Society for Clinical Nutrition and Metabolism (ESPEN) guideline on clinical nutrition in the intensive care unit had as ultimate goal the achievement of optimal nutritional support for critically ill patients and to illuminate the gaps in knowledge in order to provide priorities for future clinical research. Although malnutrition is a vital part of the treatment of patients with critical illness and injury, nutrition in the critically ill is not one size fits all. Both clinical nutrition guidelines and ICU experts have recognized the need for a new, individualized approach to nutrition. Nutrition stewardship, analog to antimicrobial and fluid stewardship, could be defined as the "ongoing effort by a healthcare institution to optimise artificial nutrition use in order to improve patient outcomes, ensure cost effective therapy and reduce adverse sequelae." A robust nutrition stewardship program could gain reputation if the concept will spread to various national programs and regulatory guidelines released in the recent past.
Collapse
Affiliation(s)
- Dafne Pisani
- Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Paolo Navalesi
- Department of Medicine, Anesthesia and Critical Care Unit, Padua University Hospital, Padua, Italy
| | - Silvia De Rosa
- Department of Anesthesiology and Intensive Care, San Bortolo Hospital, Vicenza, Italy.
| |
Collapse
|
40
|
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.
Collapse
|
41
|
Lu B, Xu A, Li J, Xu Z, Li H, Zhao Z. Nursing effect of Nasoscopically assisted nasogastri tube and nasojejunal tube placement. Am J Transl Res 2021; 13:10758-10764. [PMID: 34650752 PMCID: PMC8507015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/29/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the nursing effect of nasoscopically assisted nasogastri tube and nasojejunal tube placement. METHODS 94 patients who need to place nasogastric tube and nasojejunal tube to establish enteral nutrition were randomly divided into two groups: the observation group (n=49) and control group (n=45). The patients in the observation group received nasogastric tube placement and jejunal nutrition tube placement, and the patients in the control group received general gastroscope and placed gastric tube and jejunal nutrition tube through mouth. Success rate of catheterization, catheter pain score, satisfaction score, vital signs, completion time of catheterization, and complication were collected. RESULTS the fluctuation of vital signs in control group was significantly higher than that in observation group. There was statistical significance between two groups in vital signs after intervention (P<0.05), mainly manifested in the heart rate, breathing and pulse pressure difference. On the other hand, there was no statistical significance between two groups in pulse oxygen after nursing intervention (P>0.05). The catheter pain score is obviously improved in the observation group compared with control group after intervention. The improvement score of satisfaction in the observation group was 91.47±7.65 points, and that in the control group was 83.64±5.24 points. The completion time of catheterization was improved in the observation group compared with control group. There was statistical significance between two groups in satisfaction score and completion time of catheterization (P<0.05). The rate of abdominal distention and diarrhea in the control group was higher than that in the observation group (P<0.05). CONCLUSION Nasoscopically assisted nasogastri tube and nasojejunal tube placement has the advantages of simple and fast, short operation time, high success rate and few complications. It is the first choice of intubation method for enteral nutrition support treatment.
Collapse
Affiliation(s)
- Bing Lu
- Endoscopic Center, The First Affiliated Hospital of Hainan Medical UniversityHaikou 570102, Hainan, China
| | - Aihong Xu
- Department of Geriatrics, Sanya People’s HospitalSanya 572000, Hainan, China
| | - Jun Li
- Endoscopic Center, The First Affiliated Hospital of Hainan Medical UniversityHaikou 570102, Hainan, China
| | - Zhiyu Xu
- Department of Critical Care Medicine, Hainan General Hospital, Hainan Affilicated Hospital of Hainan Medical UniversityHaikou 570311, Hainan, China
| | - Haiping Li
- Department of Geriatrics, Sanya People’s HospitalSanya 572000, Hainan, China
| | - Zhongyan Zhao
- Department of Neurology, Hainan General Hospital, Hainan Affilicated Hospital of Hainan Medical UniversityHaikou 570311, Hainan, China
| |
Collapse
|
42
|
Hill A, Elke G, Weimann A. Nutrition in the Intensive Care Unit-A Narrative Review. Nutrients 2021; 13:nu13082851. [PMID: 34445010 PMCID: PMC8400249 DOI: 10.3390/nu13082851] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/06/2021] [Accepted: 08/17/2021] [Indexed: 12/14/2022] Open
Abstract
Background: While consent exists, that nutritional status has prognostic impact in the critically ill, the optimal feeding strategy has been a matter of debate. Methods: Narrative review of the recent evidence and international guideline recommendations focusing on basic principles of nutrition in the ICU and the treatment of specific patient groups. Covered topics are: the importance and diagnosis of malnutrition in the ICU, the optimal timing and route of nutrition, energy and protein requirements, the supplementation of specific nutrients, as well as monitoring and complications of a Medical Nutrition Therapy (MNT). Furthermore, this review summarizes the available evidence to optimize the MNT of patients grouped by primarily affected organ system. Results: Due to the considerable heterogeneity of the critically ill, MNT should be carefully adapted to the individual patient with special focus on phase of critical illness, metabolic tolerance, leading symptoms, and comorbidities. Conclusion: MNT in the ICU is complex and requiring an interdisciplinary approach and frequent reevaluation. The impact of personalized and disease-specific MNT on patient-centered clinical outcomes remains to be elucidated.
Collapse
Affiliation(s)
- Aileen Hill
- Department of Intensive Care and Anesthesiology, University Hospital RWTH Aachen University, D-52074 Aachen, Germany
- Correspondence: (A.H.); (A.W.); Tel.: +49-(0)241-80-38166 (A.H.); +49-(0)341-909-2200 (A.W.)
| | - Gunnar Elke
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, D-24105 Kiel, Germany;
| | - Arved Weimann
- Department of General, Visceral and Oncological Surgery, Surgical Intensive Care Unit, Klinikum St. Georg, D-04129 Leipzig, Germany
- Correspondence: (A.H.); (A.W.); Tel.: +49-(0)241-80-38166 (A.H.); +49-(0)341-909-2200 (A.W.)
| |
Collapse
|
43
|
Sun JK, Nie S, Chen YM, Zhou J, Wang X, Zhou SM, Mu XW. Effects of permissive hypocaloric vs standard enteral feeding on gastrointestinal function and outcomes in sepsis. World J Gastroenterol 2021; 27:4900-4912. [PMID: 34447234 PMCID: PMC8371509 DOI: 10.3748/wjg.v27.i29.4900] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/09/2021] [Accepted: 07/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intestinal mucosal barrier injury and gastrointestinal dysfunction are important causes of sepsis. However, few studies have investigated the effects of enteral underfeeding on gastrointestinal function in sepsis. Moreover, no consensus on goal enteral caloric intake has been reached in sepsis.
AIM To investigate the effects of different goal caloric requirements of enteral nutrition on the gastrointestinal function and outcomes in the acute phase of sepsis.
METHODS Patients were randomly assigned to receive 30% (defined as group A), 60% (group B), or 100% (group C) of goal caloric requirements of enteral nutrition in this prospective pilot clinical trial. The acute gastrointestinal injury (AGI) grades, incidence of feeding intolerance (FI), daily caloric intake, nutritional and inflammatory markers, and biomarkers of mucosal barrier function were collected during the first 7 d of enteral feeding. The clinical severity and outcome variables were also recorded.
RESULTS A total of 54 septic patients were enrolled. The days to goal calorie of group C (2.55 ± 0.82) were significantly longer than those of group A (3.50 ± 1.51; P = 0.046) or B (4.85 ± 1.68; P < 0.001). The FI incidence of group C (16.5%) was higher than that of group A (5.0%) or B (8.7%) (P = 0.009). No difference in the incidence of FI symptoms was found between groups A and B. The serum levels of barrier function biomarkers of group B were significantly lower than those of group A (P < 0.05) on the 7th day of feeding. The prealbumin and IL-6 levels of group A were lower than those of group B (P < 0.05) on the 7th day of feeding. No significant differences in the clinical outcome variables or 28-d mortality were found among the three groups.
CONCLUSION Early moderate enteral underfeeding (60% of goal requirements) could improve the intestinal barrier function and nutritional and inflammatory status without increasing the incidence of FI symptoms in sepsis. However, further large-scale prospective clinical trials and animal studies are required to test our findings. Moreover, the effects of different protein intake on gastrointestinal function and outcomes should also be investigated in future work.
Collapse
Affiliation(s)
- Jia-Kui Sun
- Department of Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, Jiangsu Province, China
| | - Shuai Nie
- Department of Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, Jiangsu Province, China
| | - Yong-Ming Chen
- Department of Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, Jiangsu Province, China
| | - Jing Zhou
- Department of Geriatric Intensive Care Unit, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province People’s Hospital), Nanjing 210006, Jiangsu Province, China
| | - Xiang Wang
- Department of Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, Jiangsu Province, China
| | - Su-Ming Zhou
- Department of Geriatric Intensive Care Unit, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province People’s Hospital), Nanjing 210006, Jiangsu Province, China
| | - Xin-Wei Mu
- Department of Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, Jiangsu Province, China
| |
Collapse
|
44
|
Moltu SJ, Bronsky J, Embleton N, Gerasimidis K, Indrio F, Köglmeier J, de Koning B, Lapillonne A, Norsa L, Verduci E, Domellöf M. Nutritional Management of the Critically Ill Neonate: A Position Paper of the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 2021; 73:274-289. [PMID: 33605663 DOI: 10.1097/mpg.0000000000003076] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The nutritional management of critically ill term neonates and preterm infants varies widely, and controversies exist in regard to when to initiate nutrition, mode of feeding, energy requirements, and composition of enteral and parenteral feeds. Recommendations for nutritional support in critical illness are needed. METHODS The ESPGHAN Committee on Nutrition (ESPGHAN-CoN) conducted a systematic literature search on nutritional support in critically ill neonates, including studies on basic metabolism. The Medline database and the Cochrane Library were used in the search for relevant publications. The quality of evidence was reviewed and discussed before voting on recommendations, and a consensus of 90% or more was required for the final approval. Important research gaps were also identified. RESULTS This position paper provides clinical recommendations on nutritional support during different phases of critical illness in preterm and term neonates based on available literature and expert opinion. CONCLUSION Basic research along with adequately powered trials are urgently needed to resolve key uncertainties on metabolism and nutrient requirements in this heterogeneous patient population.
Collapse
Affiliation(s)
| | - Jiri Bronsky
- Department of Paediatrics, University Hospital Motol, Prague, Czech Republic
| | - Nicholas Embleton
- Newcastle Neonatal Service, Newcastle Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Konstantinos Gerasimidis
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, UK
| | - Flavia Indrio
- Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Jutta Köglmeier
- Department of paediatric Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Barbara de Koning
- Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Alexandre Lapillonne
- Paris University, APHP Necker-Enfants Malades hospital, Paris, France and CNRC, Baylor College of Medicine, Houston, TX
| | - Lorenzo Norsa
- Paediatreic Hepatology Gastroenterology and Transplantation, ASST Papa Giovanni XXIIII, Bergamo, Italy
| | - Elvira Verduci
- Department of Health Sciences, University of Milan; Department of Paediatrics, Ospedale dei Bambini Vittore Buzzi Milan, Italy
| | - Magnus Domellöf
- Department of Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden
| |
Collapse
|
45
|
Anunciação TA, de Carvalho WC, Korn MGA, Almeida JS, Dantas AF, Teixeira LSG. Evaluation of slurry sampling preparation of enteral nutrition formulations for multielement determination using inductively coupled plasma optical emission spectrometry. Food Chem 2021; 365:130474. [PMID: 34265645 DOI: 10.1016/j.foodchem.2021.130474] [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: 01/20/2021] [Revised: 04/19/2021] [Accepted: 06/24/2021] [Indexed: 01/10/2023]
Abstract
An analytical procedure for the multielement determination in enteral nutrition formulations employing slurry sampling and inductively coupled plasma optical emission spectrometry (ICP OES) is proposed. A two-level full-factorial design was applied to assess the influence of the presence of stabilizing agents (HNO3, Triton X-100 and ethanol) on the composition of the slurry. Multiple response was established as a dependent variable. The experimental conditions for the preparation of the slurry were: 2.0 mL of sample and 8.0 mL of 10% (v/v) HNO3. The limits of detection (LOD) were 5; 9; and 10 µg L-1 for Cu, Fe, Zn, respectively. For P, and K, the LOD were 8 and 24 mg L-1, respectively. The method was applied for the analysis of three enteral nutrition formulation samples and the obtained concentrations ranges were (in mg L-1): 0.41-0.43 (Cu), 2.0-2.9 (Fe), 1.7-3.1 (Zn), 682-1409 (K), and 217-344 (P).
Collapse
Affiliation(s)
- Taiana A Anunciação
- Universidade Federal da Bahia, Instituto de Química, Departamento de Química Analítica, Campus Universitário de Ondina, 40170-115 Salvador, Bahia, Brazil
| | - Wellington C de Carvalho
- Universidade Federal da Bahia, Instituto de Química, Departamento de Química Analítica, Campus Universitário de Ondina, 40170-115 Salvador, Bahia, Brazil
| | - Maria G A Korn
- Universidade Federal da Bahia, Instituto de Química, Departamento de Química Analítica, Campus Universitário de Ondina, 40170-115 Salvador, Bahia, Brazil; INCT de Energia e Ambiente - Universidade Federal da Bahia, Campus Universitário de Ondina, 40170-115 Salvador, Bahia, Brazil
| | - Jorge S Almeida
- Universidade Federal da Bahia, Instituto de Química, Departamento de Química Analítica, Campus Universitário de Ondina, 40170-115 Salvador, Bahia, Brazil; INCT de Energia e Ambiente - Universidade Federal da Bahia, Campus Universitário de Ondina, 40170-115 Salvador, Bahia, Brazil
| | - Alailson F Dantas
- Universidade Federal da Bahia, Instituto de Química, Departamento de Química Analítica, Campus Universitário de Ondina, 40170-115 Salvador, Bahia, Brazil
| | - Leonardo S G Teixeira
- Universidade Federal da Bahia, Instituto de Química, Departamento de Química Analítica, Campus Universitário de Ondina, 40170-115 Salvador, Bahia, Brazil; INCT de Energia e Ambiente - Universidade Federal da Bahia, Campus Universitário de Ondina, 40170-115 Salvador, Bahia, Brazil.
| |
Collapse
|
46
|
McKeever L, Peterson SJ, Lateef O, Braunschweig C. The Influence of Timing in Critical Care Nutrition. Annu Rev Nutr 2021; 41:203-222. [PMID: 34143642 DOI: 10.1146/annurev-nutr-111120-114108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Proper timing of critical care nutrition has long been a matter of controversy. Critical illness waxes and wanes in stages, creating a dynamic flux in energy needs that we have only begun to examine. Furthermore, response to nutrition support likely differs greatly at the level of the individual patient in regard to genetic status, disease stage, comorbidities, and more. We review the observational and randomized literature concerning timing in nutrition support, discuss mechanisms of harm in feeding critically ill patients, and highlight the role of precision nutrition for moving the literature beyond the realm of blunt population averages into one that accounts for the patient-specific complexities of critical illness and host genetics. Expected final online publication date for the Annual Review of Nutrition, Volume 41 is September 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
Collapse
Affiliation(s)
- Liam McKeever
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania 19063, USA;
| | - Sarah J Peterson
- Department of Clinical Nutrition, Rush University Medical Center, Chicago, Illinois 60612, USA
| | - Omar Lateef
- Department of Clinical Nutrition, Rush University Medical Center, Chicago, Illinois 60612, USA
| | - Carol Braunschweig
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois 60612, USA;
| |
Collapse
|
47
|
Pertzov B, Bar-Yoseph H, Menndel Y, Bendavid I, Kagan I, Glass YD, Singer P. The effect of indirect calorimetry guided isocaloric nutrition on mortality in critically ill patients-a systematic review and meta-analysis. Eur J Clin Nutr 2021; 76:5-15. [PMID: 34131296 DOI: 10.1038/s41430-021-00919-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/22/2021] [Accepted: 04/06/2021] [Indexed: 12/29/2022]
Abstract
Indirect calorimetry (IC)-guided nutrition might positively affect the clinical outcome of critically ill patients. In this systematic review and meta-analysis, our objective was to assess the benefit of isocaloric nutrition guided by IC, compared to hypocaloric nutrition, for critically ill patients admitted to the intensive care unit (ICU). We performed a systematic review of all randomized controlled trials published through January 2021, assessing the benefit of isocaloric nutrition guided by IC. The primary outcome was 28-day all-cause mortality. Secondary outcomes were ICU and 90-day all-cause mortality, rate of nosocomial infections, and adverse events. Four trials evaluating 1052 patients were included. Patients treated with isocaloric nutrition had a lower 28-day mortality rate (risk ratio (RR) 0.79, 95% confidence interval (CI) 0.63-0.99, P = 0.04). No between-group difference was found in ICU and 90-day mortality (RR 0.92, 95% CI 0.68-1.23, P = 0.56 and RR 0.88, 95% CI 0.72-1.07; P = 0.2, respectively) and in the rate of nosocomial infections (RR 1.15, 95% CI 0.77-1.72, P = 0.51). A pooled analysis of studies that evaluated the benefit of isocaloric nutrition guided by IC, for critically ill patients in the ICU, has shown reduced 28-day mortality. However, there was no difference in 90-day mortality and nosocomial infection rate.
Collapse
Affiliation(s)
- Barak Pertzov
- Pulmonary Division, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.
| | - Haggai Bar-Yoseph
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yehonatan Menndel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.,Department of Intensive Care, Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Itai Bendavid
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.,Department of Intensive Care, Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Ilya Kagan
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.,Department of Intensive Care, Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Yehuda Daniel Glass
- Department of Medical Intensive Care, Rambam Health Care Campus Haifa, Haifa, Israel
| | - Pierre Singer
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.,Department of Intensive Care, Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| |
Collapse
|
48
|
Cox J, Gianatiempo C, Roche S, Murphy V, Isip R. A pilot study using ultrasonography as an adjunct to nutritional assessment in critically ill adult patients. Intensive Crit Care Nurs 2021; 65:103062. [PMID: 33867243 DOI: 10.1016/j.iccn.2021.103062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/02/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Jill Cox
- Rutgers University/Wound Ostomy Continence Advanced Practice Nurse: Englewood Health, 350 Engle St. Englewood, NJ, United States.
| | - Carmine Gianatiempo
- Critical Care Medicine: Englewood Health, 350 Engle St., Englewood, NJ, United States.
| | - Sharon Roche
- Critical Care Advanced Practice Nurse: Englewood Health, 350 Engle St., Englewood, NJ, United States.
| | - Virginia Murphy
- Critical Care Medicine: Englewood Health, 350 Engle St., Englewood, NJ, United States.
| | - Rachele Isip
- Wound Ostomy Continence Advanced Practice Nurse, Englewood Health, 350 Engle St., Englewood, NJ, United States.
| |
Collapse
|
49
|
Al-Yousif N, Rawal S, Jurczak M, Mahmud H, Shah FA. Endogenous Glucose Production in Critical Illness. Nutr Clin Pract 2021; 36:344-359. [PMID: 33682953 DOI: 10.1002/ncp.10646] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Regulation of endogenous glucose production (EGP) by hormonal, neuronal, and metabolic signaling pathways contributes to the maintenance of euglycemia under normal physiologic conditions. EGP is defined by the generation of glucose from substrates through glycogenolysis and gluconeogenesis, usually in fasted states, for local and systemic use. Abnormal increases in EGP are noted in patients with diabetes mellitus type 2, and elevated EGP may also impact the pathogenesis of nonalcoholic fatty liver disease and congestive heart failure. In this narrative review, we performed a literature search in PubMed to identify recently published English language articles characterizing EGP in critical illness. Evidence from preclinical and clinical studies demonstrates that critical illness can disrupt EGP through multiple mechanisms including increased systemic inflammation, counterregulatory hormone and catecholamine release, alterations in the hypothalamic-pituitary axis, insulin resistance, lactic acidosis, and iatrogenic insults such as vasopressors and glucocorticoids administered as part of clinical care. EGP contributes to hyperglycemia in critical illness when abnormally elevated and to hypoglycemia when abnormally depressed, each of which has been independently associated with increased mortality. Increased EGP may also promote protein catabolism that could worsen critical illness myopathy and impede recovery. Better understanding of the mechanisms and factors contributing to dysregulated EGP in critical illness may help in the development of therapeutic strategies that promote euglycemia, reduce intensive care unit-associated catabolism, and improve patient outcomes.
Collapse
Affiliation(s)
- Nameer Al-Yousif
- Department of Internal Medicine, UPMC Mercy Hospital, Pittsburgh, Pennsylvania, USA
| | - Sagar Rawal
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael Jurczak
- Division of Endocrinology and Metabolism, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hussain Mahmud
- Division of Endocrinology and Metabolism, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Faraaz Ali Shah
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Acute Lung Injury Center of Excellence, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
50
|
Ebihara T, Shimizu K, Ojima M, Nakamura Y, Mitsuyama Y, Ohnishi M, Ogura H, Shimazu T. Energy expenditure and oxygen uptake kinetics in critically ill elderly patients. JPEN J Parenter Enteral Nutr 2021; 46:75-82. [PMID: 33704803 DOI: 10.1002/jpen.2098] [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: 10/03/2020] [Revised: 01/09/2021] [Accepted: 02/28/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Resting energy expenditure (REE) measurement of critically ill patients is essential for better nutrition management. Younger people increase their oxygen delivery ( D ̇ O 2 ) to meet energy demands, but few reports have investigated oxygen uptake kinetics in elderly patients, which are the main target population in today's intensive care units (ICUs). In this study, we evaluated REE, D ̇ O 2 , and oxygen extraction ratio (O2 Ext: oxygen consumption [ V ̇ O 2 ]/ D ̇ O 2 ) to clarify appropriate energy needs and consumption in elderly ICU patients. METHODS This retrospective observational study included ventilated ICU patients who were divided into elderly participants (age ≥ 65 years) and nonelderly participants (age ≤64 years). V ̇ O 2 , CO2 production, and cardiac output were measured by indirect calorimetry and noninvasive hemodynamic monitoring for up to 5 days. The initial values of REE, D ̇ O 2 , and O2 Ext were compared between elderly and nonelderly patients. RESULTS This study included 102 patients, of whom 52% (n = 53) were elderly. The absolute deviation of measured REE per ideal body weight (IBW) was significantly higher in elderly than in nonelderly patients (9.3 ± 6.9 vs 6.3 ± 6.6 kcal/kg; P < .01). D ̇ O 2 had a strong negative correlation with age (P < .01). The O2 Ext value was significantly higher in elderly than in nonelderly patients (37 ± 19% vs 29 ± 13%; P = .03). CONCLUSIONS Elderly critically ill patients were characterized by higher deviations in REE, lower D ̇ O 2 , and higher O2 Ext. In elderly patients, O2 Ext rather than D ̇ O 2 could be increased to meet energy consumption demands.
Collapse
Affiliation(s)
- Takeshi Ebihara
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kentaro Shimizu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masahiro Ojima
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yohei Nakamura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yumi Mitsuyama
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Mitsuo Ohnishi
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|