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Lee N, Jeong E, Park Y, Jo Y, Kim J, Jang H. Serum lactate normalization time associated with prolonged postoperative ileus after surgical management of the small bowel and/or mesenteric injuries. BMC Surg 2024; 24:94. [PMID: 38515100 PMCID: PMC10956389 DOI: 10.1186/s12893-024-02388-1] [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: 09/27/2023] [Accepted: 03/13/2024] [Indexed: 03/23/2024] Open
Abstract
BACK GROUND Determining the optimal timing of postoperative oral feeding in trauma patients who have undergone abdominal surgery with small bowel and/or mesenteric injuries is challenging. The aim of this study is to investigate serum lactate as a factor that can predict oral feeding tolerance and prolonged postoperative ileus (PPOI) in patients who underwent surgery for small bowel and/or mesenteric injury due to trauma. METHODS The single center retrospective observational study was conducted on 367 patients who underwent surgery for small bowel and/or mesenteric injury between January 2013 and July 2021. The patient group was divided into two groups based on whether the peak serum lactate was over 2mmol/L (18 mg/dL). In the group of lactate > 2mmol/L, it was divided into prolonged postoperative ileus (PPOI) groups and groups rather than PPOI. RESULTS Patients in the peak serum lactate > 2 group had tendency to use vasopressors, lower initial systolic blood pressure, larger number of packed red blood cells for 24 h, higher injury severity score, higher PPOI incidence, and a tendency for delayed oral intake tolerance. In peak serum lactate greater than 2 mmol/L group, the lactate normalization time (OR 1.699, p = 0.04), quantity of FFP transfusion for 24 h (OR 1.145, p = 0.012), and creatine kinase (OR 1.001, p = 0.023) were related to PPOI. The lactate normalization time had the highest correlation. CONCLUSION In patients undergoing surgical management for small bowel and/or mesenteric injury after trauma, serum lactate normalization time affects oral intake tolerance and prolongs postoperative ileus.
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Affiliation(s)
- Naa Lee
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, 42 Jebong- ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Euisung Jeong
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, 42 Jebong- ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Yunchul Park
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, 42 Jebong- ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Younggoun Jo
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, 42 Jebong- ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Jungchul Kim
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, 42 Jebong- ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Hyunseok Jang
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, 42 Jebong- ro, Dong-gu, Gwangju, 61469, Republic of Korea.
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Ciríaco GV, Menezes-Júnior LAAD, Oliveira WWD, Talvani A, Turbino Ribeiro SML. Pressure ulcer incidence in critically ill patients: Role of body mass index, nutrition therapy, and other non-nutritional factors. Clin Nutr ESPEN 2023; 55:285-291. [PMID: 37202058 DOI: 10.1016/j.clnesp.2023.03.024] [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: 01/04/2023] [Revised: 02/28/2023] [Accepted: 03/30/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To assess the clinical and nutritional risk factors related to the occurrence of pressure ulcers (PUs) in patients admitted to an Intensive Care Unit (ICU). METHODS This is a cohort retrospective study, carried out by analyzing the medical records of patients admitted to the ICU of a hospital, containing information on sociodemographic, clinical, dietary, and anthropometric data, presence of mechanical ventilation, sedation, and use of noradrenaline. To verify the clinical and nutritional risk factors, multivariate Poisson's regression with robust variance was used to estimate the relative risk (RR) according to the explanatory variables. RESULTS A total of 130 patients were evaluated from January 1 to December 31, 2019. The incidence of PUs in the study population was 29.2%. In univariate analysis, male sex, suspended or enteral diet, use of mechanical ventilation, and sedatives had a significant association with the PUs (p < 0.05). However, when adjusted for potential confounders, only suspended diet remained associated with the PUs. Furthermore, in an analysis stratified by hospitalization time, it was observed that for each 1 kg/m2 increase in body mass index, there is a 10% increased risk of PUs occurrence (RR: 1.10; 95%CI: 1.01-1.23). CONCLUSION Patients with suspended diet, diabetics, with longer-time hospitalization, and overweight have a higher risk of presenting pressure ulcers.
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Affiliation(s)
| | - Luiz Antônio Alves de Menezes-Júnior
- Pós-doctorate Researcher in the Post-graduate Program in Health and Nutrition, Nutrition School, Federal University of Ouro Preto. Ouro Preto, Minas Gerais, Brazil.
| | - Wandeir Wagner de Oliveira
- Department of Family Medicine, Mental Health and Public Health, School of Medicine, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil.
| | - André Talvani
- Associate Professor in the Post-graduate Program in Health and Nutrition, Nutrition School, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil.
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Wang L, Yang H, Cheng Y, Fu X, Yao H, Jin X, Kang Y, Wu Q. Mean Arterial Pressure/Norepinephrine Equivalent Dose Index as an Early Measure of Initiation Time for Enteral Nutrition in Patients with Shock: A Prospective Observational Study. Nutrition 2022; 96:111586. [DOI: 10.1016/j.nut.2021.111586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/07/2021] [Accepted: 12/27/2021] [Indexed: 10/19/2022]
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Wu X, Wu J, Wang P, Fang X, Yu Y, Tang J, Xiao Y, Wang M, Li S, Zhang Y, Hu B, Ma T, Li Q, Wang Z, Wu A, Liu C, Dai M, Ma X, Yi H, Kang Y, Wang D, Han G, Zhang P, Wang J, Yuan Y, Wang D, Wang J, Zhou Z, Ren Z, Liu Y, Guan X, Ren J. Diagnosis and Management of Intraabdominal Infection: Guidelines by the Chinese Society of Surgical Infection and Intensive Care and the Chinese College of Gastrointestinal Fistula Surgeons. Clin Infect Dis 2021; 71:S337-S362. [PMID: 33367581 DOI: 10.1093/cid/ciaa1513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The Chinese guidelines for IAI presented here were developed by a panel that included experts from the fields of surgery, critical care, microbiology, infection control, pharmacology, and evidence-based medicine. All questions were structured in population, intervention, comparison, and outcomes format, and evidence profiles were generated. Recommendations were generated following the principles of the Grading of Recommendations Assessment, Development, and Evaluation system or Best Practice Statement (BPS), when applicable. The final guidelines include 45 graded recommendations and 17 BPSs, including the classification of disease severity, diagnosis, source control, antimicrobial therapy, microbiologic evaluation, nutritional therapy, other supportive therapies, diagnosis and management of specific IAIs, and recognition and management of source control failure. Recommendations on fluid resuscitation and organ support therapy could not be formulated and thus were not included. Accordingly, additional high-quality clinical studies should be performed in the future to address the clinicians' concerns.
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Affiliation(s)
- Xiuwen Wu
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jie Wu
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.,BenQ Medical Center, Nanjing Medical University, Nanjing, China
| | - Peige Wang
- Department of Emergency Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xueling Fang
- Department of Critical Care Medicine, First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yunsong Yu
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianguo Tang
- Department of Emergency Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Yonghong Xiao
- Department of Infectious Diseases, First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Minggui Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
| | - Shikuan Li
- Department of Emergency Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yun Zhang
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Bijie Hu
- Department of Infectious Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tao Ma
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Qiang Li
- Department of General Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhiming Wang
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Anhua Wu
- Infection Control Center, Xiangya Hospital, Central South University, Changsha, China
| | - Chang Liu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Menghua Dai
- Department of Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Xiaochun Ma
- Department of Critical Care Medicine, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Huimin Yi
- Department of Critical Care Medicine, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Daorong Wang
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Gang Han
- Department of Gastroenterology, Second Hospital of Jilin University, Changchun, China
| | - Ping Zhang
- Department of General Surgery, First Hospital of Jilin University, Changchun, China
| | - Jianzhong Wang
- Department of Gastroenterology, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Yufeng Yuan
- Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Dong Wang
- Department of Hepatobiliary Surgery, Peking University People's Hospital, Beijing, China
| | - Jian Wang
- Department of Biliary and Pancreatic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zheng Zhou
- Department of General Surgery, First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Zeqiang Ren
- Department of General Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yuxiu Liu
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiangdong Guan
- Department of Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jianan Ren
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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Wenzel F, Whitaker IY. Is there a relationship between nutritional goal achievement and pressure injury risk in intensive care unit patients receiving enteral nutrition? Intensive Crit Care Nurs 2021; 62:102926. [PMID: 32859481 DOI: 10.1016/j.iccn.2020.102926] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 07/15/2020] [Accepted: 07/20/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To assess pressure injury risk and time until pressure injury development according to the achievement of nutritional goals, i.e. caloric and protein intake within the first 72 hours of the intensive care admission. METHOD Prospective observational cohort study conducted in two units at a public university hospital. The development of pressure injury was considered the dependent variable. Survival curves were prepared with the Kaplan Meier method. Univariate and multivariate Cox regression analysis was used to identify factors associated with the development of pressure injury. RESULTS The study sample included 181 patients, of which 56.4% were male and the average age was 55 years. Neurological pathologies were the most frequent cause of hospitalisation (44.8%). The average length of stay was 17.5 days and mortality 30.4%. With regards to nutritional goals, 105 patients (58.0%) achieved their caloric goal, 130 (71.8%) achieved protein goals, and 98 (54.1%) achieved both. The frequency of pressure injury occurrence was 31.5%. Caloric intake (hazard ratio [HR] 2.3, 95% confidence interval [CI] 1.24-4.36) and protein intake (HR 3.21, 95% CI 1.76-5.86), were identified as independently associated with pressure injury development. Higher Braden scores were identified as a protective factor (HR 0.65, 95% CI 0.56-0.77). CONCLUSIONS These results indicate that the time to pressure injury development in the group of patients who did not achieve nutritional goals was shorter compared to those who achieved nutritional goals. Further studies should be conducted to confirm these data and to study the relationships in greater detail.
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Mooi NM, Ncama BP. Evidence on nutritional therapy practice guidelines and implementation in adult critically ill patients: A systematic scoping review. Curationis 2019; 42:e1-e13. [PMID: 31833375 PMCID: PMC6956683 DOI: 10.4102/curationis.v42i1.1973] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/31/2019] [Accepted: 08/20/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The rapid increase in disease-related malnutrition makes it almost impossible for healthcare practitioners and policymakers to keep up with its negative consequences. Consequently, healthcare organisations and decision-makers have called for accelerated and double-duty actions to manage the double burden of malnutrition. Guidelines standardise nutritional practices, improve nutritional status and reduce hospitalisation duration and save costs. OBJECTIVES A systematic scoping review of the nutritional therapy practice guidelines and implementation in critically ill adults was undertaken to identify the breadth of literature on the topic, summarise findings and identify gaps. METHODS A comprehensive search strategy was designed and implemented to identify eligible studies from eight databases, websites of organisations, government departments and academic platforms. Reference lists of included studies were also searched for relevant studies. We assessed the quality of included studies, completed a descriptive numerical summary and analysed them. RESULTS In total, 1555 titles and 101 abstracts were screened, 65 underwent full text review and 19 were retained for data extraction. Studies scored average to high on quality assessment, and a summary of characteristics of included studies is presented. Nutritional therapy practice guidelines are considered a proactive strategy for enhanced, uniform and individualised nutritional practices and factors that influence implementation were identified. CONCLUSIONS A gap exists between research recommendations and actual practice despite the growing interest in implementation of nutritional therapy guidelines in critical care. There is a need for more research to evaluate the practicality of available guidelines.
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Affiliation(s)
- Nomaxabiso M Mooi
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban.
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Ritter CG, Medeiros IMS, de Pádua CS, Gimenes FRE, do Prado PR. Risk factors for protein-caloric inadequacy in patients in an intensive care unit. Rev Bras Ter Intensiva 2019; 31:504-510. [PMID: 31967225 PMCID: PMC7008981 DOI: 10.5935/0103-507x.20190067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/11/2019] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To evaluate the risk factors for protein-caloric inadequacy in critically ill patients. METHODS Prospective cohort study of patients hospitalized in an adult intensive care unit between February and November 2017. Patients were followed for 7 days. The conditional probability of inadequacy was calculated using the Kaplan-Meier method and the 95% log-rank test. To assess the risk of inadequacy, crude and adjusted hazard ratios (HR) were calculated using Cox regression with a 95% confidence interval. RESULTS Of the 130 patients, 63.8% were male, 73.8% were <60 years of age, and 49.2% were diagnosed with trauma. The mean APACHE II score was 24 points, and 70.0% of the patients had a protein-caloric adequacy >80%. In the univariate analysis, the significant variables for inadequacy were use of vasoactive drugs, interruptions of diet and failure to initiate nutrition early. In the final model, patients who presented with vomiting/gastric residue (adjusted HR = 22.5; 95%CI 5.14 - 98.87) and fasting for extubation (adjusted HR = 14.75; 95%CI 3.59 - 60.63) and for examinations and interventions (adjusted HR = 12.46; 95%CI 4.52 - 34.36) had a higher risk of not achieving protein-caloric adequacy. CONCLUSION Achievement of nutritional goals > 80.0% occurred in 70.0% of patients. The risk factors for protein-caloric inadequacy were nutritional interruptions, especially due to vomiting/gastric residue and fasting for extubation, exams and surgical procedures.
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Affiliation(s)
| | | | | | - Fernanda Raphael Escobar Gimenes
- Departamento de Enfermagem Geral e Especializada, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo - São Paulo (SP), Brasil
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dos Santos HVD, de Araújo IS. Impact of protein intake and nutritional status on the clinical outcome of critically ill patients. Rev Bras Ter Intensiva 2019; 31:210-216. [PMID: 31166561 PMCID: PMC6649228 DOI: 10.5935/0103-507x.20190035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/18/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To evaluate the association of nutritional status and protein intake with the clinical outcomes of critically ill patients receiving enteral nutrition therapy in an intensive care unit. METHODS A retrospective observational analytical study was performed by collecting secondary data recorded in medical records of patients ≥ 18 years of age who were admitted to the intensive care unit and who received exclusive enteral nutrition therapy for at least 72 hours in 2017. Nutritional status was assessed by body mass index and arm circumference. For the estimation of protein requirements, the recommendation of the American Society for Parenteral and Enteral Nutrition was considered. Nutritional adequacy was assessed by the daily collection of prescribed and administered enteral formula. In the analyses, parametric and nonparametric tests were used, and significance was set at p <0.05. RESULTS Of the 188 patients evaluated, 71.3% were male. The median age of the patients was 48.5 years (31.0 - 63.75). The main clinical diagnosis was trauma (46.3%), and eutrophic was the most frequent nutritional status (54.8% according to body mass index and 46.4% according to arm circumference). Protein adequacy was not attained in 56.4% of patients, and only 46.8% reached the minimum protein recommendation. The occurrence of mortality was associated with nutritional diagnosis, body mass index (p = 0.023), arm circumference (p = 0.041) and protein adequacy (p = 0.012). CONCLUSION Nutritional status and protein intake were significantly associated with the clinical outcomes of critically ill patients.
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Harbeson D, Francis F, Bao W, Amenyogbe NA, Kollmann TR. Energy Demands of Early Life Drive a Disease Tolerant Phenotype and Dictate Outcome in Neonatal Bacterial Sepsis. Front Immunol 2018; 9:1918. [PMID: 30190719 PMCID: PMC6115499 DOI: 10.3389/fimmu.2018.01918] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 08/03/2018] [Indexed: 12/16/2022] Open
Abstract
Bacterial sepsis is one of the leading causes of death in newborns. In the face of growing antibiotic resistance, it is crucial to understand the pathology behind the disease in order to develop effective interventions. Neonatal susceptibility to sepsis can no longer be attributed to simple immune immaturity in the face of mounting evidence that the neonatal immune system is tightly regulated and well controlled. The neonatal immune response is consistent with a "disease tolerance" defense strategy (minimizing harm from immunopathology) whereas adults tend toward a "disease resistance" strategy (minimizing harm from pathogens). One major advantage of disease tolerance is that is less energetically demanding than disease resistance, consistent with the energetic limitations of early life. Immune effector cells enacting disease resistance responses switch to aerobic glycolysis upon TLR stimulation and require steady glycolytic flux to maintain the inflammatory phenotype. Rapid and intense upregulation of glucose uptake by immune cells necessitates an increased reliance on fatty acid metabolism to (a) fuel vital tissue function and (b) produce immunoregulatory intermediates which help control the magnitude of inflammation. Increasing disease resistance requires more energy: while adults have fat and protein stores to catabolize, neonates must reallocate resources away from critical growth and development. This understanding of sepsis pathology helps to explain many of the differences between neonatal and adult immune responses. Taking into account the central role of metabolism in the host response to infection and the severe metabolic demands of early life, it emerges that the striking clinical susceptibility to bacterial infection of the newborn is at its core a problem of metabolism. The evidence supporting this novel hypothesis, which has profound implications for interventions, is presented in this review.
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Affiliation(s)
- Danny Harbeson
- Department of Experimental Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Freddy Francis
- Department of Experimental Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Winnie Bao
- Department of Experimental Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nelly A. Amenyogbe
- Department of Experimental Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Tobias R. Kollmann
- Department of Experimental Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Pediatrics, Division of Infectious Diseases, University of British Columbia, Vancouver, BC, Canada
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Silva RKA, Da Rocha GF, De Souza IA, Mendonça EG, De Oliveira MS, Folly GADF. Identificação do perfil nutricional e ocorrência de complicações gastrointestinais em pacientes hospitalizados submetidos à Terapia Nutricional Enteral. HU REVISTA 2018. [DOI: 10.34019/1982-8047.2017.v43.2745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A terapia nutricional enteral (TNE) é muito importante para a recuperação e manutenção do estado nutricional dos pacientes, sendo sugerida a sua introdução precoce em até 24 a 48 horas após a admissão hospitalar. Mas, sabe-se que podem ocorrer intolerâncias gástricas, como diarreia e vômito, que podem comprometer a administração da dieta enteral. Diante disso, o objetivo do estudo foi identificar e avaliar o perfil nutricional, TNE precoce e complicações frequentes nos pacientes internados em instituição de atendimento na cidade de Barbacena-MG. Trata-se de um estudo clínico retrospectivo com revisão de prontuários de atendimento nutricional realizados nos anos de 2012 a 2013, totalizando 310 protocolos de pacientes com idade igual ou superior a 18 anos e com suporte de TNE por pelo menos três dias. A análise estatística foi realizada no software PASW Statistics 17. Dentre os avaliados, 53,55% eram desnutridos moderados, 15,16% desnutridos graves, 71,61% atingiram as necessidades nutricionais em até sete dias de TNE e 63,87% receberam TNE em até 48 horas. Entre as complicações prevaleceu à estase gástrica em 23,10% dos pacientes. Com relação à evolução, 35,16% dos pacientes tiveram alta hospitalar com alimentação por via oral, 11,94% permaneceram em nutrição enteral e 52,90% foram a óbito. Foi observada maior prevalência de desnutrição moderada, início da TNE precoce e ocorrência de estase gástrica.
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Urakov AL, Mustafin IG, Samorodov AV, Kamilov FK, Khaliullin FA. The off-label use of drugs for parenteral nutrition as a solvent of substances slightly soluble in water in pharmacological research. J Adv Pharm Technol Res 2018; 9:9-14. [PMID: 29441318 PMCID: PMC5801587 DOI: 10.4103/japtr.japtr_280_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Because of the problem to evaluate biological activity in water-soluble substances in all phases of preclinical and clinical studies, the research work enabled to develop the original solvent for poorly soluble compounds based on substances for parenteral nutrition. The main aim is to examine the impact of the original solvent based on substances for parenteral nutrition on biological systems exemplified by the hemostatic system, characterized by sensitivity and variability of the effects in response to any impact, and its comparison with the solvents that are conventional in pharmacological research. Experimental work is performed according to the “guidance on preclinical research of new pharmacological substances” in vitro. The findings show that traditional solvents at low dosages affect all the researched indicators of the hemostasis system. The smallest effect in respect of the hemostatic system was characterized by ethanol, and the most apparent antiaggregational effect was registered with dioxane. 10% concentration of original blend of lipids made no effect on hemostasis system. Thus, according to their own findings and experience in application of lipid emulsions as substances of parenteral nutrition, they can be considered to be an adequate solvent in all phases of preclinical and clinical studies of new drugs.
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Affiliation(s)
- Aleksandr L Urakov
- Department of Pharmacology, Izhevsk State Medical Academy, Izhevsk, Russia
| | - Ilshat G Mustafin
- Department of Biochemistry, Kazan State Medical University, Kazan, Russia
| | | | - Felix Kh Kamilov
- Department of Biochemistry, Bashkirian State Medical University, Ufa, Russia
| | - Ferkat A Khaliullin
- Department of Pharmaceutical Chemistry, Bashkirian State Medical University, Ufa, Russia
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Prevalence and duration of reasons for enteral nutrition feeding interruption in a tertiary intensive care unit. Nutrition 2018; 53:26-33. [PMID: 29627715 DOI: 10.1016/j.nut.2017.11.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 11/14/2017] [Accepted: 11/17/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Intensive care unit (ICU) enteral nutrition (EN) can involve frequent feeding interruption (FI). The prevalence, causes, and duration of such interruption were investigated. METHODS Reasons for EN FI identified from extensive literature review were prospectively collected in adult mechanically ventilated critically ill patients. Results were reported by descriptive statistics. Baseline and nutritional characteristics between patients who died and those alive at day 60 were compared. RESULTS A total of 148 patients receiving ≥1 day of EN for the full 12-day observational period were included in the analysis. About 332 episodes of EN FI were recorded and contributed to 12.8% (4190 hours) of the total 1367 evaluable nutrition days. For each patient, FI occurred for a median of 3 days and the total duration of FI for the entire ICU stay was 24.5 hours. Median energy and protein deficits per patient due to FI for the entire ICU stay were -1780.23 kcal and -100.58 g, respectively. Duration of FI, days with FI, and the amount of energy and protein deficits due to FI were not different between patients who had died and those who were still alive at day 60 (all P > 0.05). About 72% of the total duration of EN FI was due to procedural-related and potentially avoidable causes (primarily human factors), while only about 20% was due to feeding intolerances. CONCLUSIONS EN FI occurred primarily due to human factors, which may be minimized by adherence to an evidence-based feeding protocol as determined by a nutrition support team.
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Abstract
Nutrition continues to be a concern for the older adult in the intensive care setting despite widespread knowledge of the benefits of adequate nutrition and existing evidence-based protocols. The incidence of malnutrition in hospitalized patients ranges between 22% and 43% with the highest probability of occurrence, 50% or more, in the intensive care unit patient. The deleterious effects of malnutrition for the critically ill older adult are described with suggested and accepted screening tools for existing or acquired malnutrition. A discussion of early oral and enteral feeding interventions and strategies for overcoming barriers is explored. Enteral feeding complications are delineated, and perceived barriers or risks are disputed. This paper concludes with suggestions for future research and a definitive role for advanced nursing nutrition champions.
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