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Louis R, Weinel LM, Burrell A, Gardner B, McEwen S, Chapman MJ, O'Connor SN, Chapple LAS. Observed differences in nutrition management at two time points spanning a decade in critically ill trauma patients with and without head injury. Aust Crit Care 2024; 37:414-421. [PMID: 37391287 DOI: 10.1016/j.aucc.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/07/2023] [Accepted: 05/17/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Nutritional needs of trauma patients admitted to the intensive care unit may differ from general critically ill patients, but most current evidence is based on large clinical trials recruiting mixed populations. OBJECTIVE The aim of the study was to investigate nutrition practices at two time points that span a decade in trauma patients with and without head injury. METHODS This observational study recruited adult trauma patients receiving mechanical ventilation and artificial nutrition from a single-centre intensive care unit between February 2005 to December 2006 (cohort 1), and December 2018 to September 2020 (cohort 2). Patients were categorised into head injury and non-head injury subgroups. Data regarding energy and protein prescription and delivery were collected. Data are presented as median [interquartile range]. Wilcoxon rank-sum test assessed the differences between cohorts and subgroups, with a P value ≤ 0.05. The protocol was registered with the Australian and New Zealand Clinical Trials Registry (Trial ID: ACTRN12618001816246). RESULTS Cohort 1 included 109 patients, and 112 patients were included in cohort 2 (age: 46 ± 19 vs 50 ± 19 y; 80 vs 79% M). Overall, nutrition practice did not differ between head-injured and non-head-injured subgroups (all P > 0.05). Energy prescription and delivery decreased from time point one to time point two, regardless of subgroup (Prescription: 9824 [8820-10 581] vs 8318 [7694-9071] kJ; Delivery: 6138 [5130-7188] vs 4715 [3059-5996] kJ; all P < 0.05). Protein prescription did not change from time point one to time point two. Although protein delivery remained constant from time point one to time point two in the head injury group, protein delivery reduced in the non-head injury subgroup (70 [56-82] vs 45 [26-64] g/d, P < 0.05). CONCLUSION In this single-centre study, energy prescription and delivery in critically ill trauma patients reduced from time point one to time point two. Protein prescription did not change, but protein delivery reduced from time point one to time point two in non-head injury patients. Reasons for these differing trajectories require exploration. STUDY REGISTRATION Trial registered at www.anzctr.org.au. TRIAL ID ACTRN12618001816246.
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Affiliation(s)
- Rhea Louis
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Luke M Weinel
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Aidan Burrell
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, St Kilda Road, Melbourne, VIC, Australia; Intensive Care Unit, The Alfred Hospital, Melbourne, VIC, Australia
| | - Bethany Gardner
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Sarah McEwen
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Marianne J Chapman
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, St Kilda Road, Melbourne, VIC, Australia
| | - Stephanie N O'Connor
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Lee-Anne S Chapple
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia.
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2
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McConnochie R, O'Brien A, Parke R. A single-centre observational study of delayed defaecation in brain-injured patients in an adult intensive care unit. Aust Crit Care 2024; 37:244-250. [PMID: 37574388 DOI: 10.1016/j.aucc.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 07/07/2023] [Accepted: 07/08/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND The incidence of delayed defaecation is high in enterally fed ventilated patients in intensive care units (ICUs). Those with brain injury may be harmed by increased intracranial pressure if delayed defaecation leads to abdominal distension. There are no studies evaluating a bowel guideline in the treatment of delayed defaecation in ventilated brain-injured ICU patients. OBJECTIVE The objective of this study was to assess the incidence and clinical associations of delayed defaecation and level of compliance to an ICU bowel guideline. METHODS Data were collected on ventilated adult patients with brain injury admitted for more than 3 days to one New Zealand ICU over a 2-year period. RESULTS Data were analysed for 117 patients; 56 (48%) who defaecated within 3 days of ICU admission (Group one) and 61 (52%) with delayed defaecation after 3 days (Group two). Compliance with the bowel guideline was low. Only 1 of 61 patients who should have had a rectal examination did so, and only 7 of 61 patients who should have had an aperient on day 3 did so. All seven received Movicol®, which was not part of the guideline. Use of aperients and enemas was found to be associated with stool passage (odds ratio: 93; 95% confidence interval: 5.2-1668; p = 0.002). Patients with delayed defaecation had longer ICU stays (mean 7.1 ± 4 SD vs 5.9 ± 3 days, p = 0.07) and more often had high gastric residual volumes after day 4 (27/61 vs 14/56; p = 0.003). No differences were seen between the groups in the incidence of ventilator-associated pneumonia, bacterial infections, diarrhoea, vomiting, duration of mechanical ventilation, or mortality. CONCLUSION Delayed defaecation was common, and compliance with the guideline was low. Movicol® and phosphate enemas were effective in stool production.
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Affiliation(s)
- Rachael McConnochie
- Department of Critical Care Medicine, Auckland City Hospital, 2 Park Road, Grafton, Auckland, New Zealand.
| | - Anthony O'Brien
- Te Huataki Waiora - School of Health, University of Waikato, Private Bag 3105, Hamilton 3240, New Zealand
| | - Rachael Parke
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand; School of Nursing, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
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Park G, Munley JA, Kelly LS, Kannan KB, Mankowski RT, Sharma A, Upchurch G, Casadesus G, Chakrabarty P, Wallet SM, Maile R, Bible LE, Wang B, Moldawer LL, Mohr AM, Efron PA, Nagpal R. Gut mycobiome dysbiosis after sepsis and trauma. Crit Care 2024; 28:18. [PMID: 38212826 PMCID: PMC10785534 DOI: 10.1186/s13054-023-04780-4] [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: 11/15/2023] [Accepted: 12/14/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Sepsis and trauma are known to disrupt gut bacterial microbiome communities, but the impacts and perturbations in the fungal (mycobiome) community after severe infection or injury, particularly in patients experiencing chronic critical illness (CCI), remain unstudied. METHODS We assess persistence of the gut mycobiome perturbation (dysbiosis) in patients experiencing CCI following sepsis or trauma for up to two-to-three weeks after intensive care unit hospitalization. RESULTS We show that the dysbiotic mycobiome arrays shift toward a pathobiome state, which is more susceptible to infection, in CCI patients compared to age-matched healthy subjects. The fungal community in CCI patients is largely dominated by Candida spp; while, the commensal fungal species are depleted. Additionally, these myco-pathobiome arrays correlate with alterations in micro-ecological niche involving specific gut bacteria and gut-blood metabolites. CONCLUSIONS The findings reveal the persistence of mycobiome dysbiosis in both sepsis and trauma settings, even up to two weeks post-sepsis and trauma, highlighting the need to assess and address the increased risk of fungal infections in CCI patients.
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Affiliation(s)
- Gwoncheol Park
- Department of Health, Nutrition, and Food Sciences, Florida State University, Tallahassee, FL, 32306, USA
| | - Jennifer A Munley
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, FL, 32611, USA
| | - Lauren S Kelly
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, FL, 32611, USA
| | - Kolenkode B Kannan
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, FL, 32611, USA
| | - Robert T Mankowski
- Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, FL, 32611, USA
| | - Ashish Sharma
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, FL, 32611, USA
| | - Gilbert Upchurch
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, FL, 32611, USA
| | - Gemma Casadesus
- Department of Pharmacology and Therapeutics, University of Florida College of Medicine, Gainesville, FL, 32611, USA
| | - Paramita Chakrabarty
- Department of Neuroscience, University of Florida College of Medicine, Gainesville, FL, 32611, USA
| | - Shannon M Wallet
- Department of Oral Biology, University of Florida College of Dentistry, Gainesville, FL, 32611, USA
| | - Robert Maile
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, FL, 32611, USA
| | - Letitia E Bible
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, FL, 32611, USA
| | - Bo Wang
- Department of Biomedical and Chemical Engineering and Sciences, Florida Institute of Technology, Melbourne, FL, 32901, USA
| | - Lyle L Moldawer
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, FL, 32611, USA
| | - Alicia M Mohr
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, FL, 32611, USA
| | - Philip A Efron
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, FL, 32611, USA
| | - Ravinder Nagpal
- Department of Health, Nutrition, and Food Sciences, Florida State University, Tallahassee, FL, 32306, USA.
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Jia R, Zhao H, Yan X, Yang Z. The effect of enteral nutrition nursing intervention on postoperative treatment of chronic critically ill patients: Health prevention data analysis. Prev Med 2023; 174:107635. [PMID: 37473926 DOI: 10.1016/j.ypmed.2023.107635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/26/2023] [Accepted: 07/17/2023] [Indexed: 07/22/2023]
Abstract
The field of genomics has witnessed remarkable advancements, leading to the gradual clarification of the genetic mechanism underlying various cancers. As a result, there has been an increased emphasis on gene prevention and treatment. Against this backdrop, this paper aims to examine the impact of enteral nutrition nursing intervention on the postoperative treatment of patients with chronic critical illness, with a focus on health prevention. Based on an analysis of the clinical data of patients with chronic critical illness, the study found that enteral nutrition nursing intervention plays a crucial role in enhancing the nutritional status of patients, reducing the incidence of complications, shortening the length of hospital stay, and improving the effect of postoperative rehabilitation. The study's results provide valuable insights into the efficacy of enteral nutrition nursing intervention in the postoperative treatment of patients with chronic critical illness. By improving the nutritional status of patients, enteral nutrition nursing intervention can help reduce the risk of complications, shorten the length of hospital stay, and enhance the effectiveness of postoperative rehabilitation. These findings underscore the importance of adopting effective interventions such as enteral nutrition nursing to improve the therapeutic outcomes of chronic critical illness patients and achieve the goal of health prevention.
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Affiliation(s)
- Ruimin Jia
- Shanxi University of Chinese Medicine, Jinzhong 030619, China
| | - Hua Zhao
- Shanxi University of Chinese Medicine, Jinzhong 030619, China
| | - Xiaoning Yan
- Shanxi University of Chinese Medicine, Jinzhong 030619, China.
| | - Zhilan Yang
- Shanxi University of Chinese Medicine, Jinzhong 030619, China
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5
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Preventive strategies for feeding intolerance among patients with severe traumatic brain injury: A cross-sectional survey. Int J Nurs Sci 2022; 9:278-285. [PMID: 35891911 PMCID: PMC9304998 DOI: 10.1016/j.ijnss.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/26/2022] [Accepted: 06/13/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives This study aimed to investigate the application status of preventive measures for feeding intolerance in patients with severe traumatic brain injury (STBI) in China and analysis the differences and their causes. Methods A cross-sectional survey was conducted. From December 2019 to January 2020, ICU nurses and physicians of 89 hospitals in China were surveyed by using a questionnaire on preventive strategies for feeding intolerance in patients with STBI. The questionnaire included two parts: the general information of participants (10 items) and application of preventive measures for feeding intolerance in STBI patients (18 items). Results Totally 996 nurses and physicians completed the questionnaire. Among various methods, gastrointestinal symptoms(85.0%) and injury severity (71.4%) were mostly used to assess gastrointestinal functions and risk of feeding intolerance among STBI patients, respectively. Initiating enteral nutrition (EN) within 24–48 h (61.5%), nasogastric tubes (91.2%), 30°–45° of head-of-bed elevation (89.5%), continuous feeding by pump (72.9%), EN solution temperature of 38–40 °C (65.5%), <500 ml initial volume of EN solution (50.0%), monitoring gastric residual volume with a syringe (93.7%), and assessing gastric residual volume every 4 h (51.5%) were mostly applied for EN delivery among STBI patients. Prokinetic agents (73.3%), enema (73.6%), probiotics (79.0%), antacid agents (84.1%), and non-nutritional preparations as initial EN formula (65.6%) were commonly used for preventing feeding intolerance among STBI patients. Conclusions The survey showed that nurses and clinicians in China have a positive attitude towards preventive strategies for feeding intolerance. However, some effective new technologies and methods have not been timely applied in clinical practice. We suggest that managers, researchers, clinicians, nurses, and other health professionals should collaborate to explore effective and standard preventive strategies for feeding intolerance among patients with STBI.
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Elliott E, Shoykhet M, Bell MJ, Wai K. Nutritional Support for Pediatric Severe Traumatic Brain Injury. Front Pediatr 2022; 10:904654. [PMID: 35656382 PMCID: PMC9152222 DOI: 10.3389/fped.2022.904654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
In critically ill children with severe traumatic brain injury (sTBI), nutrition may help facilitate optimal recovery. There is ongoing research regarding nutritional practices in the pediatric intensive care unit (PICU). These are focused on identifying a patient's most appropriate energy goal, the mode and timing of nutrient delivery that results in improved outcomes, as well as balancing these goals against inherent risks associated with nutrition therapy. Within the PICU population, children with sTBI experience complex physiologic derangements in the acute post-injury period that may alter metabolic demand, leading to nutritional needs that may differ from those in other critically ill patients. Currently, there are relatively few studies examining nutrition practices in PICU patients, and even fewer studies that focus on pediatric sTBI patients. Available data suggest that contemporary neurocritical care practices may largely blunt the expected hypermetabolic state after sTBI, and that early enteral nutrition may be associated with lower morbidity and mortality. In concordance with these data, the most recent guidelines for the management of pediatric sTBI released by the Brain Trauma Foundation recommend initiation of enteral nutrition within 72 h to improve outcome (Level 3 evidence). In this review, we will summarize available literature on nutrition therapy for children with sTBI and identify gaps for future research.
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Affiliation(s)
- Elizabeth Elliott
- Critical Care Medicine, Children's National Hospital, Washington, DC, United States
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7
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A systematic review of the definitions and prevalence of feeding intolerance in critically ill adults. Clin Nutr ESPEN 2022; 49:92-102. [DOI: 10.1016/j.clnesp.2022.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/08/2022] [Accepted: 04/15/2022] [Indexed: 12/12/2022]
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8
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Liu J, Wang W, Zhang J, Qin Y. Successful postpyloric feeding tube insertion using prokinetic drugs for nasoenteric tube placement: A network meta‐analysis. Nutr Clin Pract 2022; 37:773-782. [PMID: 35233831 DOI: 10.1002/ncp.10834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Jia‐Hong Liu
- Department of Emergency Intensive Care Unit Huazhong University of Science and Technology Union Shenzhen Hospital Shenzhen Guangdong P.R. China
| | - Wen‐Juan Wang
- Department of Emergency Intensive Care Unit Huazhong University of Science and Technology Union Shenzhen Hospital Shenzhen Guangdong P.R. China
| | - Jing Zhang
- Department of Emergency Intensive Care Unit Huazhong University of Science and Technology Union Shenzhen Hospital Shenzhen Guangdong P.R. China
| | - Yu‐Ju Qin
- Department of Emergency Intensive Care Unit Huazhong University of Science and Technology Union Shenzhen Hospital Shenzhen Guangdong P.R. China
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9
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Kvolik S, Koruga N, Skiljic S. Analgesia in the Neurosurgical Intensive Care Unit. Front Neurol 2022; 12:819613. [PMID: 35185756 PMCID: PMC8848763 DOI: 10.3389/fneur.2021.819613] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 12/23/2021] [Indexed: 11/13/2022] Open
Abstract
Acute pain in neurosurgical patients is an important issue. Opioids are the most used for pain treatment in the neurosurgical ICU. Potential side effects of opioid use such as oversedation, respiratory depression, hypercapnia, worsening intracranial pressure, nausea, and vomiting may be problems and could interfere with neurologic assessment. Consequently, reducing opioids and use of non-opioid analgesics and adjuvants (N-methyl-D-aspartate antagonists, α2 -adrenergic agonists, anticonvulsants, corticosteroids), as well as non-pharmacological therapies were introduced as a part of a multimodal regimen. Local and regional anesthesia is effective in opioid reduction during the early postoperative period. Among non-opioid agents, acetaminophen and non-steroidal anti-inflammatory drugs are used frequently. Adverse events associated with opioid use in neurosurgical patients are discussed. Larger controlled studies are needed to find optimal pain management tailored to neurologically impaired neurosurgical patients.
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Affiliation(s)
- Slavica Kvolik
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Department of Anesthesiology and Critical Care, Osijek University Hospital, Osijek, Croatia
- *Correspondence: Slavica Kvolik
| | - Nenad Koruga
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Department of Neurosurgery, Osijek University Hospital, Osijek, Croatia
| | - Sonja Skiljic
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Department of Anesthesiology and Critical Care, Osijek University Hospital, Osijek, Croatia
- Sonja Skiljic
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Guo Y, Xu M, Shi G, Zhang J. A new strategy of enteral nutrition intervention for ICU patients targeting intestinal flora. Medicine (Baltimore) 2021; 100:e27763. [PMID: 34964735 PMCID: PMC8615329 DOI: 10.1097/md.0000000000027763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Enteral nutrition (EN) therapy is a routine supportive method for patients in the intensive care unit (ICU). However, the incidence of EN intolerance is prevalent, because most ICU patients suffer intestinal mucosal barrier damage and gastrointestinal motility disorder. There is no definite index to predict EN intolerance, and the current treatment methods are not effective in alleviating EN intolerance. Gut microbiota is an important component of the intestinal micro-ecological environment, and alterations in its structure and composition can reflect changes in intestinal function and microenvironment. The purpose of this study is to investigate the effect of EN on the gut microbiota of ICU patients by monitoring the dynamic alterations of gut microbiota and to screen out the microbial markers that can be used to predict the incidence of EN intolerance. METHODS One hundred ICU patients with trauma or in a period of acute stress after surgery will be enrolled, and their fecal samples will be collected at different timepoints for microbial sequencing and analysis. General clinical data (demographic information, surgical data, laboratory parameters, illness severity scores, and therapeutic drugs), nutritional status data (nutritional status assessment and nutrition therapy monitoring data), as well as clinical outcomes, will be recorded. The microbial and clinical data will be combined to analyze the baseline characteristics and dynamic alterations of gut microbiota along with the incidence of EN intolerance. Data related to the gut microbiota will be statistically analyzed by R software, and other data performed by SPSS23.0 software. CONCLUSIONS The effect of EN on gut microbiota and microbial markers predicting the intolerance of EN will lead us to develop a new nutrition intervention strategy for ICU patients. Furthermore, the results of this study will provide a basis for the discovery of potential probiotics used for the prevention and treatment of EN intolerance.
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Affiliation(s)
- Yangyang Guo
- Intensive Care Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ming Xu
- Intensive Care Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guangzhi Shi
- Intensive Care Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jindong Zhang
- Department of Gastroenterology, Peking University Third Hospital, Beijing, China
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11
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Charoensareerat T, Bhurayanontachai R, Sitaruno S, Navasakulpong A, Boonpeng A, Lerkiatbundit S, Pattharachayakul S. Efficacy and Safety of Enteral Erythromycin Estolate in Combination With Intravenous Metoclopramide vs Intravenous Metoclopramide Monotherapy in Mechanically Ventilated Patients With Enteral Feeding Intolerance: A Randomized, Double-Blind, Controlled Pilot Study. JPEN J Parenter Enteral Nutr 2020; 45:1309-1318. [PMID: 32895971 DOI: 10.1002/jpen.2013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/09/2020] [Accepted: 09/04/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND In this pilot study, we aimed to determine the efficacy and safety of enteral erythromycin estolate in combination with intravenous metoclopramide compared to intravenous metoclopramide monotherapy in mechanically ventilated patients with enteral feeding intolerance. METHODS This randomized, double-blind, controlled pilot study included 35 mechanically ventilated patients with feeding intolerance who were randomly assigned to receive 10-mg metoclopramide intravenously every 6-8 hours in combination with 250-mg enteral erythromycin estolate (study group) or placebo every 6 hours for 7 days. The primary outcome was an administered-to-target energy ratio of ≥80% at 48 hours, indicating a successful feeding. Secondary, prespecified outcomes were daily average gastric residual volume (GRV), total energy intake, administered-to-target energy ratio, hospital length of stay, in-hospital mortality, and 28-day mortality. RESULTS The rate of successful feeding was not significantly different between the study and placebo groups (47.1% and 61.1%, respectively; P = .51). The average daily GRV was significantly lower in the study group than in the placebo group (β = 91.58 [95% Wald CI, -164.35 to -18.8]), determined by generalized estimating equation. Other secondary outcomes were comparable, and the incidence of adverse events was not significantly different between the 2 groups. One common complication was cardiac arrhythmia, which was mostly self-terminated. CONCLUSION Although the combination therapy of enteral erythromycin estolate and intravenous metoclopramide reduced GRV, the successful feeding rate and other patient-specific outcomes did not improve in mechanically ventilated patients with feeding intolerance.
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Affiliation(s)
| | - Rungsun Bhurayanontachai
- Critical Care Medicine Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Sirima Sitaruno
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Songkhla, Thailand
| | - Asma Navasakulpong
- Respiratory and Respiratory Critical Care Medicine Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Apinya Boonpeng
- School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
| | - Sanguan Lerkiatbundit
- Department of Pharmacy Administration, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Songkhla, Thailand
| | - Sutthiporn Pattharachayakul
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Songkhla, Thailand
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12
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Peng J, Liu GW, Li F, Yuan M, Xiang Y, Qin D. The correlation between feeding intolerance and poor prognosis of patients with severe neurological conditions: a case-control study. Expert Rev Neurother 2019; 19:1265-1270. [PMID: 31601136 DOI: 10.1080/14737175.2019.1679627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background: This study aims to investigate the current status of feeding intolerance (FI) among patients with severe neurological conditions and to further determine the correlation between FI and their poor prognosis.Methods: This study performed a retrospective analysis of the medical data of 58 patients from January 2017 to December 2017. Patients were divided into two groups according to modified Rankin Scale (mRS) scores. Logistic regression was used to analyze the relevant factors for the poor prognosis of these patients.Results: General data analysis showed that age and diagnosis(stroke) were significantly different between the two groups (P < 0.05). Univariate analysis showed that APACHE II score, vomiting within 3 days of NICU admission, gastrointestinal bleeding within 3 days of NICU admission and occurrence of FI within 3 days of NICU admission were all risk factors for a poor prognosis of these patients(P < 0.05). Multivariate logistic regression analysis showed that FI within 3 days of NICU admission(OR 8.026, 95%CI(1.550-26.039)) and diagnosis(stroke)(OR 10.654, 95%CI (1.746-21.291)) were independent factors for a poor prognosis of patients with severe neurological conditions.Conclusion: The incidence of early FI in stroke patients is correlated with a poor prognosis.
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Affiliation(s)
- Jingjing Peng
- Department of Neurosurgery, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Guang-Wei Liu
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Feng Li
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Meizhen Yuan
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yanling Xiang
- Department of Operation Anesthesia, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Deyu Qin
- Department of Infectious, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
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13
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Ma Y, Liu T, Fu J, Fu S, Hu C, Sun B, Fan X, Zhu J. Lactobacillus acidophilus Exerts Neuroprotective Effects in Mice with Traumatic Brain Injury. J Nutr 2019; 149:1543-1552. [PMID: 31174208 DOI: 10.1093/jn/nxz105] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/11/2019] [Accepted: 04/26/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) causes dysbiosis and intestinal barrier disruption, which further exacerbate brain damage via an inflammatory pathway. Gut microbiota remodeling by Lactobacillus acidophilus (LA) is a potential intervention. OBJECTIVE The aim of this study was to investigate the neuroprotective effects of LA in TBI and elucidated underlying mechanisms. METHODS C57BL/6 male mice (aged 8-9 wk) were subjected to weight-drop impact and gavaged with saline (TBI + vehicle) or LA (1 × 1010 CFU) (TBI + LA) on the day of injury and each day after for 1, 3, or 7 d. The sham + vehicle mice underwent craniotomy without brain injury and were gavaged with saline. Sensorimotor functions were determined pre-TBI and 1, 3, and 7 d postinjury. Indexes of neuroinflammation, peripheral inflammation, and intestinal barrier function were measured on days 3 and 7. Microbiota composition was measured 3 d postinjury. The data were mainly analyzed by 2-factor ANOVA. RESULTS Compared with sham + vehicle mice, the TBI + vehicle mice exhibited impairments in the neurological severity score (+692%, day 3; +600%, day 7) and rotarod test (-58%, day 3; -45%, day 7) (P < 0.05), which were rescued by LA. The numbers of microglia (total and activated) and astrocytes and concentrations of TNF-α and IL1-β in the perilesional cortex were elevated in the TBI + vehicle mice on day 3 or 7 compared with sham + vehicle mice (P < 0.05) and were normalized by LA. Compared with sham + vehicle mice, the TBI + vehicle mice exhibited increased serum concentrations of endotoxin and TNF-α, and intestinal barrier permeability (D-lactate) on days 3 and 7 (P < 0.05), and these changes were alleviated by LA. Three days postinjury, the microbiota composition was disrupted in the TBI + vehicle mice compared with sham + vehicle mice (P < 0.05), which was restored by LA. CONCLUSION Our results demonstrate that LA exerts neuroprotective effects that may be associated with gut microbiota remodeling in TBI mice.
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Affiliation(s)
- Yuanyuan Ma
- Department of Basic Nursing, School of Nursing, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Developmental Neuropsychology, School of Psychology, Third Military Medical University (Army Medical University), Chongqing, China
| | - Tianyao Liu
- Department of Developmental Neuropsychology, School of Psychology, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jingjing Fu
- Department of Basic Nursing, School of Nursing, Third Military Medical University (Army Medical University), Chongqing, China
| | - Shaoli Fu
- Department of Basic Nursing, School of Nursing, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chen Hu
- Department of Basic Nursing, School of Nursing, Third Military Medical University (Army Medical University), Chongqing, China
| | - Bo Sun
- Department of Basic Nursing, School of Nursing, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiaotang Fan
- Department of Developmental Neuropsychology, School of Psychology, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jingci Zhu
- Department of Basic Nursing, School of Nursing, Third Military Medical University (Army Medical University), Chongqing, China
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Vieira LV, Pedrosa LAC, Souza VS, Paula CA, Rocha R. Incidence of diarrhea and associated risk factors in patients with traumatic brain injury and enteral nutrition. Metab Brain Dis 2018; 33:1755-1760. [PMID: 30014176 DOI: 10.1007/s11011-018-0287-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 07/10/2018] [Indexed: 02/05/2023]
Abstract
To determine the occurrence of diarrhea and associated factors in critically ill patients with traumatic brain injury (TBI) in use of nutritional therapy. Prospective cohort study conducted in an Intensive Care Unit (ICU) of a General Hospital reference in trauma. We evaluated TBI patients who stayed less than 72 h in the ICU, who were using EN for at least 48 h. Definition of diarrhea it was considered three or more episodes of liquid stools or semi-liquid at 24 h. For analysis were evaluated demographic, epidemiological, clinical and nutritional data. Twenty-three patients were evaluated, being 86.9% male, median 33 years old (IQR = 25-52 years) and 16-day ICU stay (IQR = 10-26 days). Diarrhea occurred in 69.6% of the patients and they had a longer time in the ICU (p = 0.007). All patients who used combination prokinetic therapy (metoclopramide and erythromycin) and used antibiotics for more than 8 days had diarrhea (p = 0.057 and p = 0.007, respectively). The incidence of diarrhea was high in TBI patients with enteral nutrition and was associated with the use of antibiotics for more than one week.
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Affiliation(s)
- Luiza Valois Vieira
- Departamento de Ciências da Nutrição, Escola de Nutrição, Universidade Federal da Bahia, Avenida Araújo Pinho, 32, Canela, CEP: 40.110-150, Salvador, Bahia, Brasil.
| | - Livia Alves Carvalho Pedrosa
- Departamento de Ciências da Nutrição, Escola de Nutrição, Universidade Federal da Bahia, Avenida Araújo Pinho, 32, Canela, CEP: 40.110-150, Salvador, Bahia, Brasil
| | - Viviane Sahade Souza
- Departamento de Ciências da Nutrição, Escola de Nutrição, Universidade Federal da Bahia, Avenida Araújo Pinho, 32, Canela, CEP: 40.110-150, Salvador, Bahia, Brasil
| | | | - Raquel Rocha
- Departamento de Ciências da Nutrição, Escola de Nutrição, Universidade Federal da Bahia, Avenida Araújo Pinho, 32, Canela, CEP: 40.110-150, Salvador, Bahia, Brasil
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Chatelon J, Bourillon C, Darmon H, Carbonne H, Chhor V, Follin A, Cholley B, Guinvarc'h A, Mantz J, Pirracchio R. Feasibility and Predictive Value of Ultrasound Assessment of the Gastric Residual Volume in Surgical Critically Ill Patients: A Pilot Study. Crit Care Med 2018; 44:e1255-e1257. [PMID: 27858828 DOI: 10.1097/ccm.0000000000002040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Jeanne Chatelon
- Department of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, APHP, Université Paris Descartes, Sorbonne Paris Cite, Paris, FranceDepartment of Radiology, Hôpital Européen Georges Pompidou, APHP, Université Paris Descartes, Sorbonne Paris Cite, Paris, FranceDepartment of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, APHP, Université Paris Descartes, Sorbonne Paris Cite, Paris, FranceDepartment of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, APHP, Université Paris Descartes, Sorbonne Paris Cite, Paris, France, Histopathology and Animal Models Unit, Institut Pasteur, Rue du Dr Roux, 75015 Paris, FranceDepartment of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, APHP, Université Paris Descartes, Sorbonne Paris Cite, Paris, France, Department of Anesthesiology and Perioperative Care, University of California San Francisco, San Francisco General Hospital and Trauma Center, San Francisco, CA, Department of Biostatistics and Medical Informatics, INSERM U-1153, team ECSTRA, Université Paris Diderot, Sorbonne Paris Cite, Paris, France
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Wang N, Song S, Chen J. Synchronized dual pulse gastric electrical stimulation improves gastric emptying and activates enteric glial cells via upregulation of GFAP and S100B with different courses of subdiaphragmatic vagotomy in rats. Mol Med Rep 2017; 15:3826-3832. [PMID: 28440477 DOI: 10.3892/mmr.2017.6471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 02/16/2017] [Indexed: 11/06/2022] Open
Abstract
Previous research and clinical practice have indicated that damage to the vagal nerve may seriously affect gastrointestinal physiological movement behavior. The aim of the current study was to observe the change of gastric motility, as well as enteric glial cells (EGCs) in the stomach with different courses of vagal nerve transection in rats prior to and following synchronized dual pulse gastric electrical stimulation. The gastric emptying rates were measured to assess the gastric motility. The glial markers, containing calcium binding protein (S100B) and glial fibrillary acidic protein (GFAP), were detected by reverse transcription‑quantitative polymerase chain reaction and double‑labeling immunofluorescence analysis. Ultrastructural changes of EGCs were observed using transmission electron microscopy. Gastric emptying was delayed in the terminal vagotomy group, compared with the terminal control group. The effect of long‑term synchronized dual pulse gastric electrical stimulation (SGES) was superior to short‑term SGES in terminal groups. The expression levels of S100B/GFAP were markedly decreased in the terminal vagotomy group compared with the terminal control group. Following short‑term or long‑term SGES, S100B/GFAP gene and protein expression increased in terminal groups. However, long‑term SGES was more effective than short‑term SGES and the difference was statistically significant. Vagal nerve damage leads to gastric motility disorder and weakens the function of EGCs. Therefore, SGES may improve stomach movement behavior and restore the impaired EGCs. The underlying mechanism of the effect remains elusive, but maybe associated with activation of EGCs.
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Affiliation(s)
- Nian Wang
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Shuangning Song
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Jie Chen
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
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Boullata JI, Carrera AL, Harvey L, Escuro AA, Hudson L, Mays A, McGinnis C, Wessel JJ, Bajpai S, Beebe ML, Kinn TJ, Klang MG, Lord L, Martin K, Pompeii-Wolfe C, Sullivan J, Wood A, Malone A, Guenter P. ASPEN Safe Practices for Enteral Nutrition Therapy [Formula: see text]. JPEN J Parenter Enteral Nutr 2016; 41:15-103. [PMID: 27815525 DOI: 10.1177/0148607116673053] [Citation(s) in RCA: 235] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Enteral nutrition (EN) is a valuable clinical intervention for patients of all ages in a variety of care settings. Along with its many outcome benefits come the potential for adverse effects. These safety issues are the result of clinical complications and of process-related errors. The latter can occur at any step from patient assessment, prescribing, and order review, to product selection, labeling, and administration. To maximize the benefits of EN while minimizing adverse events requires that a systematic approach of care be in place. This includes open communication, standardization, and incorporation of best practices into the EN process. This document provides recommendations based on the available evidence and expert consensus for safe practices, across each step of the process, for all those involved in caring for patients receiving EN.
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Affiliation(s)
- Joseph I Boullata
- 1 Clinical Nutrition Support Services, Hospital of the University of Pennsylvania and Department of Nutrition, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Lillian Harvey
- 3 Northshore University Hospital, Manhasset, New York, and Hofstra University NorthWell School of Medicine, Garden City, New York, USA
| | - Arlene A Escuro
- 4 Digestive Disease Institute Cleveland Clinic Cleveland, Ohio, USA
| | - Lauren Hudson
- 5 Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew Mays
- 6 Baptist Health Systems and University of Mississippi School of Pharmacy, Jackson, Mississippi, USA
| | - Carol McGinnis
- 7 Sanford University of South Dakota Medical Center, Sioux Falls, South Dakota, USA
| | | | - Sarita Bajpai
- 9 Indiana University Health, Indianapolis, Indiana, USA
| | | | - Tamara J Kinn
- 11 Loyola University Medical Center, Maywood, Illinois, USA
| | - Mark G Klang
- 12 Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Linda Lord
- 13 University of Rochester Medical Center, Rochester, New York, USA
| | - Karen Martin
- 14 University of Texas Center for Health Sciences at San Antonio, San Antonio, Texas, USA
| | - Cecelia Pompeii-Wolfe
- 15 University of Chicago, Medicine Comer Children's Hospital, Chicago, Illinois, USA
| | | | - Abby Wood
- 17 Baylor University Medical Center, Dallas, Texas, USA
| | - Ainsley Malone
- 18 American Society for Enteral and Parenteral Nutrition, Silver Spring, Maryland, USA
| | - Peggi Guenter
- 18 American Society for Enteral and Parenteral Nutrition, Silver Spring, Maryland, USA
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18
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The impact of measurement of respiratory quotient by indirect calorimetry on the achievement of nitrogen balance in patients with severe traumatic brain injury. Eur J Trauma Emerg Surg 2016; 43:775-782. [PMID: 27658944 DOI: 10.1007/s00068-016-0724-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 09/10/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND This study evaluated the impact of IC on the optimization of nutritional support and the achievement of +NB in patients with TBI. MATERIALS AND METHODS 27 patients (GCS ≤ 8), treated with a 5-day multimodality monitoring and goal-directed therapy protocol, received enteral nutrition on day 1 followed by IC on days 3 and 5 and assessment of NB on day 7. In the first cohort (n = 11), no adjustment in kcal was made. In the second cohort (n = 16), nutrition was targeted to an RQ of 0.83 by day 3. The first cohort was analyzed with respect to NB status; the second cohort was compared to patients with (-) and +NB of the first cohort. Data (mean ± SD) were analyzed with unpaired t test, and Chi square and Fisher exact tests. RESULTS 4/11(36 %) patients in the first cohort had +NB. The predicted mortality by TRISS, substrate utilization, and RQ was significantly lower compared to the second cohort. The mortality predicted by the CrasH model did not differ between the two cohorts. A RQ of 0.74 was associated with the preferential use of fat and protein and -NB, whereas a RQ of 0.84 favored utilization of carbohydrates and +NB. All patients whose kcal intake was adjusted based on the RQ on day 3 reached a +NB by day 7. CONCLUSION An increase in kcal ≥25 % in patients with a RQ < 0.83 on day 3 improves substrate utilization, decreases protein utilization and optimizes the achievement of +NB by day 7.
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Makkar JK, Gauli B, Jain K, Jain D, Batra YK. Comparison of erythromycin versus metoclopramide for gastric feeding intolerance in patients with traumatic brain injury: A randomized double-blind study. Saudi J Anaesth 2016; 10:308-13. [PMID: 27375386 PMCID: PMC4916815 DOI: 10.4103/1658-354x.174902] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: No randomized controlled trial demonstrates the efficacy of erythromycin or metoclopramide in patients with traumatic brain injury (TBI). This study was conducted to determine the efficacy of metoclopramide and erythromycin for improving gastric aspirate volume (GAV) in patients with TBI. Materials and Methods: Patients with Glasgow coma score more than 5 admitted to trauma Intensive Care Unit within 72 h of head injury were assessed for eligibility. 115 patients were prospectively randomized to receive metoclopramide, erythromycin, or placebo eighth hourly. Gastric feeding intolerance was defined as GAV more than 150 ml with abdominal symptoms. Two consecutive high GAV was defined as feeding failure. Feeding failure was treated by increasing the frequency of dose to 6 hourly in metoclopramide and erythromycin group. Combination therapy with both drugs was given as rescue in the placebo group. Results: Incidence of high GAV was as high as 60.5% in placebo group. Use of erythromycin was associated with a decrease in the incidence of feeding intolerance to 28.9% (P = 0.006). Although feed intolerance decreased to 43.6% in metoclopramide group, values did not reach statistical significance. The proportion of patients not having high GAV at different days were significantly higher in erythromycin group (P = 0.027, log-rank test). There was no difference in the proportion of patients not having feeding failure in three groups with increasing number of days. Conclusion: There was a significant decrease in the incidence of high GAV with the use of erythromycin when compared to metoclopramide and placebo.
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Affiliation(s)
- Jeetinder Kaur Makkar
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Basanta Gauli
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kajal Jain
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Divya Jain
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Yatinder Kumar Batra
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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BLASER AREINTAM, STARKOPF J, KIRSIMÄGI Ü, DEANE AM. Definition, prevalence, and outcome of feeding intolerance in intensive care: a systematic review and meta-analysis. Acta Anaesthesiol Scand 2014; 58:914-22. [PMID: 24611520 DOI: 10.1111/aas.12302] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2014] [Indexed: 12/16/2022]
Abstract
Clinicians and researchers frequently use the phrase 'feeding intolerance' (FI) as a descriptive term in enterally fed critically ill patients. We aimed to: (1) determine what is the most accepted definition of FI; (2) estimate the prevalence of FI; and (3) evaluate whether FI is associated with important outcomes. Systematic searches of peer-reviewed publications using PubMed, MEDLINE, and Web of Science were performed with studies reporting FI extracted. We identified 72 studies defining FI. In 33 studies, the definition was based on large gastric residual volumes (GRVs) together with other gastrointestinal symptoms, while 30 studies relied solely on large GRVs, six studies used inadequate delivery of enteral nutrition (EN) as a threshold, and three studies gastrointestinal symptoms without reference to GRV. The median volume used to define a 'large' GRV was 250 ml (ranges from 75 to 500 ml). The pooled proportion (n = 31 studies) of FI was 38.3% (95% CI 30.7-46.2). Five studies reported outcomes, all of them observed adverse outcome in FI patients. In three studies, respectively, FI was associated with increased mortality and ICU length-of-stay. In summary, FI is inconsistently defined but appears to occur frequently. There are preliminary data indicating that FI is associated with adverse outcomes. A standard definition of FI is required to determine the accuracy of these preliminary data.
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Affiliation(s)
- A. REINTAM BLASER
- Department of Anaesthesiology and Intensive Care; University of Tartu; Tartu Estonia
| | - J. STARKOPF
- Department of Anaesthesiology and Intensive Care; University of Tartu; Tartu Estonia
- Department of Anaesthesiology and Intensive Care; Tartu University Hospital; Tartu Estonia
| | - Ü. KIRSIMÄGI
- Department of Surgery; Tartu University Hospital; Tartu Estonia
| | - A. M. DEANE
- Discipline of Acute Care Medicine; University of Adelaide; Adelaide SA Australia
- Department of Critical Care Services; Royal Adelaide Hospital; Adelaide SA Australia
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Hu YC, Wang F, Zhang DD, Sun Q, Li W, Dai YX, Zhou ML, Hang CH. Expression of intestinal CD40 after experimental traumatic brain injury in rats. J Surg Res 2013; 184:1022-7. [DOI: 10.1016/j.jss.2013.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 03/23/2013] [Accepted: 04/04/2013] [Indexed: 10/26/2022]
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