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Zhang YY, Wang CY, Guo DX, Gao HN, Jin XS, Wu YL, Chen LH, Feng ZX. Improvement of the nutritional support management system for patients in intensive care units. World J Psychiatry 2024; 14:44-52. [PMID: 38327888 PMCID: PMC10845223 DOI: 10.5498/wjp.v14.i1.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/27/2023] [Accepted: 12/25/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Nutritional support for patients hospitalized in the intensive care unit (ICU) is an important part of clinical treatment and care, but there are significant implementation difficulties. AIM To introduce a modified nutritional support management system for ICU patients based on closed-loop information management and psychological counseling. METHODS The division of functions, personnel training, system construction, development of an intelligent decision-making software system, quality control, and improvement of the whole process were carried out to systematically manage nutritional support for ICU patients. RESULTS Following the implementation of the whole process management system, the scores of ICU medical staff's knowledge, attitudes/beliefs, and practices regarding nutritional support were comprehensively enhanced. The proportion of hospital bed-days of total enteral nutrition (EN) in ICU patients increased from 5.58% to 11.46%, and the proportion of EN plus parenteral nutrition increased from 42.71% to 47.07%. The rate of EN initiation within 48 h of ICU admission increased from 37.50% to 48.28%, and the EN compliance rate within 72 h elevated from 20.59% to 31.72%. After the implementation of the project, the Self-rating Anxiety Scale score decreased from 61.07 ± 9.91 points to 52.03 ± 9.02 points, the Self-rating Depression Scale score reduced from 62.47 ± 10.50 points to 56.34 ± 9.83 points, and the ICU stay decreased from 5.76 ± 2.77 d to 5.10 ± 2.12 d. CONCLUSION The nutritional support management system based on closed-loop information management and psychological counseling achieved remarkable results in clinical applications in ICU patients.
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Affiliation(s)
- Yuan-Yuan Zhang
- Department of Critical Care Medicine, Shulan (Hangzhou) Hospital, Zhejiang Shuren University Shulan International Medical College, Hangzhou 310022, Zhejiang Province, China
| | - Chun-Yi Wang
- Department of Critical Care Medicine, Shulan (Hangzhou) Hospital, Zhejiang Shuren University Shulan International Medical College, Hangzhou 310022, Zhejiang Province, China
| | - Dong-Xian Guo
- Department of Critical Care Medicine, Shulan (Hangzhou) Hospital, Zhejiang Shuren University Shulan International Medical College, Hangzhou 310022, Zhejiang Province, China
| | - Hai-Nu Gao
- Department of Critical Care Medicine, Shulan (Hangzhou) Hospital, Zhejiang Shuren University Shulan International Medical College, Hangzhou 310022, Zhejiang Province, China
| | - Xian-Shan Jin
- Department of Information, Shulan (Hangzhou) Hospital, Zhejiang Shuren University Shulan International Medical College, Hangzhou 310022, Zhejiang Province, China
| | - Yan-Li Wu
- Department of Pharmacy, Shulan (Hangzhou) Hospital, Zhejiang Shuren University Shulan International Medical College, Hangzhou 310022, Zhejiang Province, China
| | - Lu-Han Chen
- Department of Nutrition, Shulan (Hangzhou) Hospital, Zhejiang Shuren University Shulan International Medical College, Hangzhou 310022, Zhejiang Province, China
| | - Zhi-Xian Feng
- Administrative Office, Shulan (Hangzhou) Hospital, Zhejiang Shuren University Shulan International Medical College, Hangzhou 310022, Zhejiang Province, China
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Gostyńska A, Czerniel J, Kuźmińska J, Żółnowska I, Brzozowski J, Krajka-Kuźniak V, Stawny M. The Development of Magnolol-Loaded Intravenous Emulsion with Low Hepatotoxic Potential. Pharmaceuticals (Basel) 2023; 16:1262. [PMID: 37765070 PMCID: PMC10537714 DOI: 10.3390/ph16091262] [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: 08/01/2023] [Revised: 08/26/2023] [Accepted: 09/03/2023] [Indexed: 09/29/2023] Open
Abstract
Intestinal failure-associated liver disease (IFALD) is a severe liver injury occurring due to factors related to intestinal failure and parenteral nutrition administration. Different approaches are studied to reduce the risk or ameliorate the course of IFALD, including providing omega-3 fatty acids instead of soybean oil-based lipid emulsion or administering active compounds that exert a hepatoprotective effect. This study aimed to develop, optimize, and characterize magnolol-loaded intravenous lipid emulsion for parenteral nutrition. The preformulation studies allowed for chosen oils mixture of the highest capacity of magnolol solubilization. Then, magnolol-loaded SMOFlipid was developed using the passive incorporation method. The Box-Behnken design and response surface methodology were used to optimize the entrapment efficiency. The optimal formulation was subjected to short-term stress tests, and its effect on normal human liver cells and erythrocytes was determined using the MTT and hemolysis tests, respectively. The optimized magnolol-loaded SMOFlipid was characterized by the mean droplet diameter of 327.6 ± 2.9 nm with a polydispersity index of 0.12 ± 0.02 and zeta potential of -32.8 ± 1.2 mV. The entrapment efficiency of magnolol was above 98%, and pH and osmolality were sufficient for intravenous administration. The magnolol-loaded SMOFlipid samples showed a significantly lower toxic effect than bare SMOFlipid in the same concentration on THLE-2 cells, and revealed an acceptable hemolytic effect of 8.3%. The developed formulation was characterized by satisfactory stability. The in vitro studies showed the reduced cytotoxic effect of MAG-SMOF applied in high concentrations compared to bare SMOFlipid and the non-hemolytic effect on human blood cells. The magnolol-loaded SMOFlipid is promising for further development of hepatoprotective lipid emulsion for parenteral nutrition.
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Affiliation(s)
- Aleksandra Gostyńska
- Department of Pharmaceutical Chemistry, Poznan University of Medical Sciences, 6 Grunwaldzka, 60-780 Poznan, Poland; (J.C.); (J.K.); (I.Ż.); (J.B.); (M.S.)
| | - Joanna Czerniel
- Department of Pharmaceutical Chemistry, Poznan University of Medical Sciences, 6 Grunwaldzka, 60-780 Poznan, Poland; (J.C.); (J.K.); (I.Ż.); (J.B.); (M.S.)
| | - Joanna Kuźmińska
- Department of Pharmaceutical Chemistry, Poznan University of Medical Sciences, 6 Grunwaldzka, 60-780 Poznan, Poland; (J.C.); (J.K.); (I.Ż.); (J.B.); (M.S.)
| | - Izabela Żółnowska
- Department of Pharmaceutical Chemistry, Poznan University of Medical Sciences, 6 Grunwaldzka, 60-780 Poznan, Poland; (J.C.); (J.K.); (I.Ż.); (J.B.); (M.S.)
| | - Jakub Brzozowski
- Department of Pharmaceutical Chemistry, Poznan University of Medical Sciences, 6 Grunwaldzka, 60-780 Poznan, Poland; (J.C.); (J.K.); (I.Ż.); (J.B.); (M.S.)
| | - Violetta Krajka-Kuźniak
- Department of Pharmaceutical Biochemistry, Poznan University of Medical Sciences, 4 Swiecickiego, 60-781 Poznan, Poland;
| | - Maciej Stawny
- Department of Pharmaceutical Chemistry, Poznan University of Medical Sciences, 6 Grunwaldzka, 60-780 Poznan, Poland; (J.C.); (J.K.); (I.Ż.); (J.B.); (M.S.)
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Leite NP, Alvarez TS, Fonseca FLA, Hix S, Sarni ROS. Vitamin D deficiency in bedridden elderly people at home. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:61-65. [PMID: 36820714 PMCID: PMC9937594 DOI: 10.1590/1806-9282.20220613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/30/2022] [Indexed: 02/19/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate serum 25(OH)D concentrations in the homebound elderly people and relate them to level of dementia, nutritional risk, and route of dietary administration. METHODS This is a cross-sectional study involving 207 bedridden elderly people assisted by the Home Care Service in the city of Santo André - SP, from June to December 2016. The following factors were evaluated: dietary intake of vitamin D, arm circumference, triceps skin fold thickness, calf circumference, nutritional risk by Mini-Nutritional Assessment, level of dementia by the adapted Clinical Dementia Rating questionnaire, and laboratory tests such as serum concentrations of 25(OH)D, ultrasensitive C-reactive protein, alkaline phosphatase, serum calcium, and parathormone. RESULTS The mean age of the elderly people was 81.6 (9.2) years. Deficiency of 25(OH)D was observed in 76.3% of the elderly people. There was an inverse correlation between serum concentrations of 25(OH)D: parathormone (r=-0.418, p<0.001) and alkaline phosphatase (r=-0.188, p=0.006) and a direct correlation with serum calcium (r=-0.158, p=0.022). Logistic regression showed that vitamin D deficiency was directly and independently associated with oral feeding (odds ratio 7.71; 95%CI 2.91-20.40). CONCLUSION Bedridden households showed high prevalence of vitamin D deficiency without association with nutritional risk and level of dementia. Oral diet was associated with vitamin D deficiency, possibly due to low consumption of source foods.
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Affiliation(s)
- Narjara Pereira Leite
- Centro Universitário Faculdade de Medicina do ABC – Santo André (SP), Brazil.,Corresponding author:
| | | | - Fernando Luiz Affonso Fonseca
- Centro Universitário Faculdade de Medicina do ABC, Department of Pathology, Discipline of Clinical Analysis – Santo André (SP), Brazil
| | - Sonia Hix
- Centro Universitário Faculdade de Medicina do ABC, Discipline of Clinical Biochemistry – Santo André (SP), Brazil
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Honokiol-Loaded Nanoemulsion for Glioblastoma Treatment: Statistical Optimization, Physicochemical Characterization, and an In Vitro Toxicity Assay. Pharmaceutics 2023; 15:pharmaceutics15020448. [PMID: 36839769 PMCID: PMC9959519 DOI: 10.3390/pharmaceutics15020448] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Glioblastoma (GBM) is an extremely invasive and heterogenous malignant brain tumor. Despite advances in current anticancer therapy, treatment options for glioblastoma remain limited, and tumor recurrence is inevitable. Therefore, alternative therapies or new active compounds that can be used as adjuvant therapy are needed. This study aimed to develop, optimize, and characterize honokiol-loaded nanoemulsions intended for intravenous administration in glioblastoma therapy. METHODS Honokiol-loaded nanoemulsion was developed by incorporating honokiol into Lipofundin MCT/LCT 20% using a horizontal shaker. The Box-Behnken design, coupled with response surface methodology, was used to optimize the incorporation process. The effect of the developed formulation on glioblastoma cell viability was determined using the MTT test. Long-term and short-term stress tests were performed to evaluate the effect of honokiol on the stability of the oil-in-water system and the effect of different stress factors on the stability of honokiol, respectively. Its physicochemical properties, such as MDD, PDI, ZP, OSM, pH, and loading efficiency (LE%), were determined. RESULTS The optimized honokiol-loaded nanoemulsion was characterized by an MDD of 201.4 (0.7) nm with a PDI of 0.07 (0.02) and a ZP of -28.5 (0.9) mV. The LE% of honokiol was above 95%, and pH and OSM were sufficient for intravenous administration. The developed formulation was characterized by good stability and a satisfactory toxicity effect of the glioblastoma cell lines. CONCLUSIONS The honokiol-loaded nanoemulsion is a promising pharmaceutical formulation for further development in the adjuvant therapy of glioblastoma.
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Yahyapoor F, Keshani M, Sedaghat A, Feizi A, Clark CCT, Bagherniya M, Safarian M, Badpeyma M, Norouzy A. The effects of adjunctive treatment with L-carnitine on monitoring laboratory variables in ICU patients: a double-blinded randomized controlled clinical trial. Trials 2023; 24:3. [PMID: 36597167 PMCID: PMC9808964 DOI: 10.1186/s13063-022-07010-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Critically ill patients must be monitored constantly in intensive care units (ICUs). Among many laboratory variables, nutritional status indicators are a key role in the prognosis of diseases. We investigated the effects of L-carnitine adjunctive therapy on monitoring variables in critical illness. METHOD A prospective, double-blind, randomized controlled trial was implemented in a medical ICU. Participants were 54 patients, aged > 18 years, with multiple conditions, randomly assigned to receive 3 g L-carnitine per day or placebo, along with enteral feeding, for 1 week. Primary outcomes included monitoring variables related to nutritional status. RESULT Of 54 patients randomly assigned, 51 completed the trial. Serum albumin (Alb) (P-value: 0.001), total protein (P-value: 0.003), and calcium (Ca) (0.044) significantly increased in the intervention vs. control group. Alanine transaminase (ALT) (0.022), lactate (<0.001), creatinine (Cr) (0.005), and international normalized ratio (INR) (0.049) decreased meaningfully in the intervention vs. control group. CONCLUSION L-Carnitine supplementation in critically ill patients can improve several parameters including INR, Cr, ALT, lactate, Ca, Alb, and total protein. TRIAL REGISTRATION Iranian Registry of Clinical Trials IRCT 20151108024938N2. This trial was approved by the Research Ethics Committee of Mashhad University of Medical Sciences (registration code: IR.MUMS.fm.REC.1396.671) (available at https://en.irct.ir/trial/30748 , May 2018).
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Affiliation(s)
- Farveh Yahyapoor
- grid.411583.a0000 0001 2198 6209Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdi Keshani
- grid.411036.10000 0001 1498 685XFood Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran ,grid.411036.10000 0001 1498 685XDepartment of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Sedaghat
- grid.411583.a0000 0001 2198 6209Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Awat Feizi
- grid.411036.10000 0001 1498 685XBiostatistics and Epidemiology Department, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Cain C. T. Clark
- grid.8096.70000000106754565Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5FB UK
| | - Mohammad Bagherniya
- grid.411036.10000 0001 1498 685XFood Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran ,grid.411036.10000 0001 1498 685XDepartment of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran ,grid.411036.10000 0001 1498 685XAnesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Safarian
- grid.411583.a0000 0001 2198 6209Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohaddeseh Badpeyma
- grid.412888.f0000 0001 2174 8913Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran ,grid.412888.f0000 0001 2174 8913Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abdolreza Norouzy
- grid.411583.a0000 0001 2198 6209Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Yang YJ, Su S, Zhang Y, Wu D, Wang C, Wei Y, Peng X. Effects of enteral nutrition with different energy supplies on metabolic changes and organ damage in burned rats. BURNS & TRAUMA 2022; 10:tkac042. [PMID: 36420355 PMCID: PMC9678637 DOI: 10.1093/burnst/tkac042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/21/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Enteral nutrition (EN) is an important treatment for burn patients. However, severe gastrointestinal damage caused by major burns often leads to EN intolerance. Trophic EN solves this problem basically, but how to transition from trophic EN to standard EN smoothly is still a challenge in burn clinical nutrition. The aim of this study is to investigate the effects of EN with different energy supplies on metabolic changes, organ damage and prognosis in burned rats. METHODS Different feeding regimens were designed based on the continuous monitoring of resting energy expenditure in rats. Thirty-two Sprague-Dawley rats were randomly divided into a normal control group, burn +50% REE group, burn +75% REE group and burn +100% REE group. At the end of a nutritional treatment cycle (14th day), nuclear magnetic resonance spectroscopy, blood biochemistry analysis and quantification of subscab bacteria were performed to explore the differences in metabolic changes, degrees of organ damage and prognoses between the groups. RESULTS Sixteen metabolites involving seven metabolic pathways were identified from the different energy supply groups. After burn injury, resting energy consumption and body weight loss increased obviously. Meanwhile, weight loss was inversely related to energy supply. The greatest changes in the degree of organ damage, the level of plasma proteins, lipids and endotoxins, as well as the quantification of subscab bacteria were observed in the 50% REE group, followed by the 75 and 100% groups. CONCLUSIONS Achieving an early balance between energy supply and expenditure is conducive to mitigating metabolic disorders and improving prognosis after burn injury.
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Affiliation(s)
| | | | | | - Dan Wu
- Clinical Medical Research Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing China
| | - Chao Wang
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing China
| | - Yan Wei
- Clinical Medical Research Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing China
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Li K, Tong HHY, Chen Y, Sun Y, Wang J. The emerging roles of next-generation metabolomics in critical care nutrition. Crit Rev Food Sci Nutr 2022; 64:1213-1224. [PMID: 36004623 DOI: 10.1080/10408398.2022.2113761] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Critical illness leads to millions of deaths worldwide each year, with a significant surge due to the COVID-19 pandemic. Patients with critical illness are frequently associated with systemic metabolic disorders and malnutrition. The idea of intervention for critically ill patients through enteral and parenteral nutrition has been paid more and more attention gradually. However, current nutritional therapies focus on evidence-based practice, and there have been lacking holistic approaches for nutritional support assessment. Metabolomics is a well-established omics technique in system biology that enables comprehensive profiling of metabolites in a biological system and thus provides the underlying information expressed and modulated by all other omics layers. In recent years, with the development of high-resolution and accurate mass spectrometry, metabolomics entered a new "generation", promoting its broader applications in critical care nutrition. In this review, we first described the technological development and milestones of next-generation metabolomics in the past 20 years. We then discussed the emerging roles of next-generation metabolomics in advancing our understanding of critical care nutrition, such as nutritional deficiency risk evaluation, metabolic mechanisms of nutritional therapies, and novel nutrition target identification.
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Affiliation(s)
- Kefeng Li
- Department of Critical Care Medicine, Yantai Yuhuangding Hospital Affiliated with Medical College of Qingdao University, Yantai, Shandong, China
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao SAR, China
- School of Medicine, University of California, San Diego, California, USA
| | - Henry Hoi Yee Tong
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao SAR, China
| | - Yuwei Chen
- The Second Clinical Medical College, Binzhou Medical University, Binzhou, Shandong, China
| | - Yizhu Sun
- Department of Critical Care Medicine, Yantai Yuhuangding Hospital Affiliated with Medical College of Qingdao University, Yantai, Shandong, China
| | - Jing Wang
- Department of Critical Care Medicine, Yantai Yuhuangding Hospital Affiliated with Medical College of Qingdao University, Yantai, Shandong, China
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Xu J, Li S, Chen X, Tan B, Chen S, Hu B, Nie Z, Ye H, Sun C, Chi R, Chen C. A Two-Stage Bedside Intubation Method to Improve Success Rate of Post-pyloric Placement of Spiral Nasoenteric Tubes in Critically Ill Patients: A Multi-Center, Prospective Study. Front Med (Lausanne) 2022; 9:875298. [PMID: 35646990 PMCID: PMC9134184 DOI: 10.3389/fmed.2022.875298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/26/2022] [Indexed: 12/03/2022] Open
Abstract
Backgrounds Prokinetic agents could improve the success rate of post-pyloric placement of self-propelled spiral nasoenteric tubes (NETs), and bedside blind technique might apply as a rescue therapy subsequent to spontaneous transpyloric migration failure. The objective of this study was to investigated the validity and safety of these two bedside intubation methods as a sequential procedure for post-pyloric placement of spiral NETs in critically ill patients. Methods The multicenter, prospective study was conducted in intensive care units of four tertiary hospitals (June 2020 to January 2021). Eligible patients received self-propelled spiral NET placements, promoted by prokinetic agents (Stage 1). An abdominal X-ray performed 24 h post-intubation confirmed the position of the tube tip. Patients with a failed transpyloric migration entered Stage 2, where beside blind intubation was conducted (reconfirmed by X-ray). The primary end point was the overall success rate of post-pyloric placement. Results The overall success rate of post-pyloric placement of the spiral NET was 91.1% (73.4% in the third portion of the duodenum [D3] or beyond). The total adverse event rate was 21.0%, without any serious adverse events. In Stage 1, 55.6% of participants achieved transpyloric migration, of these, 44.4% migrated to D3 or beyond. The median time from decision to intubate to the initiation of enteral nutrition (EN) was 25 h. In Stage 2, 83.0% of patients had successful post-pyloric intubation (67.9% in D3 or beyond). The median time from decision to EN initiation after the two-stage process was 36 h. Conclusions Prokinetic agents-assisted self-propelled intubation and remedial bedside blind technique as a sequential procedure for post-pyloric placement of spiral NETs were effective and safe, and this two-stage process did not affect the implementation of early EN in critically ill patients. Trial Registration Chinese Clinical Trial Registry, ChiCTR1900026381. Registered on 6 October 2019.
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Affiliation(s)
- Jing Xu
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Sinian Li
- Neurological Intensive Care Unit, Maoming People's Hospital, Maoming, China
| | - Xiangyin Chen
- Surgical Intensive Care Unit, Maoming People's Hospital, Maoming, China
| | - Bo Tan
- Department of Emergency, Maoming People's Hospital, Maoming, China
| | - Shenglong Chen
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bei Hu
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhiqiang Nie
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Heng Ye
- Department of Critical Care Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Cheng Sun
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ruibin Chi
- Department of Critical Care Medicine, Xiaolan People's Hospital of Zhongshan, Zhongshan, China
| | - Chunbo Chen
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Critical Care Medicine, Maoming People's Hospital, Maoming, China
- *Correspondence: Chunbo Chen
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Application of Prognostic Models Based on Psoas Muscle Index, Stage, Pathological Grade, and Preoperative Carcinoembryonic Antigen Level in Stage II-III Colorectal Cancer Patients Undergoing Adjuvant Chemotherapy. JOURNAL OF ONCOLOGY 2022; 2022:6851900. [PMID: 35154320 PMCID: PMC8828329 DOI: 10.1155/2022/6851900] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/03/2022] [Indexed: 12/22/2022]
Abstract
Objective To investigate the effect of sarcopenia on the prognosis of stage II-III colorectal cancer patients undergoing adjuvant chemotherapy. Methods A total of 196 stage II-III colorectal cancer patients who received 8 cycles of postoperative chemotherapy were retrospectively analyzed. An abdominal CT acquired at 3-4 weeks after surgery was used to calculate the psoas muscle index. Subsequently, once gender-specific receiver operating characteristic curves were plotted and cut-off values of psoas muscle index were defined, the clinicopathological characteristics and the prognosis of patients with high and low values were compared. Lastly, prognostic models were established based on the independent prognostic factors of relapse-free survival and overall survival identified by COX analysis. Results Based on the psoas muscle index, the prevalence of sarcopenia was 37.5% among 196 patients. This prevalence has significant correlation with patients' age and gender. However, it was not related to the AJCC stage, T stage, lymph node metastasis, pathological grade, grade III-IV myelosuppression, or preoperative carcinoembryonic antigen level. In addition, both the relapse-free and the overall survival of patients with low and high psoas muscle indexes were significantly different. COX analysis indicated that the psoas muscle index was an independent prognostic factor. Both the overall survival prognostic model based on patients' psoas muscle index, stage, pathological grade, and preoperative carcinoembryonic antigen level and the relapse-free survival prognostic model based on patients' psoas muscle index, pathological grade, and preoperative carcinoembryonic antigen level could accurately predict the prognosis of patients. Conclusion For stage II-III colorectal cancer patients, the presence of sarcopenia before adjuvant chemotherapy would adversely affect their recurrence-free and overall survival. Prognostic models based on psoas muscle index, stage, pathological grade, and preoperative carcinoembryonic antigen level could accurately predict the prognosis in these patients.
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Effect of Early Versus Delayed Parenteral Nutrition on the Health Outcomes of Critically Ill Adults: A Systematic Review. J Crit Care Med (Targu Mures) 2021; 7:160-169. [PMID: 34722919 PMCID: PMC8519384 DOI: 10.2478/jccm-2021-0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 03/11/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives This systematic review aims to evaluate and summarise the findings of all relevant studies which identified the effect of early vs delayed parenteral nutrition (PN), early PN vs early supplemental PN and early PN vs standard care for critically ill adults. Methods The literature search was undertaken using PubMed, Embase, Medline, Clinical Key, and Ovid discovery databases. The reference lists of studies published from 2000 till June 2020 were hand searched. Result On screening 2088 articles, a total of five RCTs with 6,277 patients were included in this review. Only one clinical trial compared early PN and late PN; the results reported significantly shorter periods in intensive care unit (ICU) stay (p=0.02) and less ICU related infections (p=0.008) in the late PN group compared to the Early PN group. Two trials compared total parenteral nutrition (TPN) and enteral nutrition (EN) +TPN groups. Both found a significantly longer hospital stay duration (p<0.05 and p<0.01) with a higher mortality rate in the TPN group compared to the EN+TPN group. A statistically significant improvement was observed in patients' quality of life receiving early PN compared to standard care (p=0.01). In contrast, no significant difference was found in the supplemental PN vs the standard care group. Conclusion The supplemental PN patients had shorter ICU stay and lower mortality rates than TPN. However, these findings should be interpreted carefully as included studies have different initiation timing of nutritional support, and the patients' diagnosis varied.
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Santos Ferreira RD, Dos Santos C, Maranhão Mendonça LAB, Espinola Carvalho CM, Franco OL. Immunonutrition effects on coping with COVID-19. Food Funct 2021; 12:7637-7650. [PMID: 34286803 DOI: 10.1039/d1fo01278a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
COVID-19 implications are still a threat to global health. In the face of this pandemic, food and nutrition are key issues that can boost the immune system. The bioactivity of functional foods and nutrients (probiotics, prebiotics, water- and fat-soluble vitamins, minerals, flavonoids, glutamine, arginine, nucleotides, and PUFAs) contributes to immune system modulation, which establishes the status of nutrients as a factor of immune competence. These foods can contribute, especially during a pandemic, to the minimization of complications of SARS-CoV-2 infection. Therefore, it is important to support the nutritional strategies for strengthening the immune status, associated with good eating habits, as a way to confront COVID-19.
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Affiliation(s)
- Rosângela Dos Santos Ferreira
- S-Inova Biotech. Post Graduate Program in Biotechnology, Catholic University Dom Bosco-UCDB, MS 79117-010 Campo Grande, Brazil.
| | - Cristiane Dos Santos
- S-Inova Biotech. Post Graduate Program in Biotechnology, Catholic University Dom Bosco-UCDB, MS 79117-010 Campo Grande, Brazil.
| | | | | | - Octávio Luiz Franco
- S-Inova Biotech. Post Graduate Program in Biotechnology, Catholic University Dom Bosco-UCDB, MS 79117-010 Campo Grande, Brazil. and Center of Proteomic and Biochemical Analysis, Post Graduate Program in Genomic Sciences and Biotechnology, Catholic University of Brasilia, Brasilia, Distrito Federal, Brazil
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12
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Zhou W, Ruksakulpiwat S, Fan Y, Ji L. Nutritional Interventions on Physical Functioning for Critically Ill Patients: An Integrative Review. J Multidiscip Healthc 2021; 14:1489-1507. [PMID: 34177267 PMCID: PMC8219235 DOI: 10.2147/jmdh.s314132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 05/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background Poor physical functioning (PF) is a common issue among critically ill patients. It was suggested that reasonable nutrition accelerates PF recovery. However, the details and types of nutritional interventions on the PF of different intensive care unit (ICU) patients at present have not been well analyzed yet. This study aimed to systematically synthesize nutritional interventions on PF in different ICU populations. Methods Whittemore and Knafl’s framework was employed. PubMed, EMBASE, Web of Science, CINAHL Plus with Full Text, and Cochrane Library were searched to obtain studies from January 2010 to September 2020, with a manual search of the included studies’ references. Record screening, data extraction, and quality appraisal were conducted independently by each reviewer before reaching an agreement after discussion. Results Twelve studies were included reporting the effects of early parenteral nutrition, early enteral nutrition, early goal-directed nutrition, early adequate nutrition, higher protein delivery, higher energy delivery, low energy delivery, energy and protein delivery, intermittent enteral feeding on PF like muscle mass, muscle strength, and function. Function was the most common outcome but showed little improvements. Muscle strength outcomes improved the most. The mechanically ventilated were the most popular target ICU population. The commenced time of the interventions is usually within 24 to 48 hours after ICU admission. Conclusion Research on nutritional interventions on critically ill patients’ PF is limited, but most are of a high level of evidence. Few intervention studies specified their evidence basis. Qualitative studies investigating timeframe of initiating feeding, perspectives of the patients’ perspectives and caregivers are warranted to advance research and further discuss this topic.
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Affiliation(s)
- Wendie Zhou
- Clinical Nursing Teaching Department, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China.,Office of General Affairs, School of Nursing, Harbin Medical University, Harbin, People's Republic of China
| | - Suebsarn Ruksakulpiwat
- Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Yuying Fan
- Clinical Nursing Teaching Department, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China.,Office of General Affairs, School of Nursing, Harbin Medical University, Harbin, People's Republic of China
| | - Lingling Ji
- Department of Pediatrics, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
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13
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Moallemian Isfahani M, Emam-Djomeh Z, Rao IM, Rezaei N. Nutrition and Immunity in COVID-19. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1318:485-497. [PMID: 33973196 DOI: 10.1007/978-3-030-63761-3_28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Nutrition can strongly influence infection trajectories by either boosting or suppressing the immune system. During the recently emerged pandemic of coronavirus disease 2019 (COVID-19), individuals who possess diets high in fat, refined carbohydrates, and sugars have shown to be highly prone to the disease and associated adverse outcomes. Both micronutrients and macronutrients provide benefits at different stages of the infection. Thus, using appropriate nutritional recommendations and interventions is necessary to combat the infection in patients with COVID-19 in both outpatient and inpatient settings.
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Affiliation(s)
- Marjan Moallemian Isfahani
- Dietetics and Nutrition Experts Team (DiNET), Universal Scientific Education and Research Network (USERN), Tehran, Iran.,National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Emam-Djomeh
- Dietetics and Nutrition Experts Team (DiNET), Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Department of Food Science and Engineering, University College of Agriculture and Natural Resources, University of Tehran, Karaj, Iran
| | - Idupulapati M Rao
- Centro Internacional de Agricultura Tropical, Santiago de Cali, Colombia
| | - Nima Rezaei
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. .,Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. .,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
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14
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Tomczak S, Stawny M, Jelińska A. Co-Administration of Drugs and Parenteral Nutrition: In Vitro Compatibility Studies of Loop Diuretics for Safer Clinical Practice. Pharmaceutics 2020; 12:pharmaceutics12111092. [PMID: 33202945 PMCID: PMC7696202 DOI: 10.3390/pharmaceutics12111092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/06/2020] [Accepted: 11/11/2020] [Indexed: 12/26/2022] Open
Abstract
Parenteral nutrition (PN) admixtures are prone to interacting with drugs administered intravenously via a common catheter. This may cause a threat to a patient’s health and life. The literature that has been reported on the compatibility of loop diuretics with PN presents conflicting results. This work aimed to study the compatibility of furosemide and torsemide with PN used in clinical practice. Undiluted solutions of drugs were mixed with PN at various ratios determined by flow rates. In order to assess compatibility, visual control was followed by pH measurement, osmolality, mean emulsion droplet diameter (MDD), and zeta potential upon mixing and at 4 h of storage. No macroscopic changes that indicated lipid emulsion degradation were observed. After the addition of the drugs, the value of pH ranged from 6.37 ± 0.01 to 7.38 ± 0.01. The zeta potential was in reverse proportion to the drug concentration. The addition of the drugs did not affect the MDD. It may be suggested that the co-administration of furosemide or torsemide and PN caused no interaction. The absence of such signs of unwanted interactions allowed for the co-administration of the mentioned loop diuretics and PN at each of the studied ratios.
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15
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Młynarska A, Krawuczka A, Kolarczyk E, Uchmanowicz I. Rationing of Nursing Care in Intensive Care Units. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17196944. [PMID: 32977450 PMCID: PMC7579213 DOI: 10.3390/ijerph17196944] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/18/2020] [Accepted: 09/20/2020] [Indexed: 11/16/2022]
Abstract
The nursing practice refers to a wide range of tasks and responsibilities. In a situation where there is a problem of limited resources, nurses are forced to ration the patient’s care—that is, minimize and skip some tasks. The main purpose of this work was to assess the rationing level of nursing care among staff in the intensive care units. Methods: The research included 150 anaesthesiological nurses in the Silesian Region in Poland. The research was conducted from July to October 2019 using the standardized Perceived Implicit Rationing of Nursing Care (PRINCA) questionnaire on rationing nursing care, assessing the quality of patient care, and job satisfaction. The Modified Fatigue Impact Scale (MFIS) standardized questionnaire was used to assess the level of fatigue of respondents in the physical, cognitive, and psychosocial spheres. Results: Sociodemographic factors, such as gender, age, place of residence, education, seniority, and type of employment were not found to affect the rationing level of nursing care in the intensive care unit. The average quality of patient care was 6.05/10 points, while the average job satisfaction rating was 7.13/10 points. Analysis of the MFIS questionnaire showed that respondents experienced fatigue between “rare” and “sometimes”, and nursing staff fatigue was the main factor for rationing care. Conclusions: The higher the level of fatigue, the greater the rationing of care and the less satisfaction from work.
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Affiliation(s)
- Agnieszka Młynarska
- Department of Gerontology and Geriatric Nursing, Faculty of Health Sciences in Katowice, Medical University of Silesia,40−752 Katowice, Poland; (A.M.); (A.K.)
| | - Anna Krawuczka
- Department of Gerontology and Geriatric Nursing, Faculty of Health Sciences in Katowice, Medical University of Silesia,40−752 Katowice, Poland; (A.M.); (A.K.)
| | - Ewelina Kolarczyk
- Department of Propaedeutics of Nursing, Faculty of Health Sciences in Katowice, Medical University in Silesia, 40−752 Katowice, Poland
- Correspondence: ; Tel.: +48-32-252-8006
| | - Izabella Uchmanowicz
- Division of Nursing in Internal Medicine Procedures, Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, 51-618 Wroclaw, Poland;
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