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Lima J, Bernardes S, Stello BB, Richrot TS, Milanez DSJ, Silva FM. Remote nutrition care during the first wave of COVID-19 pandemic: Did it impact nutrition therapy goals? Nutr Clin Pract 2024; 39:210-217. [PMID: 37132047 DOI: 10.1002/ncp.11003] [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: 01/04/2023] [Revised: 03/14/2023] [Accepted: 03/26/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND AND AIMS Nutrition societies recommended remote hospital nutrition care during the coronavirus disease 2019 (COVID-19) pandemic. However, the pandemic's impact on nutrition care quality is unknown. We aimed to evaluate the association between remote nutrition care during the first COVID-19 wave and the time to start and achieve the nutrition therapy (NT) goals of critically ill patients. METHODS A cohort study was conducted in an intensive care unit (ICU) that assisted patients with COVID-19 between May 2020 and April 2021. The remote nutrition care lasted approximately 6 months, and dietitians prescribed the nutrition care based on medical records and daily telephone contact with nurses who were in direct contact with patients. Data were retrospectively collected, patients were grouped according to the nutrition care delivered (remote or in person), and we compared the time to start NT and achieve the nutrition goals. RESULTS One hundred fifty-eight patients (61.5 ± 14.8 years, 57% male) were evaluated, and 54.4% received remote nutrition care. The median time to start NT was 1 (1-3) day and to achieve the nutrition goals was 4 (3-6) days for both groups. The percentage of energy and protein prescribed on day 7 of the ICU stay concerning the requirements did not differ between patients with remote and patients with in-person nutrition care [95.5% ± 20.4% × 92.1% ± 26.4% (energy) and 92.9% ± 21.9% × 86.9% ± 29.2% (protein); P > 0.05 for both analyses]. CONCLUSION Remote nutrition care in patients critically ill with COVID-19 did not impact the time to start and achieve the NT goals.
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Affiliation(s)
- Júlia Lima
- Nutrition Science Graduate Program, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Simone Bernardes
- Health Sciences Graduate Program, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Bruna Barbosa Stello
- Nutrition Undergraduate Program, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Thamy Schossler Richrot
- Intensive Care Multidisciplinary Residency Program, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | | | - Flávia Moraes Silva
- Nutrition Science Graduate Program, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
- Health Sciences Graduate Program, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
- Nutrition Undergraduate Program, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
- Intensive Care Multidisciplinary Residency Program, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
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Feng L, Chen J, Xu Q. Is monitoring of gastric residual volume for critically ill patients with enteral nutrition necessary? A meta-analysis and systematic review. Int J Nurs Pract 2023; 29:e13124. [PMID: 36540042 DOI: 10.1111/ijn.13124] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/16/2022] [Accepted: 11/13/2022] [Indexed: 12/18/2023]
Abstract
BACKGROUND There are many controversies over the necessity of monitoring gastric residual volume in the nursing care of enteral nutrition. We aimed to conduct an updated meta-analysis to evaluate the effects of monitoring or not monitoring gastric residual volume on patients' outcomes and complications. METHODS We searched the Cochrane Library database to 15 April 2021 for randomized controlled trials (RCTs) on the effects of gastric residual volume and no gastric residual volume monitoring. Review Manager software was used for data analysis. RESULTS A total of seven RCTs involving 1240 enteral nutrition patients were included. Gastric residual volume monitoring was associated with reduced incidence of vomiting (OR2.33, 95% CI:1.68-3.24), whereas no gastric residual volume monitoring was associated with reduced incidence of unnecessary interruptions of enteral nutrition (OR0.38,95% CI:0.26-0.55). There were no significant differences on the incidence of abdominal distention (OR1.87, 95% CI:0.82-4.28), diarrhoea (OR1.03,95% CI:0.74-1.43), VAP (OR0.83, 95%CI:0.37-1.89), duration of mechanical ventilation (MD -0.06,95% CI:-1.22-1.10), length of ICU stay (MD -1.33, 95% CI:-3.58-0.91) and mortality (OR0.90,95% CI:0.61-1.34). CONCLUSIONS Not monitoring gastric residual volume is associated with reduced unnecessary interruptions of enteral nutrition related to inadequate feeding and increased risk of vomiting.
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Affiliation(s)
- Limei Feng
- Department of Nursing, Wuxi No. 5 Affiliated Hospital of Jiangnan University, Wuxi No. 5 People's Hospital, Jiangsu, China
| | - Judi Chen
- Department of Nursing, Wuxi No. 5 Affiliated Hospital of Jiangnan University, Wuxi No. 5 People's Hospital, Jiangsu, China
| | - Qin Xu
- School of Nursing, Nanjing Medical University, Nanjing, China
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3
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Hirschberger S, Schmid A, Kreth S. [Immunomodulation by nutritional intervention in critically ill patients]. DIE ANAESTHESIOLOGIE 2023; 72:229-244. [PMID: 36797533 PMCID: PMC9934515 DOI: 10.1007/s00101-023-01258-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 04/12/2023]
Abstract
Critically ill patients often suffer from a complex and severe immunological dysfunction. The differentiation and function of human immune cells are fundamentally controlled through metabolic processes. New concepts of immunonutrition therefore try to use enteral and parenteral nutrition to positively impact on the immune function of intensive care unit patients. This review article concisely presents the currently available evidence on the commonly used isolated supplements (anti-oxidative substances, amino acids, essential fatty acids) and difficulties related to their clinical use. The second part presents new and more comprehensive concepts of immunonutrition to influence the intestinal microbiome and to modulate the macronutrient composition. Immunonutrition of critically ill patients bears enormous potential and could become a valuable clinical tool for modulation of the immunometabolism of intensive care unit patients.
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Affiliation(s)
- Simon Hirschberger
- Klinik für Anaesthesiologie, LMU Klinikum München, München, Deutschland
- Walter-Brendel-Zentrum für experimentelle Medizin, Ludwig-Maximilians-Universität München (LMU), Marchioninistr. 68, 81377, München, Deutschland
| | - Annika Schmid
- Klinik für Anaesthesiologie, LMU Klinikum München, München, Deutschland
- Walter-Brendel-Zentrum für experimentelle Medizin, Ludwig-Maximilians-Universität München (LMU), Marchioninistr. 68, 81377, München, Deutschland
| | - Simone Kreth
- Klinik für Anaesthesiologie, LMU Klinikum München, München, Deutschland.
- Walter-Brendel-Zentrum für experimentelle Medizin, Ludwig-Maximilians-Universität München (LMU), Marchioninistr. 68, 81377, München, Deutschland.
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Rebranding Nutritional Care for Critically Ill Patients. J Crit Care Med (Targu Mures) 2023; 9:3-5. [PMID: 36890972 PMCID: PMC9987271 DOI: 10.2478/jccm-2023-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/10/2023] Open
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5
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Loss SH, Teichmann PDV, Pedroso de Paula T, Gross LDA, Costa VL, Lisboa BO, Sperb LF, Viana MV, Viana LV. LOSS et al.Nutrition as a risk for mortality and functionality in critically ill older adultsNutrition as a risk for mortality and functionality in critically ill older adults. JPEN J Parenter Enteral Nutr 2022; 46:1867-1874. [PMID: 35770828 DOI: 10.1002/jpen.2431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND & AIMS There is no specific recommendation for nutrition therapy for critically ill older adults. However, targeting caloric and protein balance and avoiding fasting could improve outcomes in this high-risk nutritional population. This study aimed to evaluate the associations between nutrition and mortality/functionality in critically ill older patients. METHODS Single-center retrospective observational study of critically ill patients aged 65 years or older. We extracted data from the dietician evaluations about calories, proteins, and the type of diet (fasting, oral, enteral, parenteral) prescribed in the first week of intensive care unit admission. Primary outcomes were intrahospital mortality and independence and functional capacity evaluated after hospital discharge. RESULTS Out of the 2,043 patients screened, 533 were included in the study. Most patients were men (52.1%), with a median age of 73 (68-78) years. Overall, the intrahospital mortality rate was 53.8%. SAPS-3, albumin, C-reactive protein, and surgical patients were independently associated with fasting in a multivariate analysis. The multivariate regression analyses showed that SAPS-3, albumin, and fasting were independently associated with mortality. Each fasting day increases the risk of mortality by 16.7%. Also, independence and functional capacity were not related to nutritional prescription. CONCLUSION Older adults (65 years or older) constitute a fragile population in which nutritional breaks were associated with increased hospital mortality. Furthermore, a prospective clinical trial is necessary to establish the best strategy to feed this population. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Sergio Henrique Loss
- Hospital de Clínica de Porto Alegre (HCPA) and Universidade Federal do Rio Grande do Sul (UFRGS)
| | - Pedro do Valle Teichmann
- Hospital de Clínica de Porto Alegre (HCPA) and Universidade Federal do Rio Grande do Sul (UFRGS)
| | - Tatiana Pedroso de Paula
- Hospital de Clínica de Porto Alegre (HCPA) and Universidade Federal do Rio Grande do Sul (UFRGS)
| | - Luiza de Azevedo Gross
- Hospital de Clínica de Porto Alegre (HCPA) and Universidade Federal do Rio Grande do Sul (UFRGS)
| | - Vicente Lobato Costa
- Hospital de Clínica de Porto Alegre (HCPA) and Universidade Federal do Rio Grande do Sul (UFRGS)
| | | | - Luiza Ferreira Sperb
- Hospital de Clínica de Porto Alegre (HCPA) and Universidade Federal do Rio Grande do Sul (UFRGS)
| | - Marina Verçoza Viana
- Hospital de Clínica de Porto Alegre (HCPA) and Universidade Federal do Rio Grande do Sul (UFRGS)
| | - Luciana Verçoza Viana
- Hospital de Clínica de Porto Alegre (HCPA) and Universidade Federal do Rio Grande do Sul (UFRGS)
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Lyons GCE, Summers MJ, Marshall AP, Chapple LAS. Systematic review of clinicians' knowledge, attitudes, and beliefs about nutrition in intensive care. Nutr Clin Pract 2021; 37:825-842. [PMID: 34617630 DOI: 10.1002/ncp.10785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Nutrition is a key component of care for critically ill patients; yet nutrition delivery is below international recommendations. In order to improve nutrition delivery to critically ill patients, an understanding of the barriers that prevent guideline adherence is required. It is known that clinicians' knowledge, attitudes, and beliefs of the role of nutrition may act as a potential barrier to nutrition delivery, but whether this remains true in critical care is unknown. The aim of this systematic scoping review was to summarize the literature exploring the knowledge, attitudes, and beliefs of clinicians around nutrition support in critically ill patients. A search of four online databases (MEDLINE via Ovid, Emcare via Ovid, PsycINFO, and CINAHL via EBSCOhost) was conducted on August 14, 2020, to identify literature that reported on clinicians' knowledge, attitudes, and beliefs of nutrition in adult intensive care patients. Data were extracted on study and participant characteristics, methodology, and key study outcomes related to nutrition. Eighteen articles met eligibility criteria and were included in the review. Key findings included the following: nutrition was seen as a priority that ranked below life-saving interventions; differences in perceived clinician responsibilities exist; common barriers to nutrition delivery included inadequate resourcing, lack of nutrition protocols, and gastrointestinal intolerance; and identified facilitators included nutrition education and the presence of a supportive multidisciplinary team. The implementation of nutrition protocols, enhanced clinical nutrition education, and further clarification of roles and responsibilities pertaining to nutrition may assist in improving nutrition delivery in critical care.
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Affiliation(s)
- Gemma C E Lyons
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Matthew J Summers
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Andrea P Marshall
- Gold Coast University Hospital, Southport, Queensland, Australia
- Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| | - Lee-Anne S Chapple
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
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Hill A, Elke G, Weimann A. Nutrition in the Intensive Care Unit-A Narrative Review. Nutrients 2021; 13:nu13082851. [PMID: 34445010 PMCID: PMC8400249 DOI: 10.3390/nu13082851] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/06/2021] [Accepted: 08/17/2021] [Indexed: 12/14/2022] Open
Abstract
Background: While consent exists, that nutritional status has prognostic impact in the critically ill, the optimal feeding strategy has been a matter of debate. Methods: Narrative review of the recent evidence and international guideline recommendations focusing on basic principles of nutrition in the ICU and the treatment of specific patient groups. Covered topics are: the importance and diagnosis of malnutrition in the ICU, the optimal timing and route of nutrition, energy and protein requirements, the supplementation of specific nutrients, as well as monitoring and complications of a Medical Nutrition Therapy (MNT). Furthermore, this review summarizes the available evidence to optimize the MNT of patients grouped by primarily affected organ system. Results: Due to the considerable heterogeneity of the critically ill, MNT should be carefully adapted to the individual patient with special focus on phase of critical illness, metabolic tolerance, leading symptoms, and comorbidities. Conclusion: MNT in the ICU is complex and requiring an interdisciplinary approach and frequent reevaluation. The impact of personalized and disease-specific MNT on patient-centered clinical outcomes remains to be elucidated.
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Affiliation(s)
- Aileen Hill
- Department of Intensive Care and Anesthesiology, University Hospital RWTH Aachen University, D-52074 Aachen, Germany
- Correspondence: (A.H.); (A.W.); Tel.: +49-(0)241-80-38166 (A.H.); +49-(0)341-909-2200 (A.W.)
| | - Gunnar Elke
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, D-24105 Kiel, Germany;
| | - Arved Weimann
- Department of General, Visceral and Oncological Surgery, Surgical Intensive Care Unit, Klinikum St. Georg, D-04129 Leipzig, Germany
- Correspondence: (A.H.); (A.W.); Tel.: +49-(0)241-80-38166 (A.H.); +49-(0)341-909-2200 (A.W.)
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8
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Poor Interrater Reliability of Retrospectively Applied Subjective Global Assessment for Malnutrition in the Critically Ill. TOP CLIN NUTR 2021. [DOI: 10.1097/tin.0000000000000234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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Preiser JC, Laureys S, van Zanten ARH, Van Gossum A. Computer-Assisted Prescription: The Future of Nutrition Care? JPEN J Parenter Enteral Nutr 2020; 45:452-454. [PMID: 32860637 DOI: 10.1002/jpen.2008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
| | - Steven Laureys
- GIGA Consciousness/Coma Science Group and Brain Center, University and University Hospital of Liège, Liège, Belgium.,International Disorders of Consciousness Institute, Hangzhou Normal University, Hangzhou, China
| | - Arthur Raymond Hubert van Zanten
- Department of Intensive Care Medicine, Gelderse Vallei Hospital, Ede, The Netherlands.,Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - André Van Gossum
- Department of Gastroenterology, Clinical Nutrition Hopital Erasme /institut Bordet, Université Libre de Bruxelles, Brussels, Belgium
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Alejandro EU, Mamerto TP, Chung G, Villavieja A, Gaus NL, Morgan E, Pineda-Cortel MRB. Gestational Diabetes Mellitus: A Harbinger of the Vicious Cycle of Diabetes. Int J Mol Sci 2020; 21:E5003. [PMID: 32679915 PMCID: PMC7404253 DOI: 10.3390/ijms21145003] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/07/2020] [Accepted: 07/13/2020] [Indexed: 12/16/2022] Open
Abstract
Gestational diabetes mellitus (GDM), characterized by a transitory form of diabetes induced by insulin resistance and pancreatic β-cell dysfunction during pregnancy, has been identified as one of the major obstacles in achieving improved maternal and child health. Approximately 9-25% of pregnancies worldwide are impacted by the acute, long-term, and transgenerational health complications of this disease. Here, we discuss how GDM affects longstanding maternal and neonatal outcomes, as well as health risks that likely persist into future generations. In addition to the current challenges in the management and diagnosis of and the complications associated with GDM, we discuss current preclinical models of GDM to better understand the underlying pathophysiology of the disease and the timely need to increase our scientific toolbox to identify strategies to prevent and treat GDM, thereby advancing clinical care.
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Affiliation(s)
- Emilyn U. Alejandro
- Department of Integrative Biology and Physiology, Medical School, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Therriz P. Mamerto
- Research Center for the Natural and Applied Sciences, University of Santo Tomas, Manila 1015, Philippines; (T.P.M.); (A.V.)
- The Graduate School, University of Santo Tomas, Manila 1015, Philippines;
| | - Grace Chung
- Department of Integrative Biology and Physiology, Medical School, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Adrian Villavieja
- Research Center for the Natural and Applied Sciences, University of Santo Tomas, Manila 1015, Philippines; (T.P.M.); (A.V.)
- The Graduate School, University of Santo Tomas, Manila 1015, Philippines;
| | - Nawirah Lumna Gaus
- The Graduate School, University of Santo Tomas, Manila 1015, Philippines;
| | - Elizabeth Morgan
- Baystate Medical Center, Baystate Health, Springfield, MA 01199, USA;
| | - Maria Ruth B. Pineda-Cortel
- Research Center for the Natural and Applied Sciences, University of Santo Tomas, Manila 1015, Philippines; (T.P.M.); (A.V.)
- The Graduate School, University of Santo Tomas, Manila 1015, Philippines;
- Department of Medical Technology, Faculty of Pharmacy, University of Santo Tomas, Manila 1015, Philippines
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