Gradual sucrose gastric loading test: A method for the prediction of nonsuccess gastric enteral feeding in critically ill surgical patients

Jerusalem Artichoke Powder Mixed in Enteral Feeding for Patients Who have Diarrhea in Surgical Intensive Care Unit: A Method of Preparation and a Pilot Study

Aim and objective

The Jerusalem artichoke (Helianthus tuberosus L.) is a tuber with high soluble fiber. The objective of this study was to demonstrate the method of preparation and pilot test this substance as an additive to enteral feeding.

Materials and methods

We processed Jerusalem artichoke into a 600 micrometers powder, tested its properties, and pilot tested its use in patients who had diarrhea (King's stool score ≥12) in a surgical intensive care unit. Two grams of Jerusalem artichoke powder were mixed in each 100 mL of hospital enteral feeding formula and administered for 5 days.

Results

Artichoke powder slightly increased the viscosity of enteral feeding formula. The dietary fiber content of the mixture was 20.8-21.6 g% and the content of fructans was 66.0-71.5 g%. In the pilot study in 11 patients, diarrhea was improved (diarrhea score < 12) in 7/11 (63.6%) patients by day 5. Improvement in diarrhea started on day 2 [median different diarrhea score (interquartile range): -4 (-8 to 0); p = 0.03] and peaked by days 4 and 5 [-7(-10 to -3); p < 0.01 and -8(-12 to -4); p < 0.01, respectively]. There were no complications during the study except three patients had a high gastric residual volume (>200 mL).

Conclusion

Processed powder of Jerusalem artichoke tuber has a high fiber content and increases viscosity of enteral feeding solutions only slightly. When administered as part of enteral nutrition to critically ill surgical patients, the diarrhea score improves in most patients.

How to cite this article

Chittawatanarat K, Surawang S, Simapaisan P, Judprasong K. Jerusalem Artichoke Powder Mixed in Enteral Feeding for Patients Who have Diarrhea in Surgical Intensive Care Unit: A Method of Preparation and a Pilot Study. Indian J Crit Care Med 2020;24(11):1051-1056.

Nationwide survey of nutritional management in an Asian upper-middle income developing country government hospitals: Combination of quantitative survey and focus group discussion

BACKGROUND & AIMS

The objective of this study was to identify the differences in pattern, process, and management of nutrition care in government hospitals in Thailand (an Asian upper-middle income developing country).

METHODS

This is a combination of a quantitative nationwide questionnaire survey and focus group discussions. A total of 2300 questionnaires were sent to government hospitals across Thailand. The responders were divided by routine-nutrition screening/assessment unit vs. non-routine-nutrition screening/assessment unit (RSA vs. NRSA). The comparison between the groups was reported as percentage and cross-sectional odds ratio (CS-OR) with 95% confidence interval (CI). The significant difference was defined as p < 0.05.

RESULTS

A total of 814 questionnaires (35.4%) were returned. The three most common tools of RSA were 42% Bhumibol Nutrition Triage (BNT), 21.2% Subjective Global Assessment (SGA) and 20.2% Nutrition Alert Form (NAF). The RSA was significantly higher in proportion for the role of the nurses (RSA vs. NRSA; CS-OR [95% CI]: 68.3% vs. 11.9%; 15.8 [11.1 to 22.7]; p < 0.01), the multidisciplinary team (90.1% vs. 0.4%; 2266 [558 to 1909]; p < 0.01), the nutrition management guidelines (60.6% vs. 2.8%; 53.6 [29.6 to 102.8]; p < 0.01), the nurse-driven enteral feeding protocols (31.7% vs. 17.5%; 2.2 [1.5 to 3.1]; p < 0.01) and preference for hospital formula enteral nutrition (91.4% vs.69.7%; 4.6 [2.9 to 7.4]; p < 0.01). For focus group discussions, the main barrier of RSA implementation was that there was no national recommendation of a screening/assessment tool, inconsistency of policy and reimbursement, and professional and acceptable workload.

CONCLUSION

Nutrition screening/assessment tools were found to be varied in Thailand. RSA affected the nutrition management working process and the types of nutrition support. The main barriers of RSA implementation were inconsistency of policy and reimbursement, acceptable workload, and national guidance as regards - screening/assessment tools.