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Chapple LAS, Ridley EJ, Ainscough K, Ballantyne L, Burrell A, Campbell L, Dux C, Ferrie S, Fetterplace K, Fox V, Jamei M, King V, Serpa Neto A, Nichol A, Osland E, Paul E, Summers MJ, Marshall AP, Udy A. Nutrition delivery across hospitalisation in critically ill patients with COVID-19: An observational study of the Australian experience. Aust Crit Care 2024; 37:422-428. [PMID: 37316370 PMCID: PMC10176103 DOI: 10.1016/j.aucc.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 02/28/2023] [Accepted: 05/06/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Data on nutrition delivery over the whole hospital admission in critically ill patients with COVID-19 are scarce, particularly in the Australian setting. OBJECTIVES The objective of this study was to describe nutrition delivery in critically ill patients admitted to Australian intensive care units (ICUs) with coronavirus disease 2019 (COVID-19), with a focus on post-ICU nutrition practices. METHODS A multicentre observational study conducted at nine sites included adult patients with a positive COVID-19 diagnosis admitted to the ICU for >24 h and discharged to an acute ward over a 12-month recruitment period from 1 March 2020. Data were extracted on baseline characteristics and clinical outcomes. Nutrition practice data from the ICU and weekly in the post-ICU ward (up to week four) included route of feeding, presence of nutrition-impacting symptoms, and nutrition support received. RESULTS A total of 103 patients were included (71% male, age: 58 ± 14 years, body mass index: 30±7 kg/m2), of whom 41.7% (n = 43) received mechanical ventilation within 14 days of ICU admission. While oral nutrition was received by more patients at any time point in the ICU (n = 93, 91.2% of patients) than enteral nutrition (EN) (n = 43, 42.2%) or parenteral nutrition (PN) (n = 2, 2.0%), EN was delivered for a greater duration of time (69.6% feeding days) than oral and PN (29.7% and 0.7%, respectively). More patients received oral intake than the other modes in the post-ICU ward (n = 95, 95.0%), and 40.0% (n = 38/95) of patients were receiving oral nutrition supplements. In the week after ICU discharge, 51.0% of patients (n = 51) had at least one nutrition-impacting symptom, most commonly a reduced appetite (n = 25; 24.5%) or dysphagia (n = 16; 15.7%). CONCLUSION Critically ill patients during the COVID-19 pandemic in Australia were more likely to receive oral nutrition than artificial nutrition support at any time point both in the ICU and in the post-ICU ward, whereas EN was provided for a greater duration when it was prescribed. Nutrition-impacting symptoms were common.
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Affiliation(s)
- Lee-Anne S Chapple
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia.
| | - Emma J Ridley
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Nutrition Department, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Kate Ainscough
- University College Dublin Clinical Research Centre at St Vincents University Hospital, Dublin, Ireland
| | - Lauren Ballantyne
- Nutrition and Dietetic Department, Bendigo Health, Bendigo, Victoria, Australia
| | - Aidan Burrell
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Intensive Care, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Lewis Campbell
- Intensive Care Unit, Royal Darwin Hospital, Darwin, Northern Territory, Australia; Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Claire Dux
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Australia; School of Human Movements and Nutrition Science, University of Queensland, Brisbane, Australia
| | - Suzie Ferrie
- Department of Nutrition & Dietetics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; School of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Kate Fetterplace
- Department of Allied Health (Clinical Nutrition), The Royal Melbourne Hospital, Melbourne, Victoria, Australia; The University of Melbourne, Department of Critical Care, Melbourne Medical School, Melbourne, Victoria, Australia
| | - Virginia Fox
- Nutrition and Dietetic Department, Bendigo Health, Bendigo, Victoria, Australia
| | - Matin Jamei
- Intensive Care Unit, Nepean Hospital, Sydney, New South Wales, Australia
| | - Victoria King
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ary Serpa Neto
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alistair Nichol
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; University College Dublin Clinical Research Centre at St Vincents University Hospital, Dublin, Ireland; Nutrition and Dietetic Department, Bendigo Health, Bendigo, Victoria, Australia; Department of Intensive Care, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Emma Osland
- Department of Intensive Care, The Alfred Hospital, Melbourne, Victoria, Australia; School of Human Movements and Nutrition Science, University of Queensland, Brisbane, Australia
| | - Eldho Paul
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Matthew J Summers
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Andrea P Marshall
- Intensive Care Unit, Gold Coast University Hospital, Southport, Queensland, Australia; Menzies Health Institute, Griffith University, Southport, Queensland, Australia
| | - Andrew Udy
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Intensive Care, The Alfred Hospital, Melbourne, Victoria, Australia
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Clode M, Tran D, Majumdar A, Ayer J, Ferrie S, Cordina R. Nutritional considerations for people living with a Fontan circulation: a narrative review. Cardiol Young 2024; 34:238-249. [PMID: 38258459 DOI: 10.1017/s1047951123004389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
The population of people living with a Fontan circulation are highly heterogenous, including both children and adults, who have complex health issues and comorbidities associated with their unique physiology throughout life. Research focused on nutritional considerations and interventions in the Fontan population is extremely limited beyond childhood. This review article discusses the current literature examining nutritional considerations in the setting of Fontan physiology and provides an overview of the available evidence to support nutritional management strategies and future research directions. Protein-losing enteropathy, growth deficits, bone mineral loss, and malabsorption are well-recognised nutritional concerns within this population, but increased adiposity, altered glucose metabolism, and skeletal muscle deficiency are also more recently identified issues. Emergencing evidence suggets that abnormal body composition is associated with poor circulatory function and health outcomes. Many nutrition-related issues, including the impact of congenital heart disease on nutritional status, factors contributing to altered body composition and comorbidities, as well as the role of the microbiome and metabolomics, remain poodly understood.
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Affiliation(s)
- Melanie Clode
- The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia
- Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Derek Tran
- The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia
- Heart Research Institute, Newtown, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Avik Majumdar
- The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia
| | - Julian Ayer
- The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia
- The Heart Centre for Children, The Sydney Children's Hospital Network, Westmead, NSW, Australia
| | - Suzie Ferrie
- The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia
- Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Rachael Cordina
- The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia
- Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Heart Research Institute, Newtown, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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Faraji H, Jamshidi S, Ferrie S, Azar PS. The Relationship between Healthy Eating Index and Lipid Profile in Healthy Individuals: A Systematic Review. Int J Prev Med 2024; 15:6. [PMID: 38487701 PMCID: PMC10935573 DOI: 10.4103/ijpvm.ijpvm_404_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/17/2023] [Indexed: 03/17/2024] Open
Abstract
Background The Healthy Eating Index (HEI) and Alternate Healthy Eating Index (AHEI) are instruments developed by competing American research teams, aiming to assess the level of adherence to a dietary pattern, claimed to prevent chronic illness conditions such as dyslipidemia. This systematic review evaluated cross-sectional studies examining the association between HEI/AHEI score and the lipid profile in healthy participants. Methods The systematic review was Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) compliant, and a search process was conducted through Scopus, Web of Knowledge, Google Scholar, Cochrane, PubMed, and ScienceDirect up to November 2022. Studies assessing the relationship between HEI/AHEI and lipid profile (low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG)) were eligible for inclusion. The statistical differences in outcomes, anthropometric indices, and demographic data were extracted from the selected studies. Also, the quality assessment of studies was performed using the Newcastle-Ottawa scale. Results The systematic search presented 17 cross-sectional studies. Most of the studies revealed a significant correlation between HEI score and lipid profile (LDL-C, HDL-C, TG, and TC) (P < 0.05), while a few of them indicated a significant relationship between AHEI score and these factors. Overall, the elevation of HEI/AHEI score was associated with the improvement in lipid profile (P < 0.05), though this association was more obvious for HEI compared with AHEI. Conclusions Overall, the results of the study indicated that an improved lipid profile in healthy individuals is associated with a higher score in either HEI or AHEI. Further research in the future is required to confirm the claim.
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Affiliation(s)
- Hossein Faraji
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sanaz Jamshidi
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Suzie Ferrie
- Critical Care Dietitian, Royal Prince Alfred Hospital and Department of Nutrition and Dietetics, School of Life and Environmental Sciences, University of Sydney, Australia
| | - Pouria Sefidmooye Azar
- Department of Nutrition, School of Applied Sciences, The University of Mississippi, Oxford, MS, United States
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Ridley EJ, Chapple LAS, Ainscough K, Burrell A, Campbell L, Dux C, Ferrie S, Fetterplace K, Jamei M, King V, Neto AS, Nichol A, Osland E, Paul E, Summers M, Marshall AP, Udy A. Nutrition care processes across hospitalisation in critically ill patients with COVID-19 in Australia: A multicentre prospective observational study. Aust Crit Care 2023; 36:955-960. [PMID: 36806392 PMCID: PMC9842626 DOI: 10.1016/j.aucc.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 12/01/2022] [Accepted: 01/10/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic highlighted major challenges with usual nutrition care processes, leading to reports of malnutrition and nutrition-related issues in these patients. OBJECTIVE The objective of this study was to describe nutrition-related service delivery practices across hospitalisation in critically ill patients with COVID-19 admitted to Australian intensive care units (ICUs) in the initial pandemic phase. METHODS This was a multicentre (nine site) observational study in Australia, linked with a national registry of critically ill patients with COVID-19. Adult patients with COVID-19 who were discharged to an acute ward following ICU admission were included over a 12-month period. Data are presented as n (%), median (interquartile range [IQR]), and odds ratio (OR [95% confidence interval {CI}]). RESULTS A total of 103 patients were included. Oral nutrition was the most common mode of nutrition (93 [93%]). In the ICU, there were 53 (52%) patients seen by a dietitian (median 4 [2-8] occasions) and malnutrition screening occurred in 51 (50%) patients most commonly with the malnutrition screening tool (50 [98%]). The odds of receiving a higher malnutrition screening tool score increased by 36% for every screening in the ICU (1st to 4th, OR: 1.39 [95% CI: 1.05-1.77] p = 0.018) (indicating increasing risk of malnutrition). On the ward, 51 (50.5%) patients were seen by a dietitian (median time to consult: 44 [22.5-75] hours post ICU discharge). The odds of dietetic consult increased by 39% every week while on the ward (OR: 1.39 [1.03-1.89], p = 0.034). Patients who received mechanical ventilation (MV) were more likely to receive dietetic input than those who never received MV. CONCLUSIONS During the initial phases of the COVID-19 pandemic in Australia, approximately half of the patients included were seen by a dietitian. An increased number of malnutrition screens were associated with a higher risk score in the ICU and likelihood of dietetic consult increased if patients received MV and as length of ward stay increased.
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Affiliation(s)
- Emma J Ridley
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Nutrition Department, The Alfred Hospital, Melbourne, Victoria, Australia.
| | - Lee-Anne S Chapple
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Kate Ainscough
- University College Dublin Clinical Research Centre at St Vincents University Hospital, Dublin, Ireland
| | - Aidan Burrell
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Intensive Care, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Lewis Campbell
- Intensive Care Unit, Royal Darwin Hospital, Darwin, Northern Territory, Australia; Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Claire Dux
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Australia; School of Human Movements and Nutrition Science, University of Queensland, Brisbane, Australia
| | - Suzie Ferrie
- Department of Nutrition & Dietetics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; School of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Kate Fetterplace
- Department of Allied Health (Clinical Nutrition), The Royal Melbourne Hospital, Melbourne, Victoria, Australia; The University of Melbourne, Department of Critical Care, Melbourne Medical School, Melbourne, Victoria, Australia
| | - Matin Jamei
- Intensive Care Unit, Nepean Hospital, Sydney, New South Wales, Australia
| | - Victoria King
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ary Serpa Neto
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alistair Nichol
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; University College Dublin Clinical Research Centre at St Vincents University Hospital, Dublin, Ireland; Department of Intensive Care, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Emma Osland
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Australia; School of Human Movements and Nutrition Science, University of Queensland, Brisbane, Australia
| | - Eldho Paul
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Matthew Summers
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Andrea P Marshall
- Intensive Care Unit, Gold Coast University Hospital, Southport, Queensland, Australia; Menzies Health Institute, Griffith University, Southport, Queensland, Australia
| | - Andrew Udy
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Intensive Care, The Alfred Hospital, Melbourne, Victoria, Australia
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Reece L, Moran B, Ferrie S, Ansari N, Koh C, Allman-Farinelli M, Carey S. A global analysis of nutrition support practices in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal malignancy. Clin Nutr ESPEN 2023; 57:297-304. [PMID: 37739672 DOI: 10.1016/j.clnesp.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/10/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Perioperative nutritional care has been identified as an important factor in the management of patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Nevertheless, there is no published consensus on best practice for nutritional management specific to this patient group. The purpose of this study was to identify the current nutrition care practices among international centres performing CRS and HIPEC for patients with peritoneal malignancy. METHODS An online survey was developed and sent to experienced CRS and HIPEC centres. The survey questions covered clinician and institution demographics, formal nutrition care pathways, pre-operative nutrition care, post-operative nutrition support and post-discharge nutritional follow-up. RESULTS Eighty-two centres were contacted, and 42 responses were received. Respondents were from 20 different countries and were mostly dietitians (71%). Nutrition assessments were frequently completed (52% pre-operatively and 86% post-operatively) and most centres used a validated nutrition screening or assessment tool (79%). Perioperative nutrition support with respect to the use of enteral nutrition, parenteral nutrition and enhanced recovery after surgery varied widely between centres. The use of routine parenteral and enteral nutrition was significantly higher in Europe compared with other locations (p = 0.028). CONCLUSIONS Nutrition care is pivotal and has been positively integrated into the complex management of patients undergoing CRS and HIPEC globally, however variation in practice is evident. The findings highlight a unique opportunity to collaboratively investigate the role nutrition plays in determining outcomes and to identify the most appropriate nutrition support methods to achieve improved clinical outcomes for these high-risk patients.
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Affiliation(s)
- Lauren Reece
- Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, NSW, Australia.
| | - Brendan Moran
- Peritoneal Malignancy Institute, Hampshire Hospital Foundation Trust, Basingstoke, United Kingdom
| | - Suzie Ferrie
- Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, NSW, Australia
| | - Nabila Ansari
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia; RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and the University of Sydney, Sydney, NSW, Australia
| | - Cherry Koh
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia; RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and the University of Sydney, Sydney, NSW, Australia
| | - Margaret Allman-Farinelli
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, NSW, Australia; Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Sharon Carey
- Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, NSW, Australia; RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and the University of Sydney, Sydney, NSW, Australia
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Summers MJ, Chapple LAS, Bellomo R, Chapman MJ, Ferrie S, Finnis ME, French C, Hurford S, Kakho N, Karahalios A, Maiden MJ, O'Connor SN, Peake SL, Presneill JJ, Ridley EJ, Tran-Duy A, Williams PJ, Young PJ, Zaloumis S, Deane AM. Study protocol for TARGET protein: The effect of augmented administration of enteral protein to critically ill adults on clinical outcomes: A cluster randomised, cross-sectional, double cross-over, clinical trial. CRIT CARE RESUSC 2023; 25:147-154. [PMID: 37876373 PMCID: PMC10581259 DOI: 10.1016/j.ccrj.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
Background It is unknown whether increasing dietary protein to 1.2-2.0 g/kg/day as recommended in international guidelines compared to current practice improves outcomes in intensive care unit (ICU) patients. The TARGET Protein trial will evaluate this. Objective To describe the study protocol for the TARGET Protein trial. Design setting and participants TARGET Protein is a cluster randomised, cross-sectional, double cross-over, pragmatic clinical trial undertaken in eight ICUs in Australia and New Zealand. Each ICU will be randomised to use one of two trial enteral formulae for three months before crossing over to the other formula, which is then repeated, with enrolment continuing at each ICU for 12 months. All patients aged ≥16 years in their index ICU admission commencing enteral nutrition will be eligible for inclusion. Eligible patients will receive the trial enteral formula to which their ICU is allocated. The two trial enteral formulae are isocaloric with a difference in protein dose: intervention 100g/1000 ml and comparator 63g/1000 ml. Staggered recruitment commenced in May 2022. Main outcomes measures The primary outcome is days free of the index hospital and alive at day 90. Secondary outcomes include days free of the index hospital at day 90 in survivors, alive at day 90, duration of invasive ventilation, ICU and hospital length of stay, incidence of tracheostomy insertion, renal replacement therapy, and discharge destination. Conclusion TARGET Protein aims to determine whether augmented enteral protein delivery reduces days free of the index hospital and alive at day 90. Trial registration Australian New Zealand Clinical Trials Registry (ACTRN12621001484831).
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Affiliation(s)
- Matthew J. Summers
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lee-anne S. Chapple
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- National Health and Medical Research Council of Australia, Centre for Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Rinaldo Bellomo
- Intensive Care Unit, Austin Health, Heidelberg, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- The University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Melbourne, Victoria, Australia
| | - Marianne J. Chapman
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- National Health and Medical Research Council of Australia, Centre for Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Suzie Ferrie
- Department of Nutrition & Dietetics, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Mark E. Finnis
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- The University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Melbourne, Victoria, Australia
| | - Craig French
- Intensive Care Unit, Sunshine Hospital, Melbourne, Victoria, Australia
| | - Sally Hurford
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Nima Kakho
- Intensive Care Unit, University Hospital Geelong, Geelong, Victoria, Australia
| | - Amalia Karahalios
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Matthew J. Maiden
- Intensive Care Unit, University Hospital Geelong, Geelong, Victoria, Australia
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
- The University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Melbourne, Victoria, Australia
| | - Stephanie N. O'Connor
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Sandra L. Peake
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Intensive Care Unit, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Jeffrey J. Presneill
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
- The University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Melbourne, Victoria, Australia
| | - Emma J. Ridley
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Dietetics and Nutrition, Alfred Hospital, Melbourne, Victoria, Australia
| | - An Tran-Duy
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patricia J. Williams
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Intensive Care Unit, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Paul J. Young
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
| | - Sophie Zaloumis
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Adam M. Deane
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
- The University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Melbourne, Victoria, Australia
| | - TARGET Protein Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- National Health and Medical Research Council of Australia, Centre for Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
- Intensive Care Unit, Austin Health, Heidelberg, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Nutrition & Dietetics, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Intensive Care Unit, Sunshine Hospital, Melbourne, Victoria, Australia
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Intensive Care Unit, University Hospital Geelong, Geelong, Victoria, Australia
- Intensive Care Unit, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
- Dietetics and Nutrition, Alfred Hospital, Melbourne, Victoria, Australia
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
- The University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Melbourne, Victoria, Australia
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Ridley E, Baskett R, Capel E, Chapple LA, Doola R, Ferrie S, Fetterplace K, Winderlich J, Serpa Neto A. Oral Versus Artificial Nutrition Therapy In Critically Ill Patients: A BI-National Prospective Observational Study In Australia And New Zealand. Clin Nutr ESPEN 2023. [DOI: 10.1016/j.clnesp.2022.09.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
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Ferrie S, Weiss NB, Chau HY, Torkel S, Stepniewski ME. Association of Subjective Global Assessment with outcomes in the intensive care unit: A retrospective cohort study. Nutr Diet 2022; 79:572-581. [PMID: 36127861 PMCID: PMC9826034 DOI: 10.1111/1747-0080.12767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 06/23/2022] [Accepted: 07/02/2022] [Indexed: 01/11/2023]
Abstract
AIMS This retrospective audit was conducted to investigate the association between outcome and protein-energy malnutrition diagnosed using Subjective Global Assessment (SGA), to evaluate the predictive validity of Subjective Global Assessment in adults admitted to intensive care. METHODS The audit analysed the medical records of 1034 consecutive adult patients who had nutrition assessment on admission to the intensive care unit between January 2017 and July 2018. Extracted data included patient demographics, nutritional status, outcomes, and Acute Physiology and Chronic Health Evaluation II score. Regression was used to explore the association between Subjective Global Assessment and outcomes. RESULTS The prevalence of protein-energy malnutrition was 39.5% (342 patients SGA-B, and 75 patients SGA-C), and there was a significant independent association between Subjective Global Assessment and outcomes both in surgical and non-surgical patients. Compared with well-nourished patients, mortality was significantly higher in the malnourished, during the intensive care admission (p = 0.007), in hospital (p < 0.0001), at 90 days (p = 0.001) and at 180 days (p = 0.002). Pressure injuries were more common (p = 0.01). Length of stay was longer in intensive care (p = 0.001) and in hospital (p < 0.001), with increased readmission rate (p < 0.001). CONCLUSION Protein-energy malnutrition diagnosed by Subjective Global Assessment had a significant independent association with adverse clinical outcomes in critically ill patients. Subjective Global Assessment appears to have predictive validity in this patient population.
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Affiliation(s)
- Suzie Ferrie
- Department of Nutrition & DieteticsRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia,Faculty of Medicine and HealthUniversity of SydneySydneyAustralia
| | | | - Hiu Yi Chau
- Faculty of Medicine and HealthUniversity of SydneySydneyAustralia
| | - Sophia Torkel
- Faculty of Medicine and HealthUniversity of SydneySydneyAustralia
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9
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Ferrie S. Evidence as foundation of practice. Nutr Diet 2022; 79:184-186. [PMID: 35393760 DOI: 10.1111/1747-0080.12737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Suzie Ferrie
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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10
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Murthy TA, Bellomo R, Chapman MJ, Deane AM, Ferrie S, Finnis ME, Hurford S, O’Connor SN, Peake SL, Summers MJ, Williams PJ, Young PJ, Chapple LAS. Protein delivery in mechanically ventilated adults in Australia and New Zealand: current practice. CRIT CARE RESUSC 2021; 23:386-393. [PMID: 38046685 PMCID: PMC10692581 DOI: 10.51893/2021.4.oa3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To quantify current protein prescription and delivery in critically ill adults in Australia and New Zealand and compare it with international guidelines. Design: Prospective, multicentre, observational study. Setting: Five intensive care units (ICUs) across Australia and New Zealand. Participants: Mechanically ventilated adults who were anticipated to receive enteral nutrition for ≥ 24 hours. Main outcome measures: Baseline demographic and nutrition data in ICU, including assessment of requirements, prescription and delivery of enteral nutrition, parenteral nutrition and protein supplementation, were collected. The primary outcome was enteral nutrition protein delivery (g/kg ideal body weight [IBW] per day). Data are reported as mean ± standard deviation or n (%). Results: 120 patients were studied (sex, 60% male; mean age, 59 ± 16 years; mean admission APACHE II score, 20 ± 8). Enteral nutrition was delivered on 88%, parenteral nutrition on 6.8%, and protein supplements on 0.3% of 1156 study days. For the 73% (88/120) of patients who had a nutritional assessment, the mean estimated protein requirements were 99 ± 22 g/day (1.46 ± 0.55 g/kg IBW per day). The mean daily protein delivery was 54 ± 23 g (0.85 ± 0.35 g/kg IBW per day) from enteral nutrition and 56 ± 23 g (0.88 ± 0.35 g/kg IBW per day) from all sources (enteral nutrition, parenteral nutrition, protein supplements). Protein delivery was ≥ 1.2 g/kg IBW per day on 29% of the total study days per patient. Conclusions: Protein delivery as a part of current usual care to critically ill adults in Australia and New Zealand remains below that recommended in international guidelines.
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Affiliation(s)
- Tejaswini Arunachala Murthy
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Rinaldo Bellomo
- Intensive Care Unit, Austin Health, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Marianne J. Chapman
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- National Health and Medical Research Council of Australia, Centre for Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, SA, Australia
| | - Adam M. Deane
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Suzie Ferrie
- Department of Nutrition & Dietetics, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Mark E. Finnis
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Sally Hurford
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Stephanie N. O’Connor
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Sandra L. Peake
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care Medicine,Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Matthew J. Summers
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Patricia J. Williams
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care Medicine,Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Paul J. Young
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
| | - Lee-anne S. Chapple
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
- National Health and Medical Research Council of Australia, Centre for Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, SA, Australia
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11
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Carey S, Waller J, Wang LY, Ferrie S. Qualifying thirst distress in the acute hospital setting – validation of a patient-reported outcome measure. Journal of Perioperative Nursing 2021. [DOI: 10.26550/2209-1092.1156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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12
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Ghavami HS, Khoshtinat M, Sadeghi-Farah S, Kalimani AB, Ferrie S, Faraji H. The relationship of coffee consumption and CVD risk factors in elderly patients with T2DM. BMC Cardiovasc Disord 2021; 21:241. [PMID: 33990183 PMCID: PMC8120716 DOI: 10.1186/s12872-021-02058-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 05/10/2021] [Indexed: 12/26/2022] Open
Abstract
Objective Clinical studies suggest increasing prevalence of cardiovascular disease (CVD) risk factors and diabetes among the elderly. Meanwhile, some food compounds, such as coffee, can also have beneficial effects on CVD risk factors. The aim of the present study was to examine the relationship between coffee consumption and CVD risk factors in the elderly with type 2 diabetes mellitus (T2DM). Methods This cross-sectional study was performed during 2017 on 300 elderly people above 60 years of age with T2DM in Isfahan, Iran. Dietary assessment was performed using a food frequency questionnaire. Coffee consumption was classified into three groups including < 1, 1–3, and > 3 cups/day. Partial correlation test was used to investigate the relationship between CVD risk factors and usual coffee consumption. Results The mean age and body mass index of participants were 70.04 ± 4.87 years and 24.74 ± 3.34 kg/m2 respectively. Coffee consumption had a significant inverse relationship with fasting plasma glucose (FPG) and diastolic blood pressure (DBP) in the elderly with T2DM (r: − 0.117, 0.134; p: 0.046, 0.022). Triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) had a significant positive relationship with coffee consumption levels (r: 0.636, 0.128; p: 0.028, 0.029). These results were obtained after controlling for potential confounders. Conclusion Increasing coffee consumption was linked to improved status of some CVD risk factors including FPG, HDL-C, and DBP in the elderly with T2DM. Nevertheless, increasing coffee consumption was also associated with higher TG level and had no significant effect on other risk factors. Further studies are required to confirm these results.
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Affiliation(s)
- Hossein Sayed Ghavami
- Department of Food Science and Technology, Lahijan Branch, Islamic Azad University, Lahijan, Iran
| | - Mehran Khoshtinat
- Department of Food Science and Technology, Roudehen Branch, Islamic Azad University, Roudehen, Iran
| | - Sepehr Sadeghi-Farah
- Department of Food Science and Technology, Lahijan Branch, Islamic Azad University, Lahijan, Iran
| | - Arman Bayati Kalimani
- Department of Food Science and Technology, Lahijan Branch, Islamic Azad University, Lahijan, Iran
| | - Suzie Ferrie
- Nutrition and Dietetics Department, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - Hossein Faraji
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.
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13
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Tran DL, Gibson H, Maiorana AJ, Verrall CE, Baker DW, Clode M, Lubans DR, Zannino D, Bullock A, Ferrie S, Briody J, Simm P, Wijesekera V, D'Almeida M, Gosbell SE, Davis GM, Weintraub R, Keech AC, Puranik R, Ugander M, Justo R, Zentner D, Majumdar A, Grigg L, Coombes JS, d'Udekem Y, Morris NR, Ayer J, Celermajer DS, Cordina R. Exercise Intolerance, Benefits, and Prescription for People Living With a Fontan Circulation: The Fontan Fitness Intervention Trial (F-FIT)-Rationale and Design. Front Pediatr 2021; 9:799125. [PMID: 35071139 PMCID: PMC8771702 DOI: 10.3389/fped.2021.799125] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/07/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Despite developments in surgical techniques and medical care, people with a Fontan circulation still experience long-term complications; non-invasive therapies to optimize the circulation have not been established. Exercise intolerance affects the majority of the population and is associated with worse prognosis. Historically, people living with a Fontan circulation were advised to avoid physical activity, but a small number of heterogenous, predominantly uncontrolled studies have shown that exercise training is safe-and for unique reasons, may even be of heightened importance in the setting of Fontan physiology. The mechanisms underlying improvements in aerobic exercise capacity and the effects of exercise training on circulatory and end-organ function remain incompletely understood. Furthermore, the optimal methods of exercise prescription are poorly characterized. This highlights the need for large, well-designed, multi-center, randomized, controlled trials. Aims and Methods: The Fontan Fitness Intervention Trial (F-FIT)-a phase III clinical trial-aims to optimize exercise prescription and delivery in people with a Fontan circulation. In this multi-center, randomized, controlled study, eligible Fontan participants will be randomized to either a 4-month supervised aerobic and resistance exercise training program of moderate-to-vigorous intensity followed by an 8-month maintenance phase; or usual care (control group). Adolescent and adult (≥16 years) Fontan participants will be randomized to either traditional face-to-face exercise training, telehealth exercise training, or usual care in a three-arm trial with an allocation of 2:2:1 (traditional:telehealth:control). Children (<16 years) will be randomized to either a physical activity and exercise program of moderate-to-vigorous intensity or usual care in a two-arm trial with a 1:1 allocation. The primary outcome is a change in aerobic exercise capacity (peak oxygen uptake) at 4-months. Secondary outcomes include safety, and changes in cardiopulmonary exercise testing measures, peripheral venous pressure, respiratory muscle and lung function, body composition, liver stiffness, neuropsychological and neurocognitive function, physical activity levels, dietary and nutritional status, vascular function, neurohormonal activation, metabolites, cardiac function, quality of life, musculoskeletal fitness, and health care utilization. Outcome measures will be assessed at baseline, 4-months, and 12-months. This manuscript will describe the pathophysiology of exercise intolerance in the Fontan circulation and the rationale and protocol for the F-FIT.
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Affiliation(s)
- Derek L Tran
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia.,Charles Perkins Centre, Heart Research Institute, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Hannah Gibson
- Charles Perkins Centre, Heart Research Institute, Sydney, NSW, Australia
| | - Andrew J Maiorana
- School of Allied Health, Curtin University, Perth, WA, Australia.,Allied Health Department, Fiona Stanley Hospital, Perth, WA, Australia
| | - Charlotte E Verrall
- The University of Sydney Westmead Clinical School, Sydney, NSW, Australia.,Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - David W Baker
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia
| | - Melanie Clode
- Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - David R Lubans
- School of Education, Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, NSW, Australia
| | - Diana Zannino
- Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Andrew Bullock
- Paediatric and Adult Congenital Cardiology, Perth Children's Hospital, Perth, WA, Australia
| | - Suzie Ferrie
- Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Julie Briody
- Department of Nuclear Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Peter Simm
- Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Vishva Wijesekera
- Department of Cardiology, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Michelle D'Almeida
- Charles Perkins Centre, Heart Research Institute, Sydney, NSW, Australia
| | - Sally E Gosbell
- Central Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia.,Charles Perkins Centre, Heart Research Institute, Sydney, NSW, Australia.,Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Glen M Davis
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Robert Weintraub
- Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Cardiology, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Anthony C Keech
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia.,NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Rajesh Puranik
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia
| | - Martin Ugander
- Royal North Shore Hospital, The Kolling Institute, Sydney, NSW, Australia
| | - Robert Justo
- Paediatric Cardiac Service, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Dominica Zentner
- The University of Melbourne Medical School, Melbourne, VIC, Australia.,Department of Cardiology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Avik Majumdar
- Central Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia.,Australian National Liver Transplant Unit, AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Leeanne Grigg
- The University of Melbourne Medical School, Melbourne, VIC, Australia.,Department of Cardiology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Jeff S Coombes
- School of Human Movement and Nutrition Sciences, Centre for Research on Exercise, Physical Activity, and Health, The University of Queensland, Brisbane, QLD, Australia
| | - Yves d'Udekem
- Division of Cardiac Surgery, Children's National Hospital, Washington, DC, United States
| | - Norman R Morris
- Allied Health Collaborative and Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, QLD, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
| | - Julian Ayer
- The University of Sydney Westmead Clinical School, Sydney, NSW, Australia.,Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - David S Celermajer
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia.,Charles Perkins Centre, Heart Research Institute, Sydney, NSW, Australia
| | - Rachael Cordina
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia.,Charles Perkins Centre, Heart Research Institute, Sydney, NSW, Australia.,Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
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14
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Chapple LAS, Summers MJ, Bellomo R, Chapman MJ, Davies AR, Ferrie S, Finnis ME, Hurford S, Lange K, Little L, O'Connor SN, Peake SL, Ridley EJ, Young PJ, Williams PJ, Deane AM. Use of a High-Protein Enteral Nutrition Formula to Increase Protein Delivery to Critically Ill Patients: A Randomized, Blinded, Parallel-Group, Feasibility Trial. JPEN J Parenter Enteral Nutr 2020; 45:699-709. [PMID: 33296079 DOI: 10.1002/jpen.2059] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/20/2020] [Accepted: 12/02/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND International guidelines recommend critically ill adults receive more protein than most receive. We aimed to establish the feasibility of a trial to evaluate whether feeding protein to international recommendations would improve outcomes, in which 1 group received protein doses representative of international guideline recommendations (high protein) and the other received doses similar to usual practice. METHODS We conducted a prospective, randomized, blinded, parallel-group, feasibility trial across 6 intensive care units. Critically ill, mechanically ventilated adults expected to receive enteral nutrition (EN) for ≥2 days were randomized to receive EN containing 63 or 100 g/L protein for ≤28 days. Data are mean (SD) or median (interquartile range). RESULTS The recruitment rate was 0.35 (0.13) patients per day, with 120 patients randomized and data available for 116 (n = 58 per group). Protein delivery was greater in the high-protein group (1.52 [0.52] vs 0.99 [0.27] grams of protein per kilogram of ideal body weight per day; difference, 0.53 [95% CI, 0.38-0.69] g/kg/d protein), with no difference in energy delivery (difference, -26 [95% CI, -190 to 137] kcal/kg/d). There were no between-group differences in the duration of feeding (8.7 [7.3] vs 8.1 [6.3] days), and blinding of the intervention was confirmed. There were no differences in clinical outcomes, including 90-day mortality (14/55 [26%] vs 15/56 [27%]; risk difference, -1.3% [95% CI, -17.7% to 15.0%]). CONCLUSION Conducting a multicenter blinded trial is feasible to compare protein delivery at international guideline-recommended levels with doses similar to usual care during critical illness.
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Affiliation(s)
- Lee-Anne S Chapple
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia.,National Health and Medical Research Council of Australia, Centre for Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - Matthew J Summers
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Rinaldo Bellomo
- Intensive Care Unit, Austin Health, Heidelberg, Victoria, Australia.,The University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, Australia
| | - Marianne J Chapman
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia.,National Health and Medical Research Council of Australia, Centre for Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia.,Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Andrew R Davies
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.,Intensive Care Unit, Frankston Hospital, Frankston, Victoria, Australia
| | - Suzie Ferrie
- Department of Nutrition & Dietetics, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Mark E Finnis
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Sally Hurford
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Kylie Lange
- National Health and Medical Research Council of Australia, Centre for Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - Lorraine Little
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Stephanie N O'Connor
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Sandra L Peake
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia.,Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.,Intensive Care Unit, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Emma J Ridley
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Paul J Young
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Patricia J Williams
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia.,Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.,Intensive Care Unit, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Adam M Deane
- The University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, Australia
| | -
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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15
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Chapple LAS, Fetterplace K, Asrani V, Burrell A, Cheng AC, Collins P, Doola R, Ferrie S, Marshall AP, Ridley EJ. Nutrition management for critically and acutely unwell hospitalised patients with coronavirus disease 2019 (COVID-19) in Australia and New Zealand. Nutr Diet 2020; 77:426-436. [PMID: 32945085 PMCID: PMC7537302 DOI: 10.1111/1747-0080.12636] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 07/23/2020] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID‐19) results from severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). The clinical features and subsequent medical treatment, combined with the impact of a global pandemic, require specific nutritional therapy in hospitalised adults. This document aims to provide Australian and New Zealand clinicians with guidance on managing critically and acutely unwell adult patients hospitalised with COVID‐19. These recommendations were developed using expert consensus, incorporating the documented clinical signs and metabolic processes associated with COVID‐19, the literature from other respiratory illnesses, in particular acute respiratory distress syndrome, and published guidelines for medical management of COVID‐19 and general nutrition and intensive care. Patients hospitalised with COVID‐19 are likely to have preexisting comorbidities, and the ensuing inflammatory response may result in increased metabolic demands, protein catabolism, and poor glycaemic control. Common medical interventions, including deep sedation, early mechanical ventilation, fluid restriction, and management in the prone position, may exacerbate gastrointestinal dysfunction and affect nutritional intake. Nutrition care should be tailored to pandemic capacity, with early gastric feeding commenced using an algorithm to provide nutrition for the first 5–7 days in lower‐nutritional‐risk patients and individualised care for high‐nutritional‐risk patients where capacity allows. Indirect calorimetry should be avoided owing to potential aerosol exposure and therefore infection risk to healthcare providers. Use of a volume‐controlled, higher‐protein enteral formula and gastric residual volume monitoring should be initiated. Careful monitoring, particularly after intensive care unit stay, is required to ensure appropriate nutrition delivery to prevent muscle deconditioning and aid recovery. The infectious nature of SARS‐CoV‐2 and the expected high volume of patient admissions will require contingency planning to optimise staffing resources including upskilling, ensure adequate nutrition supplies, facilitate remote consultations, and optimise food service management. These guidelines provide recommendations on how to manage the aforementioned aspects when providing nutrition support to patients during the SARS‐CoV‐2 pandemic.
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Affiliation(s)
- Lee-Anne S Chapple
- Intensive Care Research, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Kate Fetterplace
- Allied Health (Clinical Nutrition), Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Varsha Asrani
- Nutrition and Dietetics, Auckland City Hospital, Auckland, New Zealand.,Surgical and Translational Research (STaR) Centre, University of Auckland, Auckland, New Zealand.,Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Aidan Burrell
- Intensive Care Unit, The Alfred Hospital, Melbourne, Victoria, Australia.,Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Allen C Cheng
- Department of Infection and Epidemiology, Alfred Health, Melbourne, Victoria, Australia
| | - Peter Collins
- Nutrition and Dietetics, School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia.,Patient-Centred Health Services, Menzies Health Institute, Brisbane, Queensland, Australia
| | - Ra'eesa Doola
- Dietetics Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Suzie Ferrie
- Nutrition and Dietetics Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Andrea P Marshall
- School of Nursing and Midwifery and Menzies Health Institute, Griffith University, Gold Coast, Queensland, Australia.,Gold Coast Health, Southport, Queensland, Australia
| | - Emma J Ridley
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia.,Nutrition Department, Alfred Hospital, Melbourne, Victoria, Australia
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16
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Ferrie S. What is nutritional assessment? A quick guide for critical care clinicians. Aust Crit Care 2020; 33:295-299. [PMID: 32303438 DOI: 10.1016/j.aucc.2020.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/26/2020] [Accepted: 02/28/2020] [Indexed: 12/22/2022] Open
Abstract
Nutritional status is associated with patient outcomes such as length and cost of hospital stay, morbidity, and mortality. Trained nutrition professionals perform nutritional assessment to evaluate the patient's nutritional status, identify nutritional risk, and plan appropriate nutrition interventions. By being aware of key nutrition risk factors and by using simple methods to assess muscle stores, which may be depleted even if the patient is overweight or obese, other members of the healthcare team can help to identify who is at nutritional risk and who may be malnourished. This is helpful in identifying which patients should be referred promptly to a dietitian for appropriate nutrition therapy to improve outcomes.
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Affiliation(s)
- Suzie Ferrie
- Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia; University of Sydney, NSW 2006, Australia.
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Deane AM, Little L, Bellomo R, Chapman MJ, Davies AR, Ferrie S, Horowitz M, Hurford S, Lange K, Litton E, Mackle D, O'Connor S, Parker J, Peake SL, Presneill JJ, Ridley EJ, Singh V, van Haren F, Williams P, Young P, Iwashyna TJ. Outcomes Six Months after Delivering 100% or 70% of Enteral Calorie Requirements during Critical Illness (TARGET). A Randomized Controlled Trial. Am J Respir Crit Care Med 2020; 201:814-822. [PMID: 31904995 DOI: 10.1164/rccm.201909-1810oc] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Rationale: The long-term effects of delivering approximately 100% of recommended calorie intake via the enteral route during critical illness compared with a lesser amount of calories are unknown.Objectives: Our hypotheses were that achieving approximately 100% of recommended calorie intake during critical illness would increase quality-of-life scores, return to work, and key life activities and reduce death and disability 6 months later.Methods: We conducted a multicenter, blinded, parallel group, randomized clinical trial, with 3,957 mechanically ventilated critically ill adults allocated to energy-dense (1.5 kcal/ml) or routine (1.0 kcal/ml) enteral nutrition.Measurements and Main Results: Participants assigned energy-dense nutrition received more calories (percent recommended energy intake, mean [SD]; energy-dense: 103% [28] vs. usual: 69% [18]). Mortality at Day 180 was similar (560/1,895 [29.6%] vs. 539/1,920 [28.1%]; relative risk 1.05 [95% confidence interval, 0.95-1.16]). At a median (interquartile range) of 185 (182-193) days after randomization, 2,492 survivors were surveyed and reported similar quality of life (EuroQol five dimensions five-level quality-of-life questionnaire visual analog scale, median [interquartile range]: 75 [60-85]; group difference: 0 [95% confidence interval, 0-0]). Similar numbers of participants returned to work with no difference in hours worked or effectiveness at work (n = 818). There was no observed difference in disability (n = 1,208) or participation in key life activities (n = 705).Conclusions: The delivery of approximately 100% compared with 70% of recommended calorie intake during critical illness does not improve quality of life or functional outcomes or increase the number of survivors 6 months later.
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Affiliation(s)
- Adam M Deane
- Department of Medicine and Radiology, Melbourne Medical School, Royal Melbourne Hospital and
| | - Lorraine Little
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rinaldo Bellomo
- Centre for Integrated Critical Care, Melbourne Medical School, The University of Melbourne, Parkville, Australia
| | | | - Andrew R Davies
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Suzie Ferrie
- Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Michael Horowitz
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Sally Hurford
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Kylie Lange
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | | | - Diane Mackle
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | | | - Jane Parker
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Jeffrey J Presneill
- Department of Medicine and Radiology, Melbourne Medical School, Royal Melbourne Hospital and
| | - Emma J Ridley
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Vanessa Singh
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Frank van Haren
- Medical School, Australian National University, Canberra, Australia; and
| | | | - Paul Young
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Theodore J Iwashyna
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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Hogan S, Solomon M, Rangan A, Ferrie S, Carey S. The Impact of Preoperative Immunonutrition and Standard Polymeric Supplements on Patient Outcomes After Pelvic Exenteration Surgery, Taking Compliance Into Consideration: A Randomized Controlled Trial. JPEN J Parenter Enteral Nutr 2019; 44:806-814. [PMID: 31531997 DOI: 10.1002/jpen.1709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 08/22/2019] [Accepted: 08/26/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The effect of immunonutrition vs standard polymeric nutrition in the preoperative phase on patient outcomes is still unclear, which could be due to contributing factors such as poorly reported compliance and unequal provision of protein, energy, and volume. The aim of this study was to examine the effects of preoperative immunonutrition compared with standard polymeric supplements matched for energy, protein, volume, length of stay, and postoperative complications in pelvic exenteration surgery, taking into consideration compliance. METHODS This was a single-blinded, randomized, controlled trial in patients undergoing pelvic exenteration surgery. Fifty-two participants were randomly assigned to consume 3 immunonutrition supplements/d for 5 days preoperatively, and 56 participants were randomly assigned to consume 3 standard polymeric supplements/d for 5 days preoperatively. Primary and secondary outcome measures were assessed. Compliance with each nutrition regime was recorded during the intervention, and subanalysis was conducted. RESULTS There was no significant difference between immunonutrition and standard polymeric supplements on length of stay (P = 0.988) or postoperative complications (P = 0.179) after pelvic exenteration surgery. Compliance with nutrition supplements was significantly less in malnourished (n = 33) compared with well-nourished participants (n = 74) (P = 0.016). Compliance varied between study groups, although not significant. CONCLUSION Preoperative immunonutrition did not significantly impact length of stay or postoperative complications compared with standard polymeric supplements after pelvic exenteration surgery, despite controlling for protein, energy, and volume. Compliance, protein, and energy may considerably impact the effect of immunonutrition, particularly in malnourished patients.
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Affiliation(s)
- Sophie Hogan
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Michael Solomon
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Anna Rangan
- University of Sydney, Sydney, New South Wales, Australia
| | - Suzie Ferrie
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Sharon Carey
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
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Cheng J, Witney‐Cochrane K, Cunich M, Ferrie S, Carey S. Defining and quantifying preventable and non‐preventable hospital‐acquired malnutrition—A cohort study. Nutr Diet 2019; 76:620-627. [DOI: 10.1111/1747-0080.12553] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 04/16/2019] [Accepted: 04/26/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Joyce Cheng
- School of Life and Environmental SciencesUniversity of Sydney Camperdown New South Wales Australia
| | - Kiah Witney‐Cochrane
- Nutrition and DieteticsRoyal Prince Alfred Hospital Camperdown New South Wales Australia
| | - Michelle Cunich
- Sydney Health EconomicsSydney Local Health District Camperdown New South Wales Australia
| | - Suzie Ferrie
- School of Life and Environmental SciencesUniversity of Sydney Camperdown New South Wales Australia
- Nutrition and DieteticsRoyal Prince Alfred Hospital Camperdown New South Wales Australia
| | - Sharon Carey
- School of Life and Environmental SciencesUniversity of Sydney Camperdown New South Wales Australia
- Nutrition and DieteticsRoyal Prince Alfred Hospital Camperdown New South Wales Australia
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20
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Lehmann S, Ferrie S, Carey S. Nutrition Management in Patients With Chronic Gastrointestinal Motility Disorders: A Systematic Literature Review. Nutr Clin Pract 2019; 35:219-230. [PMID: 30989698 DOI: 10.1002/ncp.10273] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The aim of this study was to systematically review effects of nutrition interventions on outcomes in patients with chronic gastrointestinal (GI) motility disorders. There is currently a lack of evidence-based guidelines for nutrition management in this group, likely a result of the rarity of the conditions. METHODS A systematic review of all study types to evaluate current evidence-based nutrition interventions was performed using Medline, Embase, and CINAHL databases. Two independent reviewers participated in the process of this systematic review. A total of 15 studies and a total of 524 subjects were included. RESULTS Best treatment of this population group was found to include a stepwise process, progressing from oral nutrition to jejunal nutrition and lastly to parenteral nutrition. Small particle, low-fat diets were significantly better tolerated than the converse, with jejunal nutrition prior to consuming oral food significantly improving oral intake and motility. In more progressive cases, percutaneous endoscopic gastrostomy with jejunal extension nutrition had lower reported symptoms than other enteral routes. Exclusive long-term parenteral nutrition is a feasible option for advanced cases, with a 68% survival rate at 15 years duration, though oral intake with parenteral nutrition is associated with higher survival rates. CONCLUSION Treatment of patients with GI motility disorders should first trial oral nutrition. For patients who progress to jejunal or parenteral feeds, the primary aim should be to maintain or reinstate oral intake to reduce morbidity and mortality risk. Higher-quality studies are still required in this area, particularly in the areas of chronic intestinal pseudo-obstruction and systemic sclerosis.
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Affiliation(s)
- Sara Lehmann
- University of Sydney, School of Life and Environmental Sciences, Sydney, Australia
| | - Suzie Ferrie
- University of Sydney, School of Life and Environmental Sciences, Sydney, Australia.,Department of Nutrition & Dietetics, Royal Prince Alfred Hospital, Sydney, Australia
| | - Sharon Carey
- University of Sydney, School of Life and Environmental Sciences, Sydney, Australia.,Department of Nutrition & Dietetics, Royal Prince Alfred Hospital, Sydney, Australia
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21
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Heinonen T, Ferrie S, Ferguson C. Gut function in the intensive care unit - What is 'normal'? Aust Crit Care 2019; 33:151-154. [PMID: 30745063 DOI: 10.1016/j.aucc.2018.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 12/15/2018] [Accepted: 12/28/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Management of gut function in the intensive care unit (ICU) is often protocol-driven. Protocols for enteral feeding or bowel management are based on assumptions about what is 'normal' gastrointestinal motility during critical illness or in the early postoperative period, although 'normal' has not been well described in this group. OBJECTIVES This study aimed to describe aspects of gut function based on an audit of current ICU patients. METHODS A retrospective medical audit of 100 recent consecutive ICU patients was conducted to obtain data on gut function parameters in the critically ill or postoperative population. RESULTS The audit indicated that delayed gastric emptying is common in the ICU. Regardless of the definition volume used, large gastric aspirates occurred in most enterally fed patients. Patient positioning was a significant influence, with a bed angle <30° associated with increased gastric aspirates (p = 0.0002). Constipation was more common among enterally fed patients than among orally fed ones (p = 0.001) and was associated with opioids (p = 0.009). Diarrhoea was associated with antibiotic use (p = 0.047). For enterally fed patients, the first bowel motion in the ICU occurred on average day 4.60 (standard deviation, 2.78), compared to day 2.72 (standard deviation, 1.67) for orally fed patients (p = 0.0001). CONCLUSION Alteration of upper and lower gastrointestinal motility is common in critically ill and early postoperative patients. Care should be taken in interpreting protocols that relate to gut function to avoid unnecessary interventions or interruptions to nutritional therapy.
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Affiliation(s)
- Tessa Heinonen
- Nutrition & Dietetics Program, School of Life and Environmental Sciences, University of Sydney NSW 2006, Australia.
| | - Suzie Ferrie
- Nutrition & Dietetics Program, School of Life and Environmental Sciences, University of Sydney NSW 2006, Australia; Intensive Care Service, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia; Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia.
| | - Clare Ferguson
- Intensive Care Service, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia; Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia.
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Abstract
BACKGROUND Nutrition monitoring in the context of critical care presents unique challenges. Traditionally used anthropometric and biochemical markers may be difficult to obtain or confounded by factors such as fluid status and the inflammatory response. A previous survey identified 15 parameters in common use, all of which have confounding influences during critical illness. MATERIALS AND METHODS A literature search was conducted to assess current use of commonly used nutrition-monitoring parameters and to explore other possible methods that might be more useful. More than 1000 journal articles were reviewed to identify indicators of nutrition status or nutrition progress that have been used in ICU studies. The most recent 200 articles were examined to quantify the number of occurrences for each indicator. Each parameter was rated for availability and feasibility in the ICU. RESULTS There were 53 parameters found, including the 15 already identified as commonly used; 27 were used in ≥3 recent studies. Less-well-established nutrition indicators with potential for use in the ICU (moderate or high feasibility and availability) included ultrasound measurement of arm or leg muscle thickness, fatigue scoring with the Chalder scale, urinary creatinine assay, and serum insulin-like growth factor 1 level. None of these was among the commonly used indicators in recent studies. CONCLUSION This study identifies commonly used nutrition-monitoring parameters and discusses their feasibility and availability in the critical care setting. Further investigation of nutrition indicators in ICU is needed, ideally as part of a randomized trial to reduce the effect of the many possible confounding factors.
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Affiliation(s)
- Suzie Ferrie
- Royal Prince Alfred Hospital, Sydney, Australia.,University of Sydney, Sydney, Australia
| | - Erica Tsang
- Royal Prince Alfred Hospital, Sydney, Australia
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23
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Abstract
Ethical dilemmas can be challenging for the nutrition support clinician who is accustomed to evidence-based practice. The emotional and personal nature of ethical decision making can present difficulties, and conflict can arise when people have different ethical perspectives. An understanding of ethical terms and ethical theories can be helpful in clarifying the source of this conflict. These may include prominent ethical theories such as moral relativism, utilitarianism, Kantian absolutism, Aristotle's virtue ethics and ethics of care, as well as the key ethical principles in healthcare (autonomy, beneficence, nonmaleficence, and justice). Adopting a step-by-step approach can simplify the process of resolving ethical problems.
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Affiliation(s)
- Suzie Ferrie
- Royal Prince Alfred Hospital, Missenden Road, Camperdown NSW 2050, Australia.
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Reid DB, Chapple LS, O'Connor SN, Bellomo R, Buhr H, Chapman MJ, Davies AR, Eastwood GM, Ferrie S, Lange K, McIntyre J, Needham DM, Peake SL, Rai S, Ridley EJ, Rodgers H, Deane AM. The effect of augmenting early nutritional energy delivery on quality of life and employment status one year after ICU admission. Anaesth Intensive Care 2016; 44:406-12. [PMID: 27246942 DOI: 10.1177/0310057x1604400309] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Augmenting energy delivery during the acute phase of critical illness may reduce mortality and improve functional outcomes. The objective of this sub-study was to evaluate the effect of early augmented enteral nutrition (EN) during critical illness, on outcomes one year later. We performed prospective longitudinal evaluation of study participants, initially enrolled in The Augmented versus Routine approach to Giving Energy Trial (TARGET), a feasibility study that randomised critically ill patients to 1.5 kcal/ml (augmented) or 1.0 kcal/ml (routine) EN administered at the same rate for up to ten days, who were alive at one year. One year after randomisation Short Form-36 version 2 (SF-36v2) and EuroQol-5D-5L quality of life surveys, and employment status were assessed via telephone survey. At one year there were 71 survivors (1.5 kcal/ml 38 versus 1.0 kcal/ml 33; P=0.55). Thirty-nine (55%) patients consented to this follow-up study and completed the surveys (n = 23 and 16, respectively). The SF-36v2 physical and mental component summary scores were below normal population means but were similar in 1.5 kcal/ml and 1.0 kcal/ml groups (P=0.90 and P=0.71). EuroQol-5D-5L data were also comparable between groups (P=0.70). However, at one-year follow-up, more patients who received 1.5 kcal/ml were employed (7 versus 2; P=0.022). The delivery of 1.5 kcal/ml for a maximum of ten days did not affect self-rated quality of life one year later.
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Affiliation(s)
- D B Reid
- Intensive Care Registrar, Royal Adelaide Hospital, Adelaide, South Australia
| | - L S Chapple
- Department of Anaesthesia, Princess Alexandra Hospital, Brisbane, Queensland
| | - S N O'Connor
- Research Manager, Intensive Care Unit, Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, South Australia
| | - R Bellomo
- Intensive Care Consultant, Austin Hospital, Melbourne, Victoria
| | - H Buhr
- Research Manager, Intensive Care Service, Royal Prince Alfred Hospital, Sydney, New South Wales
| | - M J Chapman
- Director of Research, Department of Intensive Care Medicine, Royal Adelaide Hospital, Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia
| | - A R Davies
- Research Fellow, Department of Epidemiology and Preventative Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria
| | - G M Eastwood
- Research Manager, Department of Intensive Care, Austin Hospital, Melbourne, Victoria
| | - S Ferrie
- Critical Care Dietitian, Intensive Care Service, Royal Prince Alfred Hospital, Sydney, New South Wales
| | - K Lange
- Biostatistician, Discipline of Medicine, University of Adelaide, Adelaide, South Australia
| | - J McIntyre
- Research Coordinator, Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Adelaide, South Australia
| | - D M Needham
- Medical Director, Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, USA
| | - S L Peake
- Senior Intensive Care Clinician, Discipline of Acute Care Medicine, University of Adelaide, Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Adelaide, South Australia
| | - S Rai
- Intensive Care Specialist, The Canberra Hospital, Canberra, Australian Capital Territory
| | - E J Ridley
- Nutrition Program Manager, Department of Epidemiology and Preventative Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria
| | - H Rodgers
- Research Coordinator, The Canberra Hospital, Canberra, Australian Capital Territory
| | - A M Deane
- Department of Intensive Care Medicine, Royal Adelaide Hospital, Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia
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Ferrie S, Allman-Farinelli M, Daley M, Smith K. Protein Requirements in the Critically Ill: A Randomized Controlled Trial Using Parenteral Nutrition. JPEN J Parenter Enteral Nutr 2015; 40:795-805. [PMID: 26635305 DOI: 10.1177/0148607115618449] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 09/30/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Current recommendations for higher protein/amino acid provision in the critically ill are based on weak evidence. This double-blinded randomized controlled trial aimed to compare standard amino acid intake with the higher level recommended as the minimum for critically ill patients. METHODS In total, 119 patients requiring parenteral nutrition (PN) in an intensive care unit (ICU) were randomized to receive blinded PN solutions containing amino acids at either 0.8 g/kg or 1.2 g/kg. Primary outcome was handgrip strength at ICU discharge. Secondary outcomes measured at study day 7 included handgrip strength, fatigue score (using the Chalder scale), and ultrasound measurements of muscle thickness at defined body sites. Analysis of covariance was used to control for age, sex, nutrition status (Subjective Global Assessment), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and baseline measurement. RESULTS Actual amino acid delivery to the 2 groups was 0.9 and 1.1 g/kg respectively, averaged over the first 7 days. Grip strength at ICU discharge was not significantly different between groups (P =054) despite being improved at study day 7 in the group receiving the higher level of amino acids (mean [SD], 22.1 [10.1] vs 18.5 [11.8] kg, P =025). These patients also had less fatigue (Chalder score, mean [SD], 5.4 [2.2] vs 6.2 [2.2], P = .045) and greater forearm muscle thickness on ultrasound (mean [SD], 3.2 [0.4] vs 2.8 [0.4] cm, P < .0001). Nitrogen balance was significantly better at study day 3 but not at day 7. There was no difference between groups in mortality or length-of-stay measures. CONCLUSION The higher level of amino acids was associated with small improvements in a number of different measures, supporting guideline recommendations for ICU patients. This trial was registered at Australian New Zealand Clinical Trials Registry (www.anzctr.org.au) as ACTRN12609000366257.
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Affiliation(s)
- Suzie Ferrie
- Intensive Care Service, Royal Prince Alfred Hospital, Sydney, Australia School of Molecular Bioscience, University of Sydney, Sydney, Australia
| | | | - Mark Daley
- Intensive Care Service, Royal Prince Alfred Hospital, Sydney, Australia
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27
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Ferrie S. Feasibility, safety, and outcome of very early enteral nutrition in critically ill patients: Results of an observational study. J Crit Care 2015; 30:1145. [PMID: 26148939 DOI: 10.1016/j.jcrc.2015.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 06/05/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Suzie Ferrie
- Critical Care Dietitian, Intensive Care Service, Royal Prince Alfred Hospital, Sydney, Australia
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Ferrie S, Allman-Farinelli M, Daley M. OP014: Protein in Parenteral Nutrition for ICU Patients: A Randomised Controlled Trial. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50014-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Affiliation(s)
- Suzie Ferrie
- Royal Prince Alfred Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
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Carey S, Laws R, Ferrie S, Young J, Allman-Farinelli M. Struggling with food and eating--life after major upper gastrointestinal surgery. Support Care Cancer 2013; 21:2749-57. [PMID: 23715818 DOI: 10.1007/s00520-013-1858-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 05/16/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Few qualitative studies have explored patients' experience of food and eating following major upper gastrointestinal cancer surgery. The aim of this article was to explore the longer-term impact of different types of major upper gastrointestinal surgeries on people's relationship with food. METHODS Twenty-six people having had major upper gastrointestinal cancer surgery greater than 6 months ago participated in semi-structured interviews. These interviews aimed to explore a person's physical, emotional and social relationship with food and eating following surgery. Interviews were tape-recorded, transcribed and analysed using an inductive thematic analysis approach. RESULTS Interview findings revealed a journey of adjustment, grieving and resignation. The physical symptoms and experiences of people differed between types of surgery, but the coping mechanisms remained the same. CONCLUSIONS The grieving and resignation people experienced suggest adjustment and coping similar to that of someone with a chronic illness. Remodeling of health services is needed to ensure this patient group receives ongoing management and support.
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Affiliation(s)
- Sharon Carey
- Department of Nutrition & Dietetics, Royal Prince Alfred Hospital, Missenden Road Camperdown, NSW, 2050, Sydney, Australia,
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Conchin S, Muirhead R, Ferrie S, Carey S. Can't we just let them eat? Defining and addressing under-use of the oral route in a post-surgical ward. Asia Pac J Clin Nutr 2013; 22:200-5. [PMID: 23635362 DOI: 10.6133/apjcn.2013.22.2.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Early postoperative nutrition improves outcomes. However, postoperative fasting is a tradition that persists in some areas of surgical practice. This retrospective audit was performed to benchmark current nutrition support practices on a mixed specialty surgical ward in a large tertiary-referral teaching hospital. Thirty-eight consecutive patients, who were undergoing gynaecological or urological surgical procedures between November 2010 and May 2011, had data collected including demographics, nutritional status, details of surgery performed, postoperative complications, modes of nutrition support and time taken to progress to solid oral diet. Energy and protein provision and adequacy was estimated for the first week postoperatively. Sixteen patients commenced parenteral nutrition postoperatively without any trial of oral or enteral nutrition. Reasons for using parenteral nutrition included observed or expected gut dysmotility and lack of enteral access for feeding. These patients did demonstrate longer length of stay and higher rates of postoperative complications. Given the proportion of patients initiated immediately on parenteral nutrition and maintained on it alone, it can be argued that these patients are not able to demonstrate tolerance and receive the benefits of early enteral feeding predicted by studies within these patient groups. None of the patients met their energy and protein requirements in the first week postoperatively. Despite support in the literature, it can be challenging to implement early postoperative nutrition support after pelvic surgery. It may be necessary to employ a variety of strategies to change this aspect of practice and promote earlier introduction of an oral diet or the use of enteral nutrition.
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Affiliation(s)
- Simone Conchin
- Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Camperdown, Australia.
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Ferrie S, Rand S, Palmer S. Back to Basics: Estimating Protein Requirements for Adult Hospital Patients. A Systematic Review of Randomised Controlled Trials. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/fns.2013.42028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Affiliation(s)
- Suzie Ferrie
- Royal Prince Alfred Hospital, Camperdown, Australia
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Carey S, Ferrie S, Young J, Allman-Farinelli M. Long-term nutrition support in gastrointestinal disease—A systematic review of the evidence. Nutrition 2012; 28:4-8. [DOI: 10.1016/j.nut.2011.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 07/04/2011] [Accepted: 07/04/2011] [Indexed: 01/05/2023]
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Abstract
BACKGROUND Intensive care is a relatively new work area for dietitians in Australasia, and the role of the dietitian appears to differ widely between facilities. This may create difficulties with multicenter research collaboration and workforce planning. The aim of this study was to develop a validated survey tool to assess dietitians' involvement in their intensive care teams. METHODS A full list of all 182 adult intensive care units in Australia and New Zealand was obtained from the Australian and New Zealand Intensive Care Society, and all of these units were contacted. A survey tool was developed, piloted, and validated using correlation tests of construct validity; factor analysis was used to develop a 5-item short-form survey tool. RESULTS At least 1 dietitian participated from each of the 182 hospitals that were contacted, and no dietitians declined to participate in the survey (100% response rate). The survey had strong validity and test-retest reliability in the population surveyed. CONCLUSIONS The survey tools presented here can be used to assess dietitians' involvement in their intensive care team. The short-form tool developed in this study is conveniently brief and easy to administer, but it will need to be validated for use outside the Australian and New Zealand health systems prior to conduct of a large-scale survey.
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Affiliation(s)
- Suzie Ferrie
- Department of Nutrition & Dietetics, Royal Prince Alfred Hospital, Sydney, Australia.
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Affiliation(s)
- Suzie Ferrie
- Department of Nutrition & Dietetics, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Matthew Hoyle
- Formerly of Townsville Hospital, Townsville, Queensland, Australia
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Ferrie S. Re: The use of an inflammation-modulating diet in patients with acute lung injury or acute respiratory distress syndrome: a meta-analysis of outcome data. JPEN J Parenter Enteral Nutr 2011; 34:452; author reply 453-4. [PMID: 20631393 DOI: 10.1177/0148607110362765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ferrie S, Daley M. Lactobacillus GG as treatment for diarrhea during enteral feeding in critical illness: randomized controlled trial. JPEN J Parenter Enteral Nutr 2010; 35:43-9. [PMID: 20978244 DOI: 10.1177/0148607110370705] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Diarrhea is a common problem in critical illness. The aim of this study was to investigate the effect of probiotic treatment with Lactobacillus rhamnosus GG on established diarrhea in critically ill patients. METHODS This prospective randomized blinded trial in the adult intensive care unit of a large tertiary referral teaching hospital compared probiotic treatment with placebo. Thirty-six consecutive critically ill enterally fed adults with diarrhea were randomized to receive 2 capsules per day for 7 days of either Lactobacillus GG in an inulin base (Culturelle) or inulin alone (placebo). Diarrhea was defined as ≥3 unformed stools or >200 mL stool volume within 24 hours. Prospectively defined primary end point was duration of diarrhea, and secondary end point was mean number of loose stools per day during the 14 days from the first capsule. Results by intention-to-treat analysis: No significant difference was observed for any end point. There was a trend toward more diarrhea in the probiotic treatment group. Mean (standard deviation) duration of diarrhea was 3.83 (2.39) days for the probiotic group and 2.56 (1.85) days for the placebo group (P = .096). Mean number of loose stools per day during the 14 days from the first capsule was 1.58 (0.88) in the probiotic group and 1.10 (0.79) in the placebo group (P = .150). CONCLUSIONS This study does not support the use of Lactobacillus GG as a treatment for established diarrhea in enterally fed critically ill patients.
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Affiliation(s)
- Suzie Ferrie
- Department of Nutrition & Dietetics, Royal Prince Alfred Hospital, Sydney, Australia.
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Ferrie S. Parenteral nutrition in the critically ill patient. N Engl J Med 2010; 362:83; author reply 83-4. [PMID: 20058341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Abstract
OBJECTIVE To assess the incidence of diarrhoea in intensive care patients with a length of stay (LOS) greater than 3 days who were receiving any type of enteral tube feeding, and to measure the effect of implementing a bowel management protocol. DESIGN A 2-year prospective audit, with an intervention after 12 months. Diarrhoea was defined as bowel activity exceeding three stools of any consistency per day, or three or more unformed stools (or 300 mL) per day, for two consecutive days. SETTING A tertiary referral intensive care unit (ICU) in a large public hospital. SAMPLE Six hundred fifty-six consecutive patients admitted to ICU with a LOS >3 days. INTERVENTION A bowel management protocol was implemented to address both diarrhoea and constipation. MAIN OUTCOME MEASURES Number of patients who experienced diarrhoea during their ICU stay; number of ICU patient-days on which diarrhoea occurred. RESULTS After the protocol was implemented, diarrhoea was experienced by 13% fewer patients (p = 0.0002) and occurred on 8% fewer ICU days (p < 0.0001). CONCLUSION Use of an evidence-based protocol, and improved monitoring and reporting of bowel activity, can decrease the incidence of diarrhoea in ICU patients.
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Affiliation(s)
- Suzie Ferrie
- Intensive Care Service, Royal Prince Alfred Hospital, Camperdown, NSW 2042, Australia.
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Abstract
The importance of nutrition support in intensive care has been recognised, but many factors may limit successful provision of patients' requirements. We conducted a twelve-month prospective audit, with intervention after six months, to determine whether longer-stay (> 3 days) patients in our intensive care unit were receiving their nutritional requirements and to identify and improve factors limiting nutrition provision. Data was collected for 379 consecutive patients admitted to intensive care longer than three days. Total energy provided to each patient was recorded daily and compared with the predicted requirement. In the first six months, patients commenced nutrition 2.2 +/- 1.3 days after intensive care admission and were receiving 100% of predicted energy requirement by 4.8 +/- 3.3 days. Patients received nutrition on 82.3% of total patient-days, daily average 71.7% (43.2) of their energy requirement. Nutrition was interrupted on 30% of total patient-days. After six months, a Clinical Practice Improvement model was used to analyse reasons for inadequate feeding and introduce changes in practice. Main reasons for interruption included preparation for extubation and upper gastrointestinal intolerance. After intervention, interruptions due to these reasons were significantly reduced, however, no significant improvement was observed overall, either in the time to reach nutritional goals, or in the amount of energy received. Successful changes in practice, targeting only one or two main issues, can be overwhelmed by other factors. To effect significant improvement, a wider approach may be required.
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Affiliation(s)
- S Ferrie
- Intensive Care Service, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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