Technology to inform delivery of enteral nutrition in the intensive care unit

2021 ◽  
Author(s):  
Adam M. Deane ◽  
Marianne J. Chapman
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Enteral Nutrition

scholarly journals Impact of Propofol Sedation upon Caloric Overfeeding and Protein Inadequacy in Critically Ill Patients Receiving Nutrition Support

Pharmacy ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 121
Author(s):  
Roland N. Dickerson ◽  
Christopher T. Buckley
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Enteral Nutrition ◽  
Parenteral Nutrition ◽  
Critically Ill Patients ◽  
Protein Intake ◽  
Lipid Emulsion ◽  
Caloric Intake ◽  
Nutrition Therapy ◽  
Nutrition Support

Propofol, a commonly used sedative in the intensive care unit, is formulated in a 10% lipid emulsion that contributes 1.1 kcals per mL. As a result, propofol can significantly contribute to caloric intake and can potentially result in complications of overfeeding for patients who receive concurrent enteral or parenteral nutrition therapy. In order to avoid potential overfeeding, some clinicians have empirically decreased the infusion rate of the nutrition therapy, which also may have detrimental effects since protein intake may be inadequate. The purpose of this review is to examine the current literature regarding these issues and provide some practical suggestions on how to restrict caloric intake to avoid overfeeding and simultaneously enhance protein intake for patients who receive either parenteral or enteral nutrition for those patients receiving concurrent propofol therapy.

Diffuse digestive bezoar: a rare and severe complication of enteral nutrition in the intensive care unit (ICU)

2011 ◽  
Vol 38 (4) ◽  
pp. 730-731 ◽  
Author(s):  
Jean-Paul Bouwyn ◽  
Thomas Clavier ◽  
Jean-Pierre Eraldi ◽  
François Bougerol ◽  
Jean-Philippe Rigaud ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Enteral Nutrition ◽  
Severe Complication

Implementing Volume-Based Feeding to Optimize Delivery of Enteral Nutrition

2021 ◽  
Vol 41 (2) ◽  
pp. 16-26
Author(s):  
Angela Bonomo ◽  
Diane Lynn Blume ◽  
Katie Davis ◽  
Hee Jun Kim
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Educational Approach ◽  
Lecture Demonstration

Background At least 80% of ordered enteral nutrition should be delivered to improve outcomes in critical care patients. However, these patients typically receive 60% to 70% of ordered enteral nutrition volume. In a practice review within a 28-bed medical-surgical adult intensive care unit, patients received a median of 67.5% of ordered enteral nutrition with standard rate-based feeding. Volume-based feeding is recommended to deliver adequate enteral nutrition to critically ill patients. Objective To use a quality improvement project to increase the volume of enteral nutrition delivered in the medical-surgical intensive care unit. Methods Percentages of target volume achieved were monitored in 73 patients. Comparisons between the rate-based and volume-based feeding groups used nonparametric quality of medians test or the χ2 test. A customized volume-based feeding protocol and order set were created according to published protocols and then implemented. Standardized education included lecture, demonstration, written material, and active personal involvement, followed by a scenario-based test to apply learning. Results Immediately after implementation of this practice change, delivered enteral nutrition volume increased, resulting in a median delivery of 99.8% of ordered volume (P = .003). Delivery of a mean of 98% ordered volume was sustained over the 15 months following implementation. Conclusions Implementation of volume-based feeding optimized enteral nutrition delivery to critically ill patients in this medical-surgical intensive care unit. This success can be attributed to a comprehensive, individualized, and proactive process design and educational approach. The process can be adapted to quality improvement initiatives with other patient populations and units.

scholarly journals Quality indicators in nutrition therapy and clinical outcomes in a neonatal intensive care unit

2021 ◽  
Vol 34 ◽  
Author(s):  
Luciana Carla HOLZBACH ◽  
Renata Andrade de Medeiros MOREIRA ◽  
Renata Junqueira PEREIRA
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Weight Gain ◽  
Birth Weight ◽  
Enteral Nutrition ◽  
Gestational Age ◽  
Nutrition Therapy ◽  
Energy Deficit ◽  
Cumulative Energy ◽  
Fasting Time

ABSTRACT Objective To associate quality indicators in nutritional therapy and pre-determined clinical outcomes in a neonatal unit. Methods A total of 81 premature newborns were monitored regarding the time to initiate nutrition therapy, time to meet energy needs, energy and protein adequacy, cumulative energy deficit, adequacy of the nutritional formula and fasting periods; weight gain, the occurrence of necrotizing enterocolitis, mortality and length of stay in the intensive care unit. The data were analyzed with the Statistical Package for the Social Sciences at 5% significance level. Results The time to start enteral nutrition and the calories infused/kg/day were predictors of length of hospital stay F(2.46)=6.148; p=0.004; R2=0.211; as well as the cumulative energy deficit+birth weight+infused calories/kg/day (F=3.52; p<0.001; R2=0.422); cumulative energy deficit+calories infused/kg/day+fasting time for Enteral Nutrition (F=15.041; p<0.001; R2=0.474) were predictors of weight gain. The time to start enteral nutrition, gestational age and birth weight were inversely associated with the occurrence of necrotizing enterocolitis (β=-0.38; β=-0.198; β=-0.002). Early enteral nutrition predisposed to mortality (β=0.33). Gestational age, birth weight and calories infused/kg/day were inversely related to mortality (β=-0.442; β=-0.004; β=-0.08). Conclusions Considering the associations between indicators and outcomes, routine monitoring of the time to start enteral nutrition, energy adequacy, energy deficit and fasting time is recommended.

scholarly journals Never Too Early: Parenteral Nutrition Administration in Elderly Emergency General Surgery Patients

2021 ◽  
pp. 1-8
Author(s):  
A.K. Gergen ◽  
P. Hosokawa ◽  
C. Irwin ◽  
M.J. Cohen ◽  
F.L. Wright ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Enteral Nutrition ◽  
Elderly Patients ◽  
Parenteral Nutrition ◽  
Early Initiation ◽  
Unplanned Admission ◽  
Emergency General Surgery ◽  
Early Administration ◽  
Late Initiation

Objectives: Elderly patients requiring emergency general surgery (EGS) are at high risk for complications due to preexisting malnutrition. Thus, correcting nutritional deficits perioperatively is essential to improve outcomes. However, even in patients unable to tolerate enteral nutrition, initiation of parenteral nutrition (PN) is often delayed due to concerns of associated complications. In this study, we hypothesized that in elderly EGS patients with relative short-term contraindications to enteral nutrition, early administration of PN is as safe as delayed administration. Furthermore, early PN may improve outcomes by enhancing caloric intake and combatting malnutrition in the immediate perioperative period. Design and Setting: A single-institution, retrospective review was performed at a quaternary academic medical center. Participants: Participants consisted of 58 elderly patients >65 years of age admitted to the EGS service who required PN between July 2017 and July 2020. Measurements: Postoperative outcomes of patients started on PN on hospital day 0-3 (early initiation) were compared to patients started on PN on hospital day 4 or later (late initiation). Bivariate analysis was conducted using the Chi-square or Fisher’s exact test for categorical variables and the Wilcoxon-Mann-Whitney test and F-test for continuous variables. Results: Fifty-eight patients met inclusion criteria, with 27 (46.6%) patients receiving early PN and 31 (53.4%) receiving late PN. Both groups shared similar baseline characteristics, including degree of frailty, body mass index, and nutritional status at time of admission. Complications associated with PN administration were negligible, with no instances of central venous catheter insertion-related complications, catheter-associated bloodstream infection, or factors leading to early termination of PN therapy. A significantly higher proportion of patients in the early administration group met 60% of their caloric goal within 72 hours of admission (62.9% versus 19.5%, p=0.0007). Patients receiving late PN demonstrated a significantly higher rate of unplanned admission to the intensive care unit (38.7% versus 14.8%, p=0.04). Moreover, there was a 21.5% reduction in mortality among patients in the early initiation group compared to patients in the late initiation group (33.3% versus 54.8%, p=0.10). Conclusions: Early initiation of PN in hospitalized elderly EGS patients was not associated with increased adverse events compared to patients undergoing delayed PN administration. Furthermore, patients receiving early PN demonstrated a 2.6-fold decrease in the rate of unplanned admission to the intensive care unit and trended toward improved mortality. Based on these results, further prospective studies are warranted to further explore the safety and potential benefits of early PN administration in elderly surgical patients unable to receive enteral nutrition.

Are Intensive Care Unit Patients Undergoing Enteral Nutrition Therapy Sufficiently Fed? A Prospective, Descriptive Study

2021 ◽  
Vol 36 (2) ◽  
pp. 119-127
Author(s):  
Volkan Özen ◽  
Aylin Aydin Sayilan ◽  
Miray Turkoglu ◽  
Dilek Mut ◽  
Samet Sayilan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Enteral Nutrition ◽  
Descriptive Study ◽  
Nutrition Therapy
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