Nonocclusive mesenteric ischemia: A rare but lethal complication of enteral nutrition in critically ill patients

Critically ill patients in the intensive care unit (ICU) have a high risk of developing malnutrition, and this is associated with poorer clinical outcomes. In clinical practice, nutrition, including enteral nutrition (EN), is often not prioritized. Resulting from this, risks and safety issues for patients and healthcare professionals can emerge. The aim of this literature review, inspired by the Rapid Review Guidebook by Dobbins, 2017, was to identify risks and safety issues for patient safety in the management of EN in critically ill patients in the ICU. Three databases were used to identify studies between 2009 and 2020. We assessed 3495 studies for eligibility and included 62 in our narrative synthesis. Several risks and problems were identified: No use of clinical assessment or screening nutrition assessment, inadequate tube management, missing energy target, missing a nutritionist, bad hygiene and handling, wrong time management and speed, nutritional interruptions, wrong body position, gastrointestinal complication and infections, missing or not using guidelines, understaffing, and lack of education. Raising awareness of these risks is a central aspect in patient safety in ICU. Clinical experts can use a checklist with 12 identified top risks and the recommendations drawn up to carry out their own risk analysis in clinical practice.

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Implementing Volume-Based Feeding to Optimize Delivery of Enteral Nutrition

Critical Care Nurse ◽

10.4037/ccn2021556 ◽

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.

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Enteral nutrition discontinuation and outcomes in general critically ill patients

Clinics ◽

10.6061/clinics/2013(02)oa09 ◽

2013 ◽

Vol 68 (2) ◽

pp. 173-177 ◽

Cited By ~ 5

Author(s):

MA Silva ◽

SG Santos ◽

CD Tomasi ◽

G Luz ◽

MM Paula ◽

...

Keyword(s):

Enteral Nutrition ◽

Critically Ill ◽

Critically Ill Patients

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Effects of fenugreek seed powder on enteral nutrition tolerance and clinical outcomes in critically ill patients: A randomized clinical trial

Biomedical Research and Therapy ◽

10.15419/bmrat.v5i7.462 ◽

2018 ◽

Vol 5 (7) ◽

pp. 2528-2537

Author(s):

Akram Kooshki ◽

Zaher Khazaei ◽

Azam Zarghi ◽

Mojtaba Rad ◽

Hadi Gholam Mohammadi ◽

...

Keyword(s):

Enteral Nutrition ◽

Clinical Outcomes ◽

Critically Ill ◽

Critically Ill Patients ◽

Routine Care ◽

Fenugreek Seeds ◽

Mechanically Ventilated ◽

Fenugreek Seed ◽

Group 2 ◽

Group 1

Background: Enteral nutrition (EN) intolerance is a common complication in critically ill patients that contributes to morbidity and mortality. Based on the evidence of curing effects of fenugreek seeds in some gastrointestinal disorders, this study aimed to determine the effects of fenugreek seed powder on enteral nutrition tolerance and clinical outcomes in critically ill patients. Materials & Methods: A randomized, double-blinded clinical trial of 5-day duration was conducted on 60 mechanically ventilated patients divided in 2 groups (n=30). Group 1 was given fenugreek seed powder by gavage, twice a day in addition to routine care, while Group 2 received only routine care. Enteral nutrition tolerance and clinical outcomes were measured throughout the study. Demographic and clinical data were recorded and clinical responses to the primary outcome (enteral nutrition tolerance) and secondary outcome (other clinical factors) were interpreted. Data were analyzed using the independent t-test, Chi-squared test, covariance analysis, and repeated measure ANOVA via SPSS statistical software (v. 20); statistical significance was set at p< 0.05. Results: Patients who were fed with the fenugreek seed powder showed a significant improvement in enteral nutrition tolerance, as well as some complications of mechanical ventilation for Group 1, as compared with Group 2. The mortality rates were not different between the two groups. Conclusion: This study shows the beneficial effects of fenugreek seeds on food intolerance in critically ill patients and that the seed powder can be used as an add-on therapy with other medications. Thus, the use of fenugreek seeds to treat mechanically ventilated patients is recommended.

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