Practicalities of nutrition support in the intensive care unit: The usefulness of gastric residual volume and prokinetic agents with enteral nutrition

Background: Severe brain attack patients demonstrate hypermetabolic state and gastrointestinal dysfunction, leading to faster onset of nutritional failure. Aim: To estimate the time point where the development of nutritional failure is more probable among patients with acute brain attacks in the intensive care unit (ICU). Methods: Direct bedside observation for selected nutritional parameters was performed. When enteral nutrition was initiated, observation was performed at five points over 9 days. Findings: 84 patients with 55% mortality risk and on mechanical ventilation were included. Over the observation period, gastric residual volume increased (144 ml vs 196 ml), body weight decreased (79.4 kg vs 74.3 kg), and serum albumin reduced (3.6 g/dl to 3.1 g/dl). Caloric attainment and malnutrition score deteriorated, and feeding-related complications increased. Nutritional failure was evidently prevalent between the third and fifth day of observation. Conclusion: An earlier period of enteral nutrition entails higher probability of nutritional failure among severe brain attack patients in the ICU.

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

Pharmacy ◽

10.3390/pharmacy9030121 ◽

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.

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The Benefits of Parenteral Nutrition (PN) Versus Enteral Nutrition (EN) Among Adult Critically Ill Patients: What is the Evidence? A Literature Review

Journal of Intensive Care Medicine ◽

10.1177/0885066619843782 ◽

2019 ◽

Vol 35 (7) ◽

pp. 615-626 ◽

Cited By ~ 2

Author(s):

Angel Joel Cadena ◽

Sara Habib ◽

Fred Rincon ◽

Stephanie Dobak

Keyword(s):

Health Care ◽

Intensive Care Unit ◽

Intensive Care ◽

Enteral Nutrition ◽

Parenteral Nutrition ◽

Clinical Outcomes ◽

Critically Ill ◽

Nutrition Support ◽

Mechanical Ventilation Duration ◽

The Impact

Malnutrition is frequently seen among patients in the intensive care unit. Evidence shows that optimal nutritional support can lead to better clinical outcomes. Recent clinical trials debate over the efficacy of enteral nutrition (EN) over parenteral nutrition (PN). Multiple trials have studied the impact of EN versus PN in terms of health-care cost and clinical outcomes (including functional status, cost, infectious complications, mortality risk, length of hospital and intensive care unit stay, and mechanical ventilation duration). The aim of this review is to address the question: In critically ill adult patients requiring nutrition support, does EN compared to PN favorably impact clinical outcomes and health-care costs?

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Use of a Nutrition Support Protocol to Increase Enteral Nutrition Delivery in Critically Ill Patients

American Journal of Critical Care ◽

10.4037/ajcc2014140 ◽

2014 ◽

Vol 23 (5) ◽

pp. 396-403 ◽

Cited By ~ 16

Author(s):

Friederike Compton ◽

Christian Bojarski ◽

Britta Siegmund ◽

Markus van der Giet

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Enteral Nutrition ◽

Invasive Mechanical Ventilation ◽

Nutrition Support ◽

Early Enteral Nutrition ◽

Feeding Tubes ◽

Enteral Nutrition Support ◽

The Impact

BackgroundEarly enteral nutrition is recommended for patients in intensive care units, but nutrition provision is often hindered by a variety of unit-specific problems.ObjectivesTo evaluate the impact of a nutrition support protocol on nutrition prescription and delivery in the intensive care unit.MethodsNutrition-related data from 73 patients receiving mechanical ventilation who were treated in an adult medical intensive care unit before introduction of an enteral nutrition support protocol were retrospectively compared with data for 87 patients admitted after implementation of the protocol.ResultsAfter implementation of the protocol, enteral nutrition was started significantly earlier (P = .007) and enteral feeding goals were reached significantly faster (6 vs 10 days, P < .001) than before. Prescription of enteral nutrition on the first day of invasive mechanical ventilation increased from 38% before to 54% after (P = .03) implementation of the protocol. Prescribed and delivered nutrition doses on the first 2 days of mechanical ventilation also increased significantly (P < .001) after the protocol was implemented. Nasojejunal feeding tubes were used in 52% of patients before and 56% of patients after protocol implementation P = .63). Jejunal tubes were placed earlier after the protocol was implemented than before (median 5 vs 6.5 days), and when a jejunal tube was in place, feeding goals were reached faster (median 2 vs 3 days, P = .002).ConclusionImplementing an enteral nutrition support protocol shortened the time to reach feeding goals. Jejunal feeding tubes were necessary in more than half of the patients, and with a jejunal feeding tube in place, feeding goals were reached rapidly.

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Effects of Abdominal Massage to Overcome Gastrointestinal Dysfunction in Patients in Intensive Care Unit: A Literature Review

Padjadjaran Acute Care Nursing Journal ◽

10.24198/pacnj.v1i1.24856 ◽

2019 ◽

Vol 1 (1) ◽

Author(s):

Cecep Eli Kosasih ◽

Alisha Dewi Andriani ◽

Astriani Ayu Lestari ◽

Friska Maulia Sekarjati ◽

Hanifa Iqomatulhaq ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Literature Review ◽

Abdominal Circumference ◽

Gastric Distension ◽

Gastrointestinal Function ◽

Residual Volume ◽

Gastric Residual Volume ◽

Gastrointestinal Dysfunction ◽

Abdominal Massage

Patients who are receiving treatment at the ICU have at least one symptom of gastrointestinal dysfunction including decreased bowel noise, abdominal distension, constipation, decreased frequency of defecation, and increased GRV (gastric residual volume). Non-pharmacological interventions that can be done to improve gastrointestinal function include abdominal massage. This paper aimed to conduct a literature review on the effects of abdominal massage to overcome gastrointestinal dysfunction in patients in the ICU. Articles taken from the Google Scholar and Science Direct electronic databases with the keywords abdominal massage, gastrointestinal function, bowel function, and ICU were published from 2015 to 2019. There were four research articles discussing abdominal massage to improve gastrointestinal function. Three articles used the Randomized Controlled Design method and one article used the Quasi Experimental method. Abdominal massage has a positive effect to improve gastrointestinal function in patients receiving treatment in the ICU. Improved gastrointestinal function that can be seen from the existence of a faster time in the reduction in gastric residual volume (GRV), decreased abdominal circumference, decreased gastric distension, and decreased the incidence of constipation. It is expected that abdominal massage can be applied by ICU nurses considering this intervention has the effectiveness in terms of time and funding.Keywords: Abdominal Massage, Gastrointestinal Function, Intensive Care Unit

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Effect of gastric residual volume monitoring on incidence of ventilator-associated pneumonia in mechanically ventilated patients admitted to intensive care unit

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.36.1.1321 ◽

2019 ◽

Vol 36 (1) ◽

Author(s):

Elnaz Faramarzi ◽

Ata Mahmoodpoor ◽

Hadi Hamishehkar ◽

Kamran Shadvar ◽

Afshin Iranpour ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Ventilator Associated Pneumonia ◽

Residual Volume ◽

Gastric Residual Volume ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Icu Length Of Stay ◽

Ventilated Patients

Objectives: The value of gastric residual volume (GRV) monitoring in ventilator-associated pneumonia (VAP) has frequently been questioned in the past years. In this trial, the effect of GRV on the frequency of VAP was evaluated in critically ill patients under mechanical ventilation. Methods: This descriptive study was carried out on 150 adult patients admitted to the intensive care unit over a 14-month period, from October 2015 to January 2017. GRV was measured every three hours, and gastric intolerance was defined as GRV>250 cc. The incidence of vomiting and VAP, GRV, length of mechanical ventilation and ICU stay, APACHE II and SOFA scores, and mortality rate were noted. Results: The mean APACHEII and SOFA scores, ICU length of stay, and duration of mechanical ventilation in the GRV>250ml group were significantly higher than in the GRV≤250 ml group (P<0.05). Also, a significantly higher number of patients in the GRV>250ml group experienced infection (62.3%) and vomiting (71.7%) compared with the GRV≤250 group (P<0.01). The highest OR was observed for SOFA score >15 and APACHE II >30, which increased the risk of GVR>250 ml by 10.09 (1.01-99.97) and 8.78 (1.49-51.58), respectively. Moreover, the increase in GVR was found to be higher in the non-survivor than in the survivor group. Conclusion: Increased GRV did not result in increased rates of VAP, ICU length of stay, and mortality. Therefore, the routine measurement of GRV as an important element of the VAP prevention bundle is not recommended in critically ill patients. How to cite this: Faramarzi E, Mahmoodpoor A, Hamishehkar H, Shadvar K, Iranpour A, Sabzevari T, et al. Effect of gastric residual volume monitoring on incidence of ventilator-associated pneumonia in mechanically ventilated patients admitted to intensive care unit. Pak J Med Sci. 2020;36(1):---------. doi: https://doi.org/10.12669/pjms.36.1.1321 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Effect of gastric residual volume monitoring on incidence of ventilator-associated pneumonia in mechanically ventilated patients admitted to intensive care unit

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.36.2.1321 ◽

2019 ◽

Vol 36 (2) ◽

Author(s):

Elnaz Faramarzi ◽

Ata Mahmoodpoor ◽

Hadi Hamishehkar ◽

Kamran Shadvar ◽

Afshin Iranpour ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Ventilator Associated Pneumonia ◽

Residual Volume ◽

Gastric Residual Volume ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Icu Length Of Stay ◽

Ventilated Patients

Objectives: The value of gastric residual volume (GRV) monitoring in ventilator-associated pneumonia (VAP) has frequently been questioned in the past years. In this trial, the effect of GRV on the frequency of VAP was evaluated in critically ill patients under mechanical ventilation. Methods: This descriptive study was carried out on 150 adult patients admitted to the intensive care unit over a 14-month period, from October 2015 to January 2017. GRV was measured every three hours, and gastric intolerance was defined as GRV>250 cc. The incidence of vomiting and VAP, GRV, length of mechanical ventilation and ICU stay, APACHE II and SOFA scores, and mortality rate were noted. Results: The mean APACHEII and SOFA scores, ICU length of stay, and duration of mechanical ventilation in the GRV>250ml group were significantly higher than in the GRV≤250 ml group (P<0.05). Also, a significantly higher number of patients in the GRV>250ml group experienced infection (62.3%) and vomiting (71.7%) compared with the GRV≤250 group (P<0.01). The highest OR was observed for SOFA score >15 and APACHE II >30, which increased the risk of GVR>250 ml by 10.09 (1.01-99.97) and 8.78 (1.49-51.58), respectively. Moreover, the increase in GVR was found to be higher in the non-survivor than in the survivor group. Conclusion: Increased GRV did not result in increased rates of VAP, ICU length of stay, and mortality. Therefore, the routine measurement of GRV as an important element of the VAP prevention bundle is not recommended in critically ill patients. doi: https://doi.org/10.12669/pjms.36.2.1321 How to cite this: Faramarzi E, Mahmoodpoor A, Hamishehkar H, Shadvar K, Iranpour A, Sabzevari T, et al. Effect of gastric residual volume monitoring on incidence of ventilator-associated pneumonia in mechanically ventilated patients admitted to intensive care unit. Pak J Med Sci. 2020;36(2):48-53. doi: https://doi.org/10.12669/pjms.36.2.1321 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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The Effect of Abdominal Massage on Enteral Complications in Geriatric Patients

SAGE Open Nursing ◽

10.1177/2377960820963772 ◽

2020 ◽

Vol 6 ◽

pp. 237796082096377

Author(s):

Onur Çetinkaya ◽

Özlem Ovayolu ◽

Nimet Ovayolu

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Geriatric Patients ◽

Intervention Group ◽

Control Group ◽

Residual Volume ◽

Gastric Residual Volume ◽

Quasi Experimental ◽

Abdominal Massage ◽

Positive Effect

Introduction and Purpose Geriatric patients, who are fed by nasogastric tube (NG), may suffer from complications. Therefore, this study was conducted to evaluate the effect of abdominal massage on Gastric residual volume (GRV), distension, vomiting, and defecation in geriatric patients, who were hospitalized in intensive care unit and fed by NG. Methods The quasi-experimental study was conducted in intensive care units. The researcher applied abdominal massage to patients in the intervention group (n = 30) twice a day for 15–20 minutes before feeding. The data of the study were collected by using a questionnaire and a parameter questionnaire. Results GRV decreased significantly in the intervention group and increased significantly in the control group ( p < 0.05). The frequency of defecation significantly increased in intervention group ( p < 0.05). It was found that there was no positive effect of abdominal massage on vomiting ( p > 0.05). Conclusion It was observed that while abdominal massage reduced high GRV and distension incidence, it increased the incidence of defecation.

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