scholarly journals Clinical severity scores do not predict tolerance to enteral nutrition in critically ill children

2008 ◽  
Vol 102 (2) ◽  
pp. 191-194 ◽  
Author(s):  
César Sánchez ◽  
Jesús López-Herce ◽  
Santiago Mencía ◽  
Javier Urbano ◽  
Angel Carrillo ◽  
...  
Keyword(s):  
Enteral Nutrition ◽  
Digestive Tract ◽  
Critically Ill ◽  
Abdominal Distension ◽  
Maximum Energy ◽  
Clinical Severity ◽  
Critically Ill Children ◽  
Energy Delivery ◽  
Logistic Organ Dysfunction ◽  
Severity Scores

The objective of the present study was to analyse whether there is a relationship between the clinical severity at the time of starting transpyloric enteral nutrition (TEN) and the onset of digestive tract complications in critically ill children. Between May 2005 and December 2007, we performed a prospective, observational study with the participation of 209 critically ill children aged between 3 d and 17 years and who received TEN. The characteristics of the nutrition and its tolerance were compared with the paediatric risk of mortality (PRISM), the paediatric index of mortality (PIM) and the paediatric logistic organ dysfunction index (PELOD) at the time of starting the nutrition. Higher PRISM and PELOD scores correlated with a later time of starting enteral nutrition, a longer time to reach the maximum daily energy delivery and a longer duration of the TEN. However, the severity scores did not correlate with the maximum energy delivery achieved. Abdominal distension or excessive gastric residues were observed in 4·7 % of the patients and diarrhoea in 4·3 %. The ability of the severity scores to predict diarrhoea was of 0·67 for PRISM, 0·63 for PELOD and 0·60 for PIM-2.The severity scores were not able to predict other digestive tract complications. Higher scores of clinical severity at the time of starting enteral nutrition correlate with a later initiation of the nutrition, a longer time to reach the maximum energy delivery and a longer duration of TEN. However, their ability to predict digestive tract complications is low.

scholarly journals Relationship between energy expenditure, nutritional status and clinical severity before starting enteral nutrition in critically ill children

2011 ◽  
Vol 105 (5) ◽  
pp. 731-737 ◽  
Author(s):  
Marta Botrán ◽  
Jesús López-Herce ◽  
Santiago Mencía ◽  
Javier Urbano ◽  
Maria José Solana ◽  
...  
Keyword(s):  
Energy Expenditure ◽  
Nutritional Status ◽  
Critically Ill ◽  
Indirect Calorimetry ◽  
Clinical Severity ◽  
Retinol Binding Protein ◽  
Critically Ill Children ◽  
Biochemical Alterations ◽  
Logistic Organ Dysfunction ◽  
Risk Of Mortality

The objective of the present study was to investigate the relationship between energy expenditure (EE), biochemical and anthropometric nutritional status and severity scales in critically ill children. We performed a prospective observational study in forty-six critically ill children. The following variables were recorded before starting nutrition: age, sex, diagnosis, weight, height, risk of mortality according to the Paediatric Risk Score of Mortality (PRISM), the Revised Paediatric Index of Mortality (PIM2) and the Paediatric Logistic Organ Dysfunction (PELOD) scales, laboratory parameters (albumin, total proteins, prealbumin, transferrin, retinol-binding protein, cholesterol and TAG, and nitrogen balance) and EE measured by indirect calorimetry. The results showed that there was no relationship between EE and clinical severity evaluated using the PRISM, PIM2 and PELOD scales or with the anthropometric nutritional status or biochemical alterations. Finally, it was concluded that neither nutritional status nor clinical severity is related to EE. Therefore, EE must be measured individually in each critically ill child using indirect calorimetry.

scholarly journals Pediatric Multi-Organ Dysfunction Syndrome: Analysis by an Untargeted “Shotgun” Lipidomic Approach Reveals Low-Abundance Plasma Phospholipids and Dynamic Recovery over 8-Day Period, a Single-Center Observational Study

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 774
Author(s):  
Mara L. Leimanis-Laurens ◽  
Karen Ferguson ◽  
Emily Wolfrum ◽  
Brian Boville ◽  
Dominic Sanfilippo ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Intensive Care ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Lipid Profiles ◽  
Critically Ill Children ◽  
P Value ◽  
Time Points ◽  
Logistic Organ Dysfunction ◽  
Multi Organ Dysfunction Syndrome

Lipids are molecules involved in metabolism and inflammation. This study investigates the plasma lipidome for markers of severity and nutritional status in critically ill children. Children with multi-organ dysfunction syndrome (MODS) (n = 24) are analyzed at three time-points and cross-referenced to sedation controls (n = 4) for a total of N = 28. Eight of the patients with MODS, needed veno-arterial extracorporeal membrane oxygenation (VA ECMO) support to survive. Blood plasma lipid profiles are quantified by nano-electrospray (nESI), direct infusion high resolution/accurate mass spectrometry (MS), and tandem mass spectrometry (MS/MS), and compared to nutritional profiles and pediatric logistic organ dysfunction (PELOD) scores. Our results show that PELOD scores were not significantly different between MODS and ECMO cases across time-points (p = 0.66). Lipid profiling provides stratification between sedation controls and all MODS patients for total lysophosphatidylserine (lysoPS) (p-value = 0.004), total phosphatidylserine (PS) (p-value = 0.015), and total ether-linked phosphatidylethanolamine (ether-PE) (p-value = 0.03) after adjusting for sex and age. Nutrition intake over time did not correlate with changes in lipid profiles, as measured by caloric and protein intake. Lipid measurement in the intensive care environment shows dynamic changes over an 8-day pediatric intensive care unit (PICU) course, suggesting novel metabolic indicators for defining critically ill children.

scholarly journals Early Enteral Nutrition Is Associated With Improved Clinical Outcomes in Critically Ill Children

2020 ◽  
Vol 21 (3) ◽  
pp. 213-221 ◽  
Author(s):  
Vijay Srinivasan ◽  
Natalie R. Hasbani ◽  
Nilesh M. Mehta ◽  
Sharon Y. Irving ◽  
Sarah B. Kandil ◽  
...  
Keyword(s):  
Enteral Nutrition ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Children ◽  
Early Enteral Nutrition

scholarly journals Severe sepsis criteria, PELOD-2, and pSOFA as predictors of mortality in critically ill children with sepsis

2019 ◽  
Vol 59 (6) ◽  
pp. 318-24
Author(s):  
Anindita Wulandari ◽  
Pudjiastuti Pudjiastuti ◽  
Sri Martuti
Keyword(s):  
Severe Sepsis ◽  
Inflammatory Response ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Logistic Organ Dysfunction ◽  
High Care ◽  
Life Threatening ◽  
Physical Examinations

Background Sepsis is one of the main causes of death in infants and children. Currently, it is defined as a life-threatening organ dysfunction, caused by an inflammatory response of infection. Several organ dysfunction assessment methods are available, but they are not uniformly used. Objective To compare the accuracy of three mortality predictor tools: severe sepsis criteria, pediatric logistic organ dysfunction (PELOD)-2, and pediatric sequential organ failure assessment (pSOFA), in critically ill children with sepsis. Methods This prospective cohort study was conducted in the pediatric intensive care unit (PICU) and pediatric high care unit (HCU) of dr. Moewardi Hospital, Surakarta, Central of Java. All patients who met the systemic inflammatory response syndrome (SIRS) criteria were included in our study. The exclusion criteria were congenital anomalies of heart or kidney, malignancy, or hematological abnormalities. The data were taken from laboratory and physical examinations by the physicians on duty. The outcome assessed was mortality. Results Of 30 subjects, the mean age was 22.22 (SD 29.36) months; the most common infection source was the respiratory tract, followed by gastrointestinal tract and central nervous system. Most subjects were treated in the PICU and had a mean length of stay of 8.70 (SD 11.91) days. Severe sepsis and PELOD-2 were not significant predictors of death. However, pSOFA score was a statistically significant predictor of mortality, with odds ratio 10.11 (95%CI 1.054 to 97.002; P=0.039). Conclusion Pediatric SOFA (pSOFA) is a better predictor of mortality compared to PELOD-2 and SIRS-severe sepsis. A pSOFA score ≥ 2 increases the risk of mortality by 10.11-fold.

Prevalence, risk factors and clinical implications of hypophosphatemia in critically ill children on oral and enteral nutrition

2020 ◽  
Vol 40 ◽  
pp. 633
Author(s):  
A.M.M. Springer ◽  
T.D.R. Hortencio ◽  
E.C. Melro ◽  
T.H. de Souza ◽  
R.J.N. Nogueira
Keyword(s):  
Risk Factors ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Children ◽  
Clinical Implications

660 Prevalence, Risk Factors, and Clinical Consequence of Enteral Feeding Intolerance in the Critically Ill: An Analysis of a Multicenter, Multi-year Database

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S174-S175
Author(s):  
Daren Heyland ◽  
Luis A Ortiz ◽  
Andrew G Day
Keyword(s):  
Risk Factors ◽  
Enteral Nutrition ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Abdominal Distension ◽  
Admission Diagnosis ◽  
Apache Ii Score ◽  
Clinical Consequence ◽  
Nutrition Survey ◽  
Abdominal Girth

Abstract Introduction We aimed to determine the incidence of enteral feed intolerance (EFI), factors associated with intolerance, and to assess the influence of intolerance on key nutritional and clinical outcomes in critically ill patients. Methods We used data from The International Nutrition Survey database collected from 2007–2014. Included patients were mechanically ventilated critically ill adults who remained in the Intensive Care Unit for at least 72 hours and received some enteral nutrition during the first 12 days of their ICU stay. Data collected included nutritional prescription, adequacy, and clinical otucomes. We defined EFI as feeding is interrupted due to one of the following reasons: high gastric residual volumes (GRV), increased abdominal girth or abdominal distension, vomiting/emesis, diarrhea or subjective discomfort. Logistic regression controlling for covariates (year, region, sex, APACHE II score, admission type by primary diagnosis, BMI and baseline caloric and protein prescriptions) was used to determine risk factors for intolerance and its clinical significance. Results The current analysis included 15, 918 patients from 775 ICUs. Of these, 4, 036 (25.4%) had at least one episode of EFI. The rate rose from just below 1% on day 1 to a peak of 6% on day 4 and 5 and declined daily thereafter (See Figure). Factors predictive of EFI are shown in Table 1. Admission diagnosis was significantly predictive of EFI with patients with burn injuries showing the highest incidence. After controlling for the covariates,patients who had EFI received about 10% less EN adequacycompared to patients without of EFI (see Table 2). The mortality rate in EFI patients was 31% vs. 24% among patients who did not have EFI (OR=1.5 [95% CI, 1.4–1.6] p< 0.0001). Patients who had EFI had fewer ventilator free days, longer ICU lengths of stay, and longer time to discharge alive (all p< 0.0001) (See Table 2). Conclusions Intolerance occurs frequently during enteral nutrition in the critically ill and is associated with poorer nutritional and clinical outcomes. The identification, prevention, and optimal management in burn injured patients may improve nutrition delivery and clinical outcomes in this important “at risk” population. Applicability of Research to Practice To improve the nutrition therapy in burns patients.

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