Early versus Late Parenteral Nutrition in the ICU

2018 ◽  
pp. 192-197
Author(s):  
D. Dante Yeh
Keyword(s):  
Parenteral Nutrition ◽  
Lower Incidence ◽  
Tight Glycemic Control ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Icu Discharge ◽  
Late Initiation ◽  
Critically Ill Adults ◽  
Ill Adults ◽  
Post Cardiac Surgery

The EPaNIC study enrolled 4,640 critically ill adults who were nutritionally at risk and randomized them to either early (ICU day 3) or late (ICU day 8) supplemental parenteral nutrition (PN). In this study involving relatively thin patients with short ICU stays who were receiving tight glycemic control, early PN did not result in lower rates of mortality vs. late PN despite delivering significantly more calories in the first ICU week. In fact, late initiation of PN was associated with shorter duration of mechanical ventilation, lower incidence of renal replacement therapy, lower incidence of infections, and shorter ICU and hospital length of stay. Features of this study limiting external validity: most subjects had BMI 20–30, over 60% of subjects were post-cardiac surgery, overall median ICU stay was only 3 days, overall mortality was only 6%, nutritional management after ICU discharge was not controlled.

scholarly journals Impact of the Time to Initiation of Parenteral Nutrition on Patient Outcomes in Critically Ill Adults

2019 ◽  
Vol 12 ◽  
pp. 117863881985931
Author(s):  
Sunish Shah ◽  
James M Hollands ◽  
Laura Pontiggia ◽  
Angela L Bingham
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Nutrient Intake ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Obese Patients ◽  
Time To Initiation ◽  
Critically Ill Adults ◽  
Ill Adults

Background: The optimal time to initiate parenteral nutrition (PN) in critically ill adults in whom enteral nutrition is not feasible is controversial. Objective: The objectives were to compare in-hospital mortality and hospital length of stay in patients initiated on PN within 7 days or after 7 days of poor nutrient intake. Methods: This single-center, retrospective study included critically ill adult patients who received at least 2 consecutive days of PN during hospitalization from May 2014 to July 2016. Results: The median duration of PN (interquartile range) was 8 (5-13) days. In total, 110 patients received PN within 7 days of poor nutrient intake while 49 patients received PN after 7 days of poor nutrient intake. There was no statistically significant difference in in-hospital mortality between groups (29.09% vs 18.37%, P = .1535). Patients initiated within 7 days had a significantly shorter median hospital length of stay than patients initiated after 7 days (20 days vs 27 days, P = .0013). There were 69 patients who were classified as obese. Obese patients initiated within 7 days had a significantly shorter median hospital length of stay than obese patients initiated after 7 days (17 days vs 33 days, P = .0007). Conclusions: Time to initiation of PN did not impact in-hospital mortality. However, there was an association between early initiation of PN and a shorter hospital length of stay that was most pronounced among obese patients.

scholarly journals The efficacy and safety of prokinetics in critically ill adults receiving gastric feeding tubes: A systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245317
Author(s):  
Rong Peng ◽  
Hailong Li ◽  
Lijun Yang ◽  
Linan Zeng ◽  
Qiusha Yi ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Critically Ill ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Efficacy And Safety ◽  
Feeding Tubes ◽  
Gastric Feeding ◽  
Critically Ill Adults ◽  
Ill Adults

Background Intolerance to gastric feeding tubes is common among critically ill adults and may increase morbidity. Administration of prokinetics in the ICU is common. However, the efficacy and safety of prokinetics are unclear in critically ill adults with gastric feeding tubes. We conducted a systematic review to determine the efficacy and safety of prokinetics for improving gastric feeding tube tolerance in critically ill adults. Methods Randomized controlled trials (RCTs) were identified by systematically searching the Medline, Cochrane and Embase databases. Two independent reviewers extracted the relevant data and assessed the quality of the studies. We calculated pooled relative risks (RRs) for dichotomous outcomes and the mean differences (MDs) for continuous outcomes with the corresponding 95% confidence intervals (CIs). We assessed the risk of bias using the Cochrane risk-of-bias tool and used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to rate the quality of the evidence. Results Fifteen RCTs met the inclusion criteria. A total of 10 RCTs involving 846 participants were eligible for the quantitative analysis. Most studies (10 of 13, 76.92%) showed that prokinetics had beneficial effects on feeding intolerance in critically ill adults. In critically ill adults receiving gastric feeding, prokinetic agents may reduce the ICU length of stay (MD -2.03, 95% CI -3.96, -0.10; P = 0.04; low certainty) and the hospital length of stay (MD -3.21, 95% CI -5.35, -1.06; P = 0.003; low certainty). However, prokinetics failed to improve the outcomes of reported adverse events and all-cause mortality. Conclusion As a class of drugs, prokinetics may improve tolerance to gastric feeding to some extent in critically ill adults. However, the certainty of the evidence suggesting that prokinetics reduce the ICU or hospital length of stay is low. Prokinetics did not significantly decrease the risks of reported adverse events or all-cause mortality among critically ill adults.

Prevalence of Hyponatremia and Its Associated Morbimortality in Hospitalized Patients Receiving Parenteral Nutrition

2017 ◽  
Vol 71 (1-2) ◽  
pp. 1-7 ◽  
Author(s):  
Emilia Gómez-Hoyos ◽  
Martín Cuesta ◽  
Nayade Del Prado-González ◽  
Pilar Matía ◽  
Natalia Pérez-Ferre ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Mortality Rate ◽  
Parenteral Nutrition ◽  
Demographic Data ◽  
Tertiary Hospital ◽  
Hospital Length ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Control Subjects ◽  
Comorbidity Index

Background: The objective of the study was to determine the prevalence of hyponatremia (HN) and its associated morbimortality in hospitalized patients receiving parenteral nutrition (PN). Methods: A retrospective study including 222 patients receiving total PN (parenteral nutrition group [PNG]) over a 7-month period in a tertiary hospital and 176 matched to 179 control subjects without PN (control subjects group [CSG]). Demographic data, Charlson Comorbidity Index (CCI), date of HN detection-(serum sodium or SNa <135 mmol/L)-intrahospital mortality, and hospital length-of-stay (LOS) were registered. In the PNG, body mass index (BMI) and SNa before, during, and after PN were recorded. Results: HN was more prevalent in the PNG: 52.8 vs. 35.8% (p = 0.001), and independent of age, gender, or CCI (OR 1.8 [95% CI 1.1-2.8], p = 0.006). In patients on PN, sustained HN (75% of all intraindividual SNa <135 mmol/L) was associated with a higher mortality rate independent of age, gender, CCI, or BMI (OR 7.38 [95% CI 1.07-50.8], p = 0.042). The absence of HN in PN patients was associated with a shorter hospital LOS (<30 days) and was independent of other comorbidities (OR 3.89 [95% CI 2.11-7.18], p = 0.001). Conclusions: HN is more prevalent in patients on PN. Sustained HN is associated with a higher intrahospital mortality rate. Absence of HN is associated with a shorter hospital LOS.

The Adoption and De-Adoption of Tight Glycemic Control Among Critically Ill Adults

CHEST Journal ◽  
2014 ◽  
Vol 146 (4) ◽  
pp. 504A
Author(s):  
Daniel Niven ◽  
Gordon Rubenfeld ◽  
Andrew Kramer ◽  
Henry Stelfox
Keyword(s):  
Glycemic Control ◽  
Critically Ill ◽  
Tight Glycemic Control ◽  
Critically Ill Adults ◽  
Ill Adults

scholarly journals Parenteral Nutrition-Associated Hyperglycemia in Noncritically Ill Inpatients Is Associated with Higher Mortality

2010 ◽  
Vol 24 (7) ◽  
pp. 453-457 ◽  
Author(s):  
Sofia Sarkisian ◽  
Tanis R Fenton ◽  
Abdel Aziz Shaheen ◽  
Maitreyi Raman
Keyword(s):  
Renal Failure ◽  
Blood Glucose ◽  
Parenteral Nutrition ◽  
Blood Glucose Level ◽  
Glucose Level ◽  
Glucose Monitoring ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Coronary Events ◽  
Mean Blood Glucose

BACKGROUND: Hyperglycemia is a marker of poor clinical outcomes in studies evaluating hospitalized critically ill patients.OBJECTIVES: To identify whether glycemic control is associated with health outcomes including acute coronary events, renal failure, infection, hospital length of stay, intensive care unit (ICU) admission, sepsis and mortality in noncritically ill patients administered parenteral nutrition (PN), and to compare the current standard of care for glucose monitoring at the Foothills Medical Centre (Calgary, Alberta) with the 2009 American Society of Parenteral and Enteral Nutrition guidelines.METHODS: A retrospective chart review of 100 adult (18 years of age or older) non-ICU inpatients who received PN for seven days or longer at the Foothills Medical Centre was conducted.RESULTS: Seventeen patients (17%) had a mean blood glucose level of 10.0 mmol/L or greater. PN patients with a mean blood glucose level of 10 mmol/L or greater had a higher rate of mortality than patients with a mean blood glucose level of less than 10 mmol/L (OR 7.22; 95% CI 1.08 to 48.29; P=0.042). Hyperglycemia was independently and significantly associated with mortality when adjusted for age and sex. Acute coronary events, renal failure, infection, hospital length of stay, ventilator use and ICU admissions were not associated with hyperglycemia. Only one-half of those with hyperglycemia, and none of the patients in the euglycemic group, received adequate glucose monitoring during the first two days of PN.CONCLUSION: Hyperglycemia in noncritically ill inpatients receiving PN was found to be a risk factor for increased mortality.

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