611: POSTPYLORIC VERSUS GASTRIC FEEDING IN CRITICALLY ILL CHILDREN: A PROPENSITY SCORE MATCHED ANALYSIS

• Background Provision of enteral nutrition via the gastric route is a common nursing procedure in pediatric intensive care units. Little research, however, has focused on children’s tolerance of different types of gastric feeding regimens. • Objectives To examine the relationship between 2 gastric feeding regimens, continuous and intermittent, and children’s tolerance as measured by the number of stools and prevalences of diarrhea and vomiting. • Methods A randomized controlled trial was conducted in an Australian pediatric intensive care unit; 45 children were randomly assigned to either the continuous or the intermittent gastric feeding groups. Participants remained in the assigned feeding group for the duration of the study, and values of variables used to monitor patients’ tolerance were recorded. • Results Both feeding groups were similar with respect to Pediatric Index Mortality score, age, weight, sex, diagnosis, and use of pharmacological agents known to affect the gastrointestinal tract. Additionally, the 2 groups did not differ in study duration or the daily volume of administered enteral formula per kilogram of body weight. The number of stools per day and the prevalences of diarrhea and vomiting did not differ significantly between the 2 groups. • Discussion Continuous and intermittent gastric feeding regimens have similar outcomes with respect to the number of stools per day and the prevalence of diarrhea and vomiting in pediatric intensive care patients. Further gastric feeding studies and the development of enteral feeding guidelines for critically ill children are needed.

Download Full-text

The Safety and Efficacy of High-Speed Train Transportation for Critically Ill Children: A Retrospective Propensity Score Matching, Cohort Study

SSRN Electronic Journal ◽

10.2139/ssrn.3745804 ◽

2020 ◽

Author(s):

Xiaoyang Hong ◽

Baowang Yang ◽

Zhe Zhao ◽

Change Liu ◽

Huiling Zhang ◽

...

Keyword(s):

Cohort Study ◽

Propensity Score ◽

Propensity Score Matching ◽

Critically Ill ◽

High Speed ◽

Critically Ill Children ◽

High Speed Train ◽

Safety And Efficacy

Download Full-text

The safety and efficacy of high-speed train transport for critical children: a retrospective propensity score matching cohort study

Scientific Reports ◽

10.1038/s41598-021-98944-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Zhe Zhao ◽

Yingyue Liu ◽

Baowang Yang ◽

Huiling Zhang ◽

Xiaohong Liu ◽

...

Keyword(s):

Developing Countries ◽

Cohort Study ◽

Propensity Score ◽

Hospital Mortality ◽

Critically Ill ◽

High Speed ◽

Transport Cost ◽

Critically Ill Children ◽

High Speed Train ◽

Matching Method

AbstractIt is widely acknowledged that efficiency of pediatric critical care transport plays a vital role in treatment of critically-ill children. In developing countries, most critically-ill children were transported by ambulance, and a few by air, such as a helicopter or fixed airplane. High-speed train (HST) transport may be a potential choice for critically-ill children to a tertiary medical center for further therapy. This is a single-center, retrospective cohort study from June 01, 2016 to June 30, 2019. All the patients transported to the Pediatric Intensive Care Unit (PICU) of PLA general hospital were divided into two groups, HST group and ambulance group. The propensity score matching method was performed for the comparison between the two groups. Finally, a 2:1 patient matching was performed using the nearest-neighbor matching method without replacement. The primary outcome was hospital mortality. Secondary outcomes included duration of transport, transport cost, hospital stay, and hospitalization cost. A total of 509 critically-ill children were transported and admitted. Of them, 40 patients were transported by HST, and 469 by ambulance. The hospital mortality showed no difference between the two groups (p > 0.05). The transport distance in the HST group was longer than that in the ambulance group (1894.5 ± 907.09 vs. 902.66 ± 735.74, p < 0.001). However, compared to the HST group, the duration of transport time by ambulance was significantly longer (p < 0.001). No difference in vital signs, blood gas analysis, and critical illness score between groups at admission was noted (p > 0.05). There was no death during the transport. There was no difference between groups regarding the transport cost, hospital stays, and hospitalization cost (p > 0.05). High-quality tertiary medical centers are usually located in megacities. HST transport network for critically-ill children could be established to cover most regions of the country. Without increasing financial burden, HST medical transport can be a potentially promising option to improve the outcomes of critically-ill children in developing countries with developed HST network.Clinical Trial Registration: This study was registered at http://www.chictr.org.cn/index.aspx (chiCTR.gov; Identifier: ChiCTR2000032306).

Download Full-text

Continuous Versus Bolus Gastric Feeding in Children Receiving Mechanical Ventilation: A Systematic Review

American Journal of Critical Care ◽

10.4037/ajcc2020850 ◽

2020 ◽

Vol 29 (1) ◽

pp. 33-45

Author(s):

Ann-Marie Brown ◽

Erik C. Madsen ◽

Charlene P. Leonard ◽

Sharon L. Leslie ◽

Christine Allen ◽

...

Keyword(s):

Mechanical Ventilation ◽

Critically Ill ◽

Meta Analysis ◽

Research Question ◽

Critically Ill Children ◽

Optimal Method ◽

Nutrition Guidelines ◽

Study Population ◽

Gastric Feeding ◽

State Of The Science

Background Nutrition guidelines recommend enteral nutrition in the form of gastric feedings for critically ill children and acknowledge a lack of evidence describing an optimal method for providing these feedings. Objective To determine the state of the science regarding the efficacy of bolus (intermittent) or continuous gastric feedings to improve nutrition delivery in critically ill children receiving mechanical ventilation. Methods Five hundred seventy-nine abstracts met the inclusion criteria and were screened by 2 reviewers according to prespecified criteria. Full-text reviews were performed on 28 articles; 11 studies were selected for detailed analysis. Because of the small number of eligible studies, broader searches were conducted. Results Only 5 studies with a collective enrollment of fewer than 200 children closely addressed the specific research question. These 5 studies did not report any similarity in feeding regimens, nor did they report nutritional outcomes. Two of the articles described findings from the same study population. Although 4 of the 5 studies randomized children to bolus versus continuous feedings, only 3 studies described attainment of nutrient delivery goals in both the intervention and the control groups; the remaining study did not report this outcome. The heterogeneity in methodology and outcomes among the 5 studies did not allow for a meta-analysis. Conclusions The dearth of evidence regarding best practices and outcomes related to bolus versus continuous gastric feedings in critically ill children receiving mechanical ventilation requires additional rigorous investigation.

Download Full-text