Optimizing Nutrition for the Surgical Patient: An Evidenced Based Update to Dispel Five Common Myths in Surgical Nutrition Care

2018 ◽  
Vol 84 (6) ◽  
pp. 831-835 ◽  
Author(s):  
Jennifer L. Hartwell ◽  
Ann Cotton ◽  
Grace Rozycki
Keyword(s):  
Feeding Tube ◽  
Surgical Patient ◽  
Gastric Residual Volume ◽  
Oral Nutrition ◽  
Nutrition Care ◽  
Laboratory Markers ◽  
Surgical Nutrition ◽  
Volume Measurements ◽  
Enteral Feedings ◽  
Evidenced Based

Traditional practices in the delivery of nutrition to the surgical patient include reliance on nonspecific laboratory markers to define malnutrition, prolonged periods of nil per os, early and liberal initiation of parenteral nutrition, withholding enteral feedings based on gastric residual volume measurements, and pursuing feeding tube access for most patients unable to take oral nutrition. However, recent studies call into question all of these practices. This review aims to provide evidenced-based support to abandon these myths regarding nutrition delivery and offer practical up-to-date advice for best practices in patient care.

Vasodilating Agents

2015 ◽  
pp. 313-335
Author(s):  
Shreyajit R. Kumar ◽  
Andrew Sosa ◽  
Ilan Margulis
Keyword(s):  
Safety Profile ◽  
Clinical Utility ◽  
Cellular Mechanism ◽  
Therapeutic Modality ◽  
Surgical Patient ◽  
Salient Features ◽  
Evidenced Based

This chapter discusses the salient features of arterial and venous dilating agents commonplace in the management of the post-cardiotomy surgical patient. A keen understanding of the underlying cellular mechanism, pharmacology, indication, safety profile, and controversies of clinical utility of vasodilating agents is imperative for routine use. The evidenced-based examination of each therapeutic modality will strengthen the practitioner's fund of knowledge for management of each pathophysiological state.

Migrated PEG balloon causing acute pancreatitis

2021 ◽  
Vol 14 (4) ◽  
pp. e240605
Author(s):  
Muhammad Omar Saeed ◽  
Thomas Fleck ◽  
Ashish Awasthi ◽  
Chander Shekhar
Keyword(s):  
Acute Pancreatitis ◽  
Rare Complication ◽  
Feeding Tube ◽  
Gastrostomy Tube ◽  
Mr Cholangiopancreatography ◽  
Common Procedure ◽  
Oral Nutrition ◽  
Endoscopic Gastrostomy ◽  
Fixation Plate ◽  
Peg Tube

Percutaneous endoscopic gastrostomy (PEG) is a common procedure for an unsafe swallow or inability to maintain oral nutrition. When a PEG tube needs replacement, a balloon gastrostomy tube is usually placed through the same, well formed and mature tract without endoscopy. We present a patient with a rare complication related to the balloon gastrostomy tube, to raise awareness and minimise the risk of this complication in the future. A 67-year-old female patient presented to the emergency department with severe abdominal pain and vomiting. Her gastrostomy feeding tube displaced inwards, up to the feeding-balloon ports complex. After investigations, she was diagnosed with acute pancreatitis. MR cholangiopancreatography (MRCP) confirmed features of this and, interestingly, an inflated gastrostomy balloon could be seen abutting the major and minor ampullae. The patient confirmed that the PEG tube had been changed to a balloon gastrostomy tube some time ago, but the external fixation plate (external bumper) had been loose lately, with the tube repeatedly moving inwards. She admitted that, 1 day before admission, the PEG tube had receded into the stomach and could not be pulled out with a gentle tug. After reviewing the MRCP images, the balloon was deflated, and the tube retracted. Once correctly placed, the balloon was reinflated, and her symptoms improved over the next 2 days.

Effect of Feeding-Tube Properties on Residual Volume Measurements in Tube-Fed Patients

2005 ◽  
Vol 29 (3) ◽  
pp. 192-197 ◽  
Author(s):  
Norma A. Metheny ◽  
Jena Stewart ◽  
Gretel Nuetzel ◽  
Dana Oliver ◽  
Ray E. Clouse
Keyword(s):  
Feeding Tube ◽  
Residual Volume ◽  
Volume Measurements ◽  
Effect Of Feeding

Assessing Global Kidney Nutrition Care

2022 ◽  
pp. CJN.07800621 ◽  
Author(s):  
Angela Yee-Moon Wang ◽  
Ikechi G. Okpechi ◽  
Feng Ye ◽  
Csaba P. Kovesdy ◽  
Giuliano Brunori ◽  
...  
Keyword(s):  
International Society ◽  
Low Income ◽  
Interdisciplinary Communication ◽  
Care Delivery ◽  
Nutrition Status ◽  
Middle Income ◽  
Oral Nutrition ◽  
Content Type ◽  
Middle Income Countries ◽  
Nutrition Care

Background and objectivesNutrition intervention is an essential component of kidney disease management. This study aimed to understand current global availability and capacity of kidney nutrition care services, interdisciplinary communication, and availability of oral nutrition supplements.Design, setting, participants, & measurementsThe International Society of Renal Nutrition and Metabolism (ISRNM), working in partnership with the International Society of Nephrology (ISN) Global Kidney Health Atlas Committee, developed this Global Kidney Nutrition Care Atlas. An electronic survey was administered among key kidney care stakeholders through 182 ISN-affiliated countries between July and September 2018.ResultsOverall, 160 of 182 countries (88%) responded, of which 155 countries (97%) answered the survey items related to kidney nutrition care. Only 48% of the 155 countries have dietitians/renal dietitians to provide this specialized service. Dietary counseling, provided by a person trained in nutrition, was generally not available in 65% of low-/lower middle–income countries and “never” available in 23% of low-income countries. Forty-one percent of the countries did not provide formal assessment of nutrition status for kidney nutrition care. The availability of oral nutrition supplements varied globally and, mostly, were not freely available in low-/lower middle–income countries for both inpatient and outpatient settings. Dietitians and nephrologists only communicated “sometimes” on kidney nutrition care in ≥60% of countries globally.ConclusionsThis survey reveals significant gaps in global kidney nutrition care service capacity, availability, cost coverage, and deficiencies in interdisciplinary communication on kidney nutrition care delivery, especially in lower-income countries.

28 Timing of Enteral Nutrition Initiation in Severely Burned Patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S24-S24
Author(s):  
Nicolle M Curtis ◽  
Beth A Shields ◽  
Alicia M Williams ◽  
Saul J Vega ◽  
Leopoldo C Cancio
Keyword(s):  
Enteral Nutrition ◽  
Critically Ill ◽  
Hemodynamic Instability ◽  
Feeding Tube ◽  
Regulatory Compliance ◽  
Tube Placement ◽  
Hemodynamic Stability ◽  
Improvement Project ◽  
Oral Nutrition ◽  
Feeding Tube Placement

Abstract Introduction Early initiation of enteral nutrition (EN) for severely burned patients (pts) has been found to be associated with decreased catabolism, decreased wound infections, lower sepsis rates, shorter intensive care unit (ICU) days and hospital days, and improved mortality. The American Society for Parenteral and Enteral Nutrition (ASPEN) recommends initiating EN within 4–6 hrs of injury for critically ill adult burn pts; however, they also recommend waiting for hemodynamic stability to be achieved before starting EN in all critically ill pts. The objectives of this performance improvement project (PIP) were to evaluate the timing of EN initiation and reasons for delays in initiating EN in our critically ill burn pts. Methods We performed a retrospective evaluation on pts admitted to our ICU in 2019 with at least 20% TBSA burns. Exclusion criteria were death within 72 hrs of admission, oral nutrition, and admission over 1 calendar day after injury. This PIP was approved by our regulatory compliance division. We clinically defined hemodynamic stability as lactate levels less than 3 mmol/L with vasopressor requirements of less than 10 mcg/min norepinephrine. Demographic data were collected along with timing of EN and reasons for delays in EN initiation. Results EN was initiated 28 ± 17 hrs after admission for the 19 included pts with the following characteristics: 44 ± 16 years old, 38 ± 16% TBSA burn, all required mechanical ventilation on admission. These pts had 16 ± 10 mechanical ventilator days and 42% mortality. The shortest time to EN initiation was 9 hrs after admission. EN was delayed for initial hemodynamic instability for 10 ± 17 hrs after admission. Other delays in EN initiation after initially achieving hemodynamic stability included time to feeding tube placement (1 ± 2 hrs) and x-ray confirmation (4 ± 9 hrs), and time to EN orders (8 ± 10 hrs). EN was initiated 6 ± 6 hrs after the preceding events occurred. Some of the delays in placement of EN orders and for EN initiation after the above criteria were met included procedures (2 ± 2 hrs), becoming hemodynamically unstable again (5 ± 7 hrs), and placement of a small bore, post-pyloric feeding tube when an orogastric or nasogastric feeding tube was already available for use (2 ± 4 hrs). We were not able to retrospectively identify reasons for delays during 5 ± 6 hrs per patient. Conclusions As a result of this PIP, we found EN was not initiated in any of our critically ill burn pts within the timeline recommended by ASPEN/SCCM. The primary reasons for delays included hemodynamic instability, feeding tube placement and confirmation, adding a post-pyloric feeding tube, and procedures.

New Nutrition Guidelines: Promoting Enteral Nutrition via a Nutrition Bundle

2018 ◽  
Vol 38 (3) ◽  
pp. 46-52 ◽  
Author(s):  
Ashleigh VanBlarcom ◽  
Mary Anne McCoy
Keyword(s):  
Enteral Nutrition ◽  
Adverse Outcomes ◽  
Care Bundle ◽  
Nutrition Guidelines ◽  
Nutrition Care ◽  
Increased Risk ◽  
Hospital Stays ◽  
Enteral Feedings ◽  
Main Components ◽  
Care Costs

Malnutrition in hospitals is often overlooked, underdiagnosed, and untreated. Malnourished patients have increased risk for infection and pressure injuries, longer duration of mechanical ventilation, anemia, depressed cardiac and respiratory functions, and an overall higher risk for mortality. These complications contribute to longer hospital stays and higher health care costs. The benefits of early nutritional support in hospitals may be enhanced by use of a new nutrition care bundle that addresses all aspects of nutrition assessment and intervention. The bundle has 6 main components: assessment of malnutrition, initiation and maintenance of enteral nutrition, reduction of aspiration, implementation of enteral feeding protocols, avoiding the use of gastric residual volumes, and early initiation of parenteral nutrition when enteral feedings cannot be initiated. Implementing the nutrition bundle can help ensure that patients receive adequate nutrition during their hospital stay, thereby reducing adverse outcomes.

scholarly journals Oral Nutrition during and after Critical Illness: SPICES for Quality of Care!

Nutrients ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3509
Author(s):  
Marjorie Fadeur ◽  
Jean-Charles Preiser ◽  
Anne-Marie Verbrugge ◽  
Benoit Misset ◽  
Anne-Françoise Rousseau
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Of Care ◽  
Critical Illness ◽  
Oral Nutrition ◽  
Icu Stay ◽  
Nutrition Care ◽  
Global Status ◽  
Poor Outcomes

Malnutrition is associated to poor outcomes in critically ill patients. Oral nutrition is the route of feeding in less than half of the patients during the intensive care unit (ICU) stay and in the majority of ICU survivors. There are growing data indicating that insufficient and/or inadequate intakes in macronutrients and micronutrients are prevalent within these populations. The present narrative review focuses on barriers to food intakes and considers the different points that should be addressed in order to optimize oral intakes, both during and after ICU stay. They are gathered in the SPICES concept, which should help ICU teams improve the quality of nutrition care following 5 themes: swallowing disorders screening and management, patient global status overview, involvement of dieticians and nutritionists, clinical evaluation of nutritional intakes and outcomes, and finally, supplementation in macro-or micronutrients.

Oral feeding outcomes in neonates with congenital cardiac disease undergoing cardiac surgery

2011 ◽  
Vol 22 (1) ◽  
pp. 42-48 ◽  
Author(s):  
Sharon Sables-Baus ◽  
Jon Kaufman ◽  
Paul Cook ◽  
Eduardo M. da Cruz
Keyword(s):  
Cardiac Surgery ◽  
Cardiac Disease ◽  
Multilevel Modelling ◽  
Feeding Tube ◽  
Oral Feeding ◽  
Genetic Syndromes ◽  
Oral Nutrition ◽  
Surgical Interventions ◽  
First Feeding ◽  
Congenital Cardiac Disease

AbstractBackgroundAchievement of adequate oral nutrition is a challenging task after early neonatal cardiac surgery. This study aims to describe predictors of oral feeding outcomes for neonates after early surgical interventions.Materials and methodsA retrospective review of neonates admitted with congenital cardiac disease over a period of 1 year. We analysed predictors of the need for a feeding tube at discharge and the amount taken at each feeding. Multilevel modelling was used to look at individual change over time predicting oral amount at each feeding.ResultsWe identified 56 neonates. Diagnoses were heterogeneous; 23% of the infants had associated genetic syndromes and 45% required pre-operative mechanical ventilation. The median time from birth to surgery was 8.4 days, with 29 infants fed orally before surgery. The mean time from surgery to first oral feeding attempt was 12 hours. Time from surgery to oral feeding, the amount taken with first feeding, and cross-clamp times were significant predictors of oral feeding success, whereas the presence of a comorbidity – genetic abnormality – and longer ventilator dependency predicted failure. Almost half of the neonates required a feeding tube upon discharge, and no infant discharged was solely breastfed. Discharge with a feeding tube was associated with greater weight gain at that time.ConclusionsNeonates with congenital cardiac disease face significant barriers to successfully achieving oral feeding on hospital discharge. Enteral feeding guidelines focus on physiological stabilisation and do not always address the developmental milestones necessary to support oral feeding. Future prospective studies are necessary to identify multimodal strategies to optimise early feeding.

Nutritional Adequacy in Patients Receiving Mechanical Ventilation Who Are Fed Enterally

2005 ◽  
Vol 14 (3) ◽  
pp. 222-231 ◽  
Author(s):  
Colleen M. O’Leary-Kelley ◽  
Kathleen A. Puntillo ◽  
Juliana Barr ◽  
Nancy Stotts ◽  
Marilyn K. Douglas
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Energy Intake ◽  
Indirect Calorimetry ◽  
Critically Ill Patients ◽  
Feeding Tube ◽  
Nutritional Intake ◽  
Energy Requirements ◽  
Entire Sample ◽  
Enteral Feedings

• Background Inadequate nutritional intake in critically ill patients can lead to complications resulting in increased mortality and healthcare costs. Several factors limit adequate nutritional intake in intensive care unit patients given enteral feedings. • Objective To examine the adequacy of enteral nutritional intake and the factors that affect its delivery in patients receiving mechanical ventilation. • Methods A prospective, descriptive design was used to study 60 patients receiving enteral feedings at target or goal rate. Energy requirements were determined for the entire sample by using the Harris-Benedict equation; energy requirements for a subset of 25 patients were also determined by using indirect calorimetry. Energy received via enteral feeding and reason and duration of interruptions in feedings were recorded for 3 consecutive days. • Results Mean estimated energy requirements (8996 kJ, SD 1326 kJ) and mean energy intake received (5899 kJ, SD 3058 kJ) differed significantly (95% CI 3297-3787; P < .001). A total of 41 patients (68.3%) received less than 90% of their required energy intake, 18 (30.0%) received within ±10%, and 1 (1.7%) received more than 110%. Episodes of diarrhea, emesis, large residual volumes, feeding tube replacements, and interruptions for procedures accounted for 70% of the variance in energy received (P<.001). Procedural interruptions alone accounted for 45% of the total variance. Estimated energy requirements determined via indirect calorimetry and mean energy received did not differ. • Conclusions Most critically ill patients receiving mechanical ventilation who are fed enterally do not receive their energy requirements, primarily because of frequent interruptions in enteral feedings.

scholarly journals Ciprofloxacin absorption is impaired in patients given enteral feedings orally and via gastrostomy and jejunostomy tubes.

1996 ◽  
Vol 40 (1) ◽  
pp. 6-10 ◽  
Author(s):  
D P Healy ◽  
M C Brodbeck ◽  
C E Clendening
Keyword(s):  
Enteral Feeding ◽  
High Performance ◽  
Feeding Tube ◽  
Hospitalized Patients ◽  
Jejunostomy Tube ◽  
Time Curve ◽  
Important Interaction ◽  
Oral Group ◽  
Enteral Feedings ◽  
Enteral Formula

Twenty-six hospitalized patients participated in a randomized crossover study to evaluate the effect of enteral feedings on ciprofloxacin absorption when given orally or via gastrostomy or jejunostomy tubes. Patients in the oral group received an intact 500-mg ciprofloxacin tablet alone or ciprofloxacin plus three oral doses of Sustacal (240 ml given 8 h before, with, and 4 h after ciprofloxacin administration). Patients with gastrostomy or jejunostomy tubes received 500 mg of crushed ciprofloxacin in 60 ml water via the feeding tube. After a washout period, the patients received ciprofloxacin with a continuous enteral formula (Jevity) given at 60 to 90 ml/h beginning 6 h before drug administration and continuing for 10 h. Serial blood samples were analyzed for ciprofloxacin concentration by high-performance liquid chromatography. The maximum ciprofloxacin concentrations in serum for ciprofloxacin given and for ciprofloxacin plus enteral feeding for the oral, gastrostomy, and jejunostomy groups were (mean +/- standard deviation) 2.59 +/- 1.24 versus 1.43 +/- 0.61 micrograms/ml (P < 0.05), 3.68 +/- 1.36 versus 2.27 +/- 0.67 micrograms/ml (P < 0.05), and 3.78 +/- 1.87 versus 1.45 +/- 0.48 micrograms/ml (P < 0.05), respectively. Corresponding values for area under the concentration-time curve were 13.4 +/- 8.32 versus 9.44 +/- 4.74 micrograms/h/ml (P < 0.05) 15.9 +/- 6.62 versus 7.44 +/- 3.16 (micrograms/h/ml (P < 0.05), and 18.1 +/- 9.37 versus 5.82 +/- 2.63 micrograms.h/ml (P < 0.05). We conclude that enteral feedings given orally or via gastrostomy or jejunostomy tubes resulted in a 27 to 67% reduction in the mean bioavailability of ciprofloxacin in hospitalized patients. The decreased absorption may be clinically important, especially when the enteral feeding is coadministered with ciprofloxacin by the oral and jejunostomy tube routes. Reductions in maximum levels of ciprofloxacin in serum as a result of feedings given via a gastrostomy tube are similar to those following oral administration on an empty stomach, making a clinically important interaction by this route less likely.

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