scholarly journals Smart Phone/Device Application to Improve Delivery of Enteral Nutrition in Adult Patients Admitted to the Medical Intensive Care Unit

2019 ◽  
Vol 12 ◽  
pp. 117863881882029
Author(s):  
Sultan Mahmood ◽  
Leah Hoffman ◽  
Ijlal Akbar Ali ◽  
Yan D Zhao ◽  
Allshine Chen ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Enteral Nutrition ◽  
Clinical Guidelines ◽  
Academic Medical Center ◽  
Smart Phone ◽  
Device Application ◽  
Resident Physicians ◽  
The Impact

Background: Resident physicians are frequently uncomfortable ordering enteral nutrition (EN) and are unaware of the variety of formulas and supplements available for different disease processes. Many depend on a clinical dietician to assist with recommending EN formulas and patient energy requirements that may not be readily available on patient admission. This creates a barrier to early initiation of EN and non-compliance with Society of Critical Care Medicine and American Society of Parenteral and Enteral Nutrition clinical guidelines. Objective: Internal medicine resident physicians were provided an iPod with a smart phone/device application (EN application) to assist them in choosing EN formulas for patients during their intensive care unit (ICU) rotation. The primary outcome was improved initiation of EN within 24 hours of admission. Secondary outcomes included the following: time to initiate EN, goal calories reached, infections rates, length of stay, mortality, and concordance with clinical guidelines. Design: The study is a quasi-experimental design to improve delivery of EN at an academic medical center in the medical ICU. Data were collected from a retrospective chart review to evaluate the impact of an EN application to assist resident physicians when ordering EN. Results: Use of the EN application reduced the percent of patients with delayed initiation of EN from 61.2% prior to 37.5% ( P < .01). The mean time to initiate EN also improved 44.5 vs 31.9 hours ( P < .01). Patients were also more likely to achieve their daily caloric goal ( P < .01). Conclusion: The use of an EN application to assist internal medicine residents when ordering EN reduced delays in initiation of EN and improved overall delivery of EN to medical ICU patients.

The Impact of Delayed Symptomatic Treatment Implementation in the Intensive Care Unit

Healthcare ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 35
Author(s):  
Lesley Meng ◽  
Krzysztof Laudanski ◽  
Mariana Restrepo ◽  
Ann Huffenberger ◽  
Christian Terwiesch
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Symptomatic Treatment ◽  
Medication Administration ◽  
Average Delay ◽  
Treatment Implementation ◽  
Medication Delivery ◽  
The Impact

We estimated the harm related to medication delivery delays across 12,474 medication administration instances in an intensive care unit using retrospective data in a large urban academic medical center between 2012 and 2015. We leveraged an instrumental variables (IV) approach that addresses unobserved confounds in this setting. We focused on nurse shift changes as disruptors of timely medication (vasodilators, antipyretics, and bronchodilators) delivery to estimate the impact of delay. The average delay around a nurse shift change was 60.8 min (p < 0.001) for antipyretics, 39.5 min (p < 0.001) for bronchodilators, and 57.1 min (p < 0.001) for vasodilators. This delay can increase the odds of developing a fever by 32.94%, tachypnea by 79.5%, and hypertension by 134%, respectively. Compared to estimates generated by a naïve regression approach, our IV estimates tend to be higher, suggesting the existence of a bias from providers prioritizing more critical patients.

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

2019 ◽  
Vol 35 (7) ◽  
pp. 615-626 ◽  
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?

Early Enteral Nutrition in Geriatric Burn Patients: Is There a Benefit?

2020 ◽  
Vol 41 (5) ◽  
pp. 986-991
Author(s):  
Lourdes Castanon ◽  
Samer Asmar ◽  
Letitia Bible ◽  
Mohamad Chehab ◽  
Michael Ditillo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Enteral Nutrition ◽  
Early Enteral Nutrition ◽  
Burn Patients ◽  
Improvement Program ◽  
Burn Care ◽  
The Impact ◽  
Complications And Mortality

Abstract Nutrition is a critical component of acute burn care and wound healing. There is no consensus over the appropriate timing of initiating enteral nutrition in geriatric burn patients. This study aimed to assess the impact of early enteral nutrition on outcomes in this patient population. We performed a 1-year (2017) analysis of the American College of Surgeons Trauma Quality Improvement Program and included all older adult (age ≥65 years) isolated thermal burn patients who were admitted for more than 24 hr and received enteral nutrition. Patients were stratified into two groups based on the timing of initiation of feeding: early (≤24 hr) vs late (&gt;24 hr). Multivariate logistic regression was performed to control for potential confounding factors. Outcome measures were hospital and intensive care unit lengths of stay, in-hospital complications, and mortality. A total of 1,004,440 trauma patients were analyzed, of which 324 patients were included (early: 90 vs late: 234). The mean age was 73.9 years and mean TBSA burnt was 31%. Patients in the early enteral nutrition group had significantly lower rates of in-hospital complications and mortality (15.6% vs 26.1%; P = 0.044), and a shorter hospital length of stay (17 [11,23] days vs 20 [14,24] days; P = 0.042) and intensive care unit length of stay (13 [8,15] days vs 17 [9,21] days; P = 0.042). In our regression model of geriatric burn patients, early enteral nutrition was associated with improved outcomes. The cumulative benefits observed may warrant incorporating early enteral nutrition as part of intensive care protocols.

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

2014 ◽  
Vol 23 (5) ◽  
pp. 396-403 ◽  
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 &lt; .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 &lt; .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.

The impact of adding 1 month of intensive care unit training in a categorical internal medicine residency program*

2009 ◽  
Vol 37 (4) ◽  
pp. 1223-1228 ◽  
Author(s):  
John J. Mullon ◽  
Ognjen Gajic ◽  
Bhargavi Gali ◽  
Robert D. Ficalora ◽  
Joseph C. Kolars ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Residency Program ◽  
Internal Medicine Residency ◽  
Internal Medicine Residency Program ◽  
The Impact

scholarly journals 0196 Differences in Sleep Duration and Alertness Among Internal Medicine Interns Comparing Intensive Care Unit to General Medicine Rotations: A Secondary Analysis of the ICOMPARE Trial

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A77-A77
Author(s):  
M Cordoza ◽  
M Basner ◽  
D A Asch ◽  
J A Shea ◽  
L M Bellini ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Sleep Duration ◽  
General Medicine ◽  
Internal Medicine Resident ◽  
Response Speed ◽  
Mixed Effect ◽  
Excessive Sleepiness ◽  
The Impact

Abstract Introduction Little is known about the impact of specific rotations on medical residents’ sleep. The purpose of this analysis was to examine the difference in sleep duration and alertness among internal-medicine resident interns during intensive care unit (ICU) compared to general medicine (GM) rotations. Methods This is a secondary report of a randomized non-inferiority trial of 63 United States internal-medicine residency programs. Programs were assigned to either standard duty-hour (80h workweek/16h shifts) or flexible (80h workweek/no shift-length limit) policies. Interns were followed for 2 weeks during either a GM or ICU rotation. The primary outcome was sleep duration/24h (actigraphy). Secondary outcomes were sleepiness (Karolinska Sleepiness Scale [KSS]) and alertness (number of Brief Psychomotor Vigilance Test [PVT-B] lapses). Data were averaged across days (thirteen 24-hour periods). Linear mixed-effect models with random program intercept were used to determine the association between each outcome by rotation, controlling for age, sex, and policy followed. Results N=386 interns were included (mean age 27.9±2.1y, 194 (50.3%) males), with n=261 (67.6%) in GM, and n=125 (32.4%) in ICU. Average sleep duration was 7.00±0.08h and 6.84±0.10h for GM and ICU respectively (p=.09; 95%CI -0.02;0.33h). Percent of days with self-reports of excessive sleepiness were significantly more likely for ICU vs GM from 12am-6am (ICU: 20.2%; GM: 12.5%) and 6am-12pm (ICU: 20.5%; GM: 14.3%). GM had significantly more days with no excessive sleepiness (GM: 40.5%; ICU: 28.1%). Average KSS was 4.8±0.1 for both GM and ICU (p=.60; 95%CI -0.18;0.32). Average number of PVT-B lapses were 5.5±0.5 and 5.7±0.7 for GM and ICU respectively (p=.83; 95%CI -1.48;1.18 lapses). There were no significant differences in PVT-B response speed or false starts between rotations. Conclusion Interns in ICU may experience more excessive sleepiness compared to GM interns, especially in early morning hours. However, sleep duration and alertness were not significantly different between rotations. Support Funded by the National Heart, Lung, and Blood Institute and American Council for Graduate Medical Education

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