Feasibility, tolerance and effectiveness of enteral feeding in critically ill patients in prone position

Aim To assess the feasibility, tolerance and effectiveness of enteral nutrition in critically ill patients receiving invasive mechanical ventilation in the prone position for severe Acute Respiratory Distress Syndrome (ARDS). Methods Prospective observational study conducted in a multidisciplinary critical care unit of a tertiary care hospital from January 2013 until July 2015. All patients with ARDS who received invasive mechanical ventilation in prone position during the study period were included. Patients’ demographics, severity of illness (Acute Physiology and Chronic Health Evaluation (APACHE II) score), baseline markers of nutritional status (subjective global assessment (SGA) and body mass index), details of nutrition delivery during prone and supine hours and outcomes (Length of stay and discharge status) were recorded. Results Fifty-one patients met inclusion criteria out of whom four patients were excluded from analysis since they did not receive any enteral nutrition due to severe hemodynamic instability. The mean age of patients was 46.4 ± 12.9 years, with male:female ratio of 7:3. On admission, SGA revealed moderate malnutrition in 51% of patients and the mean APACHE II score was 26.8 ± 9.2. The average duration of prone ventilation per patient was 60.2 ± 30.7 h. All patients received continuous nasogastric/orogastric feeds. The mean calories (kcal/kg/day) and protein (g/kg/day) prescribed in the supine position were 24.5 ± 3.8 and 1.1 ± 0.2 while the mean calories and protein prescribed in prone position were 23.5 ± 3.6 and 1.1 ± 0.2, respectively. Percentage of prescribed calories received by patients in supine position was similar to that in prone position (83.2% vs. 79.6%; P = 0.12). Patients received a higher percentage of prescribed protein in supine compared to prone position (80.8% vs. 75%, P = 0.02). The proportion of patients who received at least 75% of the caloric and protein goals was 37 (78.7%) and 37 (78.7%) in supine and 32 (68.1%) and 21 (44.6%) in prone position. Conclusion In critically ill patients receiving invasive mechanical ventilation in the prone position, enteral nutrition with nasogastric/orogastric feeding is feasible and well tolerated. Nutritional delivery of calories and proteins in prone position is comparable to that in supine position.

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Characteristics of Critically-Ill Patients at Two Tertiary Care Hospitals in Sudan

Sultan Qaboos University Medical Journal [SQUMJ] ◽

10.18295/squmj.2018.18.02.011 ◽

2018 ◽

Vol 18 (2) ◽

pp. 190 ◽

Cited By ~ 2

Author(s):

Hagir Sulieman ◽

Wael El-Mahdi ◽

Mohannad Awadelkareem ◽

Lama Nazer

Keyword(s):

Mechanical Ventilation ◽

Critical Care ◽

Intensive Care ◽

Length Of Stay ◽

Critically Ill ◽

Critically Ill Patients ◽

Tertiary Care ◽

Apache Ii ◽

The Mean ◽

Tertiary Care Hospitals

Objectives: Knowledge of intensive care unit (ICU) admission patterns and characteristics is necessary for the development of critical care services, particularly in low-resource settings. This study aimed to describe the characteristics of critically-ill patients admitted to ICUs in Sudan. Methods: This prospective observational study was conducted between February and May 2017 in the ICUs of two government tertiary care hospitals inKhartoum, Sudan. A total of 100 consecutive adult patients admitted to the ICUs were included in the study. The patients’ demographic and clinical characteristics and Acute Physiologic Assessment and Chronic Health Evaluation (APACHE II) scores upon admission were recorded, as well as the reason for admission, presence of any underlying comorbidities, interventional requirements like mechanical ventilation or haemodialysis, length of stay in the ICU and patient outcome. Results: Of the sample, 58% were female and 42% were male. The mean age was 47.4 ± 18.3 years old. Upon admission, the mean APACHE II score was 14.2 ± 9.6. In total, 54% of the patients had no known underlying comorbidities. The most common reasons for ICU admission were neurological diseases (27%), sepsis or infectious diseases (19%) and postoperative management (12%). Mechanical ventilation and haemodialysis were required by 35% and 11% of the patients, respectively. The average length of stay was 10.0 ± 7.2 days and the mortality rate was 24%. Conclusion: Most of the patients admitted to the ICUs were middle-aged females with no known underlying comorbidities. Larger studies are necessary to provide a comprehensive understanding of the critical care needs of Sudanese hospitals.Keywords: Intensive Care Units; Patient Admission, trends; Critical Care Outcomes; Developing Countries; Sudan.

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Aminoglycoside Volume of Distribution and Illness Severity in Critically Ill Septic Patients

Anaesthesia and Intensive Care ◽

10.1177/0310057x9302100206 ◽

1993 ◽

Vol 21 (2) ◽

pp. 172-173 ◽

Cited By ~ 99

Author(s):

P. E. Marik

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Volume Of Distribution ◽

Illness Severity ◽

Apache Ii ◽

Apache Ii Score ◽

Blood Levels ◽

Wide Range ◽

The Mean ◽

Tissue Oedema

The volume of distribution of amikacin and the APACHE II score were determined in 42 critically ill patients being treated for a gram-negative infection. The mean volume of distribution (Vdt) was 0.41±0.12 l/kg with a wide range (normal of 0.25 l/kg). There was a good relationship between the Vdt and illness severity as measured by the APACHE II score (r=0.70; P<0.001). Critically ill patients should receive larger loading doses of aminoglycosides in order to achieve therapeutic blood levels. The aminoglycoside Vdt may be useful in determining the degree of capillary leak and tissue oedema that accompanies sepsis.

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A Review of the Tolerance and Adequacy of Enteral Nutrition Administered in the Prone Position in Critically Ill Patients Receiving Mechanical Ventilation

Current Developments in Nutrition ◽

10.1093/cdn/nzab029_017 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 216-216

Author(s):

Carolyn Ellis ◽

Miranda Brown ◽

Kristine Anne Del Rosario ◽

Paige Heiden ◽

Gabriella Salazar ◽

...

Keyword(s):

Mechanical Ventilation ◽

Enteral Nutrition ◽

Critically Ill ◽

Prone Position ◽

Supine Position ◽

Dropout Rate ◽

Cochrane Library ◽

Prone Positioning ◽

Inclusion Criteria ◽

Mechanically Ventilated

Abstract Objectives During the coronavirus 2019 (COVID-19) pandemic, more patients require enteral nutrition (EN) while mechanically ventilated in the prone position (PP). Prone positioning may improve oxygenation in patients receiving mechanical ventilation; however, it is unclear how it affects EN adequacy and tolerance. This review explored how EN delivered in the PP impacts EN tolerance (vomiting, diarrhea, abdominal distention, or aspiration pneumonia) and adequacy (meeting estimated energy and protein requirements) in critically ill adults receiving mechanical ventilation. Methods A literature search was conducted in PubMed, CINAHL, Academic Search Premier, and Cochrane Library for English-language studies exploring EN administered in the PP published between 2000–2020. Studies that met inclusion criteria enrolled adult patients in intensive care units with acute respiratory distress syndrome or other respiratory conditions requiring mechanical ventilation, were cohort studies with ≥5 patients per study group, and had a dropout rate <20%. Studies were excluded if patients received only parenteral nutrition. Results Of 45 studies, 4 met inclusion criteria. Three were prospective cohorts and 1 was a before-after study. When comparing EN tolerance in the PP and supine positions, 1 study found no difference in diarrhea occurrence, 2 studies found no difference in the rate of vomiting, and 1 study found significantly higher rates of vomiting while in the PP. For feeding adequacy, 2 studies found no difference in the % of calories received when administered in prone or supine positions, while 1 study found patients in the PP received significantly less EN volume than patients in the supine position. One study concluded that prophylactic prokinetic agent use and head elevation while prone resulted in larger EN volumes delivered with reduced vomiting risk. Conclusions These results suggest the adequacy of EN delivered in the PP is comparable to the supine position and PP does not substantially increase vomiting or diarrhea risk. Prone positioning should not be considered an immediate contraindication to EN for adults receiving mechanical ventilation. These findings may apply to the nutritional management of critically ill mechanically ventilated adults with COVID-19. Funding Sources None

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Etiology, incidence, and outcomes of patient–ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation

Scientific Reports ◽

10.1038/s41598-021-90013-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yongfang Zhou ◽

Steven R. Holets ◽

Man Li ◽

Gustavo A. Cortes-Puentes ◽

Todd J. Meyer ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Critically Ill ◽

Critically Ill Patients ◽

Invasive Mechanical Ventilation ◽

Surgical Intensive Care ◽

Mechanically Ventilated ◽

History Of ◽

Training Background ◽

The Relationship

AbstractPatient–ventilator asynchrony (PVA) is commonly encountered during mechanical ventilation of critically ill patients. Estimates of PVA incidence vary widely. Type, risk factors, and consequences of PVA remain unclear. We aimed to measure the incidence and identify types of PVA, characterize risk factors for development, and explore the relationship between PVA and outcome among critically ill, mechanically ventilated adult patients admitted to medical, surgical, and medical-surgical intensive care units in a large academic institution staffed with varying provider training background. A single center, retrospective cohort study of all adult critically ill patients undergoing invasive mechanical ventilation for ≥ 12 h. A total of 676 patients who underwent 696 episodes of mechanical ventilation were included. Overall PVA occurred in 170 (24%) episodes. Double triggering 92(13%) was most common, followed by flow starvation 73(10%). A history of smoking, and pneumonia, sepsis, or ARDS were risk factors for overall PVA and double triggering (all P < 0.05). Compared with volume targeted ventilation, pressure targeted ventilation decreased the occurrence of events (all P < 0.01). During volume controlled synchronized intermittent mandatory ventilation and pressure targeted ventilation, ventilator settings were associated with the incidence of overall PVA. The number of overall PVA, as well as double triggering and flow starvation specifically, were associated with worse outcomes and fewer hospital-free days (all P < 0.01). Double triggering and flow starvation are the most common PVA among critically ill, mechanically ventilated patients. Overall incidence as well as double triggering and flow starvation PVA specifically, portend worse outcome.

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Serum potassium levels and outcomes in critically ill patients in the medical intensive care unit

Journal of International Medical Research ◽

10.1177/0300060517744427 ◽

2018 ◽

Vol 46 (3) ◽

pp. 1254-1262 ◽

Cited By ~ 3

Author(s):

Surat Tongyoo ◽

Tanuwong Viarasilpa ◽

Chairat Permpikul

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Serum Potassium ◽

Critically Ill Patients ◽

Medical Intensive Care Unit ◽

Apache Ii ◽

Apache Ii Score ◽

Icu Mortality ◽

Medical Intensive Care

Objective To compare the outcomes of patients with and without a mean serum potassium (K+) level within the recommended range (3.5–4.5 mEq/L). Methods This prospective cohort study involved patients admitted to the medical intensive care unit (ICU) of Siriraj Hospital from May 2012 to February 2013. The patients’ baseline characteristics, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, serum K+ level, and hospital outcomes were recorded. Patients with a mean K+ level of 3.5 to 4.5 mEq/L and with all individual K+ values of 3.0 to 5.0 mEq/L were allocated to the normal K+ group. The remaining patients were allocated to the abnormal K+ group. Results In total, 160 patients were included. Their mean age was 59.3±18.3 years, and their mean APACHE II score was 21.8±14.0. The normal K+ group comprised 74 (46.3%) patients. The abnormal K+ group had a significantly higher mean APACHE II score, proportion of coronary artery disease, and rate of vasopressor treatment. An abnormal serum K+ level was associated with significantly higher ICU mortality and incidence of ventricular fibrillation. Conclusion Critically ill patients with abnormal K+ levels had a higher incidence of ventricular arrhythmia and ICU mortality than patients with normal K+ levels.

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Evaluation of Delivery of Enteral Nutrition in Critically Ill Patients Receiving Mechanical Ventilation

American Journal of Critical Care ◽

10.4037/ajcc2008.17.1.53 ◽

2008 ◽

Vol 17 (1) ◽

pp. 53-61 ◽

Cited By ~ 71

Author(s):

Debra O’Meara ◽

Eduardo Mireles-Cabodevila ◽

Fran Frame ◽

A. Christine Hummell ◽

Jeffrey Hammel ◽

...

Keyword(s):

Mechanical Ventilation ◽

Enteral Nutrition ◽

Critically Ill ◽

Critically Ill Patients ◽

Feeding Tube ◽

Feeding Tubes ◽

Academic Center ◽

Specific Step ◽

Feeding Process ◽

Medical Intensive Care

Background Published reports consistently describe incomplete delivery of prescribed enteral nutrition. Which specific step in the process delays or interferes with the administration of a full dose of nutrients is unclear. Objectives To assess factors associated with interruptions in enteral nutrition in critically ill patients receiving mechanical ventilation. Methods An observational prospective study of 59 consecutive patients who required mechanical ventilation and were receiving enteral nutrition was done in an 18-bed medical intensive care unit of an academic center. Data were collected prospectively on standardized forms. Steps involved in the feeding process from admission to discharge were recorded, each step was timed, and delivery of nutrition was quantified. Results Patients received approximately 50% (mean, 1106.3; SD, 885.9 Cal) of the prescribed caloric needs. Enteral nutrition was interrupted 27.3% of the available time. A mean of 1.13 interruptions occurred per patient per day; enteral nutrition was interrupted a mean of 6 (SD, 0.9) hours per patient each day. Prolonged interruptions were mainly associated with problems related to small-bore feeding tubes (25.5%), increased residual volumes (13.3%), weaning (11.7%), and other reasons (22.8%). Placement and confirmation of placement of the small-bore feeding tube were significant causes of incomplete delivery of nutrients on the day of admission. Conclusions Delivery of enteral nutrition in critically ill patients receiving mechanical ventilation is interrupted by practices embedded in the care of these patients. Evaluation of the process reveals areas to improve the delivery of enteral nutrition.

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APACHE II Score and Multiple Organ Failure Score as Predictors of Mortality Rate of Critically Ill Patients

Korean Journal of Anesthesiology ◽

10.4097/kjae.1997.32.5.754 ◽

1997 ◽

Vol 32 (5) ◽

pp. 754

Author(s):

Eun Chi Bang ◽

Shin Ok Koh ◽

Jai Won Jung

Keyword(s):

Mortality Rate ◽

Multiple Organ Failure ◽

Organ Failure ◽

Critically Ill ◽

Critically Ill Patients ◽

Multiple Organ ◽

Apache Ii ◽

Apache Ii Score ◽

Predictors Of Mortality ◽

Organ Failure Score

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Intra-Abdominal Pressure as a Marker of Enteral Nutrition Intolerance in Critically Ill Patients. The PIANE Study

Nutrients ◽

10.3390/nu11112616 ◽

2019 ◽

Vol 11 (11) ◽

pp. 2616

Author(s):

M Bordejé ◽

Juan Montejo ◽

M Mateu ◽

Manuel Solera ◽

Jose Acosta ◽

...

Keyword(s):

Mechanical Ventilation ◽

Enteral Nutrition ◽

Critically Ill ◽

Critically Ill Patients ◽

Urinary Catheter ◽

Abdominal Pressure ◽

Icu Patients ◽

Group A ◽

Group B ◽

Low Sensitivity

To determine whether elevated intra-abdominal pressure (IAP) is associated with a higher rate of enteral nutrition-related gastrointestinal (GI) complications; to assess the value of IAP as a predictor of enteral nutrition (EN) intolerance. Intensive Care Unit (ICU) patients on mechanical ventilation requiring at least 5 days of EN were recruited for a prospective, observational, non-interventional, multicenter study. EN was performed and GI complications were managed with an established protocol. IAP was determined via a urinary catheter. Patients who developed any GI complications were considered as presenting EN intolerance. Variables related to EN, IAP and GI complications were monitored daily. Statistical analysis compared patients without GI complications (group A) vs. GI complications (group B). 247 patients were recruited from 28 participating ICUs (group A: 119, group B: 128). No differences between groups were recorded. Patients in group B (p < 0.001) spent more days on EN (8.1 ± 8.4 vs. 18.1 ± 13.7), on mechanical ventilation (8.0 ± 7.7 vs. 19.3 ± 14.9) and in the ICU (12.3 ± 11.4 vs. 24.8 ± 17.5). IAP prior to the GI complication was (14.3 ± 3.1 vs. 15.8 ± 4.8) (p < 0.003). The best IAP value identified for EN intolerance was 14 mmHg but it had low sensitivity and specificity. Although a higher IAP was associated with EN intolerance, IAP alone did not emerge as a good predictor of EN intolerance in critically ill patients.

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