Screening and risk factors of exocrine pancreatic insufficiency in critically ill adult patients receiving enteral nutrition

Objective To investigate the prevalence of and factors associated with diarrhoea in the early stage of enteral nutrition in critically ill patients in intensive care units (ICUs). Methods This prospective, multicentre, observational study enrolled consecutive patients who were newly admitted to ICUs and received enteral nutrition treatment. Events were observed continuously for 7 days or until patients were transferred out of the ICU after enteral nutrition. Demographic and clinical data, enteral nutrition data, diarrhoea-related data and outcomes were recorded. A multivariate logistic regression analysis was used to analyse the risk factors for diarrhoea. Results The study included 533 patients, of whom 164 (30.8%) developed diarrhoea. Diarrhoea was most commonly observed on the first to third days after starting enteral nutrition treatment. The median (interquartile range) duration of diarrhoea was 2 (1–3) days. The administration of gastrointestinal prokinetic agents, the increase in acute physiological and chronic health scores and the pyloric posterior feeding method were independent risk factors for diarrhoea. Conclusion The increased severity of illness, the administration of gastrointestinal prokinetic agents and the pyloric posterior feeding method were independent risk factors for diarrhoea in critically ill ICU patients undergoing enteral nutrition treatment.

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Prevalence, risk factors and clinical implications of hypophosphatemia in critically ill children on oral and enteral nutrition

Clinical Nutrition ESPEN ◽

10.1016/j.clnesp.2020.09.683 ◽

2020 ◽

Vol 40 ◽

pp. 633

Author(s):

A.M.M. Springer ◽

T.D.R. Hortencio ◽

E.C. Melro ◽

T.H. de Souza ◽

R.J.N. Nogueira

Keyword(s):

Risk Factors ◽

Enteral Nutrition ◽

Critically Ill ◽

Critically Ill Children ◽

Clinical Implications

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Long-term Enteral Access in Aspiration-prone Patients

Journal of Intensive Care Medicine ◽

10.1177/088506669501000404 ◽

1995 ◽

Vol 10 (4) ◽

pp. 179-186 ◽

Cited By ~ 8

Author(s):

Alex C. Cech ◽

Jon B. Morris ◽

James L. Mullen ◽

Gary W. Crooks

Keyword(s):

Risk Factors ◽

High Risk ◽

Enteral Nutrition ◽

Critically Ill ◽

Enteral Feeding ◽

Critically Ill Patients ◽

Nutrition Support ◽

Enteral Access ◽

Enteral Nutrition Support

Aspiration pneumonia is a serious complication of enteral feeding. Many critically ill patients are particularly at risk for aspiration. Few studies have rigorously compared various access devices. Risk factors for aspiration and studies examining aspiration associated with enteral feeding devices are reviewed. We recommend a surgical jejunostomy for all patients at high risk for aspiration who require more than 3 weeks of enteral nutrition support.

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660 Prevalence, Risk Factors, and Clinical Consequence of Enteral Feeding Intolerance in the Critically Ill: An Analysis of a Multicenter, Multi-year Database

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.276 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S174-S175

Author(s):

Daren Heyland ◽

Luis A Ortiz ◽

Andrew G Day

Keyword(s):

Risk Factors ◽

Enteral Nutrition ◽

Clinical Outcomes ◽

Critically Ill ◽

Abdominal Distension ◽

Admission Diagnosis ◽

Apache Ii Score ◽

Clinical Consequence ◽

Nutrition Survey ◽

Abdominal Girth

Abstract Introduction We aimed to determine the incidence of enteral feed intolerance (EFI), factors associated with intolerance, and to assess the influence of intolerance on key nutritional and clinical outcomes in critically ill patients. Methods We used data from The International Nutrition Survey database collected from 2007–2014. Included patients were mechanically ventilated critically ill adults who remained in the Intensive Care Unit for at least 72 hours and received some enteral nutrition during the first 12 days of their ICU stay. Data collected included nutritional prescription, adequacy, and clinical otucomes. We defined EFI as feeding is interrupted due to one of the following reasons: high gastric residual volumes (GRV), increased abdominal girth or abdominal distension, vomiting/emesis, diarrhea or subjective discomfort. Logistic regression controlling for covariates (year, region, sex, APACHE II score, admission type by primary diagnosis, BMI and baseline caloric and protein prescriptions) was used to determine risk factors for intolerance and its clinical significance. Results The current analysis included 15, 918 patients from 775 ICUs. Of these, 4, 036 (25.4%) had at least one episode of EFI. The rate rose from just below 1% on day 1 to a peak of 6% on day 4 and 5 and declined daily thereafter (See Figure). Factors predictive of EFI are shown in Table 1. Admission diagnosis was significantly predictive of EFI with patients with burn injuries showing the highest incidence. After controlling for the covariates,patients who had EFI received about 10% less EN adequacycompared to patients without of EFI (see Table 2). The mortality rate in EFI patients was 31% vs. 24% among patients who did not have EFI (OR=1.5 [95% CI, 1.4–1.6] p< 0.0001). Patients who had EFI had fewer ventilator free days, longer ICU lengths of stay, and longer time to discharge alive (all p< 0.0001) (See Table 2). Conclusions Intolerance occurs frequently during enteral nutrition in the critically ill and is associated with poorer nutritional and clinical outcomes. The identification, prevention, and optimal management in burn injured patients may improve nutrition delivery and clinical outcomes in this important “at risk” population. Applicability of Research to Practice To improve the nutrition therapy in burns patients.

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Vancomycin-Associated Acute Kidney Injury in Critically Ill Adolescent and Young Adult Patients

Journal of Pharmacy Practice ◽

10.1177/0897190019829652 ◽

2019 ◽

Vol 33 (6) ◽

pp. 749-753 ◽

Cited By ~ 2

Author(s):

William B. Hays ◽

Emma Tillman

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Young Adult ◽

Critically Ill ◽

Kidney Injury ◽

Adult Patients ◽

Adolescent And Young Adult ◽

Daily Dose ◽

Vancomycin Trough ◽

Trough Levels

Background: Risk factors for the development of vancomycin-associated acute kidney injury (AKI) have been evaluated in both pediatric and adult populations; however, no previous studies exist evaluating this in the critically ill adolescent and young adult patients. Objective: Identify the incidence of AKI and examine risk factors for the development of AKI in critically ill adolescents and young adults on vancomycin. Methods: This retrospective review evaluated the incidence of AKI in patients 15 to 25 years of age who received vancomycin, while admitted to an intensive care unit. Acute kidney injury in this population was defined as an increase in serum creatinine by 0.5 mg/dL or 50% from baseline. Patients who developed AKI were evaluated for specific risk factors compared to those who did not develop AKI. Results: A total of 50 patients (20 developed AKI) were included in the study. There was no difference in vancomycin daily dose or duration of vancomycin therapy. Maximum vancomycin trough (31.15 mg/dL vs 12.5 mg/dL, P = .006), percentage of patients with concurrent nephrotoxic medication (95% vs 60%, P = .012) and concurrent vasopressor (55% vs 23%, P = .029) were higher in those who developed AKI. Percentage of patients who underwent a procedure while on vancomycin (35% vs 6.7%, P = .021) was also higher within the AKI group. Conclusions: Vancomycin-associated AKI occurred in 40% of critically ill adolescent and young adult patients. These patients may be more likely to develop vancomycin-associated AKI if they had undergone a procedure, as well as in the presence of high vancomycin trough levels, concurrent nephrotoxic agents, and concurrent vasopressor therapy.

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Endocrine and exocrine pancreatic insufficiency after acute pancreatitis: long-term follow-up study

Herald of Pancreatic Club ◽

10.33149/vkp.2018.03.04 ◽

2018 ◽

Vol 41 (3) ◽

pp. 20-30

Author(s):

J. Tu ◽

J. Zhang ◽

L. Ke ◽

Y. Yang ◽

Q. Yang ◽

...

Keyword(s):

Risk Factors ◽

Insulin Resistance ◽

Acute Pancreatitis ◽

Blood Glucose ◽

Pancreatic Necrosis ◽

Pancreatic Insufficiency ◽

Exocrine Pancreatic Insufficiency ◽

Long Term Follow Up

Introduction. Patients could develop endocrine and exocrine pancreatic insufficiency after acute pancreatitis (AP), but the morbidity, risk factors and outcome remain unclear. The aim of the present study was to evaluate the incidence of endocrine and exocrine pancreatic insufficiency after AP and the risk factors of endocrine pancreatic insufficiency through a long-term follow-up investigation. Methods. Follow-up assessment of the endocrine and exocrine function was conducted for the discharged patients with AP episodes. Oral Glucose Tolerance Test (OGTT) and faecal elastase-1(FE-1) test were used as primary parameters. Fasting blood-glucose (FBG), fasting insulin (FINS), glycosylated hemoglobin HBA1c, 2-h postprandial blood glucose (2hPG), Homa beta cell function index (HOMA-β), homeostasis model assessment of insulin resistance (HOMA-IR) and FE-1 were collected. Abdominal contrast-enhanced computed tomography (CECT) was performed to investigate the pancreatic morphology and the other related data during hospitalization was also collected. Results. One hundred thirteen patients were included in this study and 34 of whom (30.1%) developed diabetes mellitus (DM), 33 (29.2%) suffered impaired glucose tolerance (IGT). Moreover, 33 patients (29.2%) developed mild to moderate exocrine pancreatic insufficiency with 100μg/g<FE-1<200μg/g and 7 patients (6.2%) were diagnosed with severe exocrine pancreatic insufficiency with FE-1<100μg/g. The morbidity of DM and IGT in patients with pancreatic necrosis was significant higher than that in the non-pancreatic necrosis group (χ2 = 13.442,P = 0.001). The multiple logistic regression analysis showed that extent of pancreatic necrosis<30% (P = 0.012, OR = 0.061) were the protective factors of endocrine pancreatic insufficiency. HOMA-IR (P = 0.002, OR = 6.626), Wall-off necrosis (WON) (P = 0.013, OR = 184.772) were the risk factors. Conclusion. The integrated morbidity of DM and IGT after AP was 59.25%, which was higher than exocrine pancreatic insufficiency. 6.2% and 29.2% of patients developed severe and mild to moderate exocrine pancreatic insufficiency, respectively. The extent of pancreatic necrosis>50%, WON and insulin resistance were the independent risk factors of new onset diabetes after AP.

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