The efficacy and safety of prokinetics in critically ill adults receiving gastric feeding tubes: A systematic review and meta-analysis

Background Intolerance to gastric feeding tubes is common among critically ill adults and may increase morbidity. Administration of prokinetics in the ICU is common. However, the efficacy and safety of prokinetics are unclear in critically ill adults with gastric feeding tubes. We conducted a systematic review to determine the efficacy and safety of prokinetics for improving gastric feeding tube tolerance in critically ill adults. Methods Randomized controlled trials (RCTs) were identified by systematically searching the Medline, Cochrane and Embase databases. Two independent reviewers extracted the relevant data and assessed the quality of the studies. We calculated pooled relative risks (RRs) for dichotomous outcomes and the mean differences (MDs) for continuous outcomes with the corresponding 95% confidence intervals (CIs). We assessed the risk of bias using the Cochrane risk-of-bias tool and used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to rate the quality of the evidence. Results Fifteen RCTs met the inclusion criteria. A total of 10 RCTs involving 846 participants were eligible for the quantitative analysis. Most studies (10 of 13, 76.92%) showed that prokinetics had beneficial effects on feeding intolerance in critically ill adults. In critically ill adults receiving gastric feeding, prokinetic agents may reduce the ICU length of stay (MD -2.03, 95% CI -3.96, -0.10; P = 0.04; low certainty) and the hospital length of stay (MD -3.21, 95% CI -5.35, -1.06; P = 0.003; low certainty). However, prokinetics failed to improve the outcomes of reported adverse events and all-cause mortality. Conclusion As a class of drugs, prokinetics may improve tolerance to gastric feeding to some extent in critically ill adults. However, the certainty of the evidence suggesting that prokinetics reduce the ICU or hospital length of stay is low. Prokinetics did not significantly decrease the risks of reported adverse events or all-cause mortality among critically ill adults.

Download Full-text

Impact of the Time to Initiation of Parenteral Nutrition on Patient Outcomes in Critically Ill Adults

Nutrition and Metabolic Insights ◽

10.1177/1178638819859315 ◽

2019 ◽

Vol 12 ◽

pp. 117863881985931

Author(s):

Sunish Shah ◽

James M Hollands ◽

Laura Pontiggia ◽

Angela L Bingham

Keyword(s):

Length Of Stay ◽

Hospital Mortality ◽

Critically Ill ◽

Nutrient Intake ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Obese Patients ◽

Time To Initiation ◽

Critically Ill Adults ◽

Ill Adults

Background: The optimal time to initiate parenteral nutrition (PN) in critically ill adults in whom enteral nutrition is not feasible is controversial. Objective: The objectives were to compare in-hospital mortality and hospital length of stay in patients initiated on PN within 7 days or after 7 days of poor nutrient intake. Methods: This single-center, retrospective study included critically ill adult patients who received at least 2 consecutive days of PN during hospitalization from May 2014 to July 2016. Results: The median duration of PN (interquartile range) was 8 (5-13) days. In total, 110 patients received PN within 7 days of poor nutrient intake while 49 patients received PN after 7 days of poor nutrient intake. There was no statistically significant difference in in-hospital mortality between groups (29.09% vs 18.37%, P = .1535). Patients initiated within 7 days had a significantly shorter median hospital length of stay than patients initiated after 7 days (20 days vs 27 days, P = .0013). There were 69 patients who were classified as obese. Obese patients initiated within 7 days had a significantly shorter median hospital length of stay than obese patients initiated after 7 days (17 days vs 33 days, P = .0007). Conclusions: Time to initiation of PN did not impact in-hospital mortality. However, there was an association between early initiation of PN and a shorter hospital length of stay that was most pronounced among obese patients.

Download Full-text

Delirium and Associated Length of Stay and Costs in Critically Ill Patients

Critical Care Research and Practice ◽

10.1155/2021/6612187 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Claudia Dziegielewski ◽

Charlenn Skead ◽

Toros Canturk ◽

Colleen Webber ◽

Shannon M. Fernando ◽

...

Keyword(s):

Length Of Stay ◽

Critically Ill ◽

Critically Ill Patients ◽

Hospital Costs ◽

Hospital Length ◽

Mean Difference ◽

Hospital Length Of Stay ◽

The Mean ◽

The Impact

Purpose. Delirium frequently affects critically ill patients in the intensive care unit (ICU). The purpose of this study is to evaluate the impact of delirium on ICU and hospital length of stay (LOS) and perform a cost analysis. Materials and Methods. Prospective studies and randomized controlled trials of patients in the ICU with delirium published between January 1, 2015, and December 31, 2020, were evaluated. Outcome variables including ICU and hospital LOS were obtained, and ICU and hospital costs were derived from the respective LOS. Results. Forty-one studies met inclusion criteria. The mean difference of ICU LOS between patients with and without delirium was significant at 4.77 days ( p < 0.001 ); for hospital LOS, this was significant at 6.67 days ( p < 0.001 ). Cost data were extractable for 27 studies in which both ICU and hospital LOS were available. The mean difference of ICU costs between patients with and without delirium was significant at $3,921 ( p < 0.001 ); for hospital costs, the mean difference was $5,936 ( p < 0.001 ). Conclusion. ICU and hospital LOS and associated costs were significantly higher for patients with delirium, compared to those without delirium. Further research is necessary to elucidate other determinants of increased costs and cost-reducing strategies for critically ill patients with delirium. This can provide insight into the required resources for the prevention of delirium, which may contribute to decreasing healthcare expenditure while optimizing the quality of care.

Download Full-text

Evaluation of the quality of evidence supporting guideline recommendations for the nutritional management of critically ill adults

Clinical Nutrition ESPEN ◽

10.1016/j.clnesp.2020.07.004 ◽

2020 ◽

Vol 39 ◽

pp. 144-149

Author(s):

Elena Xu ◽

Sofia Tejada ◽

Candela Solé-Lleonart ◽

Laura Campogiani ◽

Francisco Valenzuela-Sanchez ◽

...

Keyword(s):

Critically Ill ◽

Nutritional Management ◽

Quality Of Evidence ◽

Critically Ill Adults ◽

Ill Adults

Download Full-text

Efficacy and Safety of Once-Daily Amikacin in Combination with Ceftazidime in Critically Ill Adults with Severe Gram-Negative Infections

Journal of Chemotherapy ◽

10.1179/joc.1996.8.6.457 ◽

1996 ◽

Vol 8 (6) ◽

pp. 457-464 ◽

Cited By ~ 6

Author(s):

D.F. Fayed ◽

N.S. Dahmash ◽

A.H. Al-Zeer ◽

A.M. Shibl ◽

S.O. Huraib ◽

...

Keyword(s):

Critically Ill ◽

Efficacy And Safety ◽

Once Daily ◽

Gram Negative ◽

Critically Ill Adults ◽

Ill Adults

Download Full-text

Efficacy and safety of tocilizumab in critically ill adults with COVID-19 infection in Bahrain: A report of 5 cases

Respiratory Medicine Case Reports ◽

10.1016/j.rmcr.2020.101139 ◽

2020 ◽

Vol 30 ◽

pp. 101139 ◽

Cited By ~ 1

Author(s):

Mohamed M ElSeirafi ◽

Hasan MSN Hasan ◽

Kannan Sridharan ◽

Alaa Zamoori ◽

Sana Alkhawaja ◽

...

Keyword(s):

Critically Ill ◽

Efficacy And Safety ◽

Critically Ill Adults ◽

Ill Adults

Download Full-text

Hypophosphatemia and Outcomes in ICU: A Systematic Review and Meta-Analysis

Journal of Intensive Care Medicine ◽

10.1177/0885066620940274 ◽

2020 ◽

pp. 088506662094027

Author(s):

Jeremy Cheuk Kin Sin ◽

Lillian King ◽

Emma Ballard ◽

Stacey Llewellyn ◽

Kevin B. Laupland ◽

...

Keyword(s):

Length Of Stay ◽

Critically Ill ◽

Critically Ill Patients ◽

Meta Analysis ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Cochrane Library ◽

Secondary Outcome ◽

Icu Length Of Stay ◽

Newcastle Ottawa Scale

Purpose: Hypophosphatemia is reported in up to 5% of hospitalized patients and ranges from 20% to 80% in critically ill patients. The consequences of hypophosphatemia for critically ill patients remain controversial. We evaluated the effect of hypophosphatemia on mortality and length of stay in intensive care unit (ICU) patients. Methods: MEDLINE, EMBASE, Cochrane Library (Reviews and Trials), and PubMed were searched for articles in English. The primary outcome was mortality and secondary outcome was length of stay. The quality of evidence was graded using a modified Newcastle-Ottawa Scale. Results: Our search yielded 828 articles and ultimately included 12 studies with 7626 participants in the analysis. Hypophosphatemia was associated with increased hospital length of stay (2.19 days [95% CI, 1.74-2.64]) and ICU length of stay (2.22 days [95% CI, 1.00-3.44]) but not mortality (risk ratio: 1.13 [95% CI, 0.98-1.31]; P = .09). Conclusions: Hypophosphatemia in ICU was associated with increased hospital and ICU length of stay but not all-cause mortality. Hypophosphatemia appears to be a marker of disease severity. Limited number of available studies and varied study designs did not allow for the ascertainment of the effect of severe hypophosphatemia on patient mortality.

Download Full-text

1858P Role of depression and quality of life (QOL) status as predictors of hospital length of stay (HLOS) and overall survival (OS) in hospitalized oncologic patients (pts)

Annals of Oncology ◽

10.1016/j.annonc.2020.08.1505 ◽

2020 ◽

Vol 31 ◽

pp. S1062-S1063

Author(s):

O. Mirallas ◽

D.E. López Valbuena ◽

M.A. Rezqallah Aron ◽

G. Molina ◽

S. Vega ◽

...

Keyword(s):

Quality Of Life ◽

Overall Survival ◽

Length Of Stay ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Oncologic Patients

Download Full-text

Extended Versus Short-Course Corticosteroid Taper Regimens in the Management of Chronic Obstructive Pulmonary Disease Exacerbations in Critically Ill Patients

Journal of Intensive Care Medicine ◽

10.1177/0885066617741470 ◽

2017 ◽

Vol 35 (3) ◽

pp. 257-263 ◽

Cited By ~ 2

Author(s):

Teresa Poon ◽

Daryl Glick Paris ◽

Samuel L. Aitken ◽

Paru Patrawalla ◽

Eric Bondarsky ◽

...

Keyword(s):

Length Of Stay ◽

Treatment Failure ◽

Critically Ill ◽

Critically Ill Patients ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Short Course ◽

Extended Course

Background: Previous literature has suggested that a short course of corticosteroids is similarly effective as an extended course for managing an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, there are limited data regarding the optimal corticosteroid regimen in critically ill patients and the dosing strategies remain highly variable in this population. Methods: This retrospective cohort study evaluated patients with AECOPD admitted to the intensive care unit within a 2-year period. Patients were divided into short-course (≤5 days) or extended-course (>5 days) corticosteroid taper groups. The primary end point was treatment failure, defined as the need for intubation, reintubation, or noninvasive mechanical ventilation. Secondary end points included the duration of mechanical ventilation, hospital and intensive care unit length of stay, and adverse events. Results: Of the 151 patients who met the inclusion criteria, 94 received an extended taper and 57 received a short taper. Treatment failure occurred in 3 patients, who were all in the extended taper group ( P = .17). In a propensity score-matched cohort, the hospital length of stay was 7 days in the short taper group compared to 11 days in the extended taper group ( P < .0001). No differences in adverse events were observed. Conclusion: A short-course corticosteroid taper in critically ill patients with AECOPD is associated with reduced hospital length of stay and decreased corticosteroid exposure without increased risk of treatment failure. A prospective randomized trial is warranted.

Download Full-text