Enteral and Parenteral Nutritional Support - test

2017 ◽  
Author(s):  
Cherisse Berry ◽  
Jose J Diaz
Keyword(s):  
Enteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Nutritional Assessment ◽  
Morbidity And Mortality ◽  
Nutritional Risk ◽  
Omega 3 ◽  
Refeeding Syndrome ◽  
Surgical Critical Care ◽  
Increased Risk

Malnutrition among the critically ill is widely prevalent, resulting in impaired ventilator drive, prolonged ventilator dependence, impaired immunologic function, and increased risk of infection. The initiation of early nutrition therapy, specifically enteral nutrition, decreases the early loss of lean mass, provides calories, and improves patients’ immunity and healing, which is critical for improving morbidity and mortality in patients suffering from critical illness.  Determining nutritional risk using the Nutrition Risk in Critically Ill (NUTRIC) score; assessing nutritional needs, including protein and calorie needs, with ongoing reassessments; gaining gastrointestinal access for initiating early enteral therapy with a standard polymeric isotonic or near-isotonic 1 to 1.5 kcal/mL formula for surgical critically ill patients within 24 to 48 hours of admission to the intensive care unit; monitoring for gastrointestinal intolerance and complications; and selecting immunonutrition, specifically arginine and omega-3 fatty acids, for the postoperative surgical critical care patient are key strategies in overcoming malnutrition and improving overall morbidity and mortality in critically ill patients. This review contains 1 figure, 3 tables, and 52 references. Key words: enteral nutrition, immunonutrition, nutritional assessment, nutritional risk, refeeding syndrome

scholarly journals Comparison of Feeding Efficiency and Hospital Mortality between Small Bowel and Nasogastric Tube Feeding in Critically Ill Patients at High Nutritional Risk

Nutrients ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 2009
Author(s):  
Wei-Ning Wang ◽  
Chen-Yu Wang ◽  
Chiann-Yi Hsu ◽  
Pin-Kuei Fu
Keyword(s):  
Small Bowel ◽  
Enteral Nutrition ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Energy Intake ◽  
Nasogastric Tube ◽  
Critically Ill Patients ◽  
Nutritional Risk ◽  
Nutrition Risk ◽  
Achievement Rate

Nasogastric tube enteral nutrition (NGEN) should be initiated within 48 h for patients at high nutritional risk. However, whether small bowel enteral nutrition (SBEN) should be routinely used instead of NGEN to improve hospital mortality remains unclear. We retrospectively analyzed 113 critically ill patients with modified Nutrition Risk in Critically Ill (mNUTRIC) score ≥ 5 and feeding volume < 750 mL/day in the first week of their stay in the intensive care unit (ICU). Age, sex, mNUTRIC score, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score were matched in the SBEN (n = 48) and NGEN (n = 65) groups. Through a univariate analysis, factors associated with hospital mortality were SBEN group (hazard ratio (HR), 0.56; 95% confidence interval (CI), 0.31–1.00), Simplified Organ Failure Assessment (SOFA) score on day 7 (HR, 1.12; 95% CI, 1.03–1.22), and energy intake achievement rate < 65% (HR, 2.53; 95% CI, 1.25–5.11). A multivariate analysis indicated that energy intake achievement rate < 65% on the third follow-up day (HR, 2.29; 95% CI, 1.12–4.69) was the only factor independently associated with mortality. We suggest initiation of SBEN on the seventh ICU day before parenteral nutrition initiation for critically ill patients at high nutrition risk.

Parenteral nutrition in the ICU

2016 ◽  
Author(s):  
Jonathan Cohen ◽  
Shaul Lev
Keyword(s):  
Animal Models ◽  
Enteral Nutrition ◽  
Parenteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Nutrition Support ◽  
Glutamine Supplementation ◽  
Artificial Nutrition ◽  
Omega 3 ◽  
Aspen Guidelines

Parenteral nutrition (PN) is a technique of artificial nutrition support, which consists of the intravenous administration of macronutrients, micronutrients, and water. PN has become integrated into intensive care unit (ICU) patient management with the aim of preventing energy deficits and preserving lean body mass. The addition of PN to enteral nutrition is known as supplemental PN. Parenteral feeding should be considered whenever enteral nutritional support is contraindicated, or when enteral nutrition alone is unable to meet energy and nutrient requirements. International guidelines differ considerably regarding the indications for PN. Thus, the ESPEN guidelines recommend initiating PN in critically-ill patients who do not meet caloric goals within 2–3 days of commencing EN, while the Canadian guidelines recommend PN only after extensive attempts to feed with EN have failed. The ASPEN guidelines advocate administering PN after 8 days of attempting EN unsuccessfully. Several studies have demonstrated that parenteral glutamine supplementation may improve outcome, and the ESPEN guidelines give a grade A recommendation to the use of glutamine in critically-ill patients who receive PN. Studies on IV omega-3 fatty acids have yielded promising results in animal models of acute respiratory distress syndrome and proved superior to solutions with omega -6 compositions. The discrepancy between animal models and clinical practice could be related to different time frames.

scholarly journals Hypophosphatemia and risk of refeeding syndrome in critically ill patients before and after nutritional therapy

2020 ◽  
Vol 66 (9) ◽  
pp. 1241-1246
Author(s):  
Amanda Coelho Ribeiro ◽  
Diana Borges Dock-Nascimento ◽  
João Manoel Silva Jr. ◽  
Cervantes Caporossi ◽  
José Eduardo de Aguilar-Nascimento
Keyword(s):  
Enteral Nutrition ◽  
Parenteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Nutritional Therapy ◽  
Tertiary Hospital ◽  
Serum Phosphorus ◽  
Refeeding Syndrome ◽  
Before And After ◽  
Phosphorus Levels

Summary OBJECTIVE: To investigate the prevalence of hypophosphatemia as a marker of refeeding syndrome (RFS) before and after the start of nutritional therapy (NT) in critically ill patients. METHODS: Retrospective cohort study including 917 adult patients admitted at the intensive care unit (ICU) of a tertiary hospital in Cuiabá-MT/Brasil. We assessed the frequency of hypophosphatemia (phosphorus <2.5mg/dl) as a risk marker for RFS. Serum phosphorus levels were measured and compared at admission (P1) and after the start of NT (P2). RESULTS: We observed a significant increase (36.3%) of hypophosphatemia and, consequently, a greater risk of RFS from P1 to P2 (25.6 vs 34.9%; p<0.001). After the start of NT, malnourished patients had a greater fall of serum phosphorus. Patients receiving NT had an approximately 1.5 times greater risk of developing RFS (OR= 1.44 95%CI 1.10-1,89; p= 0.01) when compared to those who received an oral diet. Parenteral nutrition was more associated with hypophosphatemia than either enteral nutrition (p=0,001) or parenteral nutrition supplemented with enteral nutrition (p=0,002). CONCLUSION: The frequency of critically ill patients with hypophosphatemia and at risk for RFS on admission is high and this risk increases after the start of NT, especially in malnourished patients and those receiving parenteral nutrition.

scholarly journals Anaemia and transfusion triggers in critically ill patients – What we have learnt thus far

2018 ◽  
Vol 20 (4) ◽  
pp. 284-289
Author(s):  
Amritpal Singh Jandu ◽  
Steven Vidgeon ◽  
Nadeem Ahmed
Keyword(s):  
Blood Loss ◽  
Blood Cell ◽  
Critically Ill ◽  
Red Blood Cell ◽  
Critically Ill Patients ◽  
Occult Blood ◽  
Morbidity And Mortality ◽  
Common Finding ◽  
Increased Risk ◽  
Red Blood Cell Transfusions

Anaemia is a common finding in critically ill patients, the cause of which is multi-factorial including: sepsis, haemolysis (and disseminated intravascular coagulation), iatrogenic blood loss secondary to laboratory sampling, post-operative anaemia, bone marrow suppression/failure, decreased production of erythropoietin, anaemia secondary to drugs/toxins, overt or occult blood loss, functional iron deficiency, poor nutrition and haemodilution. Anaemia is associated with deleterious outcomes including increased risk of cardiac-related morbidity and mortality and decrease in oxygen-carrying capacity in the face of increased metabolic demands. There is a growing body of evidence, which demonstrates that packed red blood cell transfusions are associated with poorer outcomes. Clinicians therefore need to weigh the potential benefit of treating anaemia against the desire to avoid unnecessary transfusions. We explored current literature regarding transfusion triggers and morbidity and mortality associated with packed red blood cell transfusions transfusion, concentrating on studies that have been conducted in critical care patients. In addition, we reflected on trials which considered the viability of iron transfusion and erythropoietin in critically unwell patients.

scholarly journals Nutritional Assessment in the Critically Ill Patients

2020 ◽  
Author(s):  
Elham Bagheri ◽  
Farzaneh Hematian ◽  
Mandana Izadpanah ◽  
Mahbobeh Rashidi
Keyword(s):  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Nutritional Assessment ◽  
Apache Ii ◽  
Nutritional Risk ◽  
Apache Ii Score ◽  
Number Of Patients ◽  
Study Results ◽  
The Impact

Background: Malnutrition is a prevalent complication among critically ill patients. It has very detrimental effects on the patients' clinical course. This study aimed to investigate the impact of nutrition in the intensive care unit (ICU) patients. Methods: In this epidemiologic-analytic study conducted in the surgical ICU of Imam Khomeini hospital, Ahvaz, Iran, 34 patients were selected and divided into two groups. The first group of patients received the appropriate nutrition. The second group received an inappropriate diet, and the nutritional risk was evaluated according to the modified- Nutrition Risk in Critically ill (m-NUTRIC) score. The energy was calculated by using 25 Kcal/kg, also the two groups were compared in terms of ICU mortality, ICU stays, Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II Scoring, and the Sequential Organ Failure Assessment (SOFA) Score. Results: Baseline data, such as APACHE II score and mean age, except sex, were not significantly different between the two groups. In this study, results were toward shorter ICU stay, less mortality, and better SOFA score in the group receiving appropriate nutrition compared to the other group. However, due to the low number of patients, no significant differences were observed in the two groups. Conclusion: Our data suggest that nutritional support should be considered as an essential part of the medication during critical illness.

scholarly journals Comparison of Feeding Efficacy and Hospital Mortality Between Small Bowel and Nasogastric Tube Enteral Nutrition in Critical Illness at High Nutritional Risk

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1152-1152 ◽  
Author(s):  
Wei-Ning Wang ◽  
Pin-Kuei Fu ◽  
Chiann-Yi Hsu
Keyword(s):  
Small Bowel ◽  
Enteral Nutrition ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Energy Intake ◽  
Nasogastric Tube ◽  
Critically Ill Patients ◽  
Protein Intake ◽  
Nutritional Risk ◽  
Achievement Rate

Abstract Objectives The current guidelines recommend that early enteral nutrition (EN) support by nasogastric tube enteral nutrition (NGEN) should be initiated within 48 h in the critically ill patients at high nutritional risk. Small bowel EN (SBEN) was suggested for those who are NGEN intolerance. Our previous study showed adjuvant feeding with SBEN at 7th ICU day may improve feeding efficacy and have survival benefit for those energy achievement rate more than 65% at the 3rd day after SBEN. However, the comparison of feeding efficacy and hospital mortality between SBEN and NGEN remains unclear. Methods A retrospective cohort study enrolled 113 critically ill patients at high nutrition risk (modified NUTRIC score≧5) and at inadequate feeding volume (&lt; 750 ml/day) in the first week of ICU stay. Patients were classified into SBEN (N = 48) and NGEN (N = 65) group at 8th ICU day (enrolled day). Daily actual energy intake was recorded after enrolled day in each group and feeding efficiency was compared between two groups. Cox regression analysis was used to assess factors associated with hospital mortality. Results The feeding volume, energy and protein intake, and achievement rate (%) of energy and protein intake increased significantly in the SBEN group at the 3rd following day (P &lt; 0.001). Hospital mortality in this cohort was 43.3%. By univariate analysis, SBEN group (HR: 0.56, 95% CI: 0.31–1.00, P = 0.049), SOFA score at day 7 (HR:1.12, 95% CI: 1.03–1.22, P = 0.009) and energy intake achievement rate &lt; 65% at the 3rd followed-up day (HR: 2.53, 95% CI: 1.25–5.11, P = 0.010) were associated with hospital mortality. By multivariate analysis, the only factor associated hospital mortality in this cohort was energy intake achievement rate &lt; 65% at the 3rd followed-up day (HR: 2.29, 95% CI: 1.12–4.69, P = 0.023). Conclusions SBEN improves energy delivery and might be reduced in hospital mortality in critically ill patients at high nutritional risk after 1 week of stomach enteral nutrition in ICU. Funding Sources None.

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