scholarly journals Metabolic and Nutritional Characteristics of Long-Stay Critically Ill Patients

2019 ◽  
Vol 8 (7) ◽  
pp. 985 ◽  
Author(s):  
Marina V. Viana ◽  
Olivier Pantet ◽  
Geraldine Bagnoud ◽  
Arianne Martinez ◽  
Eva Favre ◽  
...  
Keyword(s):  
Critically Ill ◽  
Protein Delivery ◽  
Nutrition Risk ◽  
Icu Stay ◽  
Arterial Blood ◽  
Icu Discharge ◽  
Two Phases ◽  
Poor Outcomes ◽  
Chronically Critically Ill ◽  
Arterial Blood Glucose

Background: insufficient feeding is frequent in the intensive care unit (ICU), which results in poor outcomes. Little is known about the nutrition pattern of patients requiring prolonged ICU stays. The aims of our study are to describe the demographic, metabolic, and nutritional specificities of chronically critically ill (CCI) patients defined by an ICU stay >2 weeks, and to identify an early risk factor. Methods: analysis of consecutive patients prospectively admitted to the CCI program, with the following variables: demographic characteristics, Nutrition Risk Screening (NRS-2002) score, total daily energy from nutritional and non-nutritional sources, protein and glucose intakes, all arterial blood glucose values, length of ICU and hospital stay, and outcome (ICU and 90-day survival). Two phases were considered for the analysis: the first 10 days, and the next 20 days of the ICU stay. Statistics: parametric and non-parametric tests. Results: 150 patients, aged 60 ± 15 years were prospectively included. Median (Q1, Q3) length of ICU stay was 31 (26, 46) days. The mortality was 18% at ICU discharge and 35.3% at 90 days. Non-survivors were older (p = 0.024), tended to have a higher SAPSII score (p = 0.072), with a significantly higher NRS score (p = 0.033). Enteral nutrition predominated, while combined feeding was minimally used. All patients received energy and protein below the ICU’s protocol recommendation. The proportion of days with fasting was 10.8%, being significantly higher in non-survivors (2 versus 3 days; p = 0.038). Higher protein delivery was associated with an increase in prealbumin over time (r2 = 0.19, p = 0.027). Conclusions: High NRS scores may identify patients at highest risk of poor outcome when exposed to underfeeding. Further studies are required to evaluate a nutrition strategy for patients with high NRS, addressing combined parenteral nutrition and protein delivery.

scholarly journals Association of early-onset constipation and diarrhea with patient outcomes in critically ill ventilated patients: a retrospective observational cohort study

2021 ◽  
Author(s):  
Gen Aikawa ◽  
Akira Ouchi ◽  
Hideaki Sakuramoto ◽  
Tetsuya Hoshino ◽  
Yuki Enomoto ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Early Onset ◽  
Multivariable Analysis ◽  
Icu Admission ◽  
Icu Stay ◽  
Normal Defecation ◽  
Poor Outcomes ◽  
Length Of Icu Stay ◽  
Ventilated Patients

Abstract Constipation and diarrhea are both associated with poor outcomes in critically ill patients. Although constipation and diarrhea are closely related, few studies have examined them simultaneously. The purpose of this study was to describe patient defecation status after intensive care unit (ICU) admission and determine the association of early-onset constipation and diarrhea after ICU admission with outcomes for critically ill ventilated patients. Critically ill patients were retrospectively investigated and their defecation status was assessed during the first week after admission. The patients were divided into three groups: normal defecation, constipation, and diarrhea, and multiple comparison tests were performed. Additionally, multivariable analysis was performed for mortality and length of stay. Of the 85 critically ill ventilated patients, 47 (55%) experienced constipation, and 12 (14%) experienced diarrhea during the first week of ICU admission. Patients with normal defecation and diarrhea increased from the fourth and fifth day of ICU admission. Diarrhea was significantly associated with the length of ICU stay (B=7.534, 95% confidence interval: 0.116-14.951). Early-onset constipation and diarrhea were common in critically ill ventilated patients, and early-onset diarrhea was associated with the length of ICU stay. Prevention of constipation and diarrhea before the fifth day of ICU admission is essential.

scholarly journals Interest of treating iron deficiency, diagnosed according to hepcidin quantification, on outcomes after a prolonged ICU stay compared to standard care: a multicenter, randomized, single-blinded trial.

2020 ◽  
Author(s):  
sigismond lasocki ◽  
Pierre ASFAR ◽  
Samir JABER ◽  
Martine FERRANDIERE ◽  
Thomas KERFORNE ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Critically Ill ◽  
Primary Endpoint ◽  
Critically Ill Patients ◽  
Standard Care ◽  
Intravenous Iron ◽  
Icu Stay ◽  
Icu Discharge ◽  
Prolonged Icu Stay ◽  
One Year

Abstract Background: Anemia is a significant problem in patients on ICU. Its commonest cause, iron deficiency (ID), is difficult to diagnosed in the context of inflammation. Hepcidin is a new marker of ID. We aimed to assess whether hepcidin levels would accurately guide treatment of ID in critically ill anemic patients after a prolonged ICU stay and affect the post-ICU outcomes. Methods: In a controlled, single-blinded, multicenter study, anemic (WHO definition) critically ill patients with an ICU stay ≥5 days were randomized when discharge was expected to either intervention by hepcidin treatment protocol or control. In the intervention arm patients were treated with intravenous iron (1g of ferric carboxymaltose) when hepcidin was <20 μg/l and with intravenous iron and erythropoietin for 20≤ hepcidin <41 μg/l. Control patients were treated according to standard care (hepcidin quantification remained blinded). Primary endpoint was the number of days spent in hospital 90 days after ICU discharge (post-ICU LOS). Secondary endpoints were day 15 anemia, day 30 fatigue, day-90 mortality and one-year survival. Results: Of 405 randomized patients, 399 were analyzed (201 in intervention and 198 in control arm). 220(55%) had ID at discharge (i.e. an hepcidin <41 μg/l). Primary endpoint was not different (medians(IQR) post-ICU LOS 33(13;90) vs 33(11;90) days for intervention and control respectively, median difference -1(-3;1) days, p=0.78). D90 mortality was significantly lower in the intervention arm (16(8%) vs 33(16.6%) deaths, absolute risk difference -8.7 (-15.1 to -2.3)%, p=0.008, OR 95%IC, 0.46, 0.22 to 0.94, p=0.035) and one-year survival was improved (p =0.0394). Conclusion: Treatment of ID diagnosed according to hepcidin levels did not reduce the post-ICU LOS, but may reduce the long-term mortality in critically ill patients about to be discharged after a prolonged stay.

scholarly journals Impact of treating iron deficiency, diagnosed according to hepcidin quantification, on outcomes after a prolonged ICU stay compared to standard care: a multicenter, randomized, single-blinded trial.

2020 ◽  
Author(s):  
sigismond lasocki ◽  
Pierre ASFAR ◽  
Samir JABER ◽  
Martine FERRANDIERE ◽  
Thomas KERFORNE ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Critically Ill ◽  
Primary Endpoint ◽  
Critically Ill Patients ◽  
Standard Care ◽  
Intravenous Iron ◽  
Icu Stay ◽  
Icu Discharge ◽  
Prolonged Icu Stay ◽  
One Year

Abstract Background: Anemia is a significant problem in patients on ICU. Its commonest cause, iron deficiency (ID), is difficult to diagnosed in the context of inflammation. Hepcidin is a new marker of ID. We aimed to assess whether hepcidin levels would accurately guide treatment of ID in critically ill anemic patients after a prolonged ICU stay and affect the post-ICU outcomes. Methods: In a controlled, single-blinded, multicenter study, anemic (WHO definition) critically ill patients with an ICU stay ≥5 days were randomized when discharge was expected to either intervention by hepcidin treatment protocol or control. In the intervention arm patients were treated with intravenous iron (1g of ferric carboxymaltose) when hepcidin was <20 μg/l and with intravenous iron and erythropoietin for 20≤ hepcidin <41 μg/l. Control patients were treated according to standard care (hepcidin quantification remained blinded). Primary endpoint was the number of days spent in hospital 90 days after ICU discharge (post-ICU LOS). Secondary endpoints were day 15 anemia, day 30 fatigue, day-90 mortality and one-year survival. Results: Of 405 randomized patients, 399 were analyzed (201 in intervention and 198 in control arm). 220(55%) had ID at discharge (i.e. an hepcidin <41 μg/l). Primary endpoint was not different (medians(IQR) post-ICU LOS 33(13;90) vs33(11;90) days for intervention and control respectively, median difference -1(-3;1) days, p=0.78). D90 mortality was significantly lower in intervention arm (16(8%) vs 33(16.6%) deaths, absolute risk difference -8.7 (-15.1 to -2.3)%, p=0.008, OR 95%IC, 0.46, 0.22 to 0.94, p=0.035) and one-year survival was improved (p =0.04). Conclusion: Treatment of ID diagnosed according to hepcidin levels did not reduce the post-ICU LOS, but was associated with a significant reduction in D90 mortality and with improved 1-year survival in critically ill patients about to be discharged after a prolonged stay.

scholarly journals Impact of treating iron deficiency, diagnosed according to hepcidin quantification, on outcomes after a prolonged ICU stay compared to standard care: a multicenter, randomized, single-blinded trial

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Sigismond Lasocki ◽  
◽  
Pierre Asfar ◽  
Samir Jaber ◽  
Martine Ferrandiere ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Critically Ill ◽  
Primary Endpoint ◽  
Critically Ill Patients ◽  
Standard Care ◽  
Intravenous Iron ◽  
Prolonged Stay ◽  
Icu Stay ◽  
Icu Discharge ◽  
Prolonged Icu Stay

Abstract Background Anemia is a significant problem in patients on ICU. Its commonest cause, iron deficiency (ID), is difficult to diagnose in the context of inflammation. Hepcidin is a new marker of ID. We aimed to assess whether hepcidin levels would accurately guide treatment of ID in critically ill anemic patients after a prolonged ICU stay and affect the post-ICU outcomes. Methods In a controlled, single-blinded, multicenter study, anemic (WHO definition) critically ill patients with an ICU stay ≥ 5 days were randomized when discharge was expected to either intervention by hepcidin treatment protocol or control. In the intervention arm, patients were treated with intravenous iron (1 g of ferric carboxymaltose) when hepcidin was < 20 μg/l and with intravenous iron and erythropoietin for 20 ≤ hepcidin < 41 μg/l. Control patients were treated according to standard care (hepcidin quantification remained blinded). Primary endpoint was the number of days spent in hospital 90 days after ICU discharge (post-ICU LOS). Secondary endpoints were day 15 anemia, day 30 fatigue, day 90 mortality and 1-year survival. Results Of 405 randomized patients, 399 were analyzed (201 in intervention and 198 in control arm). A total of 220 patients (55%) had ID at discharge (i.e., a hepcidin < 41 μg/l). Primary endpoint was not different (medians (IQR) post-ICU LOS 33(13;90) vs. 33(11;90) days for intervention and control, respectively, median difference − 1(− 3;1) days, p = 0.78). D90 mortality was significantly lower in intervention arm (16(8%) vs 33(16.6%) deaths, absolute risk difference − 8.7 (− 15.1 to − 2.3)%, p = 0.008, OR 95% IC, 0.46, 0.22–0.94, p = 0.035), and one-year survival was improved (p = 0.04). Conclusion Treatment of ID diagnosed according to hepcidin levels did not reduce the post-ICU LOS, but was associated with a significant reduction in D90 mortality and with improved 1-year survival in critically ill patients about to be discharged after a prolonged stay. Trial registration www.clinicaltrial.gov NCT02276690 (October 28, 2014; retrospectively registered)

scholarly journals Effect of Early Nutritional Support on Clinical Outcomes of Critically Ill Patients with Sepsis and Septic Shock

2021 ◽  
Author(s):  
Jun Kwon Cha ◽  
Hyung-sook Kim ◽  
Eun Ji Kim ◽  
Eunsook Lee ◽  
Jae ho Lee ◽  
...  
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Protein Delivery ◽  
High Energy ◽  
Nutritional Requirement ◽  
Nutrition Risk ◽  
Log Linear ◽  
Sepsis And Septic Shock

Abstract PurposeThe initial nutritional delivery policy for patients with sepsis admitted to the intensive care unit (ICU) is not fully elucidated. This study aimed to determine whether initial adequate nutrition supply and route of nutrition delivery during the first week of sepsis onset may improve the clinical outcomes of critically ill septic patients. MethodsWe examined 834 adult patients with sepsis and septic shock in the ICU between November 2013 and May 2017 retrospectively. Poisson log-linear and Cox regressions were performed to assess the relationship between clinical outcomes, sex, modified nutrition risk in the critically ill (mNUTRIC) scores, sequential organ failure assessment and acute physiology and chronic health evaluation scores, route of nutrition delivery, and daily energy and protein delivery during the first week since sepsis onset. ResultsPatients who had higher protein intakes during the first week since sepsis onset had lower in-hospital mortality, while higher energy intakes were associated with lower the 30-day mortality. Route of nutrition delivery was not associated with 1-year mortality in the group with > 70% of the nutritional requirement; however, enteral feeding (EN) with supplemental parenteral nutrition (PN) was superior to only EN or only PN in patients who were underfed. ConclusionFor patients with sepsis and septic shock, a high daily average protein intake may lower in-hospital mortality and a high energy intake may lower the 30-day mortality, especially for patients with high mNUTRIC scores. For underfed patients, EN with supplemental PN may be better than EN or PN alone.

scholarly journals Energy target achievement and its determinants in critically ill COVID-19 patients in Indonesia

2021 ◽  
Vol 4 (2) ◽  
pp. 38-45
Author(s):  
Niken Puruhita ◽  
Febe Christianto ◽  
Luciana Sutanto ◽  
Banundari Rachmawati ◽  
Sofyan Harahap ◽  
...  
Keyword(s):  
Critically Ill ◽  
Secondary Data ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Nutrition Risk ◽  
Parenteral Route ◽  
Icu Stay ◽  
Icu Length Of Stay ◽  
Target Energy ◽  
Enteral And Parenteral Nutrition

Introduction. Achievement of energy target in critically ill Covid-19 patients in Intensive Care Unit (ICU) is challenging. This study was aimed to depict the possibility of achieving energy target and its determinants in critically ill Covid-19 patients. Methods. A cross sectional study was conducted in ICU of dr. Kariadi Hospital Semarang, Indonesia. Secondary data were obtained from Covid-19 patients who were in ICU for minimum 3 days, from March to December 2020. Data collected included age, sex, Body Mass Index (BMI), comorbidities, Modified Nutrition Risk in Critically Ill (mNUTRIC) score, energy intake, route of nutrition delivery (enteral or combination of enteral and parenteral nutrition), lactate status, ICU length of stay (LOS), duration of mechanical ventilator and mortality. Risk Prevalence calculations were conducted to measure risks. Variables with significant associations and p< 0.25 were included in multiple logistic regression. Results. A total of 188 subjects were included in the analysis. Most patients were male (62.8%) and obese (61.8%). As much as 56.9% patients were able to achieve energy target of 20 kcal/kgBW on day 3 of ICU stay. Those with low risk mNUTRIC score and nutrition delivery was through enteral and parenteral route were more likely to achieve target energy of 20 kcal/kgBW in the first 3 days in the ICU. Conclusions. Achieving energy target of 20 kcal on day 3 of ICU stay for critically ill Covid-19 patients is feasible. Low mNutric score and nutrition delivery through enteral and parenteral route were two determinants for the achievement.

scholarly journals Association Between Glycemic Gap and Mortality in Critically Ill Patients with Diabetes

2021 ◽  
Author(s):  
Ran Lou ◽  
Li Jiang ◽  
Bo Zhu
Keyword(s):  
Blood Glucose ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Predictive Power ◽  
Severe Hypoglycemia ◽  
Survival Group ◽  
Icu Stay ◽  
Arterial Blood ◽  
Patients With Diabetes ◽  
Average Glucose

Abstract Objectives: Dysglycemia is pervasive and associated with poor outcomes in critically ill patients. Hyperglycemia, hypoglycemia and blood glucose fluctuation might all affect the outcomes, but appropriate level of blood glucose is uncertain especially in patients with diabetes regarding to the situation of glucose control before hospitalization. This study was aimed to investigate the effect of difference between mean blood glucose during ICU stay and level of blood glucose prior to admission to ICU upon outcomes of critically ill patients with diabetes.Method: This retrospective study undertaken in a 24-bed intensive care unit(ICU). Patients with diabetes expected to stay for more than 24hs were enrolled, HbA1c was tested within 3 days after admission and converted to the A1C-derived average glucose (ADAG) by the equation: ADAG = [ ( HbA1c * 28.7 ) – 46.7 ] * 18-1, arterial blood glucose measurements were fourth per day routinely during the first 7 days after admission, the mean glucose level(MGL) and SOFA (within 3 days, 5 days and 7days) were calculated for each person, GAPadm and GAPmean was calculated as admission blood glucose and MGL minus ADAG respectively, the incidence of moderate hypoglycemia(MH), severe hypoglycemia (SH), total dosage of glucocorticoids and average daily dosage of insulin within 7 days, duration of renal replacement therapy(RRT), ventilator-free hours and non-ICU stay days within 28 days were also collected. Patients enrolled were divided into survival group and non-survival group according to survival or not at 28-day, compare GAPadm and GAPmean between the two groups and explore the relationship between GAP and mortality in these critically ill patients.Results: 431 patients were enrolled and divided into survival group (n=256) and non-survival group (n=175). It was shown that two groups had comparable level of HbA1c, the non-survivors had greater APACHE II, SOFA, GAPadm, GAPmean-3, GAPmean-5, GAPmean-7 and higher MH and SH incidences. Less duration of ventilator-free, non-ICU stay and longer duration of RRT were recorded in non-survival group, of whom received less carbohydrates intake, higher insulin daily dosage and glucocorticoid dosage. GAPmean-5 had the greatest predictive power with AUC of 0.807(95%CI: 0.762-0.851), the cut-off value was 3.6mmol/L(sensitivity 77.7% and specificity 76.6%). The AUC was increased to 0.852(95%CI: 0.814-0.889) incorporated with SOFA5 (NRI = 11.34%, P < 0.001 ). Conclusion: Glycemic GAP between mean level of blood glucose especially MGL within 5 days after admission to ICU and A1C-derived average glucose was independently associated with 28-day mortality of critically ill patients with diabetes. The predictive power was optimized with addition of the top level of SOFA within 5 days.

scholarly journals Interest of Treating Iron Deficiency, Diagnosed According to Hepcidin Quantification, on Outcomes After a Prolonged Icu Stay Compared to Standard Care: A Multicenter, Randomized, Single-blinded Trial

2020 ◽  
Author(s):  
sigismond lasocki ◽  
Pierre ASFAR ◽  
Samir JABER ◽  
Martine FERRANDIERE ◽  
Thomas KERFORNE ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Critically Ill ◽  
Primary Endpoint ◽  
Critically Ill Patients ◽  
Standard Care ◽  
Intravenous Iron ◽  
Prolonged Stay ◽  
Icu Stay ◽  
Icu Discharge ◽  
Prolonged Icu Stay

Abstract Background: Anemia is a significant problem in patients on ICU. Its commonest cause, iron deficiency (ID), is difficult to diagnosed in the context of inflammation. Hepcidin is a new marker of ID. We aimed to assess whether hepcidin levels would accurately guide treatment of ID in critically ill anemic patients after a prolonged ICU stay and affect the post-ICU outcomes. Methods: In a controlled, single-blinded, multicenter study, anemic (WHO definition) critically ill patients with an ICU stay ≥5 days were randomized when discharge was expected to either intervention by hepcidin treatment protocol or control. In the intervention arm patients were treated with intravenous iron (1g of ferric carboxymaltose) when hepcidin was <20 μg/l and with intravenous iron and erythropoietin for 20≤ hepcidin <41 μg/l. Control patients were treated according to standard care (hepcidin quantification remained blinded). Primary endpoint was the number of days spent in hospital 90 days after ICU discharge (post-ICU LOS). Secondary endpoints were day 15 anemia, day 30 fatigue and day 90 mortality. Results: Of 405 randomized patients, 399 were analyzed (201 in intervention and 198 in control arm). 220(55%) had ID at discharge (i.e. an hepcidin <41 μg/l). Primary endpoint was not different (medians(IQR) post-ICU LOS 33(13;90) vs 33(11;90) days for intervention and control respectively, median difference -1(-3;1) days, p=0.78). D90 mortality was significantly lower in the intervention arm (16(8%) vs 33(16.6%) deaths, absolute risk difference -8.7 (-15.1 to -2.3)%, p=0.008). Conclusion: Treatment of ID diagnosed according to hepcidin levels did not reduce the post-ICU LOS, but may reduce the long-term mortality in critically ill patients about to be discharged after a prolonged stay. Trial Registration: www.clinicaltrial.gov NCT02276690 (October 28, 2014; Retrospectively registered)

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