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.

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.

scholarly journals Optimal Time and Target for Evaluating Energy Delivery after Adjuvant Feeding with Small Bowel Enteral Nutrition in Critically Ill Patients at High Nutrition Risk

Nutrients ◽  
2019 ◽  
Vol 11 (3) ◽  
pp. 645
Author(s):  
Wei-Ning Wang ◽  
Mei-Fang Yang ◽  
Chen-Yu Wang ◽  
Chiann-Yi Hsu ◽  
Bor-Jen Lee ◽  
...  
Keyword(s):  
Small Bowel ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Energy Intake ◽  
Critically Ill Patients ◽  
Protein Intake ◽  
Optimal Time ◽  
Nutrition Risk ◽  
Energy Delivery ◽  
Achievement Rate

Small bowel enteral nutrition (SBEN) may improve nutrient delivery to critically ill patients intolerant of gastric enteral nutrition. However, the optimal time and target for evaluating SBEN efficacy are unknown. This retrospective cohort study investigates these parameters in 55 critically ill patients at high nutrition risk (modified NUTRIC score ≥ 5). Daily actual energy intake was recorded from 3 days before SBEN initiation until 7 days thereafter. The energy achievement rate (%) was calculated as follows: (actual energy intake/estimated energy requirement) × 100. The optimal time was determined from the day on which energy achievement rate reached >60% post-SBEN. Assessment results were as follows: median APACHE II score, 27; SOFA score, 10.0; modified NUTRIC score, 7; and median time point of SBEN initiation, ICU day 8. The feeding volume, energy and protein intake, and achievement rate (%) of energy and protein intake increased significantly after SBEN (p < 0.001). An energy achievement rate less than 65% 3 days after SBEN was significantly associated with increased mortality after adjusting for confounding factors (odds ratio, 4.97; 95% confidence interval, 1.44–17.07). SBEN improves energy delivery in critically ill patients who are still at high nutrition risk after 1 week of stomach enteral nutrition.

Nutrition Risk in Critically Ill Versus the Nutritional Risk Screening 2002: Are They Comparable for Assessing Risk of Malnutrition in Critically Ill Patients?

2018 ◽  
Vol 43 (1) ◽  
pp. 81-87 ◽  
Author(s):  
Cecilia Canales ◽  
Ali Elsayes ◽  
D. Dante Yeh ◽  
Donna Belcher ◽  
Anna Nakayama ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Nutritional Risk ◽  
Risk Screening ◽  
Nutrition Risk ◽  
Nutritional Risk Screening 2002 ◽  
Nutritional Risk Screening

scholarly journals The Association between Nutritional Status and In-Hospital Mortality of COVID-19 in Critically-Ill Patients in the ICU

Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3302
Author(s):  
Michał Czapla ◽  
Raúl Juárez-Vela ◽  
Vicente Gea-Caballero ◽  
Stanisław Zieliński ◽  
Marzena Zielińska
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nutritional Status ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Nutritional Risk ◽  
Risk Of Death ◽  
The Impact

Background: Coronavirus disease 2019 (COVID-19) has become one of the leading causes of death worldwide. The impact of poor nutritional status on increased mortality and prolonged ICU (intensive care unit) stay in critically ill patients is well-documented. This study aims to assess how nutritional status and BMI (body mass index) affected in-hospital mortality in critically ill COVID-19 patients Methods: We conducted a retrospective study and analysed medical records of 286 COVID-19 patients admitted to the intensive care unit of the University Clinical Hospital in Wroclaw (Poland). Results: A total of 286 patients were analysed. In the sample group, 8% of patients who died had a BMI within the normal range, 46% were overweight, and 46% were obese. There was a statistically significantly higher death rate in men (73%) and those with BMIs between 25.0–29.9 (p = 0.011). Nonsurvivors had a statistically significantly higher HF (Heart Failure) rate (p = 0.037) and HT (hypertension) rate (p < 0.001). Furthermore, nonsurvivors were statistically significantly older (p < 0.001). The risk of death was higher in overweight patients (HR = 2.13; p = 0.038). Mortality was influenced by higher scores in parameters such as age (HR = 1.03; p = 0.001), NRS2002 (nutritional risk score, HR = 1.18; p = 0.019), PCT (procalcitonin, HR = 1.10; p < 0.001) and potassium level (HR = 1.40; p = 0.023). Conclusions: Being overweight in critically ill COVID-19 patients requiring invasive mechanical ventilation increases their risk of death significantly. Additional factors indicating a higher risk of death include the patient’s age, high PCT, potassium levels, and NRS ≥ 3 measured at the time of admission to the ICU.

SUN-LB644: Nutritional Risk Assessment in Critically Ill Patients Using Nutrition Risk in Critically Ill (NUTRIC) Score

2019 ◽  
Vol 38 ◽  
pp. S298-S299
Author(s):  
R. Kalavathy ◽  
Sumaya Ahmed Al Araj ◽  
Nazneen Zara ◽  
Yousuf Altair ◽  
Khadra Omer
Keyword(s):  
Risk Assessment ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Nutritional Risk ◽  
Nutrition Risk

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 NUTRIC and Modified NUTRIC are Accurate Predictors of Outcome in End-Stage Liver Disease: A Validation in Critically Ill Patients with Liver Cirrhosis

Nutrients ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 2134
Author(s):  
Ulrich Mayr ◽  
Julia Pfau ◽  
Marina Lukas ◽  
Ulrike Bauer ◽  
Alexander Herner ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Area Under Curve ◽  
Nutritional Risk ◽  
Predictors Of Outcome ◽  
Discriminative Ability ◽  
Nutrition Risk ◽  
Prognostic Accuracy ◽  
Cirrhotic Patients ◽  
End Stage

Malnutrition in critically ill patients with cirrhosis is a frequent but often overlooked complication with high prognostic relevance. The Nutrition Risk in Critically ill (NUTRIC) score and its modified variant (mNUTRIC) were established to assess the nutrition risk of intensive care unit patients. Considering the high mortality of cirrhosis in critically ill patients, this study aims to evaluate the discriminative ability of NUTRIC and mNUTRIC to predict outcome. We performed a retro-prospective evaluation in 150 Caucasian cirrhotic patients admitted to our ICU. Comparative prognostic analyses between NUTRIC and mNUTRIC were assessed in 114 patients. On ICU admission, a large proportion of 65% were classified as high NUTRIC (6–10) and 75% were categorized as high mNUTRIC (5–9). High nutritional risk was linked to disease severity and poor outcome. NUTRIC was moderately superior to mNUTRIC in prediction of 28-day mortality (area under curve 0.806 vs. 0.788) as well as 3-month mortality (area under curve 0.839 vs. 0.819). We found a significant association of NUTRIC and mNUTRIC with MELD, CHILD, renal function, interleukin 6 and albumin, but not with body mass index. NUTRIC and mNUTRIC are characterized by high prognostic accuracy in critically ill patients with cirrhosis. NUTRIC revealed a moderate advantage in prognostic ability compared to mNUTRIC.

scholarly journals Targeted Energy Intake Is the Important Determinant of Clinical Outcomes in Medical Critically Ill Patients with High Nutrition Risk

Nutrients ◽  
2018 ◽  
Vol 10 (11) ◽  
pp. 1731 ◽  
Author(s):  
Chen-Yu Wang ◽  
Pin-Kuei Fu ◽  
Chun-Te Huang ◽  
Chao-Hsiu Chen ◽  
Bor-Jen Lee ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Energy Intake ◽  
Critically Ill Patients ◽  
Risk Group ◽  
Mortality Rates ◽  
High Energy ◽  
Cross Sectional ◽  
Nutrition Risk

The clinical conditions of critically ill patients are highly heterogeneous; therefore, nutrient requirements should be personalized based on the patient’s nutritional status. However, nutritional status is not always considered when evaluating a patient’s nutritional therapy in the medical intensive care unit (ICU). We conducted a retrospective cross-sectional study to assess the effect of ICU patients’ nutrition risk status on the association between energy intake and clinical outcomes (i.e., hospital, 14-day and 28-day mortality). The nutrition risk of critically ill patients was classified as either high- or low-nutrition risk using the modified Nutrition Risk in the Critically Ill score. There were 559 (75.3%) patients in the high nutrition risk group, while 183 patients were in the low nutrition risk group. Higher mean energy intake was associated with lower hospital, 14-day and 28-day mortality rates in patients with high nutrition risk; while there were no significant associations between mean energy intake and clinical outcomes in patients with low nutrition risk. Further examination of the association between amount of energy intake and clinical outcomes showed that patients with high nutrition risk who consumed at least 800 kcal/day had significantly lower hospital, 14-day and 28-day mortality rates. Although patients with low nutrition risk did not benefit from high energy intake, patients with high nutrition risk are suggested to consume at least 800 kcal/day in order to reduce their mortality rate in the medical ICU.

scholarly journals Semi-elemental versus polymeric formula for enteral nutrition in brain-injured critically ill patients: a randomized trial

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Laurent Carteron ◽  
Emmanuel Samain ◽  
Hadrien Winiszewski ◽  
Gilles Blasco ◽  
Anne-Sophie Balon ◽  
...  
Keyword(s):  
Enteral Nutrition ◽  
Critically Ill ◽  
Energy Intake ◽  
Primary Endpoint ◽  
Critically Ill Patients ◽  
Daily Energy Intake ◽  
Gastrointestinal Tolerance ◽  
Brain Injured ◽  
Daily Energy ◽  
Polymeric Formula

Abstract Background The properties of semi-elemental enteral nutrition might theoretically improve gastrointestinal tolerance in brain-injured patients, known to suffer gastroparesis. The purpose of this study was to compare the efficacy and tolerance of a semi-elemental versus a polymeric formula for enteral nutrition (EN) in brain-injured critically ill patients. Methods Prospective, randomized study including brain-injured adult patients [Glasgow Coma Scale (GCS) ≤ 8] with an expected duration of mechanical ventilation > 48 h. Intervention: an enteral semi-elemental (SE group) or polymeric (P group) formula. EN was started within 36 h after admission to the intensive care unit and was delivered according to a standardized nurse-driven protocol. The primary endpoint was the percentage of patients who received both 60% of the daily energy goal at 3 days and 100% of the daily energy goal at 5 days after inclusion. Tolerance of EN was assessed by the rate of gastroparesis, vomiting and diarrhea. Results Respectively, 100 and 95 patients were analyzed in the SE and P groups: Age (57[44–65] versus 55[40–65] years) and GCS (6[3–7] versus 5[3–7]) did not differ between groups. The percentage of patients achieving the primary endpoint was similar (46% and 48%, respectively; relative risk (RR) [95% confidence interval (CI)] = 1.05 (0.78–1.42); p = 0.73). The mean daily energy intake was, respectively, 20.2 ± 6.3 versus 21.0 ± 6.5 kcal/kg/day (p = 0.42). Protein intakes were 1.3 ± 0.4 versus 1.1 ± 0.3 g/kg/day (p < 0.0001). Respectively, 18% versus 12% patients presented gastroparesis (p = 0.21), and 16% versus 8% patients suffered from diarrhea (p = 0.11). No patient presented vomiting in either group. Conclusion Semi-elemental compared to polymeric formula did not improve daily energy intake or gastrointestinal tolerance of enteral nutrition. Trial registration EudraCT/ID-RCB 2012-A00078-35 (registered January 17, 2012).

scholarly journals Use of mNUTRIC-Score for Nutrition Risk Assessment and Prognosis Prediction in Critically Ill Patients with COVID-19: A Retrospective Observational Study

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Francisco G. Yanowsky-Escatell ◽  
Areli L. Ontiveros-Galindo ◽  
Kevin J. Arellano-Arteaga ◽  
Luis M. Román-Pintos ◽  
Carlos A. Andrade-Castellanos ◽  
...  
Keyword(s):  
Risk Factor ◽  
Observational Study ◽  
Critically Ill ◽  
Mortality Risk ◽  
Critically Ill Patients ◽  
Cox Regression ◽  
Nutritional Risk ◽  
Retrospective Observational Study ◽  
Nutrition Risk ◽  
Cox Regression Analysis

Introduction. Nutritional risk is highly prevalent in patients with COVID-19. Relevant data on nutritional assessment in the critically ill population are scarce. This study was conducted to evaluate the modified Nutrition Risk in the Critically Ill (mNUTRIC)-Score as a mortality risk factor in mechanically ventilated patients with COVID-19. Methods. We conducted this retrospective observational study in critically ill patients with COVID-19. Patients’ characteristics and clinical information were obtained from electronic medical records. The nutritional risk for each patient was assessed at the time of mechanical ventilation using the mNUTRIC-Score. The major outcome was 28-day mortality. Results. Ninety-eight patients were analyzed (mean age, 57.22 ± 13.66 years, 68.4% male); 46.9% of critically ill COVID-19 patients were categorized as being at high nutrition risk (mNUTRIC-Score of ≥5). A multivariate logistic regression model indicated that high nutritional risk has higher 28-day hospital mortality (OR = 4.206, 95% CI: 1.147–15.425, p = 0.030 ). A multivariate Cox regression analysis showed that high-risk mNUTRIC-Score had a significantly increased full-length mortality risk during hospitalization (OR = 1.991, 95% CI: 1.219–3.252, p = 0.006 ). Conclusion. The mNUTRIC-Score is an independent mortality risk factor during hospitalization in critically ill COVID-19 patients.

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