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Nutritional critical ill

Amanda Haney, Emily Burritt, Christopher J Babbitt
BACKGROUND AND AIMS: Children who are critically ill undergo metabolic stress and it is important that they receive adequate calories and protein in order to recover. Our objective was to investigate the impact of early enteral nutrition (EEN) on pediatric intensive care (PICU) patients with acute respiratory failure. METHODS: A retrospective cohort study was performed on all patients admitted to a 20 bed PICU at a tertiary children's hospital over a 30 month period...
August 2018: Clinical Nutrition ESPEN
Abdulkerim Yildiz, Ali Yigit, Ali Ramazan Benli
Background: The geriatric population in intensive care units (ICUs) has recently increased. The aim of this study was to analyse the impact of initial complete blood count (CBC)-related parameters and nutritional status on morbidity and mortality in geriatric ICU patients. Methods: A retrospective analysis was made of geriatric patients admitted to our tertiary adult ICU for 1 year. Patients with a length of stay (LOS) of < 48 h, with hematological malignancy or age < 65 years age were excluded from the study...
July 2018: Journal of Clinical Medicine Research
Rosalie Yandell, Susan Wang, Peter Bautz, Alison Shanks, Stephanie O'Connor, Adam Deane, Kylie Lange, Marianne Chapman
BACKGROUND: Optimising nutrition support in critically ill patients with an open abdomen is challenging. OBJECTIVES: The aims of this study were to (i) quantify the amount and adequacy of nutrition support administered and (ii) determine any relationships that exist between mode of nutrition support delivery and clinical outcomes in critically ill patients with an open abdomen. METHODS: A retrospective review of critically ill patients mechanically ventilated for at least 48 h with an open abdomen in a mixed quaternary referral intensive care unit...
June 11, 2018: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
Ummu K Jamaludin, Fatanah M Suhaimi, Normy Norfiza Abdul Razak, Azrina Md Ralib, Mohd Basri Mat Nor, Christopher G Pretty, Luqman Humaidi
BACKGROUND AND OBJECTIVE: Blood glucose variability is common in healthcare and it is not related or influenced by diabetes mellitus. To minimise the risk of high blood glucose in critically ill patients, Stochastic Targeted Blood Glucose Control Protocol is used in intensive care unit at hospitals worldwide. Thus, this study focuses on the performance of stochastic modelling protocol in comparison to the current blood glucose management protocols in the Malaysian intensive care unit...
August 2018: Computer Methods and Programs in Biomedicine
Arthur R H van Zanten
PURPOSE OF REVIEW: To summarize the most recent advances in acute metabolic care and critical care nutrition. RECENT FINDINGS: Recent research has demonstrated unknown consequences of high protein and amino acid administration in the early phase of ICU stay associated with dysregulated glucagon release leading to hepatic amino acid breakdown and suggested adverse effects on autophagy and long-term outcome. Progress has been made to measure body composition in the ICU...
June 8, 2018: Current Opinion in Critical Care
Rianne Boot, Kristine W A C Koekkoek, Arthur R H van Zanten
PURPOSE OF REVIEW: To provide an overview of recent findings concerning refeeding syndrome (RFS) among critically ill patients and recommendations for daily practice. RECENT FINDINGS: Recent literature shows that RFS is common among critically ill ventilated patients. Usual risk factors for non-ICU patients addressed on ICU admission do not identify patients developing RFS. A marked drop of phosphate levels (>0.16 mmol/l) from normal levels within 72 h of commencement of feeding, selects patients that benefit from hypocaloric or restricted caloric intake for at least 48 h resulting in lower long-term mortality...
June 8, 2018: Current Opinion in Critical Care
Arthur R H van Zanten, Laurent Petit, Jan De Waele, Hans Kieft, Janneke de Wilde, Peter van Horssen, Marianne Klebach, Zandrie Hofman
BACKGROUND: Optimal energy and protein provision through enteral nutrition is essential for critically ill patients. However, in clinical practice, the intake achieved is often far below the recommended targets. Because no polymeric formula with sufficient protein content is available, adequate protein intake can be achieved only by supplemental amino acids or semi-elemental formula administration. In the present study, we investigated whether protein intake can be increased with a new, very high intact-protein formula (VHPF) for enteral feeding...
June 12, 2018: Critical Care: the Official Journal of the Critical Care Forum
Alistair S Curry, Shkun Chadda, Aurélie Danel, Douglas L Nguyen
Objectives: Gastrointestinal (GI) intolerance is associated with adverse outcomes in critically ill patients receiving enteral nutrition (EN). The objective of this analysis is to quantify the cost of GI intolerance and the cost implications of starting with semi-elemental EN in intensive care units (ICUs). Study design: A US-based cost-consequence model was developed to compare the costs for patients with and without GI intolerance and the costs with semi-elemental or standard EN while varying the proportion of GI intolerance cases avoided...
2018: ClinicoEconomics and Outcomes Research: CEOR
Sharon R Lewis, Oliver J Schofield-Robinson, Phil Alderson, Andrew F Smith
BACKGROUND: Critically ill people are at increased risk of malnutrition. Acute and chronic illness, trauma and inflammation induce stress-related catabolism, and drug-induced adverse effects may reduce appetite or increase nausea and vomiting. In addition, patient management in the intensive care unit (ICU) may also interrupt feeding routines. Methods to deliver nutritional requirements include provision of enteral nutrition (EN), or parenteral nutrition (PN), or a combination of both (EN and PN)...
June 8, 2018: Cochrane Database of Systematic Reviews
C Mantegazza, N Landy, G V Zuccotti, J Köglmeier
BACKGROUND: Parenteral Nutrition (PN) is prescribed to children with intestinal failure. Although life saving, complications are common. Recommendations for indications and constituents of PN are made in the 2005 guidelines by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). The aim of this study was to establish if the indications for prescribing PN in a tertiary children's hospital were appropriate, and to identify complications encountered. Data were compared to those published by the National Confidential Enquiry into patient outcome and death (NCEPOD) carried out in the United Kingdom in 2010...
June 8, 2018: Italian Journal of Pediatrics
Mary F Stuever, Ryan F Kidner, Floria E Chae, David C Evans
Enteral nutrition (EN) is widely used in intensive care units around the world, but the optimal dosing strategy during the first week of critical illness is still controversial. Numerous studies in the past decade have provided conflicting recommendations regarding the roles of trophic and permissive/intentional underfeeding strategies. Further complicating effective medical decision making is the widespread, yet unintentional and persistent underdelivery of prescribed energy and protein, in addition to the trend for recommending ever-higher amounts of protein delivery...
June 2018: Nutrition in Clinical Practice
Mary S McCarthy, Robert G Martindale
Acute illness-associated malnutrition leads to muscle wasting, delayed wound healing, failure to wean from ventilator support, and possibly higher rates of infection and longer hospital stays unless appropriate metabolic support is provided in the form of nutrition therapy. Agreement is still lacking about the value of individual immune-modulating substrates for specific patient populations. However, it has long been agreed that there are 3 primary targets for these substrates: 1) mucosal barrier function, 2) cellular defense function, and 3) local and systemic inflammation...
June 2018: Nutrition in Clinical Practice
Jane Maria Gervasio
Soybean oil-based lipid injectable emulsion (SO-based ILE) is an 18-carbon, ω-6 macronutrient providing a concentrated source of calories, which can be administered in or with parenteral nutrition to patients unable to tolerate or consume adequate enteral nutrition. Beyond the provision of energy, SO-based ILE provides linoleic and linolenic acid, 2 essential fatty acids necessary for the prevention of essential fatty acid deficiency. However, SO-based ILE with its high levels of ω-6 fatty acids, long-chain triglycerides, phospholipid emulsifiers, and glycerin has been associated with worsening clinical outcomes, including increase of infections, lengthier intensive care and hospital stay, and prolonged mechanical ventilation...
June 2018: Nutrition in Clinical Practice
Yaseen M Arabi, Hasan M Al-Dorzi
PURPOSE OF REVIEW: Full nutritional support during the acute phase of critical illness has traditionally been recommended to reduce catabolism and prevent malnutrition. Approaches to achieve full nutrition include early initiation of nutritional support, targeting full nutritional requirement as soon as possible and initiation of supplemental parenteral nutrition when enteral nutrition does not reach the target. RECENT FINDINGS: Existing evidence supports early enteral nutrition over delayed enteral nutrition or early parenteral nutrition...
June 4, 2018: Current Opinion in Critical Care
Danielle E Bear, Nicholas Hart, Zudin Puthucheary
PURPOSE OF REVIEW: There has been a recent shift in the focus of providing nutrition support to critically ill adults towards enhancing recovery and promoting survivorship. With this has come an evaluation of our current approaches to nutrition support, which includes whether continuous feeding is optimal, particularly for reducing muscle wasting, but also for managing blood glucose levels and feeding intolerance and at the organizational level. This review will discuss the pros and cons of using intermittent and continuous feeding relating to several aspects of the management of critically ill adults...
June 4, 2018: Current Opinion in Critical Care
Megan Rattray, Andrea Marshall, Ben Desbrow, Shelley Roberts
BACKGROUND: Evidence-based guidelines (EBG) recommend recommencing oral feeding (liquids and solids) ≤24 hours after surgery. The aims of this study were to determine time to first diet (any) and solid-diet prescriptions, delivery, and intakes among adult, non-critically ill, postoperative patients. METHODS: This prospective cross-sectional study included 100 postsurgical patients. Demographic and perioperative dietary-related data were collected from patients' medical records or via direct observation...
June 7, 2018: Nutrition in Clinical Practice
Greet De Vlieger, Catherine Ingels, Pieter J Wouters, Yves Debaveye, Ilse Vanhorebeek, Joost Wauters, Alexander Wilmer, Michael P Casaer, Greet Van den Berghe
OBJECTIVE: In the EPaNIC RCT (N=4,640), postponing the administration of parenteral nutrition (PN) to beyond one week in the intensive care unit (ICU) (late-PN) reduced the number of ICU-acquired infections and the costs for antimicrobial drugs as compared with initiation of PN within 24-48h of admission (early-PN). In a secondary analysis, we hypothesise that late-PN reduces the odds to acquire an invasive fungal infection (IFI) in the ICU. METHODS: The impact of late-PN (N=2,328) versus early-PN (N=2,312) on acquired IFI and on the likelihood to acquire an IFI over time was assessed in univariable and multivariable analyses...
June 2, 2018: Clinical Microbiology and Infection
Zahra Vahdat Shariatpanahi, Fatemeh Jamshidi, Javad Nasrollahzadeh, Zohreh Amiri, Houman Teymourian
Background: In patients admitted to the Intensive Care Unit (ICU), Enteral Nutrition (EN) is the first choice for feeding support, however, it is often complicated by gastrointestinal side effects, such as diarrhea. There are no studies that have specifically evaluated effect of a prebiotic, which prevents diarrhea during enteral nutrition. Objective: This study aimed at evaluating the effect of honey in enteral diet during occurrence of diarrhea and fecal microbiotain in critically ill patients...
February 2018: Anesthesiology and Pain Medicine
Mario I Perman, Agustín Ciapponi, Juan Va Franco, Cecilia Loudet, Adriana Crivelli, Virginia Garrote, Gastón Perman
BACKGROUND: There are controversies about the amount of calories and the type of nutritional support that should be given to critically-ill people. Several authors advocate the potential benefits of hypocaloric nutrition support, but the evidence is inconclusive. OBJECTIVES: To assess the effects of prescribed hypocaloric nutrition support in comparison with standard nutrition support for critically-ill adults SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Cochrane Library), MEDLINE, Embase and LILACS (from inception to 20 June 2017) with a specific strategy for each database...
June 4, 2018: Cochrane Database of Systematic Reviews
Ira Orinovsky, Ela Raizman
BACKGROUND: Enteral nutrition in intensive care unit patients has important prognostic clinical value. Feeding protocols are recommended by clinical practice guidelines as a key strategy to maximize the benefits and minimize the risks of enteral feedings. OBJECTIVE: To examine whether enteral nutrition in critically ill patients could be improved by implementation of a nurse-led evidence-based feeding protocol. METHODS: An interprofessional group of intensive care unit nurses, physicians, and a clinical dietitian designed a protocol to address and correct the shortcomings of enteral feeding...
June 2018: Critical Care Nurse
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