1
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Talks BJ, Lynch N, Bowe I, Kelly C, Iqbal MS. A retrospective cohort study of reactive nasogastric tube feeding for head and neck cancer patients undergoing radiotherapy: Clinical and financial implications. Clin Otolaryngol 2024; 49:359-362. [PMID: 38421130 DOI: 10.1111/coa.14149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/13/2023] [Accepted: 02/11/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Benjamin James Talks
- Northern Head and Neck Cancer Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle Upon Tyne, UK
- Newcastle University Medical School, Newcastle University, Newcastle Upon Tyne, UK
| | - Nola Lynch
- Northern Head and Neck Cancer Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Isobel Bowe
- Northern Head and Neck Cancer Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Charles Kelly
- Northern Head and Neck Cancer Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle Upon Tyne, UK
- Newcastle University Medical School, Newcastle University, Newcastle Upon Tyne, UK
| | - Muhammad Shahid Iqbal
- Northern Head and Neck Cancer Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle Upon Tyne, UK
- Newcastle University Medical School, Newcastle University, Newcastle Upon Tyne, UK
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2
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Duruvasal PD, Devi U, Patil U, Sethuraman G. Comparison of Paladai Cup Against Nifty Cup Feeding in Preterm Low-Birth-Weight Infants: An Open-Labeled Randomized Controlled Trial. Breastfeed Med 2024. [PMID: 38634633 DOI: 10.1089/bfm.2023.0308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Background: Neonatal Intuitive Feeding Technology (NIFTY) cup feeding has been found to be feasible in preterm low-birth-weight babies. However, literature on direct comparison of the same with paladai feeding is lacking. Methods: In this open-labeled, randomized controlled trial, preterm infants (<34 weeks/<1800 g) on full oral gastric tube feeding for at least 3 consecutive days, eligible to be given a trial of suck and swallow cup feeding, prior to initiation of direct breastfeeding, were randomized to the two feeding intervention groups: paladai cup and Nifty cup. The primary outcome was the time taken from initiation of oral cup feeds to reaching complete gavage-free cup feeds for at least 24 hours. Secondary outcomes were the ease of use of both instruments, the adverse effects during and within 10 minutes after feeding, and anthropometric parameters (head circumference and weight gain). Results: The median (IQR) time taken from initiation to complete transition to full cup feeding for at least 24 hours was not significantly different [4(3,7) days in Nifty cup group versus 3(2,6) days in paladai cup group, p = 0.25]. Mean ± SD weight gain from intervention to discharge was also similar in both the groups (16 ± 6 g/kg/day in Nifty cup group versus 17 ± 5 g/kg/day in paladai cup group, p = 0.18). Adverse events did not differ (32.9% in group A versus 27.1% in group B, p = 0.580). Nurses did not find any difference in ease of teaching caregivers [median (IQR) Nifty cup group 4(4,5) versus paladai cup group 4(4,5), p = 0.13]. Conclusion: The efficacy and adverse event rates were similar between Nifty cup feeding and paladai cup feeding in preterm infants. Both feeding modalities can be used prior to transition to direct breastfeeding in preterm low-birth-weight infants.
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Affiliation(s)
| | - Usha Devi
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - Utkarsh Patil
- Department of Neonatology, Chettinad Hospital & Research Institute, Kanchipuram, India
| | - Giridhar Sethuraman
- Department of Neonatology, Chettinad Hospital & Research Institute, Kanchipuram, India
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3
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Lee SS. Retrograde jejunoduodenogastric intussusception associated with fully functioning nonballoon nasojejunal feeding catheter: A case report. Medicine (Baltimore) 2024; 103:e37772. [PMID: 38608117 PMCID: PMC11018159 DOI: 10.1097/md.0000000000037772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/11/2024] [Indexed: 04/14/2024] Open
Abstract
RATIONALE Retrograde jejunoduodenogastric intussusception refers to invagination of distal small intestine into the stomach. It is extremely rare. It is often associated with displaced feeding catheter in which its balloon tip migrates past the gastric pylorus. The intussusception is triggered by retraction of migrated catheter. It is often accompanied by feeding intolerance or catheter malfunction. This report describes a distinctive case of retrograde jejunoduodenogastric intussusception associated with a fully functioning nonballoon nasojejunal tube. PATIENT CONCERN A 19-year-old female was presented with repeated vomiting and abdominal distension for 5 days. DIAGNOSIS An abdominal computerized tomography revealed retrograde jejunoduodenogastric intussusception causing air/fluid-filled gastric distension. Immediate endoscopic examination revealed a loop of small intestine, protruding through the pylorus. Progressed ischemia of the migrated small bowel loop was confirmed. INTERVENTIONS At laparotomy, a jejunal loop migrating into the duodenum and stomach at the level of the ligament of Treitz was noticed. After manual reduction of migrated bowel, 2 segmental resections of necrotic segment were performed. A feeding jejunostomy was constructed in the proximal jejunum. OUTCOMES Enteral feeding through the surgically constructed feeding jejunostomy was started on the 5th operative day and the patient was discharged on the 16th postoperative day. LESSONS When a patient under tube feeding exhibits abrupt intractable gastroesophageal reflux with a sign of catheter migration, we must consider the possibility of catheter-related intussusception. Having a fully functioning feeding catheter with nonballoon tip does not preclude retrograde jejunoduodenogastric intussusception.
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Affiliation(s)
- Seung Soo Lee
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- Department of Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
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4
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Nguyen C, Singh G, Rubio K, Mclemore K, Kuschner W. Par enteral Nutrition in the Critically Ill Adult: A Narrative Review. J Intensive Care Med 2024:8850666241246748. [PMID: 38602149 DOI: 10.1177/08850666241246748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Malnutrition in adult intensive care unit patients is associated with poor clinical outcomes. Providing adequate nutritional support to the critically ill adult should be an important goal for the intensivist. This narrative review aims to delineate the role of parenteral nutrition (PN) in meeting nutritional goals. We examined the data regarding the safety and efficacy of PN compared to enteral nutrition. In addition, we describe practical considerations for the use of PN in the ICU including patient nutritional risk stratification, nutrient composition selection for PN, route of PN administration, and biochemical monitoring.
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Affiliation(s)
- Christopher Nguyen
- Pulmonary, Critical Care and Sleep Medicine Section, Veterans Affairs Palo Alto Health Care System, Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Gaurav Singh
- Pulmonary, Critical Care and Sleep Medicine Section, Veterans Affairs Palo Alto Health Care System, Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Karen Rubio
- Department of Intensive Care Medicine, Kaiser Oakland Medical Center, Oakland, CA, USA
| | - Karen Mclemore
- Department of Intensive Care Medicine, Kaiser Oakland Medical Center, Oakland, CA, USA
| | - Ware Kuschner
- Pulmonary, Critical Care and Sleep Medicine Section, Veterans Affairs Palo Alto Health Care System, Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
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Csomós Á, Klicsu L, László I, Bobek I, Sárkány Á, Gál B. [Artificial nutrition in intensive care: Hungarian results of the EuroPN study]. Orv Hetil 2024; 165:531-537. [PMID: 38583139 DOI: 10.1556/650.2024.33017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 02/17/2024] [Indexed: 04/09/2024]
Abstract
Bevezetés: A kritikus állapotú betegek mesterséges táplálásának
jelentősége jól ismert, hiányában a folyamatos fehérjelebontás miatt romlik a
sebgyógyulás, valamint emelkedik a lélegeztetőgépen töltött napok száma.
Célkitűzés: A korábban publikált EuroPN nemzetközi
vizsgálat célja az volt, hogy európai összehasonlításban felmérje a részt vevő
intenzív osztályok aktuális táplálási gyakorlatát, és megvizsgálja a kalória-,
illetve fehérjebevitel hatását a lélegeztetőgépről való leszoktatásban és a 90
napos halálozásban. A jelen kézirat a vizsgálatban részt vevő magyarországi
osztályok eredményeit elemzi. Módszer: Vizsgálatunkba azokat a
betegeket vontuk be, akiket legalább 5 napja kezeltek az intenzív osztályon. A
klinikai és a táplálási adatokat napokra bontva gyűjtöttük az intenzív osztályos
felvételt követő első 5 napban retrospektíven, majd azt követően maximum 15
napon át (vagy az elbocsátás/elhalálozás napjáig) prospektíven. A
betegkimeneteli adatokat a 15., a 30. és a 90. napon rögzítettük.
Eredmények: Magyarországról 6 intenzív osztályról összesen
111 beteget vontunk be a vizsgálatba. A kumulatív kalória- és fehérjebevitel
tekintetében a magyarországi betegek nagyobb arányban kapták meg az
ESPEN-célértékeket: kalória esetében az előírt kalória 92%-át (95% CI 68; 118)
sikerült biztosítani (vs. 83% Európában [95% CI 59; 107]);
fehérje esetében pedig még jelentősebb a különbség: Magyarországon 83% (95%CI
57; 121), ezzel szemben Európában 65% (95% CI 41; 91) volt a bevitel és az
ESPEN-célérték aránya. Megbeszélés és következtetés: A
nemzetközi EuroPN-adatelemzésben a nagyobb kumulatív kalória- és fehérjebevitel
csökkentette a lélegeztetőgépről való leszoktatás időtartamát. A magyarországi
betegek esetében gyorsabban értük el ezeket a célértékeket, köszönhetően annak,
hogy a kiegészítő parenteralis táplálást nagyobb arányban alkalmaztuk. Orv
Hetil. 2024; 165(14): 531–537.
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Affiliation(s)
- Ákos Csomós
- 1 Észak-pesti Centrumkórház - Honvédkórház, Központi Aneszteziológiai és Intenzív Terápiás Osztály Budapest, Róbert K. krt. 44., 1134 Magyarország
| | - László Klicsu
- 2 Szabolcs-Szatmár-Bereg Vármegyei Oktatókórház, Nyíregyházi Jósa András Tagkórház, Aneszteziológiai és Intenzív Terápiás Osztály Nyíregyháza Magyarország
| | - István László
- 3 Debreceni Egyetem, Általános Orvostudományi Kar, Klinikai Központ, Aneszteziológiai és Intenzív Terápiás Klinika Debrecen Magyarország
| | - Ilona Bobek
- 4 Dél-pesti Centrumkórház, Központi Aneszteziológiai és Intenzív Betegellátó Osztály Budapest Magyarország
| | - Ágnes Sárkány
- 5 Fejér Vármegyei Szent György Egyetemi Oktató Kórház, Központi Aneszteziológiai és Intenzív Betegellátó Osztály Székesfehérvár Magyarország
| | - Béla Gál
- 6 Veszprém Vármegyei Csolnoky Ferenc Kórház, Központi Aneszteziológiai és Intenzív Terápiás Osztály Veszprém Magyarország
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Cridge H, Parker VJ, Kathrani A. Nutritional management of pancreatitis and concurrent disease in dogs and cats. J Am Vet Med Assoc 2024:1-7. [PMID: 38569533 DOI: 10.2460/javma.23.11.0641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 02/15/2024] [Indexed: 04/05/2024]
Abstract
Nutrition is considered a key part of the management of pancreatitis in dogs and cats. While limited prospective research exists, experimental studies, retrospective studies, and anecdote allow for formulation of nutritional guidelines. Historically, fat has been considered the key nutrient of interest in pancreatitis; however, other nutrients and dietary factors, including energy density, digestibility, protein, carbohydrates, and fiber, are all of importance in these patients. Indeed protein particle size may be of greater significance than dietary fat in the management of pancreatitis in cats. Low-fat gastrointestinal diets are frequently recommended in the initial management of pancreatitis in dogs, while hydrolyzed diets are often considered first-line diets in cats with pancreatitis. The presence or absence of comorbid disease may also alter nutritional recommendations. When diseases occur concurrently, the dietary strategies for the most life-threatening illness, or the illness with the greatest impact on quality of life, is recommended to be prioritized. Many dogs and cats with pancreatitis can be transitioned back to their prediagnosis diet or another commercial maintenance diet, provided that significant comorbid disease is absent. Use of a low-fat diet in the long term may be prioritized in dogs with recurrent episodes of pancreatitis.
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Affiliation(s)
- Harry Cridge
- 1Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI
| | - Valerie J Parker
- 2Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH
| | - Aarti Kathrani
- 3Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK
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Vadgaonkar A, Kamat N, Parekh S, Patil G, Dalal A, Maydeo A. Oesophageal perforation by migrated Ryles tube. Trop Doct 2024:494755241241832. [PMID: 38562095 DOI: 10.1177/00494755241241832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
A 72-year woman with a history of multiple cerebrovascular accidents presented with severe epigastric pain. An oesophageal perforation by the tip of a Ryles tube, which had migrated into the mediastinum, was diagnosed by radiography. An attempt at pushing the nasogastric tube into the stomach resulted in increasing the rupture to about 6 cm in size. Replacement by a triple-lumen nasojejunal feeding tube and subsequent feeding with c.1,400 calories per day enabled the perforation to close without further intervention.
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Affiliation(s)
- Amol Vadgaonkar
- Consultant, Institute of Gastrosciences, Sir H. N. Reliance Foundation Hospital and Research Centre, Girgaon, Mumbai, Maharashtra, India
| | - Nagesh Kamat
- Senior Research Scientist, Institute of Gastrosciences, Sir H. N. Reliance Foundation Hospital and Research Centre, Girgaon, Mumbai, Maharashtra, India
| | - Sanil Parekh
- Consultant, Institute of Gastrosciences, Sir H. N. Reliance Foundation Hospital and Research Centre, Girgaon, Mumbai, Maharashtra, India
| | - Gaurav Patil
- Consultant, Institute of Gastrosciences, Sir H. N. Reliance Foundation Hospital and Research Centre, Girgaon, Mumbai, Maharashtra, India
| | - Ankit Dalal
- Consultant, Institute of Gastrosciences, Sir H. N. Reliance Foundation Hospital and Research Centre, Girgaon, Mumbai, Maharashtra, India
| | - Amit Maydeo
- Chairman, Institute of Gastrosciences, Sir H. N. Reliance Foundation Hospital and Research Centre, Girgaon, Mumbai, Maharashtra, India
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8
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Wenzel F, Whitaker IY. Relationship between nutritional goals and pressure injuries in critical care patients receiving enteral nutrition. J Wound Care 2024; 33:271-277. [PMID: 38573900 DOI: 10.12968/jowc.2024.33.4.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
OBJECTIVE To examine the relationship between pressure injury (PI) development and achievement of nutritional goals (protein and caloric), as well as consider the clinical conditions, hospitalisation factors, and risk assessment for PI development in patients who are critically ill and receiving enteral nutrition (EN) in the intensive care unit (ICU). METHOD An observational cohort study was conducted in the ICU of the University Hospital in São Paulo, Brazil. Inclusion criteria were as follows: age ≥18 years; length of ICU stay ≥24 hours; without PI at ICU admission; and receiving EN exclusively during ICU stay. The development of PI was considered the dependent variable. The Chi-squared test was applied to compare categorical variables, and the Mann-Whitney U test was used to compare continuous variables between groups of patients with and without a PI. The analysis of the achievement of nutritional goals was performed using Fisher's exact test. A significance level of 5% (p-value<0.05) and a confidence interval (CI) of 95% was adopted in all statistical tests. RESULTS A total of 181 patients met the inclusion criteria, of whom 102 (56.4%) were male and 79 (43.6%) were female. Mean age was 55.1 years, and mean length of ICU stay was 17.5 days. PI development was associated with not achieving nutritional goals. There was a higher percentage (65.3%) of patients without a PI when both protein and caloric goals were achieved. In contrast, 45.6% of patients developed a PI when the goals were not achieved. The mean days for sedation, vasoactive drugs and mechanical ventilation were all significantly higher in patients who developed a PI (p<0.001). CONCLUSION There was a significant association between patients developing a PI and deficits in caloric and protein intake. Patients who did not develop PIs had a greater calorie and protein intake compared with those who developed a PI.
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Affiliation(s)
- Fernanda Wenzel
- Hospital e Maternidade Escola Mario de Moraes Altenfelder Silva, São Paulo, SP, Brazil
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9
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Hubbard GP, Van Wyk J, Grinyer L, Onley R, White S, Fleming CA, Baxter J, Forwood L, Stratton RJ. Appropriate handling and storage reduce the risk of bacterial growth in enteral feeding systems reused within 24 hours. Nutr Clin Pract 2024; 39:437-449. [PMID: 37635446 DOI: 10.1002/ncp.11058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/27/2023] [Accepted: 07/23/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Enteral tube feeding can require considerable amounts of plastic equipment including delivery sets and containers, often disposed of after a single feeding session because of bacterial contamination concerns. The aim of this research was to assess whether reuse of delivery sets and containers for up to 24 h is safe from a microbiological perspective. METHODS Four enteral tube feeding systems (FS) were tested under hygienic controlled or repeated inoculation challenge conditions using key foodborne pathogens, to assess bacterial growth over time (FS1: ready-to-hang, closed 1-L system with delivery set reused, stored at room temperature [RT]; FS2: a prepared, powdered, open 1-L system with delivery set and container reused, stored at RT; FS3 and FS4: prepared, powdered, open 200-ml bolus systems with delivery set and container reused, stored at RT [FS3] and refrigeration [FS4]). Feed samples were cultured at 0.5, 6.5, 12.5, 18.5, and 24.5 h with >2 Δlog considered significant bacterial growth. RESULTS Under hygienic control, FS1, FS3, and FS4 were below the level of enumeration (<5 CFU/g) for all bacteria tested, at all time points. In FS2, significant bacterial growth was observed from 18.5 h. Under repeated bacterial inoculation challenge, no significant growth was observed in FS1 and FS4 over 24.5 h; however, significant growth was observed in FS2 after 6.5 h and in FS3 after 10-12 h. CONCLUSION With hygienic handling technique, there is limited bacterial growth with reuse of delivery sets and containers over 24 h. Refrigeration between feeding sessions and using boluses of reconstituted powdered feed reduce bacterial growth risk.
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Affiliation(s)
| | | | | | | | - Sean White
- Department of Dietetics, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Carole-Anne Fleming
- NHSGGC Adult Acute Dietetic Service, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | | | - Rebecca J Stratton
- Nutricia Ltd, Trowbridge, UK
- School of Medicine, University of Southampton, Southampton, UK
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Sun JK, Lv C, Gao L, Mao W, Li W, Ke L. Nutrition therapy in critically ill patients with severe acute pancreatitis. Nutr Clin Pract 2024; 39:271-280. [PMID: 38357829 DOI: 10.1002/ncp.11135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/16/2024] Open
Abstract
A significant proportion of patients (10%-20%) with acute pancreatitis develop severe acute pancreatitis characterized by pancreatic necrosis, systemic inflammation, and organ failure, commonly requiring intensive care unit (ICU) admission. In this specific population, nutrition therapy is more challenging than that in the general ICU population, primarily because of inevitable gastrointestinal involvement by pancreatic inflammation. In this review, we discussed several key aspects of nutrition therapy in this population, including key pathophysiology that may impede nutrition therapy, the timing and implementation of enteral nutrition and parenteral nutrition, the importance of specific nutrient supplements, and the long-term outcomes that may be addressed by nutrition therapy.
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Affiliation(s)
- Jia-Kui Sun
- Department of Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Cheng Lv
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu Province, China
- Research Institute of Critical Care Medicine and Emergency Rescue At, Nanjing University, Nanjing, Jiangsu Province, China
| | - Lin Gao
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu Province, China
- Research Institute of Critical Care Medicine and Emergency Rescue At, Nanjing University, Nanjing, Jiangsu Province, China
| | - Wenjian Mao
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu Province, China
- Research Institute of Critical Care Medicine and Emergency Rescue At, Nanjing University, Nanjing, Jiangsu Province, China
| | - Weiqin Li
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu Province, China
- Research Institute of Critical Care Medicine and Emergency Rescue At, Nanjing University, Nanjing, Jiangsu Province, China
| | - Lu Ke
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu Province, China
- Research Institute of Critical Care Medicine and Emergency Rescue At, Nanjing University, Nanjing, Jiangsu Province, China
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11
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Limketkai BN, Rau S, Fasulo C. Preventative and therapeutic potential of nutrition for inflammatory bowel diseases: A narrative review. JPEN J Parenter Enteral Nutr 2024; 48:258-266. [PMID: 38357793 DOI: 10.1002/jpen.2606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/10/2023] [Accepted: 01/18/2024] [Indexed: 02/16/2024]
Abstract
Diet strongly shapes the gut microbiome and metabolome, which in turn influence intestinal inflammation in patients with inflammatory bowel disease (IBD). Separate from inflammation and malnutrition, diet's direct interactions with the gastrointestinal system can also provoke or attenuate a host of nonspecific gastrointestinal symptoms. Given these multifaceted effects of diet on inflammation and symptoms, nutrition has been investigated for its potential roles in the prevention and treatment of IBD. This review presents epidemiological, observational cohort, and clinical trial evidence that underlie our current understanding of nutrition for prevention and treatment of IBD.
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Affiliation(s)
- Berkeley N Limketkai
- Vatche & Tamar Manoukian Division of Digestive Diseases, UCLA School of Medicine, Los Angeles, California, USA
| | - Sameeha Rau
- Vatche & Tamar Manoukian Division of Digestive Diseases, UCLA School of Medicine, Los Angeles, California, USA
| | - Christina Fasulo
- Vatche & Tamar Manoukian Division of Digestive Diseases, UCLA School of Medicine, Los Angeles, California, USA
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12
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Berry AJ, Bilbo A. Exocrine pancreatic insufficiency and pancreatic exocrine replacement therapy in clinical practice. Nutr Clin Pract 2024; 39 Suppl 1:S78-S88. [PMID: 38429965 DOI: 10.1002/ncp.11124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/02/2024] [Accepted: 01/07/2024] [Indexed: 03/03/2024] Open
Abstract
Exocrine pancreatic insufficiency (EPI) is a complex condition that disrupts normal digestion and absorption. Patients with EPI may suffer from mild to debilitating malabsorption with a constellation of symptoms that can have a significant effect on quality of life and nutrition status. Pancreatic enzyme replacement therapy (PERT) is effective and safe to treat EPI and is the standard of care for this condition. A wide variety and various forms of these products exist, as well as numerous guidelines and recommendations. Obtaining PERT for patients can oftentimes be cost prohibitive. Determining the presence and extent of EPI can be challenging and patient specific, making it difficult for practitioners. This narrative review will explore these issues, as well as several disease states potentially affected by EPI, and review current management strategies.
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Affiliation(s)
- Amy J Berry
- Department of Clinical Nutrition, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Amy Bilbo
- Department of Clinical Nutrition, Medical University of South Carolina, Charleston, South Carolina, USA
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Guinhut M, Guezennec S, Raynard B. [Nutritional management of patients during surgical prehabilitation and rehabilitation programs]. Soins 2024; 69:38-41. [PMID: 38614518 DOI: 10.1016/j.soin.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/15/2024]
Abstract
Undernutrition (UD) increases perioperative morbidity and mortality. Its prevention and treatment are therefore essential in surgical prehabilitation and rehabilitation programs. Nutritional treatment is individualized according to the patient's nutritional status, ingesta and protein-energy requirements. Oral nutrition is optimized to increase intakes through personalized dietary advice and oral nutritional supplements. Artificial nutrition support is indicated in cases of UD or high risk of UD before major surgery. Enteral nutrition is preferred to parenteral nutrition when the digestive tract is functional.
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Affiliation(s)
- Marie Guinhut
- Service de nutrition clinique et soins de suite et réadaptation oncologique, Institut Gustave-Roussy, 24 rue Albert-Thuret, 94550 Chevilly-Larue, France.
| | - Séverine Guezennec
- Service de nutrition clinique et soins de suite et réadaptation oncologique, Institut Gustave-Roussy, 24 rue Albert-Thuret, 94550 Chevilly-Larue, France
| | - Bruno Raynard
- Service de nutrition clinique et soins de suite et réadaptation oncologique, Institut Gustave-Roussy, 24 rue Albert-Thuret, 94550 Chevilly-Larue, France
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14
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Schwarz E, Nass O, Giocondo V, Kozeniecki Schneider ML. Identification of enteral nutrition errors in a single-center quality-improvement audit. Nutr Clin Pract 2024; 39:470-474. [PMID: 37772481 DOI: 10.1002/ncp.11076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/22/2023] [Accepted: 08/27/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Enteral nutrition (EN) therapy is a multistep process including evaluation, prescription, procurement, dispensing, labeling, administration, and monitoring. EN therapy is prone to human errors, but these are poorly defined in the literature. The purpose of this study was to audit EN administration practices to quantify errors of execution and identify which components of the EN order were labeled, administered, or documented incorrectly. METHODS On 2 nonconsecutive days, we identified all hospitalized patients with active EN orders and prospectively collected the following information: EN formula hanging/documented, formula hang time, infusion rate/documented rate (continuous EN), infused volume and documented schedule (intermittent EN), and EN modular documentation. Mismatches to the EN order were considered errors. We reviewed 1 month of hospital EN-related safety events for comparison. RESULTS Of 1045 data points collected from 160 patients, we identified 275 errors of execution: 135 labeling errors and 140 administration errors. The most common were hang time >48 h (85%), wrong number of modulars documented (48%), and wrong infusion rate (19%). We found one reported safety event (wrong formula delivered but not infused). CONCLUSION We identified a 15.9% error rate in EN order execution/documentation and 14% compliance with documentation of 48-h hang time. Errors (safety events) were grossly underreported. This highlighted several areas of opportunity to improve current EN use process, consistent with previous research on EN and oral nutrition supplement administration. Based on our findings, we plan to recommend implementation of EN barcoding at our institution, to model the familiar medication administration record.
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Affiliation(s)
- Elise Schwarz
- Nutrition Services Department, Froedtert Hospital, Milwaukee, Wisconsin, USA
| | - Olivia Nass
- Nutrition Services Department, Froedtert Hospital, Milwaukee, Wisconsin, USA
- Department of Clinical Nutrition, Tampa General Hospital, Tampa, Florida, USA
| | - Vanessa Giocondo
- Nutrition Services Department, Froedtert Hospital, Milwaukee, Wisconsin, USA
- Clinical Nutrition Services, Medical University of South Carolina, Charleston, South Carolina, USA
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15
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Page K, Viner Smith E, Chapple LAS. Nutrition practices in hospitalized adults receiving noninvasive forms of respiratory support: A scoping review. Nutr Clin Pract 2024; 39:344-355. [PMID: 37840215 DOI: 10.1002/ncp.11081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/14/2023] [Accepted: 09/17/2023] [Indexed: 10/17/2023] Open
Abstract
The use of noninvasive respiratory support is increasing, with noninvasive ventilation (NIV) and high-flow nasal cannula providing unique barriers to nutrition support. Limited data related to nutrition management for these patients in the intensive care unit (ICU) exist; however, the literature in non-critically ill patients is not well described, and its improvement may help to inform practice within the ICU. Therefore, a scoping review was conducted of MEDLINE, EmCare, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) databases on August 18, 2022, to identify original publications that included adult patients receiving noninvasive respiratory support in a hospital setting with data related to nutrition management. Data were extracted on study design, population, details of respiratory support, and concepts relating to nutrition management (grouped into nutrition screening, assessment, delivery route, intake, and anthropometry). Eleven studies were included, most of which were small (<100 patients), single-center, observational trials in patients receiving NIV only. Five studies reported results related to route of nutrition and nutrition assessment, two on anthropometry, and one each on quantifying intake and nutrition screening; some studies reported multiple parameters. There was a lack of consensus regarding the ideal method for nutrition assessment and route of nutrition. Oral nutrition was the route most frequently reported, yet calorie and protein delivery via this route were inadequate, and barriers to intake included poor appetite, fatigue, and patient cognition. Future research should address barriers pertinent to this population and the impact of nutrition on outcomes.
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Affiliation(s)
- Kaitlyn Page
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Elizabeth Viner Smith
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Intensive Care Research Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Lee-Anne S Chapple
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Intensive Care Research Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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16
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Schultz ER, Kim Y. Clinical outcomes associated with blenderized tube feedings in adults: A systematic review. Nutr Clin Pract 2024; 39:330-343. [PMID: 37867408 DOI: 10.1002/ncp.11087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/18/2023] [Accepted: 09/24/2023] [Indexed: 10/24/2023] Open
Abstract
Nearly half a million individuals in the United States are dependent on enteral nutrition to meet their nutrition needs. Public interest in blenderized tube feeding (BTF) has increased over the past decade; however, medical professionals indicate a lack of knowledge about these products and their effects. The purpose of this review is to analyze clinical outcomes in adults who use a BTF formula as their primary nutrition source. A literature search was conducted in PubMed, Scopus, and CINAHL using search terms "adult," "enteral nutrition," "tube feeding," "BTF," blenderized," "blended," "homemade," and "pureed." Nine studies met the inclusion criteria and were analyzed in the review. Under close monitoring, BTF does not pose a higher risk for deterioration in anthropometric measurements. Furthermore, BTF use is consistently associated with improvements in diarrhea. As such, clinicians should consider the use of these formulas in the acute care or rehabilitation settings. Additional research is needed in patients with diverse clinical backgrounds in free-living communities. Larger populations sizes and longer intervention time frames are crucial to providing statistically significant results needed to strengthen the quality of evidence on this topic.
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Affiliation(s)
- Erin R Schultz
- School of Rehabilitation and Medical Sciences, Central Michigan University, Mount Pleasant, Michigan, USA
| | - Yeonsoo Kim
- School of Rehabilitation and Medical Sciences, Central Michigan University, Mount Pleasant, Michigan, USA
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McGrath KH, Collins T, Comerford A, McCallum Z, Comito M, Herbison K, Cochrane OR, Burgess DM, Kane S, Coster K, Cooper M, Jesson K. A clinical consensus paper on jejunal tube feeding in children. JPEN J Parenter Enteral Nutr 2024; 48:337-344. [PMID: 38430136 DOI: 10.1002/jpen.2615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/05/2024] [Accepted: 02/05/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Feeding problems are common in children with complex medical problems or acute critical illness and enteral nutrition may be required. In certain situations, gastric tube feeding is poorly tolerated or may not be feasible. When feed intolerance persists despite appropriate adjustments to oral and gastric enteral regimens, jejunal tube feeding can be considered as an option for nutrition support. METHODS A multidisciplinary expert working group of the Australasian Society of Parenteral and Enteral Nutrition was convened. They identified topic questions and five key areas of jejunal tube feeding in children. Literatures searches were undertaken on Pubmed, Embase, and Medline for all relevant studies, between January 2000 and September 2022 (n = 103). Studies were assessed using National Health and Medical Research Council guidelines to generate statements, which were discussed as a group, followed by voting on statements using a modified Delphi process to determine consensus. RESULTS A total of 24 consensus statements were created for five key areas: patient selection, type and selection of feeding tube, complications, clinical use of jejunal tubes, follow-up, and reassessment. CONCLUSION Jejunal tube feeding is a safe and effective means of providing nutrition in a select group of pediatric patients with complex medical needs, who are unable to be fed by gastric tube feeding. Appropriate patient selection is important as complications associated with jejunal tube feeding are not uncommon, and although mostly minor, can be significant or require tube reinsertion. All children receiving jejunal tube feeding should have multidisciplinary team assessment and follow-up.
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Affiliation(s)
- Kathleen H McGrath
- Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tanya Collins
- Department of Nutrition and Dietetics, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Annabel Comerford
- Nutrition Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Zoe McCallum
- Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Neurodevelopment and Disability, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Michaela Comito
- Department of Nutrition and Food Services, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Kim Herbison
- Department of Paediatric Dietetics, Starship Children's Hospital, Auckland, New Zealand
| | - Olivia Rose Cochrane
- Department of Paediatric Dietetics, Starship Children's Hospital, Auckland, New Zealand
| | - Deirdre Mary Burgess
- Department of Paediatric Gastroenterology, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Sarah Kane
- Department of Dietetics and Food Services, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Keryn Coster
- Department of Nutrition and Food Services, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Michele Cooper
- Department of Paediatric Gastroenterology, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Kathryn Jesson
- Department of Paediatric Gastroenterology, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
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18
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Lu H, Li T, Xia Y, Shao L, Yu S, Xu L. Management of an Esophago-pleural Fistula after Emergent Endoscopic Variceal Injectional Sclerotherapy: A Case Report And Literature Review. Intern Med 2024; 63:937-941. [PMID: 37587038 DOI: 10.2169/internalmedicine.1961-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
A 48-year-old man developed sudden-onset haematemesis and melena after decompensated posthepatitic cirrhosis. Endoscopic variceal injectional sclerotherapy was emergently performed. However, the patient developed esophago-pleural fistula, empyema, and liver failure. He thus received symptomatic treatments and nasojejunal feedings, which failed to restore the nutrition as the gastroesophageal reflux exacerbated the hydrothorax. Percutaneous endoscopic gastro-jejunal (PEG-J) was therefore carefully performed for enteral nutrition support. The patient had recovered from the fistula at a six-month follow-up, which allowed the resumption of an oral diet. Our literature review revealed that PEG-J is a feasible approach to treating esophago-pleural fistula, a rare but lethal complication of endoscopic sclerotherapy.
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Affiliation(s)
- Hongpeng Lu
- Department of Gastroenterology, The First Affiliated Hospital of Ningbo University, China
| | - Tongyu Li
- Department of Hematology, The First Affiliated Hospital of Ningbo University, China
| | - Ying Xia
- Department of Gastroenterology, The First Affiliated Hospital of Ningbo University, China
| | - Lihong Shao
- Department of Gastroenterology, The First Affiliated Hospital of Ningbo University, China
| | - Siyi Yu
- Department of Gastroenterology, The First Affiliated Hospital of Ningbo University, China
| | - Lei Xu
- Department of Gastroenterology, The First Affiliated Hospital of Ningbo University, China
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Özgörü H, Mutlu B, Erkut Z. Effect of lying position on gastric residual volume in premature infants: A systematic review. Nutr Clin Pract 2024; 39:295-310. [PMID: 37846552 DOI: 10.1002/ncp.11070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 07/19/2023] [Accepted: 08/15/2023] [Indexed: 10/18/2023] Open
Abstract
Premature infants' gastric residual volume may be affected by position. This systematic review was conducted to examine the effect of lying position on the gastric residual volume of preterm newborns fed by gastric tube. Electronic databases (PubMed, MEDLINE, MEDLINE Complete, Academic Search Ultimate, CINAHL Complete, Cochrane, and Scopus) were searched for randomized controlled experimental or quasiexperimental studies in English published between 2011 and 2022 investigating the effect of one or more lying positions on gastric residual volume in premature newborns. The PICOS strategy was used in preparing and reporting the systematic review. A total of 304 articles were retrieved, and the full texts of 12 articles were evaluated for suitability. After eliminating the excluded articles, 10 articles were included in the analysis. The quality of evidence varied, with four studies judged to have poor quality whereas the remaining six were considered to range from moderate to good in quality. Based on the results obtained from the studies, it was determined that gastric residual volume was the least in the right lateral and prone positions and more in the left lateral and supine positions compared with the other two positions, with no difference between the two latter positions. The methodological differences, such as the evaluation of different positions, the timing of positioning and the duration of maintaining in the same position, and the measurement times of gastric residual volume made it difficult to reach a definitive proof. We concluded that high-evidence studies evaluating all positions are needed.
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Affiliation(s)
- Hande Özgörü
- Doctorate Program, Institute of Graduate Studies, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Birsen Mutlu
- Department of Pediatric Nursing, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Zeynep Erkut
- School of Nursing, Maltepe University, Istanbul, Turkey
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20
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Li X, Fan L, Pan X, Kwok CS. Enteral nutrition in children and adolescents who receive extracorporeal membrane oxygenation and its impact on complications and mortality: A systematic review and meta-analysis. JPEN J Parenter Enteral Nutr 2024. [PMID: 38554128 DOI: 10.1002/jpen.2626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 03/02/2024] [Accepted: 03/04/2024] [Indexed: 04/01/2024]
Abstract
Enteral nutrition (EN) is one method of nutrition support for children and adolescents receiving extracorporeal membrane oxygenation (ECMO) therapy, and there are no guidelines for its use in this population. We conducted a systematic review to determine whether EN is effective and safe in children supported by ECMO. We searched the Cochrane Library database, MEDLINE, and Embase on Ovid in March 2023 to identify studies that evaluated children and adolescents who received ECMO and were treated with EN. Random effects meta-analysis was used to estimate the odds of mortality with EN compared with parenteral nutrition (PN). A total of 14 studies were included in this review with 1650 patients (796 received EN). The median duration of ECMO was 5-10 days, and the median EN initiation time ranged from 23 h to 7 days. The pooled results suggest no significant difference in mortality with EN compared with PN (odds ratio [OR] = 0.77; 95% CI, 0.56-1.05; I2 = 26%). Exclusion of the only study that reported an increase in mortality resulted in a borderline significant reduction in mortality with EN (OR = 0.71; 95% CI, 0.51-1.00; I2 = 26%). The predictors of EN were male sex, older age, heavier weight, greater height, cardiac diagnosis, longer duration of ECMO, and use of venovenous ECMO. Most studies suggest no correlation between EN and complications. EN use in children and adolescents who receive ECMO does not appear to be associated with increased mortality compared with PN and was safe in terms of intestinal complications and feeding intolerance.
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Affiliation(s)
- Xiuhong Li
- Department of Post-Qualifying Healthcare Practice, Birmingham City University, Birmingham, UK
- Shenzhen Children's Hospital, Cardiothoracic Surgery Department, Shenzhen, China
| | - Liping Fan
- Shenzhen Children's Hospital, Cardiothoracic Surgery Department, Shenzhen, China
| | - Xiaolan Pan
- Shenzhen Children's Hospital, Cardiothoracic Surgery Department, Shenzhen, China
| | - Chun Shing Kwok
- Department of Post-Qualifying Healthcare Practice, Birmingham City University, Birmingham, UK
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21
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Zhang Z, He F, Lin Z, Li Z, Xiang F, Cai W. Application of a downward tract adherence method in the manual bedside placement of post-pyloric tubes in the intensive care unit. Technol Health Care 2024:THC230824. [PMID: 38607773 DOI: 10.3233/thc-230824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
BACKGROUND At present, there are few studies on the technical requirements of manual bedside placement of post-pyloric tube in Intensive Care Unit patients. OBJECTIVE To investigate the application value of downward tract adherence method in the manual bedside placement of jejunal tubes. METHODS In the downward group, 160 patients underwent manual bedside placement of jejunal tubes by a downward tract adherence method. In the conventional group, 144 patients were treated with conventional gas injection during the placement. The success rate, average time, and adverse reactions of the placement in the two groups were investigated and compared. RESULTS The success rate of the placement in the downward group was significantly higher (95% vs. 75%, P< 0.001) and the average time for the successful placement was shortened (23 ± 5.91 min vs. 26 ± 5.49 min, P= 0.025) than that in the conventional group. No treatment-related adverse reactions occurred in either group, and there were also no significant differences in vital sign changes. CONCLUSIONS The use of the downward tract adherence method in the manual bedside placement of postpyloric tubes for the intensive care patients at the bedside has a higher success rate, effectivity and safety.
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22
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Zhang R, Wu Y, Xv R, Wang W, Zhang L, Wang A, Li M, Jiang W, Jin G, Hu X. Clinical application of real-time continuous glucose monitoring system during postoperative enteral nutrition therapy in esophageal cancer patients. Nutr Clin Pract 2024. [PMID: 38522023 DOI: 10.1002/ncp.11143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/11/2024] [Accepted: 02/16/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Enteral nutrition (EN) support therapy increases the risk of abnormal blood glucose (BG). The aim of this study is to evaluate the clinical value of a real-time continuous glucose monitoring (rt-CGM) system in BG monitoring during postoperative EN support therapy in patients with esophageal cancer. METHODS Patients without diabetes mellitus (DM) with esophageal cancer who planned to receive postoperative EN were enrolled. With the self-monitoring of BG value as the reference BG, the accuracy of rt-CGM was evaluated by the mean absolute relative difference (MARD) value, correlation efficient, agreement analysis, and Parkes and Clarke error grid plot. Finally, paired t tests were used to compare the differences in glucose fluctuations between EN and non-EN days and slow and fast days. RESULTS The total MARD value of the rt-CGM system was 13.53%. There was a high correlation between interstitial glucose and fingertip capillary BG (consistency correlation efficient = 0.884 [95% confidence interval, 0.874-0.894]). Results of 15/15%, 20/20%, 30/30% agreement analysis were 58.51%, 84.71%, and 99.65%, respectively. The Parkes and Clarke error grid showed that the proportion of the A and B regions were 100% and 99.94%, respectively. The glucose fluctuations on EN days vs non-EN days and on fast days vs slow days were large, and the difference was statistically significant (P < 0.001). CONCLUSION The rt-CGM system achieved clinical accuracy and can be used as a new option for glucose monitoring during postoperative EN therapy. The magnitude of glucose fluctuation during EN therapy remains large, even in the postoperative population without DM.
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Affiliation(s)
- Ranran Zhang
- Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Ying Wu
- Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Rui Xv
- Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Wei Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Lei Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Ansheng Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Min Li
- Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Wei Jiang
- Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
- National Standardized Metabolic Disease Management Center, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Guoxi Jin
- Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
- National Standardized Metabolic Disease Management Center, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Xiaolei Hu
- Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
- National Standardized Metabolic Disease Management Center, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
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23
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Wittholz K, Bongetti AJ, Fetterplace K, Caldow MK, Karahalios A, De Souza DP, Elahee Doomun SN, Rooyackers O, Koopman R, Lynch GS, Ali Abdelhamid Y, Deane AM. Plasma beta-hydroxy-beta-methylbutyrate availability after enteral administration during critical illness after trauma: An exploratory study. JPEN J Parenter Enteral Nutr 2024. [PMID: 38522007 DOI: 10.1002/jpen.2622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND During critical illness skeletal muscle wasting occurs rapidly. Although beta-hydroxy-beta-methylbutyrate (HMB) is a potential treatment to attenuate this process, the plasma appearance and muscle concentration is uncertain. METHODS This was an exploratory study nested within a blinded, parallel group, randomized clinical trial in which critically ill patients after trauma received enteral HMB (3 g daily) or placebo. Plasma samples were collected at 0, 60, and 180 min after study supplement administration on day 1. Needle biopsies of the vastus lateralis muscle were collected (baseline and day 7 of the HMB treatment intervention period). An external standard curve was used to calculate HMB concentrations in plasma and muscle. RESULTS Data were available for 16 participants (male n = 12 (75%), median [interquartile range] age 50 [29-58] years) who received placebo and 18 participants (male n = 14 (78%), age 49 [34-55] years) who received HMB. Plasma HMB concentrations were similar at baseline but increased after HMB (T = 60 min: placebo 0.60 [0.44-1.31] µM; intervention 51.65 [22.76-64.72] µM). Paired muscle biopsies were collected from 11 participants (placebo n = 7, HMB n = 4). Muscle HMB concentrations were similar at baseline between groups (2.35 [2.17-2.95]; 2.07 [1.78-2.31] µM). For participants in the intervention group who had the repeat biopsy within 4 h of HMB administration, concentrations were greater (7.2 and 12.3 µM) than those who had the repeat biopsy >4 h after HMB (2.7 and 2.1 µM). CONCLUSION In this exploratory study, enteral HMB administration increased plasma HMB availability. The small sample size limits interpretation of the muscle HMB findings.
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Affiliation(s)
- Kym Wittholz
- Department of Allied Health (Clinical Nutrition), Royal Melbourne Hospital, Melbourne, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Amy J Bongetti
- Department of Anatomy and Physiology, Centre for Muscle Research, University of Melbourne, Melbourne, Australia
| | - Kate Fetterplace
- Department of Allied Health (Clinical Nutrition), Royal Melbourne Hospital, Melbourne, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Marissa K Caldow
- Department of Anatomy and Physiology, Centre for Muscle Research, University of Melbourne, Melbourne, Australia
| | - Amalia Karahalios
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - David P De Souza
- Metabolomics Australia, Bio21 Institute, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Olav Rooyackers
- Division of Anesthesiology and Intensive Care, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, Huddinge, Sweden
| | - René Koopman
- Department of Anatomy and Physiology, Centre for Muscle Research, University of Melbourne, Melbourne, Australia
| | - Gordon S Lynch
- Department of Anatomy and Physiology, Centre for Muscle Research, University of Melbourne, Melbourne, Australia
| | - Yasmine Ali Abdelhamid
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia
| | - Adam M Deane
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia
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24
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Piñar-Gutiérrez A, González-Gracia L, Vázquez Gutiérrez R, García-Rey S, Jiménez-Sánchez A, González-Navarro I, Tatay-Domínguez D, Garrancho-Domínguez P, Remón-Ruiz PJ, Martínez-Ortega AJ, Serrano-Aguayo P, Giménez-Andreu MD, García-Fernández FJ, Bozada-García JM, Nacarino-Mejías V, López-Iglesias Á, Pereira-Cunill JL, García-Luna PP. Percutaneous Gastrostomies: Associated Complications in PUSH vs. PULL Techniques over 12 Years in a Referral Centre. J Clin Med 2024; 13:1836. [PMID: 38610601 PMCID: PMC11012573 DOI: 10.3390/jcm13071836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Objectives: To compare complications associated with percutaneous gastrostomies performed using PUSH and PULL techniques, whether endoscopic (PEG) or radiological (PRG), in a tertiary-level hospital. Methods: This was a prospective observational study. Adult patients who underwent percutaneous PULL or PUSH gastrostomy using PEG or PRG techniques at the Virgen del Rocio University Hospital and subsequently followed up in the Nutrition Unit between 2009-2020 were included. X2 tests or Fisher's test were used for the comparison of proportions when necessary. Univariate analysis was conducted to study risk factors for PRG-associated complications. Results: n = 423 (PULL = 181; PUSH = 242). The PULL technique was associated with a higher percentage of total complications (37.6% vs. 23.8%; p = 0.005), exudate (18.2% vs. 11.2%; p = 0.039), and irritation (3.3% vs. 0%; p = 0.006). In the total sample, there were 5 (1.1%) cases of peritonitis, 3 (0.7%) gastrocolic fistulas, and 1 (0.2%) death due to complications associated with gastrostomy. Gender, age, and different indications were not risk factors for a higher number of complications. The most common indications were neurological diseases (35.9%), head and neck cancer (29%), and amyotrophic lateral sclerosis (17.2%). Conclusions: The PULL technique was associated with more total complications than the PUSH technique, but both were shown to be safe techniques, as the majority of complications were minor.
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Affiliation(s)
- Ana Piñar-Gutiérrez
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Lucía González-Gracia
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Rocío Vázquez Gutiérrez
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Silvia García-Rey
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Andrés Jiménez-Sánchez
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Irene González-Navarro
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Dolores Tatay-Domínguez
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Pilar Garrancho-Domínguez
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Pablo J. Remón-Ruiz
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Antonio J. Martínez-Ortega
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Pilar Serrano-Aguayo
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - María Dolores Giménez-Andreu
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | | | | | | | - Álvaro López-Iglesias
- Unidad de Radiodiagnóstico, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain
| | - José Luis Pereira-Cunill
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Pedro Pablo García-Luna
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
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Chloupek A, Jurkiewicz D. The Effect of Hospital-Based Liquid Diet and Commercial Formulas on Laboratory Parameters and Postoperative Complications in Patients with Head and Neck Cancer. J Clin Med 2024; 13:1844. [PMID: 38610609 PMCID: PMC11012823 DOI: 10.3390/jcm13071844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Patients with head and neck cancer (HNC) are at high risk of malnutrition. The aim of this study was to compare the effect of polymeric formulas available commercially and a high-protein liquid diet prepared in the hospital on laboratory parameters and postoperative complications in patients undergoing surgery for HNC. Methods: This single-center retrospective study included 149 patients who underwent surgery for HNC between 2008 and 2017. The following data were collected: patient and tumor characteristics, postoperative complications, and laboratory parameters measured at baseline and after surgery, including creatinine, alanine transaminase (ALT), aspartate transaminase (AST), and blood glucose levels. Correlations between the duration of enteral nutrition and blood parameters were assessed. Results: After surgery, patients receiving commercial formulas had lower creatinine and blood glucose levels and higher ALT and ASP levels than those on the hospital-based diet. The longer duration of feeding with commercial formulas before surgery was associated with enhanced preoperative levels of ALT and ASP and with lower postoperative blood glucose. Patients on the hospital-based diet had a higher rate of postoperative complications than those receiving commercial formulas (16.1% vs. 3.3%). Conclusions: There were no clinically important differences in blood parameters among patients with HNC depending on the type of preparations used for enteral feeding. However, increased levels of liver enzymes in patients fed with commercial formulas were notable. The early initiation of enteral nutrition before surgery helped achieve normal blood glucose levels after surgery. The use of commercial preparations contributed to reducing the number and incidence of postoperative complications.
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Affiliation(s)
- Aldona Chloupek
- Department of Cranio-Maxillofacial Surgery, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland
| | - Dariusz Jurkiewicz
- Department of Otolaryngology and Oncology, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland
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Brown T, Johnson T, Gomes A, Samavat H, Byham-Gray L. Knowledge and clinical practice of ASPEN registered dietitian nutritionist members regarding blenderized tube feedings. Nutr Clin Pract 2024. [PMID: 38506319 DOI: 10.1002/ncp.11145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/17/2024] [Accepted: 02/25/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Blenderized tube feedings (BTFs) are used by patients/caregivers who report improvements in gastrointestinal tolerance compared with standard commercial feedings. Despite positive outcomes, registered dietitian nutritionists or international equivalents (RDN/Is) hesitate to recommend BTFs. We aimed to determine if an association exists between dietitian characteristics and willingness to recommend BTFs. METHODS A BTF-specific survey (N = 157) assessed for validity and reliability was administered to the American Society for Parenteral and Enteral Nutrition (ASPEN) RDN/I members. Binary logistic regression analyses examined the association between age, years of clinical practice, BTF training/education, patient population served, and willingness to recommend BTFs. RESULTS The response rate was 4.3% of ASPEN RDN/I members. Most respondents were White females with a median age of 39.0 years and 12 years of clinical experience. Although 98.7% of respondents expressed a willingness to support and 73% to recommend BTFs, 60% were not using BTFs in clinical practice. For 94.8% of RDN/Is, the primary reason for BTF use was patient/caregiver requests. After adjustment for age and years of clinical practice, RDN/Is who served pediatric populations (odds ratio [OR] = 4.28; 95% CI, 1.52-12.09) or used three or more professional resources (OR = 2.49; 95% CI, 1.12-5.57), industry-sponsored resources (OR = 3.15; 95% CI, 1.39-7.15), or one or more experiential learning resources (OR = 3.14; 95% CI, 1.38-7.17) were more likely to recommend BTFs whereas those serving adults were less likely to recommend BTFs (OR = 0.33; 95% CI, 0.12-0.95). CONCLUSION Pediatric RDN/Is and individuals with BTF-specific education/training were more inclined to recommend BTFs.
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Affiliation(s)
- Terry Brown
- Food and Nutrition Services, HealthTrust Supply Chain, Coppell, Texas, USA
- Department of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, Newark, New Jersey, USA
| | | | - Allison Gomes
- Department of Nutrition, Cedar Crest College, Allentown, Pennsylvania, USA
| | - Hamed Samavat
- Department of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, Newark, New Jersey, USA
| | - Laura Byham-Gray
- Department of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, Newark, New Jersey, USA
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da Silva ITF, Medeiros CO, Leobet J, Beux MR, Rabito EI, Etgeton SAP, Fiori LS. Assessment of the risk of contamination of enteral nutrition bottles based on the simulation of home use conditions and hygiene procedures. Nutr Clin Pract 2024. [PMID: 38491970 DOI: 10.1002/ncp.11144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/07/2024] [Accepted: 02/25/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Home-prepared enteral formulations are supplied to patients through enteral nutrition bottles, via a gravity bag or other container, which may be inadequately sanitized and reused more times than recommended by the manufacturer. Such procedures increase the risk of contamination and can compromise the patient's clinical outcome. In light of this, the present study aimed to assess the risk of contamination of enteral nutrition bottles by simulating home use conditions and hygiene procedures. METHODS A simulation of bottle usage was conducted across the three categories of enteral nutrition (homemade enteral preparations, blended enteral preparations, and commercial enteral formulas) for 3 days, using three hygiene procedures reported by caregivers: use of detergent (DET); use of detergent and boiling water (DET+BW); and use of detergent and bleach (DET+BL). The microbiological contamination was determined by the analysis of aerobic mesophilic microorganisms. RESULTS The bottles that were used for 3 days, regardless of the enteral nutrition category, were within the acceptable limit for aerobic mesophilic microorganisms (between <4 and 8.0 colony-forming units [CFU]/cm2 ) when sanitized using the DET+BW and DET+BL procedures. The enteral nutrition bottles, when cleaned using the DET procedure during the 3 days of usage, showed low microbial contamination (between <4 and 3.0 CFU/cm2 ) in blended preparation and commercial formula only. CONCLUSION Thus, regardless of the enteral nutrition category, we found that the bottles can be used for 3 days, as long as the DET+BW or DET+BL hygiene procedure is applied and safe food handling measures are adopted.
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Affiliation(s)
| | - Caroline O Medeiros
- Department of Nutrition, Federal University of Parana, Paraná, Brazil
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Parana, Paraná, Brazil
| | - Jaqueline Leobet
- Department of Nutrition, Federal University of Parana, Paraná, Brazil
| | - Márcia R Beux
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Parana, Paraná, Brazil
| | - Estela I Rabito
- Department of Nutrition, Federal University of Parana, Paraná, Brazil
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Parana, Paraná, Brazil
| | - Schaina A P Etgeton
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Parana, Paraná, Brazil
| | - Lize S Fiori
- Department of Nutrition, Federal University of Parana, Paraná, Brazil
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Parana, Paraná, Brazil
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Wittholz K, Hinckfus C, Karahalios A, Panganiban H, Phillips N, Rotherham H, Rechnitzer T, Ali Abdelhamid Y, Deane AM, Fetterplace K. Association between protocol change to a higher-protein formula with lower energy targets and nutrient delivery in critically ill patients with COVID-19: A retrospective cohort study. JPEN J Parenter Enteral Nutr 2024. [PMID: 38477349 DOI: 10.1002/jpen.2620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Guidelines recommend prioritizing protein provision while avoiding excessive energy delivery to critically ill patients with coronavirus disease 2019 (COVID-19), but there are no prospective studies evaluating such a targeted approach in this group. We aimed to evaluate the effect of a "higher-protein formula protocol" on protein, energy, and volume delivery when compared with standard nutrition protocol. METHODS This was a retrospective cohort study of adult patients with COVID-19 who received mechanical ventilation for >72 h and enteral nutrition. Before October 2021, the standard nutrition protocol for patients was 0.7 ml/kg/h ideal body weight (IBW) of a 63 g/L protein and 1250 kcal/L formula. From October 2021, we implemented a higher-protein formula protocol for patients with COVID-19. The initial prescription was 0.5 ml/kg/h IBW of a 100 g/L protein and 1260 kcal/L formula with greater emphasis on energy targets being directed by indirect calorimetry when possible. Measured outcomes included protein, energy, and volume delivered. RESULTS There were 114 participants (standard protocol, 48; higher-protein protocol, 66) with 1324 days of nutrition support. The median (95% CI) differences in protein, energy, and volume delivery between targeted and standard protocol periods were 0.08 g/kg/day (-0.02 to 0.18 g/kg/day), -1.71 kcal/kg/day (-3.64 to 0.21 kcal/kg/day) and -1.5 ml/kg/day (-2.9 to -0.1 ml/kg/day). Thirty-three patients (standard protocol, 7; higher-protein protocol, 26) had 44 indirect calorimetry assessments. There was no difference in measured energy expenditure over time (increased by 0.49 kcal/kg/day [-0.89 to 1.88 kcal/kg/day]). CONCLUSION Implementation of a higher-protein formula protocol to patients with COVID-19 modestly reduced volume administration without impacting protein and energy delivery.
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Affiliation(s)
- Kym Wittholz
- Department of Allied Health (Clinical Nutrition), The Royal Melbourne Hospital, Melbourne, Australia
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Chloe Hinckfus
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
- Department of Intensive Care, The Royal Melbourne Hospital, Melbourne, Australia
| | - Amalia Karahalios
- Centre of Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Haustine Panganiban
- Department of Intensive Care, The Royal Melbourne Hospital, Melbourne, Australia
| | - Nadine Phillips
- Centre of Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Hannah Rotherham
- Department of Intensive Care, The Royal Melbourne Hospital, Melbourne, Australia
| | - Thomas Rechnitzer
- Department of Intensive Care, The Royal Melbourne Hospital, Melbourne, Australia
| | - Yasmine Ali Abdelhamid
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
- Department of Intensive Care, The Royal Melbourne Hospital, Melbourne, Australia
| | - Adam M Deane
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
- Department of Intensive Care, The Royal Melbourne Hospital, Melbourne, Australia
| | - Kate Fetterplace
- Department of Allied Health (Clinical Nutrition), The Royal Melbourne Hospital, Melbourne, Australia
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
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Tume LN, Lynes AA, Waugh V, Johnston BW, Kazi A, Truman N, Szakmany T. Nurses' decision-making around gastric residual volume measurement in UK adult intensive care: A four-centre survey. Nurs Crit Care 2024. [PMID: 38454554 DOI: 10.1111/nicc.13056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/07/2024] [Accepted: 02/14/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Despite increasing evidence of the potential inaccuracy and unwarranted practice of regular GRV measurement in critically in adults, this practice persists within the United Kingdom. AIM To explore adult intensive care nurses' decision-making around the practice of GRV measurement to guide enteral feeding. METHODS A cross-sectional 16 item electronic survey in four adult intensive care units (ICUs) in England and Wales. RESULTS Two hundred and seventy-three responses were obtained across four ICUs with acceptable response rates for most [Unit 1 74 /127 = 58.2%; Unit 2 87/129 = 67.4%; Unit 3 77/120 = 64.1%; Unit 4 35/168 = 20.8%]. Most (243/273 (89%) reported measuring GRV 4-6 hourly, with most (223/273 82%) reporting that the main reason was to assess feed tolerance or intolerance and 37/273 (13.5%) saying their unit protocol required it. In terms of factors affecting decision-making, volume obtained was the most important factor, followed by the condition of the patient, with aspirate colour and appearance less important. When asked how they would feel about not measuring GRV routinely, the majority (78.2%) of nurses felt worried (140/273 = 51.2%) or very worried (74/273 = 27%). CONCLUSIONS Factors affecting the nurses' decision-making around GRV were based largely on fear of risk (around vomiting and pulmonary aspiration) and compliance with unit protocols. RELEVANCE TO CLINICAL PRACTICE Despite increasing evidence suggesting it is unnecessary, nurses' beliefs around the value of this practice persist and it continues to be embedded into unit protocols around feeding.
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Affiliation(s)
- Lyvonne N Tume
- Edge Hill University, Ormskirk, UK
- Alder Hey Children's NHS FT, Liverpool, UK
| | - Andrew A Lynes
- Liverpool University Hospitals NHS Foundation Trust Aintree Hospital Critical Care, Lower Lane, UK
| | - Victoria Waugh
- Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
| | - Brian W Johnston
- Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
| | - Aayesha Kazi
- East Lancashire Hospitals trust (ELHT), Royal Blackburn Hospital, Blackburn, UK
| | - Nicholas Truman
- Intensive Care Medicine and Anaesthetics, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Tamas Szakmany
- Cardiff University, UK
- Aneurin Bevan University Health Board, UK
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Tatterton M, Mulcahy J, Mankelow J, Harding M, Scrace J, Fisher M, Bethell C. Checking nasogastric tube safety in children cared for in the community: a re-examination of the evidence base. Nurs Child Young People 2024:e1493. [PMID: 38433664 DOI: 10.7748/ncyp.2024.e1493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 03/05/2024]
Abstract
Nasogastric tube feeding is generally considered safe provided a nasogastric aspirate with a pH ≤5.5, which indicates that the end of tube is correctly located in the stomach, can be obtained. When this is not possible, hospital attendance or admission is usually required so that an X-ray can be undertaken to check the tube's position. This practice is based on an interpretation of the evidence that places undue importance on nasogastric aspirate pH testing before every use of a tube that is already in place, with potential negative consequences for children cared for in the community and their families. Following a re-examination of the evidence base, a revised approach is proposed in this article: when a child has a tube in place, provided its position has been confirmed as correct on initial placement using aspirate pH testing, nurses can use checks other than aspirate pH testing, alongside their clinical judgement, to determine whether it is safe and appropriate to use the tube. This proposed revised approach would reduce delayed or missed administration of fluids, feeds and medicines and enable more children to remain at home.
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Affiliation(s)
- Michael Tatterton
- Bluebell Wood Children's Hospice, Sheffield, and associate professor of children and young people's nursing, University of Bradford, Bradford, England
| | - Jane Mulcahy
- Sussex Community NHS Foundation Trust, East Sussex, England
| | | | - Maria Harding
- Sussex Community NHS Foundation Trust, East Sussex, England
| | | | | | - Claire Bethell
- Bluebell Wood Children's Hospice, Sheffield, and lecturer in children and young people's nursing, University of Bradford, Bradford, England
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Leite HP, Hatanaka EF, Sabio GSG, Evangelista NMDA, de Camargo MFC. Iodine status in children with intestinal failure. J Pediatr Gastroenterol Nutr 2024; 78:691-698. [PMID: 38323710 DOI: 10.1002/jpn3.12117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 02/08/2024]
Abstract
OBJECTIVES Children on long-term parenteral nutrition (PN) are at high risk of iodine deficiency (ID). However, most available information comes from cross-sectional studies. We investigated the iodine status, associated factors, and prevalence of hypothyroidism in children with intestinal failure (IF) who were followed up longitudinally. METHODS This was a cohort study of children with IF monitored for urine iodine concentration (UIC), iodine intake, serum selenium concentration, and thyroid function in an intestinal rehabilitation program. The outcome variable ID was defined as a UIC value < 100 μg/L. Adjusted generalized estimating equations were used to assess the effects of the exposure variables on the UIC. RESULTS Twenty-four patients aged 62.7 (39.1; 79.7) months who received PN for 46.5 (21.5) months were included. The average energy supply was 81.2 kcal/kg/day, 77.6% of which was provided by PN. An average of 5.2 UIC measurements per patient were performed. ID prevalence decreased from baseline (83.3%) to the last assessment (45.8%). Three patients had hypothyroidism secondary to iodine and selenium combined severe deficiency. Iodine intake from enteral or oral nutritional formulas was positively associated with UIC (β = 0.71 [0.35, 1.07]; p < 0.001). Meeting approximately 80% of the estimated average requirement for iodine from nutritional formulas resulted in a greater probability of normal UIC values. CONCLUSION ID is highly prevalent in children with IF who receive long-term PN and its frequency decreases with iodine intake from nutritional formulas. Severe combined iodine and selenium deficiencies are associated with the development of hypothyroidism in these patients.
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Affiliation(s)
- Heitor Pons Leite
- Center for Intestinal Rehabilitation, Transplant Division, Hospital Samaritano de São Paulo, São Paulo, Brazil
- Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Eduardo Freitas Hatanaka
- Center for Intestinal Rehabilitation, Transplant Division, Hospital Samaritano de São Paulo, São Paulo, Brazil
- Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil
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Robison RD, Patel S, Bunker J, Rudolph JL, Teno JM, Rogus-Pulia N. Pre-hospitalization dysphagia and feeding tube placement in nursing home residents with advanced dementia. J Am Geriatr Soc 2024; 72:778-790. [PMID: 38156795 DOI: 10.1111/jgs.18729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/28/2023] [Accepted: 11/16/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Despite research demonstrating the risks of using feeding tubes in persons with advanced dementia, they continue to be placed. The natural history of dysphagia among patients with advanced dementia has not been examined. We conducted a secondary analysis of a national cohort of persons with advanced dementia staying at a nursing home stay before hospitalization to examine (1) pre-hospitalization dysphagia prevalence and (2) risk of feeding tube placement during hospitalization based on preexisting dysphagia. METHODS A retrospective cohort study consisting of all nursing home (NH) residents (≥66 years) with advanced dementia (Cognitive Function Scale score ≥2), a hospitalization between 2013-2017, and a Minimum Data Set (MDS) 3.0 assessment within 120 days before hospitalization. Pre-hospitalization dysphagia status and surgically placed feeding tube insertion during hospitalization were determined by MDS 3.0 swallowing items and ICD-9 codes, respectively. A multivariate logistic model clustering on hospital was used to examine the association of dysphagia with percutaneous endoscopic gastrostomy (PEG) feeding tube placement after adjustment for confounders. RESULTS Between 2013 and 2017, 889,983 persons with NH stay with advanced dementia (mean age: 84.5, SD: 7.5, and 63.5% female) were hospitalized. Pre-hospitalization dysphagia was documented in 5.4% (n = 47,574) and characterized by oral dysphagia (n = 21,438, 2.4%), pharyngeal dysphagia (n = 24,257, 2.7%), and general swallowing complaints/pain (n = 14,928, 1.7%). Overall, PEG feeding tubes were placed in 3529 patients (11.2%) with pre-hospitalization dysphagia, whereas 27,893 (88.8%) did not have pre-hospitalization dysphagia according to MDS 3.0 items. Feeding tube placement risk increased with the number of dysphagia items noted on the pre-hospitalization MDS (6 vs. 0 dysphagia variables: OR = 5.43, 95% CI: 3.19-9.27). CONCLUSIONS Based on MDS 3.0 assessment, only 11% of PEG feeding tubes were inserted in persons with prior dysphagia. Future research is needed on whether this represents inadequate assessment or the impact of potentially reversible intercurrent illness resulting in feeding tube placement.
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Affiliation(s)
- Raele Donetha Robison
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health (SMPH), Madison, Wisconsin, USA
- Center for Health Disparities Research, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Sweta Patel
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Jennifer Bunker
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - James L Rudolph
- Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, Rhode Island, USA
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
| | - Joan M Teno
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Nicole Rogus-Pulia
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health (SMPH), Madison, Wisconsin, USA
- Center for Health Disparities Research, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
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Peng F, Wang H, Li J, Ma M, Jiang X, Run H, Li Q, Leng J, Xiao L, Tang L. Best evidence summary for prevention and management of enteral feeding intolerance in critically ill patients. J Clin Nurs 2024; 33:781-796. [PMID: 37994227 DOI: 10.1111/jocn.16934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/17/2023] [Accepted: 10/18/2023] [Indexed: 11/24/2023]
Abstract
AIM To evaluate and summarize the evidence for prevention and management of enteral feeding intolerance in critically ill patients and provide reference for clinical practice. DESIGN This study was an evidence summary followed by the evidence summary reporting standard of Fudan University Center for Evidence-based Nursing. METHODS Current literatures were systematically searched for the best evidence for prevention and management of enteral feeding intolerance in critically ill patients. Literature types included clinical guidelines, best practice information sheets, expert consensuses, systematic reviews, evidence summaries and cohort studies. DATA SOURCES UpToDate, BMJ Best Practice, Joanna Briggs Institute, Guidelines International Network, National Institute for Health and Care Excellence, Registered Nurses Association of Ontario, Scottish Intercollegiate Guidelines Network, the Cochrane Library, Embase, PubMed, Sinomed, Web of Science, Yi Maitong Guidelines Network, DynaMed, MEDLINE, CNKI, WanFang database, Chinese Medical Journal Full-text Database, European Society for Clinical Nutrition and Metabolism website, the American Society for Parenteral and Enteral Nutrition website were searched from January 2012 to April 2023. RESULTS We finally identified 18 articles that had high-quality results. We summarized the 24 pieces of best evidence from these articles, covering five aspects: screening and assessment of the risk of enteral nutritional tolerance; formulation of enteral nutrition preparations; enteral nutritional feeding implementation; feeding intolerance symptom prevention and management; and multidisciplinary management. Of these pieces of evidence, 19 were 'strong' and 5 were 'weak', 7 pieces of evidence were recommended in level one and 4 pieces of evidence were recommended in level two. CONCLUSION The following 24 pieces of evidence for prevention and management of enteral feeding intolerance in critically ill patients were finally recommended. However, as these evidences came from different countries, relevant factors such as the clinical environment should be evaluated before application. Future studies should focus on more specific symptoms of feeding intolerance and more targeted prevention design applications. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE The clinical medical staffs are recommended to take evidence-based recommendations for the implementation of standardized enteral nutrition to improve patient outcomes and decrease gastrointestinal intolerance in critically ill patients. IMPACT The management of enteral nutrition feeding intolerance has always been a challenge and difficulty in critically ill patients. This study summarizes 24 pieces of the best evidence for prevention and management of enteral nutrition feeding intolerance in critically ill patients. Following and implementing these 24 pieces of evidence is beneficial to the prevention and management of feeding intolerance in clinical practice. The 24 pieces of evidence include five aspects, including screening and assessment of the risk of enteral nutritional tolerance, formulation of enteral nutrition preparations, enteral nutritional feeding implementation, feeding intolerance symptom prevention and management and multidisciplinary management. These five aspects constitute a good implementation process. Screening and assessment of enteral nutritional tolerance throughout intervention are important guarantees for developing a feasible nutrition program in critically ill patients. This study will be benefit to global medical workers in the nutritional management of critically ill patients. REPORTING METHOD This evidence summary followed the evidence summary reporting specifications of Fudan University Center for Evidence-based Nursing, which were based on the methodological process for the summary of the evidence produced by the Joanna Briggs Institute (JBI). The reporting specifications include problem establishment, literature retrieval, literature screening, literature evaluation, the summary and grading of evidence and the formation of practical suggestions. This study was based on the evidence summary reporting specifications of the Fudan University Center for the Evidence-based Nursing, the register name is 'Best evidence summary for prevention and management of enteral feeding intolerance in critically ill patients', the registration number is 'ES20231823'.
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Affiliation(s)
- Fang Peng
- School of Nursing, University of South China, Hunan, P.R. China
- Department of Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Huaqin Wang
- Department of Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Jianzhi Li
- School of Nursing, University of South China, Hunan, P.R. China
| | - Mengqi Ma
- School of Nursing, University of South China, Hunan, P.R. China
| | - Xuemeng Jiang
- School of Nursing, University of South China, Hunan, P.R. China
| | - Han Run
- School of Nursing, University of South China, Hunan, P.R. China
| | - Qingting Li
- Department of Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Juanjuan Leng
- School of Nursing, University of South China, Hunan, P.R. China
| | - Luwei Xiao
- School of Nursing, University of South China, Hunan, P.R. China
| | - Li Tang
- Department of Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
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Kirk AHP, Ong C, Wong JJM, Loh SW, Mok YH, Lee JH. Nutritional Intake in Children with Septic Shock: A Retrospective Single-Center Study. J Pediatr Intensive Care 2024; 13:18-24. [PMID: 38571981 PMCID: PMC10987225 DOI: 10.1055/s-0041-1736146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/13/2021] [Indexed: 10/20/2022] Open
Abstract
Nutritional practice in children with severe sepsis or septic shock remains poorly described. We aimed to describe nutrition received by children with severe sepsis or septic shock and explore the association of nutritional intake with clinical outcomes. This study was a retrospective study of children who required pediatric intensive care unit (PICU) admission from 2009 to 2016. Outcomes were mortality, ventilator-free days (VFDs), and PICU-free days (IFDs). A total of 74 patients with septic shock or severe sepsis were identified. Forty-one (55.4%) patients received enteral nutrition (EN) only, 6 (8.1%) patients received parental nutrition (PN) only, 15 (20.3%) patients received both EN and PN, and 12 (16.2%) patients received intravenous fluids alone. Eight of 74 (10.8%) and 4 of 74 (5.4%) had adequate energy and protein intake, respectively. Patients who received early EN had lower odds of 28-day mortality (adjusted hazard ratio [HR] = 0.09, 95% confidence interval [CI]: 0.02, 0.45, p = 0.03) more 28-day VFDs (adjusted β-coefficient = 18.21 [95% CI: 11.11, 25.32], p < 0.001), and IFDs (adjusted ß-coefficient = 16.71 [95% CI: 9.86, 23.56], p < 0.001) than patients who did not receive EN. Late EN was also associated with lower odds of mortality, more VFDs, and IFDs compared with no EN (HR = 0.06, 95% CI: 0.02, 0.23; p < 0.001; adjusted β coefficient = 15.66, 95% CI: 9.31, 22.02; p < 0.001; and 12.34 [95% CI: 6.22, 18.46], p < 0.001; respectively). Inadequate calories and protein were not associated with mortality. EN in children with septic shock or severe sepsis was associated with improved clinical outcomes. Future prospective studies are required to explore the impact of EN timing and optimal nutritional intake in these children.
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Affiliation(s)
- Angela H. P. Kirk
- Division of Nursing, Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore
| | - Chengsi Ong
- Department of Nutrition and Dietetics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Judith J.-M. Wong
- Division of Medicine, Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Sin Wee Loh
- Division of Medicine, Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yee Hui Mok
- Division of Medicine, Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jan Hau Lee
- Division of Medicine, Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Pan S, Cheah L, Bushra R, Ribbits A, Grimes S, O'Neill JR. Impact of early enteral feed composition on the rate of chyle leak post-esophagectomy. Dis Esophagus 2024:doae008. [PMID: 38366666 DOI: 10.1093/dote/doae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/12/2024] [Indexed: 02/18/2024]
Abstract
Patients undergoing esophagectomy are at risk of malnutrition and benefit from perioperative enteral feeding. Esophagectomy carries a risk of chyle leak, and this risk may be influenced by early enteral feed composition. We evaluated the impact of early enteral medium-chain triglyceride-rich feed on the prevalence and severity of chyle leak post-esophagectomy, length of stay, and postoperative weight change. This retrospective study included consecutive patients undergoing esophagectomy at a single center between January 2015 and December 2022. Patients received enteral feed on postoperative days 1-5 with Nutrison Energy or Protein Plus Energy ('standard') (January 2015- June 2021) or Nutrison Peptisorb Plus High Energy High Protein ('HEHP') enteral feed (June 2021 to December 2022). All patients transitioned to 'standard' supplemental jejunal feeding on postoperative day 6 onwards and were discharged on oral IDDSI level 4 diet. Patients who did not commence early enteral feeding were excluded from analysis. A total of 329 patients were included. Patients who received early HEHP feed had fewer chyle leaks (5/52; 9.6%) compared with patients who received standard feed (68/277; 24.5%, P = 0.017). The HEHP group had a shorter total length of hospital stay (P = 0.011). Weight change from preoperative baseline was equivalent in both groups at 6 weeks (P = 0.066) and 3 months (P = 0.400). In the context of routine jejunostomy use and early enteral feeding post-esophagectomy, HEHP feed on postoperative days 1-5 was associated with significantly fewer chyle leaks and shorter length of stay compared with standard feed. No difference was noted in postoperative weight change between groups.
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Affiliation(s)
- Sally Pan
- Cambridge Oesophagogastric Centre, Division of Digestive Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Lilyanne Cheah
- Cambridge Oesophagogastric Centre, Division of Digestive Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Raisa Bushra
- Cambridge Oesophagogastric Centre, Division of Digestive Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Alexander Ribbits
- Cambridge Oesophagogastric Centre, Division of Digestive Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Samantha Grimes
- Cambridge Oesophagogastric Centre, Division of Digestive Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - J Robert O'Neill
- Cambridge Oesophagogastric Centre, Division of Digestive Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Edinburgh Cancer Research, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
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Chen W, Peng M, Ye Z, Ai Y, Liu Z. The mode and timing of administrating nutritional treatment of critically ill elderly patients in intensive care units: a multicenter prospective study. Front Med (Lausanne) 2024; 11:1321599. [PMID: 38384419 PMCID: PMC10879295 DOI: 10.3389/fmed.2024.1321599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 01/15/2024] [Indexed: 02/23/2024] Open
Abstract
Introduction Critically ill patients are more susceptible to malnutrition due to their severe illness. Moreover, elderly patients who are critically ill lack specific nutrition recommendations, with nutritional care in the intensive care units (ICUs) deplorable for the elderly. This study aims to investigate nutrition treatment and its correlation to mortality in elderly patients who are critically ill in intensive care units. Method A multiple-center prospective cohort study was conducted in China from 128 intensive care units (ICUs). A total of 1,238 elderly patients were included in the study from 26 April 2017. We analyzed the nutrition characteristics of elderly patients who are critically ill, including initiated timing, route, ways of enteral nutrition (EN), and feeding complications, including the adverse aspects of feeding, acute gastrointestinal injury (AGI), and feeding interruption. Multivariate logistic regression analysis was used to screen out the impact of nutrition treatment on a 28-day survival prognosis of elderly patients in the ICU. Result A total of 1,238 patients with a median age of 76 (IQR 70-83) were enrolled in the study. The Sequential Organ Failure (SOFA) median score was 7 (interquartile range: IQR 5-10) and the median Acute Physiology and Chronic Health Evaluation (APACHE) II was 21 (IQR 16-25). The all-cause mortality score was 11.6%. The percentage of nutritional treatment initiated 24 h after ICU admission was 58%, with an EN of 34.2% and a parenteral nutrition (PN) of 16.0% in elderly patients who are critically ill. Patients who had gastrointestinal dysfunction with AGI stage from 2 to 4 were 25.2%. Compared to the survivors' group, the non-survivors group had a lower ratio of EN delivery (57% vs. 71%; p = 0.015), a higher ratio of post-pyloric feeding (9% vs. 2%; p = 0.027), and higher frequency of feeding interrupt (24% vs. 17%, p = 0.048). Multivariable logistics regression analysis showed that patients above 76 years old with OR (odds ratio) 2.576 (95% CI, 1.127-5.889), respiratory rate > 22 beats/min, and ICU admission for 24 h were independent risk predictors of the 28-day mortality study in elderly patients who are critically ill. Similarly, other independent risk predictors of the 28-day mortality study were those with an OR of 2.385 (95%CI, 1.101-5.168), lactate >1.5 mmol/L, and ICU admission for 24 h, those with an OR of 7.004 (95%CI, 2.395-20.717) and early PN delivery within 24 h of ICU admission, and finally those with an OR of 5.401 (95%CI, 1.175-24.821) with EN delivery as reference. Conclusion This multi-center prospective study describes clinical characteristics, the mode and timing of nutrition treatment, frequency of AGI, and adverse effects of nutrition in elderly ICU patients. According to this survey, ICU patients with early PN delivery, older age, faster respiratory rate, and higher lactate level may experience poor prognosis.
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Affiliation(s)
- Wei Chen
- Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Provincial Clinical Research Center for Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Milin Peng
- Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Provincial Clinical Research Center for Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhiwen Ye
- Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Provincial Clinical Research Center for Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuhang Ai
- Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Provincial Clinical Research Center for Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhiyong Liu
- Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Provincial Clinical Research Center for Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Obayashi M, Iwata S, Okuda T, Mori I, Nakane S, Togawa Y, Sugimoto M, Togawa T, Muramatsu K, Saitoh S, Sugiura T, Iwata O. Antenatal Growth, Gestational Age, Birth, Enteral Feeding, and Blood Citrulline Levels in Very Low Birth Weight Infants. Nutrients 2024; 16:476. [PMID: 38398801 PMCID: PMC10893150 DOI: 10.3390/nu16040476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/30/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024] Open
Abstract
Early enteral nutrition using reliable biomarkers of intestinal function must be established to improve neurodevelopmental outcomes in very low birth weight infants (VLBWIs). Serum citrulline levels reflect the intestinal function in adults. To elucidate the relationship among antenatal growth, postnatal enteral nutrition, and blood citrulline levels, a retrospective single-center observational study was conducted on 248 VLBWIs born between April 2014 and March 2021. A mixed effect model and post hoc simple slope analysis were used to estimate the correlations between clinical variables and citrulline levels at Early (day 5.1) and Late (day 24.3) postnatal ages. Greater gestational age, birth weight, and amount of enteral nutrition at the time of blood sampling were associated with lower citrulline levels at the Early postnatal age and higher citrulline levels at the Late postnatal age. Provided that Early citrulline levels predominantly reflect the consequence of antenatal citrulline metabolism, it is suggested that fetal growth and maturation are likely to promote citrulline catabolism in utero and its synthesis after birth. With additional insights into the temporal transition point wherein the maturation-dependent balance of citrulline metabolism shifts from catabolism-dominant to synthesis-dominant, citrulline emerges as a potential biomarker for assessing intestinal function and gastrointestinal disorders.
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Affiliation(s)
- Midori Obayashi
- Department of Pediatrics and Neonatology, Toyohashi Municipal Hospital, 50 Aza Hakken Nishi, Aotake-cho, Toyohashi 441-8570, Japan (T.O.); (I.M.); (S.N.); (M.S.)
| | - Sachiko Iwata
- Center for Human Development and Family Science, Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho, Nagoya 467-8601, Japan; (S.I.); (S.S.)
| | - Tomoya Okuda
- Department of Pediatrics and Neonatology, Toyohashi Municipal Hospital, 50 Aza Hakken Nishi, Aotake-cho, Toyohashi 441-8570, Japan (T.O.); (I.M.); (S.N.); (M.S.)
| | - Ichita Mori
- Department of Pediatrics and Neonatology, Toyohashi Municipal Hospital, 50 Aza Hakken Nishi, Aotake-cho, Toyohashi 441-8570, Japan (T.O.); (I.M.); (S.N.); (M.S.)
| | - Shigeharu Nakane
- Department of Pediatrics and Neonatology, Toyohashi Municipal Hospital, 50 Aza Hakken Nishi, Aotake-cho, Toyohashi 441-8570, Japan (T.O.); (I.M.); (S.N.); (M.S.)
| | - Yasuko Togawa
- Department of Pediatrics and Neonatology, Toyohashi Municipal Hospital, 50 Aza Hakken Nishi, Aotake-cho, Toyohashi 441-8570, Japan (T.O.); (I.M.); (S.N.); (M.S.)
| | - Mari Sugimoto
- Department of Pediatrics and Neonatology, Toyohashi Municipal Hospital, 50 Aza Hakken Nishi, Aotake-cho, Toyohashi 441-8570, Japan (T.O.); (I.M.); (S.N.); (M.S.)
| | - Takao Togawa
- Department of Pediatrics and Neonatology, Toyohashi Municipal Hospital, 50 Aza Hakken Nishi, Aotake-cho, Toyohashi 441-8570, Japan (T.O.); (I.M.); (S.N.); (M.S.)
- Center for Human Development and Family Science, Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho, Nagoya 467-8601, Japan; (S.I.); (S.S.)
| | - Kanji Muramatsu
- Department of Pediatrics and Neonatology, Toyohashi Municipal Hospital, 50 Aza Hakken Nishi, Aotake-cho, Toyohashi 441-8570, Japan (T.O.); (I.M.); (S.N.); (M.S.)
| | - Shinji Saitoh
- Center for Human Development and Family Science, Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho, Nagoya 467-8601, Japan; (S.I.); (S.S.)
| | - Takahiro Sugiura
- Department of Pediatrics and Neonatology, Toyohashi Municipal Hospital, 50 Aza Hakken Nishi, Aotake-cho, Toyohashi 441-8570, Japan (T.O.); (I.M.); (S.N.); (M.S.)
| | - Osuke Iwata
- Department of Pediatrics and Neonatology, Toyohashi Municipal Hospital, 50 Aza Hakken Nishi, Aotake-cho, Toyohashi 441-8570, Japan (T.O.); (I.M.); (S.N.); (M.S.)
- Center for Human Development and Family Science, Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho, Nagoya 467-8601, Japan; (S.I.); (S.S.)
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Byrnes A, Glen K, Matthews-Rensch K, Fry J, MacLaughlin H, Cutmore C, Dux C, Treleaven E, Banks M, Hiatt J, Wu YC, Wan YTJ, Young A. Use and safety of enteral nutrition protocols in acute care: A scoping review of literature and retrospective audit of practice. Nutr Diet 2024; 81:51-62. [PMID: 37287439 DOI: 10.1111/1747-0080.12819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/24/2023] [Accepted: 05/09/2023] [Indexed: 06/09/2023]
Abstract
AIM Standardised enteral nutrition protocols are recommended in critical care, however their use and safety are not well described in other inpatient populations. This mixed methods study reports on the use and safety of enteral nutrition protocols for non-critically ill adults. METHODS A scoping review of published literature was conducted. In addition a retrospective audit of practice at an Australian tertiary teaching hospital with an existing hospital-wide standardised enteral nutrition protocol was performed. Data on use, safety and adequacy of enteral nutrition prescription were collected from medical records for patients receiving enteral nutrition on acute wards (January-March 2020). RESULTS Screening of 9298 records yielded six primary research articles. Studies were generally low quality. Published literature suggested that protocols may reduce time to enteral nutrition initiation and goal rate, and improve adequacy of nutrition provision. No adverse outcomes were reported. From the local audit of practice (105 admissions, 98 patients), enteral nutrition commencement was timely (median 0 (IQR 0-1) days from request; goal rate: median 1 (IQR 0-2) days from commencement and adequate (nil underfeeding), without prior dietitian review in 82% of cases. Enteral nutrition was commenced per protocol in 61% of instances. No adverse events, including refeeding syndrome, were observed. CONCLUSIONS Most inpatients requiring enteral nutrition can be safely and adequately managed on enteral nutrition protocols. Evaluation of protocols outside of the critical care setting remains a gap in the literature. Standardised enteral nutrition protocols may improve delivery of nutrition to patients, whilst allowing dietitians to focus on those with specialised nutrition support needs.
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Affiliation(s)
- Angela Byrnes
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Kate Glen
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | | | - Jessica Fry
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | | | - Clare Cutmore
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Claire Dux
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Elise Treleaven
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Merrilyn Banks
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Joanne Hiatt
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Yuet Ching Wu
- Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | | | - Adrienne Young
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- The University of Queensland, Saint Lucia, Queensland, Australia
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Neumann ML, Allen JY, Ladner A, Kakani S, Weaver MS, Mercer DF. Exploring the impact of pediatric short bowel syndrome on parent well-being using a disease-specific pilot survey. Nutr Clin Pract 2024; 39:154-167. [PMID: 37245122 DOI: 10.1002/ncp.11008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/10/2023] [Accepted: 04/16/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Children with short bowel syndrome (SBS) have complex care needs, most of which are met in the home by family caregivers who may experience a range of stressors unique to this experience. Prior research suggests that parents of children with SBS have poorer health-related quality of life than peers parenting children without health needs, but the mechanisms shaping parent outcomes are understudied. METHODS A pilot survey was developed using a community-driven research design to measure the impact of disease-specific items on parent-perceived well-being. The cross-sectional survey, which included both closed-ended and open-ended items, was distributed to a convenience sample of parents of children with SBS. Quantitative and qualitative data were integrated for a mixed-methods analysis of how individual items impacted parent well-being. RESULTS Twenty parents completed the survey. Sleep interruptions, lack of support and resources, and psychological stressors and their mental health implications were more frequently reported as stressors than logistics related to caregiving (e.g., managing therapies and preparing specialized meals). CONCLUSION The impact of a child's SBS on parent well-being may stem mainly from three interconnected domains: poor sleep and its consequences, lack of access to support and resources, and a range of psychological stressors that affect parent mental health. Understanding the mechanisms through which SBS shapes parent well-being is a necessary first step for developing targeted interventions to support parents and provide family-centered care.
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Affiliation(s)
- Marie L Neumann
- Department of Surgery, Division of Transplant Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Department of Communication Studies, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
- The Gutsy Perspective, Huntsville, Alabama, USA
| | - Jessica Y Allen
- The Gutsy Perspective, Huntsville, Alabama, USA
- Department of Psychology, Birmingham-Southern College, Birmingham, Alabama, USA
| | - Amy Ladner
- The Gutsy Perspective, Huntsville, Alabama, USA
| | | | - Meaghann S Weaver
- Department of Pediatrics, Division of Pediatric Palliative Care, Children's Hospital and Medical Center, Omaha, Nebraska, USA
- National Center for Ethics in Health Care, US Department of Veterans Affairs, Washington, DC, USA
| | - David F Mercer
- Department of Surgery, Division of Transplant Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Hasse JM, Meng S, Silpe S, Naziruddin B. Nutrition challenges following total pancreatectomy with islet autotransplantation. Nutr Clin Pract 2024; 39:86-99. [PMID: 38213274 DOI: 10.1002/ncp.11106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 01/13/2024] Open
Abstract
Total pancreatectomy with islet autotransplantation (TPIAT) is a surgical treatment option for patients with chronic pancreatitis who have not responded to other therapies. TP offers pain relief whereas IAT preserves beta cell mass to reduce endocrine insufficiency. During the surgical procedure, the entire pancreas is removed. Islet cells from the pancreas are then isolated, purified, and infused into the liver via the portal vein. Successful TPIAT relieves pain for a majority of patients but is not without obstacles, specifically gastrointestinal, exocrine, and endocrine challenges. The postoperative phase can be complicated by gastrointestinal symptoms causing patients to have difficulty regaining adequate oral intake. Enteral nutrition is frequently provided as a bridge to oral diet. Patients undergoing TPIAT must be monitored for macronutrient and micronutrient deficiencies following the procedure. Exocrine insufficiency must be treated lifelong with pancreatic enzyme replacement therapy. Endocrine function must be monitored and exogenous insulin provided in the postoperative phase; however, a majority of patients undergoing TPIAT require little or no long-term insulin. Although TPIAT can be a successful option for patients with chronic pancreatitis, nutrition-related concerns must be addressed for optimal recovery.
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Affiliation(s)
- Jeanette M Hasse
- Baylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Shumei Meng
- Division of Endocrinology, Internal Medicine, Baylor University Medical Center, Dallas, Texas, USA
| | - Stephanie Silpe
- Baylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Bashoo Naziruddin
- Islet Cell Laboratory, Baylor Research Institute, Baylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
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41
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Hahn M, Wood A, Hasse JM. Nutrition support management of organ transplant recipients in the acute posttransplant phase. Nutr Clin Pract 2024; 39:45-58. [PMID: 38081296 DOI: 10.1002/ncp.11104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/09/2023] [Accepted: 11/12/2023] [Indexed: 01/13/2024] Open
Abstract
Patients who undergo solid organ transplant can have an extensive and challenging postoperative course. The chronicity of the disease state prior to transplant in combination with transplant-specific complications and immunosuppressant medications can lead to distinct challenges that are not observed in other critically ill patients. Although the manifestation of posttransplant complications may be specific to the organ being transplanted, there are common transplant challenges that affect nutrition therapy in these patients. Effects of malnutrition, metabolic aberrations, and posttransplant organ dysfunction should be considered when developing a nutrition care plan for patients in the immediate posttransplant phase. This article addresses the various complications that can arise in the immediate posttransplant phase among patients undergoing solid organ transplant and the appropriate nutrition interventions or considerations for this specialized patient population.
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Affiliation(s)
- Michaelann Hahn
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Abby Wood
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Jeanette M Hasse
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
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Wallinga MM, Newkirk M, Gardner MT, Ziegler J. Variation in metabolic demand following severe pediatric traumatic brain injury: A case review. Nutr Clin Pract 2024; 39:246-253. [PMID: 37221644 DOI: 10.1002/ncp.11010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 04/02/2023] [Accepted: 04/16/2023] [Indexed: 05/25/2023] Open
Abstract
A traumatic brain injury (TBI) is one of the most common pediatric traumas among children in the United States. Appropriate nutrition support, including the initiation of early enteral nutrition, within the first 48 h after injury is crucial for children with a TBI. It is important that clinicians avoid both underfeeding and overfeeding, as both can lead to poor outcomes. However, the variable metabolic response to a TBI can make determining appropriate nutrition support difficult. Because of the dynamic metabolic demand, indirect calorimetry (IC) is recommended, instead of predictive equations, to measure energy requirements. Although IC is suggested and ideal, few hospitals have the technology available. This case review discusses the variable metabolic response, identified using IC, in a child with a severe TBI. The case report highlights the ability of the team to meet measured energy requirements early, even in the setting of fluid overload. It also highlights the presumed positive impact of early and appropriate nutrition provision on the patient's clinical and functional recovery. Further research is needed to investigate the metabolic response to TBIs in children and the impact optimal feedings based on the measured resting energy expenditure have on clinical, functional, and rehabilitation outcomes.
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Affiliation(s)
- Melissa M Wallinga
- Department of Clinical and Preventative Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey, USA
- Pediatric Intensive Care Unit, St. Luke's Children's Hospital, Boise, Idaho, USA
| | - Melanie Newkirk
- Department of Clinical and Preventative Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey, USA
| | - Michelle T Gardner
- Pediatric Intensive Care Unit, St. Luke's Children's Hospital, Boise, Idaho, USA
| | - Jane Ziegler
- Department of Clinical and Preventative Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey, USA
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Nucci AM, Crim K, King E, Ganoza AJ, Remaley L, Rudolph J. Nutrition support considerations in pediatric small bowel transplantation. Nutr Clin Pract 2024; 39:75-85. [PMID: 37925666 DOI: 10.1002/ncp.11091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/06/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023] Open
Abstract
Enteral autonomy is the primary goal of intestinal failure therapy. Intestinal transplantation (ITx) is an option when enteral autonomy cannot be achieved and management complications become life-threatening. The purpose of this review is to summarize existing medical literature related to nutrition requirements, nutrition status, and nutrition support after pediatric ITx. Achieving or maintaining adequate growth after intestinal transplant in children can be challenging because of episodes of rejection that require the use of corticosteroids, occurrences of infection that require a reduction or discontinuation of enteral or parenteral support, and fat malabsorption caused by impaired lymphatic circulation. Nutrient requirements should be assessed and modified regularly based on nutrition status, growth, ventilatory status, wound healing, and the presence of complications. Parenteral nutrition (PN) should be initiated as a continuous infusion early postoperatively. Enteral support should be initiated after evidence of graft bowel function and in the absence of clinical complications. Foods high in simple carbohydrates should be limited, as consumption may result in osmotic diarrhea. Short-term use of a fat-free diet followed by a low-fat diet may reduce the risk of the development of chylous ascites. Micronutrient deficiencies and food allergies are common occurrences after pediatric ITx. Enteral/oral vitamin and mineral supplementation may be required after PN is weaned. Nutrition management of children after ITx can be challenging for all members of the healthcare team. Anthropometric parameters and micronutrient status should be monitored regularly so that interventions to promote growth and prevent or reverse nutrient deficiencies can be implemented promptly.
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Affiliation(s)
- Anita M Nucci
- Department of Nutrition, Georgia State University, Atlanta, Georgia, USA
| | | | - Elizabeth King
- Department of Nutrition, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Armando J Ganoza
- Thomas E. Starzl Transplant Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lisa Remaley
- Thomas E. Starzl Transplant Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jeffrey Rudolph
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Davies SJ, Wheelwright S. The impact of jejunostomy feeding on nutritional outcomes after oesophagectomy. J Hum Nutr Diet 2024; 37:126-136. [PMID: 37789732 DOI: 10.1111/jhn.13235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/03/2023] [Accepted: 08/21/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Nutritional status is compromised long-term following oesophagectomy. Controversy surrounds the optimal route for nutrition support postoperatively and there is wide variation in the use of feeding jejunostomy tubes. METHODS A retrospective service evaluation was conducted for all consecutive adults who underwent oesophagectomy for a cancer diagnosis within a specialist centre between April 2016 and July 2019 (n = 165). Nutritional and clinical outcomes were compared for patients who received jejunostomy feeding (n = 24), versus those who did not (n = 141). RESULTS Patients with feeding jejunostomy lost significantly less weight at both 6 and 12 months postoperatively compared to those without jejunostomy (p ≤ 0.001 and p = 0.001, respectively). This remained statistically significant in multiple regression, controlling for age, gender, preoperative tumour staging and adjuvant treatment (p ≤ 0.001 and p = 0.03, respectively). Median length of home enteral feeding was 10 weeks after discharge in the jejunostomy group. We observed minor jejunostomy tube-related complications in four patients (16.7%). Of those readmitted within 90 days of surgery in the non-jejunostomy group, nutritional failure was a factor in 43.2% of these readmissions. "Rescue tube feeding" was required by 8.5% of the non-jejunostomy group within the first postoperative year, including 6.4% within 90 days of surgery. CONCLUSIONS Use of short-term supplementary jejunal feeding in addition to oral intake after hospital discharge is beneficial for maintaining weight after oesophagectomy. We suggest a future randomised-controlled trial to confirm these findings.
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Affiliation(s)
- Sarah J Davies
- School of Health Sciences, Southampton, UK
- Department of Nutrition & Dietetics, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
- Department of Dietitics/SLT, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Sally Wheelwright
- School of Health Sciences, Southampton, UK
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Brighton, UK
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45
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Walker S, Johnson TW, Carter H, Spurlock AY, Johnson K, Hussey J. Blenderized food tube feeding in very young pediatric patients with special healthcare needs. Nutr Clin Pract 2024; 39:202-209. [PMID: 36871186 DOI: 10.1002/ncp.10975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 01/18/2023] [Accepted: 02/05/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Up to 85% of children with severe developmental disabilities have feeding disorders and require enteral tube feeding. Many caregivers desire blenderized tube feeding (BTF) instead of commercial formula (CF) for their child, citing a desire for a more physiologic feeding, to reduce gastrointestinal (GI) symptoms and/or promote oral intake. METHODS In this retrospective, single-center study, medical records (n = 34) of very young children (aged ≤36 months) with severe developmental disabilities were reviewed. Comparisons of growth parameters, GI symptoms, oral feeding, and GI medication use were made between the initial introduction of BTF and again at the last patient encounter when the children aged out of the program. RESULTS Of the 34 charts reviewed (16 male and 18 female patients), comparisons between baseline BTF introduction and the last patient encounter indicated reductions in adverse GI symptoms, significant GI medication reduction (P = 0.000), increased oral food intake, and nonsignificant improvements in growth parameters. These positive outcomes were realized whether children received full or partial BTF or type of BTF formulation. CONCLUSION Consistent with similar research studies, transitioning very young children with significant special healthcare needs from CF to BTF resulted in improvement in GI symptoms, reduced need for GI medications, supported growth goals, and contributed to improved oral feeding.
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Affiliation(s)
- Shawna Walker
- The Resource Exchange, Colorado Springs, Colorado, USA
| | - Teresa W Johnson
- Kinesiology & Health Promotion, Troy University, Troy, Alabama, USA
| | - Holly Carter
- Kinesiology & Health Promotion, Troy University, Troy, Alabama, USA
| | - Amy Y Spurlock
- School of Nursing, Boise State University, Boise, Idaho, USA
| | - Kelly Johnson
- Kinesiology & Health Promotion, Troy University, Troy, Alabama, USA
| | - Jenna Hussey
- Kinesiology & Health Promotion, Troy University, Troy, Alabama, USA
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46
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Koretz RL. JPEN Journal Club 79. If it may, it also may not. JPEN J Parenter Enteral Nutr 2024; 48:239-241. [PMID: 37497594 DOI: 10.1002/jpen.2555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Ronald L Koretz
- Olive View-UCLA Medical Center, Sylmar, California, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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47
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Downs EM, Brun A, Bellin MD. Nutrition support in the pediatric total pancreatectomy with islet autotransplantation recipient. Nutr Clin Pract 2024; 39:100-108. [PMID: 38073153 DOI: 10.1002/ncp.11101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 01/13/2024] Open
Abstract
For children with diminished quality of life and chronic pain caused by acute recurrent or chronic pancreatitis who are undergoing total pancreatectomy with islet autotransplantation, postoperative nutrition support has several unique characteristics. Surgical complications may lead to delays in nutrition support initiation or require modifications to the regimen. Early postoperative dysmotility requires the use of temporary enteral nutrition until this improves. The resultant complete exocrine pancreatic insufficiency necessitates lifelong pancreatic enzyme replacement therapy and fat-soluble vitamin supplementation. A low-oxalate diet is recommended to prevent kidney stones. Carbohydrate counting is needed for the provision of short-term insulin dosing and possibly long-term as well, depending on the transplanted islet yield. Children should have careful nutrition assessment and monitoring at several follow-up visits during the first year, then annually, and at any time with concerns.
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Affiliation(s)
- Elissa M Downs
- Pediatric Gastroenterology, Hepatology, and Nutrition, M Health Fairview, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Amanda Brun
- Nutrition Services, M Health Fairview, Minneapolis, Minnesota, USA
| | - Melena D Bellin
- Pediatric Endocrinology and Transplant Surgery, M Health Fairview, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
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Fati F, Pulvirenti R, Longo G, Antoniello LM, Zambaiti E, Gamba P. Percutaneous endoscopic gastrostomy in children receiving peritoneal dialysis: A tertiary centre long-term experience and literature review. Perit Dial Int 2024:8968608231223812. [PMID: 38265012 DOI: 10.1177/08968608231223812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Children with severe chronic kidney disease receiving maintenance peritoneal dialysis (PD) are often malnourished and may require nutritional supplementation. Recent PD guidelines address laparoscopic and open surgical gastrostomy as safe approaches in children established on PD, while existing evidence on percutaneous endoscopic gastrostomy (PEG) is still lacking; as well as the role of perioperative antibiotic and antifungal prophylaxis. Hence, this study aimed to report our experience with PEG placement in patients on PD and compare it with the available literature. METHODS We retrospectively reviewed the medical records from patients on PD, who underwent PEG placement at a tertiary referral centre between 2000 and 2020. Data on perioperative management, complications and outcomes were retrieved. An extensive literature search was performed; studies describing PEG placement and perioperative prophylaxis in patients on PD were used as a comparison. Descriptive statistical analysis was conducted. RESULTS Seven patients (five males) were included. Perioperative antibiotic and antifungal prophylaxis were standard practice. At a median follow-up of 27 months (10-75), the peritonitis rate was 0.2 patient/years. No statistical significance was found between the peritonitis rate before and after PEG placement (p = 0.2). Patients' demographics and postoperative complications were comparable to the reported studies. CONCLUSIONS Based on our experience, our technique of PEG insertion with antimicrobial prophylaxis is feasible and associated with an acceptable complication risk in patients on PD. Further multicentric studies about surgical technique in patients on PD will be necessary to verify the feasibility of PEG and standardise the perioperative protocol.
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Affiliation(s)
- Federica Fati
- Pediatric Surgery Unit, Women's and Children's Health Department, University Hospital of Padua, Italy
| | - Rebecca Pulvirenti
- Pediatric Surgery Unit, Women's and Children's Health Department, University Hospital of Padua, Italy
| | - Germana Longo
- Pediatric Nephrology, Dialysis and Transplant Unit, Women's and Children's Health Department, University Hospital of Padua, Italy
| | - Luca Maria Antoniello
- Pediatric Surgery Unit, Women's and Children's Health Department, University Hospital of Padua, Italy
| | - Elisa Zambaiti
- Pediatric Surgery Unit, Women's and Children's Health Department, University Hospital of Padua, Italy
- Pediatric Surgery Unit, Patologia e Cura del Bambino Department, Ospedale Infantile Regina Margherita, Turin, Italy
| | - Piergiorgio Gamba
- Pediatric Surgery Unit, Women's and Children's Health Department, University Hospital of Padua, Italy
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Trivedi A, Teo E, Walker KS. Probiotics for the postoperative management of term neonates after gastrointestinal surgery. Cochrane Database Syst Rev 2024; 1:CD012265. [PMID: 38258877 PMCID: PMC10804440 DOI: 10.1002/14651858.cd012265.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND The intestinal microflora has an essential role in providing a barrier against colonisation of pathogens, facilitating important metabolic functions, stimulating the development of the immune system, and maintaining intestinal motility. Probiotics are live microorganisms that can be administered to supplement the gut flora. Neonates who have undergone gastrointestinal surgery are particularly susceptible to infectious complications in the postoperative period. This may be partly due to a disruption of the integrity of the gut and its intestinal microflora. There may be a role for probiotics in reducing the incidence of sepsis and improving intestinal motility, thus reducing morbidity and mortality and improving enteral feeding in neonates in the postoperative period. OBJECTIVES To evaluate the efficacy and safety of administering probiotics after gastrointestinal surgery for the postoperative management of neonates born from 35 weeks of gestation. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and trial registries in August 2023. We checked reference lists of included studies and relevant systematic reviews for additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) that investigated the postoperative administration of oral probiotics versus placebo or no treatment in neonates born from 35 weeks of gestation who had one or more gastrointestinal surgical procedures. We applied no restrictions regarding the type or dosage of probiotics or the duration of treatment. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods, and we used GRADE to assess the certainty of evidence. MAIN RESULTS We identified one RCT that recruited 61 neonates with a gestational age of 35 weeks or more. All infants were admitted to a neonatal intensive care unit and had surgery for gastrointestinal pathologies. There may be little or no difference in proven sepsis (positive bacterial culture, local or systemic) between infants who receive probiotics compared with those who receive placebo (odds ratio (OR) 0.64, 95% confidence interval (CI) 0.16 to 2.55; 61 infants; low-certainty evidence). Probiotics compared to placebo may have little or no effect on time to full enteral feeds (mean difference (MD) 0.63 days, 95% CI -4.02 to 5.28; 61 infants; low-certainty evidence). There were no reported deaths prior to discharge from hospital in either study arm. Two weeks after supplementation, the infants who received probiotics had a substantially higher relative abundance of non-pathogenic intestinal microflora (Bifidobacteriaceae) than those who received placebo (MD 38.22, 95% CI 28.40 to 48.04; 39 infants; low-certainty evidence). AUTHORS' CONCLUSIONS This review provides low-certainty evidence from one small RCT that probiotics compared to placebo have little or no effect on the risk of proven sepsis (positive bacterial culture, local or systemic) or time to full-enteral feeds in neonates who have undergone gastrointestinal surgery. Probiotics may substantially increase the abundance of beneficial bacterial in the intestine of these neonates, but the clinical implications of this finding are unknown. There is a need for adequately powered RCTs to assess the role of probiotics in this population. We identified two ongoing studies. As neither reported the gestational age of prospective study participants, we are unsure if they will be eligible for inclusion in this review.
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Affiliation(s)
- Amit Trivedi
- Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Edward Teo
- Emergency Department, Concord Repatriation General Hospital, Sydney, Australia
| | - Karen S Walker
- Neonatal intensive Care Unit, Royal Prince Alfred hospital, Sydney, Australia
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50
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Utrilla Fornals A, Costas-Batlle C, Medlin S, Menjón-Lajusticia E, Cisneros-González J, Saura-Carmona P, Montoro-Huguet MA. Metabolic and Nutritional Issues after Lower Digestive Tract Surgery: The Important Role of the Dietitian in a Multidisciplinary Setting. Nutrients 2024; 16:246. [PMID: 38257141 PMCID: PMC10820062 DOI: 10.3390/nu16020246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 12/31/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
Many patients undergo small bowel and colon surgery for reasons related to malignancy, inflammatory bowel disease (IBD), mesenteric ischemia, and other benign conditions, including post-operative adhesions, hernias, trauma, volvulus, or diverticula. Some patients arrive in the operating theatre severely malnourished due to an underlying disease, while others develop complications (e.g., anastomotic leaks, abscesses, or strictures) that induce a systemic inflammatory response that can increase their energy and protein requirements. Finally, anatomical and functional changes resulting from surgery can affect either nutritional status due to malabsorption or nutritional support (NS) pathways. The dietitian providing NS to these patients needs to understand the pathophysiology underlying these sequelae and collaborate with other professionals, including surgeons, internists, nurses, and pharmacists. The aim of this review is to provide an overview of the nutritional and metabolic consequences of different types of lower gastrointestinal surgery and the role of the dietitian in providing comprehensive patient care. This article reviews the effects of small bowel resection on macronutrient and micronutrient absorption, the effects of colectomies (e.g., ileocolectomy, low anterior resection, abdominoperineal resection, and proctocolectomy) that require special dietary considerations, nutritional considerations specific to ostomized patients, and clinical practice guidelines for caregivers of patients who have undergone a surgery for local and systemic complications of IBD. Finally, we highlight the valuable contribution of the dietitian in the challenging management of short bowel syndrome and intestinal failure.
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Affiliation(s)
| | - Cristian Costas-Batlle
- Department of Nutrition and Dietetics, Bradford Teaching Hospitals NHS Foundation Trust, Bradford BD9 6RJ, UK;
| | | | - Elisa Menjón-Lajusticia
- Gastroenterology, Hepatology and Nutrition Unit, University Hospital San Jorge, 22004 Huesca, Spain;
| | - Julia Cisneros-González
- Faculty of Health and Sport Sciences, University of Zaragoza, 22002 Huesca, Spain; (J.C.-G.); (P.S.-C.)
| | - Patricia Saura-Carmona
- Faculty of Health and Sport Sciences, University of Zaragoza, 22002 Huesca, Spain; (J.C.-G.); (P.S.-C.)
| | - Miguel A. Montoro-Huguet
- Gastroenterology, Hepatology and Nutrition Unit, University Hospital San Jorge, 22004 Huesca, Spain;
- Faculty of Health and Sport Sciences, University of Zaragoza, 22002 Huesca, Spain; (J.C.-G.); (P.S.-C.)
- Department of Medicine, Faculty of Health and Sport Sciences, University of Zaragoza, 22002 Huesca, Spain
- Aragon Health Research Institute (IIS Aragon), University of Zaragoza, 22002 Huesca, Spain
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