scholarly journals Vasopressors and Nutrition Therapy: Safe Dose for the Outset of Enteral Nutrition?

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Luís Henrique Simões Covello ◽  
Marcella Giovana Gava-Brandolis ◽  
Melina Gouveia Castro ◽  
Martins Fidelis Dos Santos Netos ◽  
William Manzanares ◽  
...  
Keyword(s):  
Intensive Care ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Signs ◽  
Nutritional Therapy ◽  
Fluid Replacement ◽  
Vasoactive Drugs ◽  
Inclusion Criteria ◽  
Safe Dose

Background and Aims. Patients with hemodynamic instability need to receive intensive treatment as fluid replacement and vasoactive drugs. In the meantime, it is supposed to initiate nutritional therapy within 24 to 48 hours after admission to the intensive care unit (ICU), as an essential part of patient’s intensive care and better outcomes. However, there are many controversies tangential to the prescription of enteral nutrition (EN) concomitant to the use of vasopressor and its doses. In this way, the present study aimed to identify what the literature presents of evidence to guide the clinical practice concerning the safe dose of vasopressors for the initiation of nutritional therapy in critically ill patients. Methods. This review was carried out in PubMed, ProQuest, Web of Science, and Medline databases. The descriptors were used to perform the search strategy: Critical Care, Intensive Care Units, Vasoconstrictor Agents, and Enteral Nutrition. Inclusion criteria were patients of both genders, over 18 years of age, using vasoactive drugs, with the possibility of receiving EN therapy, and articles written in English, Portuguese, and Spanish. In addition, exclusion criteria were case reports, non-papers, and repeated papers. Results. 10 articles met our inclusion criteria. Conclusion. It was observed that there are many controversies about the supply of EN in critically ill patients using vasopressor, especially about the safe dose, and it was not possible to identify a cutoff value for the beginning therapy. Despite the drug doses, clinical signs are still the most important parameters in the evaluation of EN tolerance.

scholarly journals Risks in Management of Enteral Nutrition in Intensive Care Units: A Literature Review and Narrative Synthesis

Nutrients ◽  
2020 ◽  
Vol 13 (1) ◽  
pp. 82
Author(s):  
Magdalena Hoffmann ◽  
Christine Maria Schwarz ◽  
Stefan Fürst ◽  
Christina Starchl ◽  
Elisabeth Lobmeyr ◽  
...  
Keyword(s):  
Patient Safety ◽  
Intensive Care ◽  
Clinical Practice ◽  
Literature Review ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Rapid Review ◽  
Narrative Synthesis ◽  
Safety Issues

Critically ill patients in the intensive care unit (ICU) have a high risk of developing malnutrition, and this is associated with poorer clinical outcomes. In clinical practice, nutrition, including enteral nutrition (EN), is often not prioritized. Resulting from this, risks and safety issues for patients and healthcare professionals can emerge. The aim of this literature review, inspired by the Rapid Review Guidebook by Dobbins, 2017, was to identify risks and safety issues for patient safety in the management of EN in critically ill patients in the ICU. Three databases were used to identify studies between 2009 and 2020. We assessed 3495 studies for eligibility and included 62 in our narrative synthesis. Several risks and problems were identified: No use of clinical assessment or screening nutrition assessment, inadequate tube management, missing energy target, missing a nutritionist, bad hygiene and handling, wrong time management and speed, nutritional interruptions, wrong body position, gastrointestinal complication and infections, missing or not using guidelines, understaffing, and lack of education. Raising awareness of these risks is a central aspect in patient safety in ICU. Clinical experts can use a checklist with 12 identified top risks and the recommendations drawn up to carry out their own risk analysis in clinical practice.

Implementing Volume-Based Feeding to Optimize Delivery of Enteral Nutrition

2021 ◽  
Vol 41 (2) ◽  
pp. 16-26
Author(s):  
Angela Bonomo ◽  
Diane Lynn Blume ◽  
Katie Davis ◽  
Hee Jun Kim
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Educational Approach ◽  
Lecture Demonstration

Background At least 80% of ordered enteral nutrition should be delivered to improve outcomes in critical care patients. However, these patients typically receive 60% to 70% of ordered enteral nutrition volume. In a practice review within a 28-bed medical-surgical adult intensive care unit, patients received a median of 67.5% of ordered enteral nutrition with standard rate-based feeding. Volume-based feeding is recommended to deliver adequate enteral nutrition to critically ill patients. Objective To use a quality improvement project to increase the volume of enteral nutrition delivered in the medical-surgical intensive care unit. Methods Percentages of target volume achieved were monitored in 73 patients. Comparisons between the rate-based and volume-based feeding groups used nonparametric quality of medians test or the χ2 test. A customized volume-based feeding protocol and order set were created according to published protocols and then implemented. Standardized education included lecture, demonstration, written material, and active personal involvement, followed by a scenario-based test to apply learning. Results Immediately after implementation of this practice change, delivered enteral nutrition volume increased, resulting in a median delivery of 99.8% of ordered volume (P = .003). Delivery of a mean of 98% ordered volume was sustained over the 15 months following implementation. Conclusions Implementation of volume-based feeding optimized enteral nutrition delivery to critically ill patients in this medical-surgical intensive care unit. This success can be attributed to a comprehensive, individualized, and proactive process design and educational approach. The process can be adapted to quality improvement initiatives with other patient populations and units.

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

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

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

Enteral nutrition in critically ill patients undergoing vasoactive drugs therapy. The nutrivad study. Preliminary results

2018 ◽  
Vol 37 ◽  
pp. S53
Author(s):  
J.L. Flordelis Lasierra ◽  
J.C. Montejo González ◽  
J.C. López Delgado ◽  
P. Zárate Chug ◽  
F. Martínez Lozano Aranaga ◽  
...  
Keyword(s):  
Enteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Vasoactive Drugs ◽  
Preliminary Results

scholarly journals Epileptic seizures in critically ill patients

Medicina ◽  
2009 ◽  
Vol 45 (6) ◽  
pp. 501 ◽  
Author(s):  
Virginija Stasiukynienė ◽  
Vidas Pilvinis ◽  
Dagmara Reingardienė ◽  
Liuda Janauskaitė
Keyword(s):  
Intensive Care ◽  
Status Epilepticus ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cortical Neurons ◽  
Central Nervous System Infection ◽  
Clinical Signs ◽  
Convulsive Status Epilepticus ◽  
Neurologic Complication ◽  
Gamma Aminobutyric Acid

The aim of this article – to review the causes, clinical signs, pathophysiology, consequences, and treatment of seizures and status epilepticus in critically ill patients. Only 25% of people, who have seizures and status epilepticus, have epilepsy as well. In the intensive care settings, seizures and status epilepticus are a common neurologic complication, which is attributable to primary neurologic pathology (stroke, hemorrhage, tumor, central nervous system infection, head trauma) or secondary to critical illness (anoxic brain damage, intoxications, metabolic abnormalities) and clinical management. There are three main subtypes of status epilepticus in intensive care units: generalized convulsive status epilepticus, focal motor status epilepticus, and nonconvulsive status epilepticus. A seizure is a consequence of electrical neurological derangement because of sudden imbalance between the inhibitory and excitatory forces within the network of cortical neurons. The main inhibiting neurotransmitter in the brain is gamma-aminobutyric acid (GABA), which binds to GABA-A and GABA-B receptors. The main excitatory neurotransmitter is glutamate, which binds to N-methyl-D-aspartate receptors. Different ions (Cl–, K+, Na+, Ca2+) also play a role in the pathophysiology of seizures. Prolonged status epilepticus may lead to different systemic and neurologic consequences. Generalized convulsive status epilepticus is one of the most common emergencies encountered in clinical practice, which requires immediate treatment. The first-line drugs are benzodiazepines (lorazepam, diazepam), the second-line ones – phenytoin and fosphenytoin. For the treatment of refractory status epilepticus, barbiturates (phenobarbital, pentobarbital, thiopental), valproate, midazolam, propofol, and isoflurane are used. The dosage of drugs and parameters to monitor are referred in the article. The mortality from generalized convulsive status epilepticus is 15–50%; the main factors, influencing prognosis, are the cause and the duration of status epilepticus and age of a patient.

scholarly journals Feeding adequacy among Critically Ill Patients in the Intensive Care Unit and Its Association with Clinical Outcomes: A Narrative Review

2017 ◽  
Vol 5 (2) ◽  
pp. 113-121
Author(s):  
Zheng Yii Lee ◽  
Mohd Yusof Barakatun Nisak ◽  
Ibrahim Noor Airini
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Nutritional Therapy ◽  
Close Monitoring ◽  
Oral Nutrition ◽  
Injured Patients ◽  
Relationship Of

The Intensive Care Unit (ICU) is one of the disciplines in the hospital that provides close monitoring to the seriously ill or injured patients, also known as the critically ill patients. Critically ill patients in the ICU are usually unable to maintain volitional oral nutrition intake and therefore require nutritional therapy. Nutritional therapy can be delivered via the enteral or parenteral route. Optimal nutrition adequacy (i.e. neither underfeeding nor overfeeding) is very important for better clinical outcome. However, the problem of suboptimal feeding adequacy continues to be reported over the years. This article attempts to give an overview of the literature on feeding adequacy and the relationship of feeding adequacy with clinical outcomes among the critically ill patients in the ICU.Bangladesh Crit Care J September 2017; 5(2): 113-121

scholarly journals Monitoramento da terapia nutricional enteral em doentes críticos no Brasil: uma revisão

2020 ◽  
Vol 2 (35) ◽  
pp. 166-170
Author(s):  
Talita Ariane Amaro Lobato ◽  
Priscila Casarin Garla
Keyword(s):  
Intensive Care ◽  
Nutritional Status ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Quality Indicators ◽  
Critically Ill Patients ◽  
Nutritional Therapy ◽  
Nutritional Intervention ◽  
Gastrointestinal Complications ◽  
Routine Monitoring

Introduction: Nutritional therapy is of fundamental importance in the care of critically ill patients, being part of the essential care in intensive care units (ICU), associated with evidence that proves that the nutritional status directly interferes in the clinical evolution of critically ill patients. Routine monitoring has the main objective of ensuring that the nutritional intervention is chosen and provided as planned and prescribed. This review sought to demonstrate the monitoring of enteral nutritional therapy (ENT) in critically ill patients in studies conducted in Brazil. Methods: A search was conducted in the PubMed, LILACS and SciELO databases, between 2014 and August 2019, on quality indicators in NET related to the adequacy of the administration of the infused volume, caloric and protein value, in adult patients (> 18 years) under intensive care. Results: On average, an adequacy of the infused volume of 74.1% was observed, a caloric adequacy of 71.8% and protein of 67.3% of the prescribed value. The most cited reasons for interrupting the administration of NET were gastrointestinal complications and fasting for procedures. Conclusions: The findings showed that, according to quality indicators, NET offered to critically ill patients did not reach the pre-established goal. However, they support the development of strategies to correct inadequacies of this therapy

Anemia in the Critically Ill Patient

2008 ◽  
Vol 21 (6) ◽  
pp. 405-410
Author(s):  
Erkan Hassan
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Patient ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Nutritional Therapy ◽  
Critically Ill Patient ◽  
Multiprofessional Team ◽  
Allogenic Blood ◽  
Proinflammatory Mediators

Anemia in critically ill patients has been described as an acute form of anemia of inflammatory disease and is characterized by a blunted erythropoietic response due in part to proinflammatory mediators. Management of anemia in critically ill patients is a complex issue and is best approached via a multiprofessional team regarding the use of allogenic blood, iron, nutritional therapy, and erythropoietic agents. Indiscriminant, ``routine'' red blood cell transfusions may not only be unnecessary, but may pose unnecessary risk to the intensive care unit patient. Most intensive care unit patients can tolerate lower hemoglobin/hematocrit concentrations than the typically accepted ``10/30 rule.'' Lower transfusion triggers with an overall transfusion strategy is warranted in the intensive care unit patient. The use of recombinant human erythropoietic agents may not be necessary with appropriate transfusion practices.

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