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

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

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

scholarly journals Full versus Trophic Feeds in Critically Ill Adults with High and Low Nutritional Risk Scores: A Randomized Controlled Trial

Nutrients ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3518
Author(s):  
Chen-Yu Wang ◽  
Pin-Kuei Fu ◽  
Wen-Cheng Chao ◽  
Wei-Ning Wang ◽  
Chao-Hsiu Chen ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Controlled Trial ◽  
Risk Scores ◽  
Nutrition Risk ◽  
Randomized Controlled ◽  
Trophic Feeding

Although energy intake might be associated with clinical outcomes in critically ill patients, it remains unclear whether full or trophic feeding is suitable for critically ill patients with high or low nutrition risk. We conducted a prospective study to determine which feeding energy intakes were associated with clinical outcomes in critically ill patients with high or low nutrition risk. This was an investigator-initiated, single center, single blind, randomized controlled trial. Critically ill patients were allocated to either high or low nutrition risk based on their Nutrition Risk in the Critically Ill score, and then randomized to receive either the full or the trophic feeding. The feeding procedure was administered for six days. No significant differences were observed in hospital, 14-day and 28-day mortalities, the length of ventilator dependency, or ICU and hospital stay among the four groups. There were no associations between energy and protein intakes and hospital, 14-day and 28-day mortalities in any of the four groups. However, protein intake was positively associated with the length of hospital stay and ventilator dependency in patients with low nutrition risk receiving trophic feeding. Full or trophic feeding in critically ill patients showed no associations with clinical outcomes, regardless of nutrition risk.

scholarly journals Comparison of Feeding Efficiency and Hospital Mortality between Small Bowel and Nasogastric Tube Feeding in Critically Ill Patients at High Nutritional Risk

Nutrients ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 2009
Author(s):  
Wei-Ning Wang ◽  
Chen-Yu Wang ◽  
Chiann-Yi Hsu ◽  
Pin-Kuei Fu
Keyword(s):  
Small Bowel ◽  
Enteral Nutrition ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Energy Intake ◽  
Nasogastric Tube ◽  
Critically Ill Patients ◽  
Nutritional Risk ◽  
Nutrition Risk ◽  
Achievement Rate

Nasogastric tube enteral nutrition (NGEN) should be initiated within 48 h for patients at high nutritional risk. However, whether small bowel enteral nutrition (SBEN) should be routinely used instead of NGEN to improve hospital mortality remains unclear. We retrospectively analyzed 113 critically ill patients with modified Nutrition Risk in Critically Ill (mNUTRIC) score ≥ 5 and feeding volume < 750 mL/day in the first week of their stay in the intensive care unit (ICU). Age, sex, mNUTRIC score, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score were matched in the SBEN (n = 48) and NGEN (n = 65) groups. Through a univariate analysis, factors associated with hospital mortality were SBEN group (hazard ratio (HR), 0.56; 95% confidence interval (CI), 0.31–1.00), Simplified Organ Failure Assessment (SOFA) score on day 7 (HR, 1.12; 95% CI, 1.03–1.22), and energy intake achievement rate < 65% (HR, 2.53; 95% CI, 1.25–5.11). A multivariate analysis indicated that energy intake achievement rate < 65% on the third follow-up day (HR, 2.29; 95% CI, 1.12–4.69) was the only factor independently associated with mortality. We suggest initiation of SBEN on the seventh ICU day before parenteral nutrition initiation for critically ill patients at high nutrition risk.

scholarly journals Varying association of laboratory values with reference ranges and outcomes in critically ill patients: an analysis of data from five databases in four countries across Asia, Europe and North America

2021 ◽  
Vol 28 (1) ◽  
pp. e100419
Author(s):  
Haoran Xu ◽  
Louis Agha-Mir-Salim ◽  
Zachary O’Brien ◽  
Dora C Huang ◽  
Peiyao Li ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cross Sectional Study ◽  
Specific Reference ◽  
Reference Ranges ◽  
Cross Sectional ◽  
Laboratory Values ◽  
Laboratory Results ◽  
The Usa

BackgroundDespite wide usage across all areas of medicine, it is uncertain how useful standard reference ranges of laboratory values are for critically ill patients.ObjectivesThe aim of this study is to assess the distributions of standard laboratory measurements in more than 330 selected intensive care units (ICUs) across the USA, Amsterdam, Beijing and Tarragona; compare differences and similarities across different geographical locations and evaluate how they may be associated with differences in length of stay (LOS) and mortality in the ICU.MethodsA multi-centre, retrospective, cross-sectional study of data from five databases for adult patients first admitted to an ICU between 2001 and 2019 was conducted. The included databases contained patient-level data regarding demographics, interventions, clinical outcomes and laboratory results. Kernel density estimation functions were applied to the distributions of laboratory tests, and the overlapping coefficient and Cohen standardised mean difference were used to quantify differences in these distributions.ResultsThe 259 382 patients studied across five databases in four countries showed a high degree of heterogeneity with regard to demographics, case mix, interventions and outcomes. A high level of divergence in the studied laboratory results (creatinine, haemoglobin, lactate, sodium) from the locally used reference ranges was observed, even when stratified by outcome.ConclusionStandardised reference ranges have limited relevance to ICU patients across a range of geographies. The development of context-specific reference ranges, especially as it relates to clinical outcomes like LOS and mortality, may be more useful to clinicians.

scholarly journals Nutrition in acute renal failure

2005 ◽  
Vol 123 (3) ◽  
pp. 143-147 ◽  
Author(s):  
Sérgio Mussi Guimarães ◽  
José Paulo Cipullo ◽  
Suzana Margareth Ajeje Lobo ◽  
Emmanuel de Almeida Burdmann
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Nutritional Status ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Nutritional Support ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Traditional Methods

Nutritional status has been considered to be one of the possible determinants of mortality rates in cases of acute renal failure (ARF). However, most studies evaluating possible mortality indicators in ARF cases have not focused on the nutritional status, possibly because of the difficulties involved in assessing the nutritional status of critically ill patients. Although the traditional methods for assessing nutritional status are used for ARF patients, they are not the best choice in this population. The use of nutritional support for these patients has produced conflicting results regarding morbidity and mortality. This review covers the mechanisms and indicators of malnutrition in ARF cases and the types of nutritional support that may be used.

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

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

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

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

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

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

scholarly journals Asupan Energi dan Protein Berhubungan dengan Gizi Kurang pada Anak Usia 6-24 Bulan

2017 ◽  
Vol 1 (2) ◽  
pp. 124
Author(s):  
Dewi Kencono Jati ◽  
Triska Susila Nindya
Keyword(s):  
Nutritional Status ◽  
Energy Intake ◽  
Random Sampling ◽  
Protein Intake ◽  
Nutrient Intake ◽  
Measurement Data ◽  
Simple Random Sampling ◽  
High Energy ◽  
Chi Square ◽  
Cross Sectional

  Background: Children under two years of age are susceptible to nutritional problems. Nutrient intake are needed for optimal growth and mental development. Inadequate energy intake in the long run can lead to protein energy malnutrition.Objectives: The purpose of this study was to analyze the association energy and protein intake with nutritional status of children aged 6 to 24 months. Methods: This research used cross sectional design aprroach.  The subjects of this study were 62 children under two years (aged 6-24 months). Selection of sample was using simple random sampling Data was collected through interviews using a structured questionnaire, nutrient intake using 2x24hours recall, and weight measurement. Data was analyzed using Chi-square test. Results: The results showed that majority of the children had inadequate energy intake, adequate protein intake, 24.2% were underweight. There was a correlation between energy intake (p=0.044) and protein intake (p=0.038) with nutritional status WAZ. Conclusion: The conclusion of this study is  energy and protein intake contribute to underweight incidences among children aged 6-24 months. Therefore, it could be advised to increase high energy and protein intake for optimum growth.ABSTRAK Latar belakang: Anak dengan usia di bawah dua tahun rentan mengalami masalah gizi. Asupan gizi dibutuhkan untuk pertumbuhan dan perkembangan fisik dan mental. Asupan energi yang tidak mencukupi dalam waktu jangka panjang dapat menyebabkan gizi kurang yang berdampak pada kekurangan energi-protein. Tujuan: Tujuan dari penelitian ini adalah untuk menganalisis hubungan asupan energi dan protein dengan status gizi berdasarkan BB/U pada anak usia 6-24 bulan di wilayah kerja Puskesmas Klampis Ngasem, Surabaya.Metode: Penelitian ini menggunakan desain cross sectional. Subyek dari penelitian ini adalah 62 bayi di bawah dua tahun (baduta) berusia 6-24 bulan yang didapatkan dari metode simple random sampling. Pengumpulan data dilakukan dengan menggunakan kuesioner terstruktur, asupan gizi dengan recall 2x24hrs, dan pengukuran berat badan. Teknik analisis data dilakukan dengan uji statistik Chi-square. Hasil: Hasil penelitian menunjukkan bahwa sebagian besar baduta memiliki asupan energi tidak adekuat, asupan protein adekuat, dan 24,2% mengalami underweight. Terdapat hubungan asupan energi (p=0,044) dan asupan protein (p=0,038) dengan status gizi BB/U.Kesimpulan: Energi dan protein berkontribusi terhadap kejadian underweight pada baduta. Oleh karena itu, disarankan selalu melakukan peningkatan konsumsi pangan dengan memberikan asupan makanan yang mengandung energi dan protein untuk pertumbuhan yang optimal.

scholarly journals Asupan Energi dan Protein Berhubungan dengan Gizi Kurang pada Anak Usia 6-24 Bulan

2017 ◽  
Vol 1 (2) ◽  
pp. 124 ◽  
Author(s):  
Dewi Kencono Jati ◽  
Triska Susila Nindya
Keyword(s):  
Nutritional Status ◽  
Energy Intake ◽  
Random Sampling ◽  
Protein Intake ◽  
Nutrient Intake ◽  
Measurement Data ◽  
Simple Random Sampling ◽  
High Energy ◽  
Chi Square ◽  
Cross Sectional

  Background: Children under two years of age are susceptible to nutritional problems. Nutrient intake are needed for optimal growth and mental development. Inadequate energy intake in the long run can lead to protein energy malnutrition.Objectives: The purpose of this study was to analyze the association energy and protein intake with nutritional status of children aged 6 to 24 months. Methods: This research used cross sectional design aprroach.  The subjects of this study were 62 children under two years (aged 6-24 months). Selection of sample was using simple random sampling Data was collected through interviews using a structured questionnaire, nutrient intake using 2x24hours recall, and weight measurement. Data was analyzed using Chi-square test. Results: The results showed that majority of the children had inadequate energy intake, adequate protein intake, 24.2% were underweight. There was a correlation between energy intake (p=0.044) and protein intake (p=0.038) with nutritional status WAZ. Conclusion: The conclusion of this study is  energy and protein intake contribute to underweight incidences among children aged 6-24 months. Therefore, it could be advised to increase high energy and protein intake for optimum growth.ABSTRAK Latar belakang: Anak dengan usia di bawah dua tahun rentan mengalami masalah gizi. Asupan gizi dibutuhkan untuk pertumbuhan dan perkembangan fisik dan mental. Asupan energi yang tidak mencukupi dalam waktu jangka panjang dapat menyebabkan gizi kurang yang berdampak pada kekurangan energi-protein. Tujuan: Tujuan dari penelitian ini adalah untuk menganalisis hubungan asupan energi dan protein dengan status gizi berdasarkan BB/U pada anak usia 6-24 bulan di wilayah kerja Puskesmas Klampis Ngasem, Surabaya.Metode: Penelitian ini menggunakan desain cross sectional. Subyek dari penelitian ini adalah 62 bayi di bawah dua tahun (baduta) berusia 6-24 bulan yang didapatkan dari metode simple random sampling. Pengumpulan data dilakukan dengan menggunakan kuesioner terstruktur, asupan gizi dengan recall 2x24hrs, dan pengukuran berat badan. Teknik analisis data dilakukan dengan uji statistik Chi-square. Hasil: Hasil penelitian menunjukkan bahwa sebagian besar baduta memiliki asupan energi tidak adekuat, asupan protein adekuat, dan 24,2% mengalami underweight. Terdapat hubungan asupan energi (p=0,044) dan asupan protein (p=0,038) dengan status gizi BB/U.Kesimpulan: Energi dan protein berkontribusi terhadap kejadian underweight pada baduta. Oleh karena itu, disarankan selalu melakukan peningkatan konsumsi pangan dengan memberikan asupan makanan yang mengandung energi dan protein untuk pertumbuhan yang optimal.

scholarly journals Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: a systematic review and meta-analysis of non-randomized cohort studies

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Eleni Papoutsi ◽  
Vassilis G. Giannakoulis ◽  
Eleni Xourgia ◽  
Christina Routsi ◽  
Anastasia Kotanidou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Mortality And Morbidity ◽  
Icu Admission ◽  
All Cause Mortality ◽  
Detectable Difference

Abstract Background Although several international guidelines recommend early over late intubation of patients with severe coronavirus disease 2019 (COVID-19), this issue is still controversial. We aimed to investigate the effect (if any) of timing of intubation on clinical outcomes of critically ill patients with COVID-19 by carrying out a systematic review and meta-analysis. Methods PubMed and Scopus were systematically searched, while references and preprint servers were explored, for relevant articles up to December 26, 2020, to identify studies which reported on mortality and/or morbidity of patients with COVID-19 undergoing early versus late intubation. “Early” was defined as intubation within 24 h from intensive care unit (ICU) admission, while “late” as intubation at any time after 24 h of ICU admission. All-cause mortality and duration of mechanical ventilation (MV) were the primary outcomes of the meta-analysis. Pooled risk ratio (RR), pooled mean difference (MD) and 95% confidence intervals (CI) were calculated using a random effects model. The meta-analysis was registered with PROSPERO (CRD42020222147). Results A total of 12 studies, involving 8944 critically ill patients with COVID-19, were included. There was no statistically detectable difference on all-cause mortality between patients undergoing early versus late intubation (3981 deaths; 45.4% versus 39.1%; RR 1.07, 95% CI 0.99–1.15, p = 0.08). This was also the case for duration of MV (1892 patients; MD − 0.58 days, 95% CI − 3.06 to 1.89 days, p = 0.65). In a sensitivity analysis using an alternate definition of early/late intubation, intubation without versus with a prior trial of high-flow nasal cannula or noninvasive mechanical ventilation was still not associated with a statistically detectable difference on all-cause mortality (1128 deaths; 48.9% versus 42.5%; RR 1.11, 95% CI 0.99–1.25, p = 0.08). Conclusions The synthesized evidence suggests that timing of intubation may have no effect on mortality and morbidity of critically ill patients with COVID-19. These results might justify a wait-and-see approach, which may lead to fewer intubations. Relevant guidelines may therefore need to be updated.

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