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 Medical Nutrition Therapy in Critically Ill Patients Treated on Intensive and Intermediate Care Units: A Literature Review

2019 ◽  
Vol 8 (9) ◽  
pp. 1395 ◽  
Author(s):  
Andrea Kopp Lugli ◽  
Aude de Watteville ◽  
Alexa Hollinger ◽  
Nicole Goetz ◽  
Claudia Heidegger
Keyword(s):  
Clinical Practice ◽  
Stress Response ◽  
Literature Review ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Current Knowledge ◽  
Nutrition Therapy ◽  
Intermediate Care ◽  
Medical Nutrition Therapy ◽  
Medical Nutrition

Medical nutrition therapy in critically ill patients remains challenging, not only because of the pronounced stress response with a higher risk for complications, but also due to their heterogeneity evolving from different phases of illness. The present review aims to address current knowledge and guidelines in order to summarize how they can be best implemented into daily clinical practice. Further studies are urgently needed to answer such important questions as best timing, route, dose, and composition of medical nutrition therapy for critically ill patients and to determine how to assess and to adapt to patients’ individual needs.

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 Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines

2017 ◽  
Vol 43 (3) ◽  
pp. 380-398 ◽  
Author(s):  
Annika Reintam Blaser ◽  
◽  
Joel Starkopf ◽  
Waleed Alhazzani ◽  
Mette M. Berger ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Critically Ill Patients ◽  
Early Enteral Nutrition

Qualitätsmanagement auf der Intensivstation

2018 ◽  
Vol 143 (21) ◽  
pp. 1541-1546
Author(s):  
Reimer Riessen ◽  
Michael Haap
Keyword(s):  
Intensive Care Unit ◽  
Patient Safety ◽  
Intensive Care ◽  
Quality Management ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Interdisciplinary Team ◽  
Management Measures

AbstractThe care of critically ill patients in an intensive care unit is effected by an interprofessional and interdisciplinary team. Quality and success of intensive care is mainly based on the performance of this team. Suitable quality management measures, based on valid indicators, insure an optimal workflow for the benefit of patient safety.

scholarly journals CRM en una Unidad de Cuidados Intensivos: Mejorando la seguridad en el paciente crítico

2019 ◽  
Vol 10 (12) ◽  
pp. 6
Author(s):  
Inmaculada Hernández García ◽  
María Lema Tomé ◽  
Pilar Cabrerizo Torrente ◽  
Estefanía Chamorro García ◽  
Ana Isabel Galve Marqués ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Patient Safety ◽  
Intensive Care ◽  
Resource Management ◽  
Adverse Events ◽  
Human Factors ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Aviation Safety ◽  
Awareness Training

El factor humano contribuye en la mayoría de los eventos adversos que suceden tanto en aviación como en nuestro entorno médico. El conocimiento y entrenamiento del factor humano es lo que se conoce como CRM (“Recursos para el manejo de las crisis”). El objetivo de este estudio fue determinar si la implementación del CRM en una Unidad de Cuidados Intensivos conlleva algún impacto en el desenlace del paciente crítico. ABSTRACT CRM in intensive care unit: improving critical patient safety.  Human factors account for the majority of adverse events in both aviation and medicine. Human factors awareness training entitled “Crew Resource Management (CRM)” is associated with improved aviation safety. We determined whether implementation of CRM impacts outcome in critically ill patients.

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