scholarly journals Enteral nutritional intake in adult korean intensivecare patients

2013 ◽  
Vol 22 (2) ◽  
pp. 126-135 ◽  
Author(s):  
Hyunjung Kim ◽  
Nancy A. Stotts ◽  
Erika S. Froelicher ◽  
Marguerite M. Engler ◽  
Carol Porter
Keyword(s):  
Intensive Care ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Energy Intake ◽  
Enteral Feeding ◽  
Protein Intake ◽  
Nutritional Intake ◽  
Gastrointestinal Intolerance ◽  
Critically Ill Adults ◽  
Prolonged Feeding

BackgroundNutritional support is important for maximizing clinical outcomes in critically ill patients, but enteral nutritional intake is often inadequate.ObjectiveTo assess the nutritional intake of energy and protein during the first 4 days after initiation of enteral feeding and to examine the relationship between intake and interruptions of enteral feeding in Korean patients in intensive care.MethodsA cohort of 34 critically ill adults who had a primary medical diagnosis and received bolus enteral feeding were studied prospectively. Energy and protein requirements were determined by using the Harris-Benedict equation and the American Dietetic Association equation. Energy and protein intake prescribed and received and the reasons for and lengths of feeding interruptions were recorded for 4 consecutive days immediately after enteral feeding began.ResultsAlthough the differences between requirements and intakes of energy and protein decreased significantly, patients did not receive required energy and protein intake during the 4 days of the study. Energy intake prescribed was consistently less than required on each of the 4 days. Enteral nutrition was withheld for a mean of 6 hours per patient for the 4 days. Prolonged feeding interruptions due to gastrointestinal intolerance (r= –0.874; P < .001) and procedures (r= –0.839; P = .005) were negatively associated with the percentage of prescribed energy received.ConclusionsEnteral nutritional intake was insufficient in bolus-fed Korean intensive care patients because of prolonged feeding interruptions and underprescription of enteral nutrition. Feeding interruptions due to gastrointestinal intolerance and procedures were the main contributors to inadequate energy intake. (American Journal of Critical Care. 2013;22:126–135)

Improvement of Nutritional Intake in Intensive Care Unit Patients via a Nurse-Led Enteral Nutrition Feeding Protocol

2018 ◽  
Vol 38 (3) ◽  
pp. 38-44 ◽  
Author(s):  
Ira Orinovsky ◽  
Ela Raizman
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Enteral Nutrition ◽  
Enteral Feeding ◽  
Intervention Group ◽  
Nutritional Intake ◽  
Control Group ◽  
Clinical Value ◽  
Feeding Group ◽  
Feeding Protocol

Background Enteral nutrition in intensive care unit patients has important prognostic clinical value. Feeding protocols are recommended by clinical practice guidelines as a key strategy to maximize the benefits and minimize the risks of enteral feedings. Objective To examine whether enteral nutrition in critically ill patients could be improved by implementation of a nurse-led evidence-based feeding protocol. Methods An interprofessional group of intensive care unit nurses, physicians, and a clinical dietitian designed a protocol to address and correct the shortcomings of enteral feeding. Data on feeding and clinical outcomes were collected retrospectively for patients for 12 months before (control group) and then for 12 months after (interventional group) implementation of the protocol. Results Enteral feeding was started significantly earlier (P = .007) after admission to the intensive care unit in the intervention group (52.3 hours; SD, 42.6) than in the control group (70.3 hours; SD, 65.2). Use of the protocol resulted in a significant increase in nutritional intake; 90% of patients in the intervention group but only 34% in the traditional feeding group achieved their caloric target within 96 hours after admission (P < .001). After implementation of the protocol, cessation of feeding due to intolerance was significantly less (P = .03) in the intervention group (6%) than in the traditional feeding group (14 %), and no adverse events were detected. Conclusions Adherence to standardized guidelines with a written protocol for an early start and timely escalation of enteral feeding can improve nutritional intake among intensive care unit patients.

Maximizing Nutrition Support Practice and Measuring Adherence to Nutrition Support Guidelines in a Canadian Tertiary Care ICU

2017 ◽  
Vol 33 (3) ◽  
pp. 209-217 ◽  
Author(s):  
Michele E. McCall ◽  
Alice Adamo ◽  
Katherine Latko ◽  
Ashley K. Rieder ◽  
Nicole Durand ◽  
...  
Keyword(s):  
Enteral Nutrition ◽  
Enteral Feeding ◽  
Tertiary Care ◽  
Nutritional Intake ◽  
Nutrition Support ◽  
Mechanically Ventilated ◽  
Tertiary Teaching ◽  
Gastrointestinal Intolerance ◽  
Surgical Icu ◽  
American Society

Objective: New comprehensive guidelines for nutrition support (NS) in the intensive care unit (ICU) can be used to improve quality of care and benchmark current practice. The objective of this study was to (a) compare NS practices in our medical/surgical ICU (MSICU) to 18 recommendations described in the Canadian Clinical Practice Guidelines and Society of Critical Care Medicine/American Society of Parenteral and Enteral Nutrition guidelines, (b) determine the percentage of goal calories and protein delivered, and (c) identify the barriers to successful NS delivery. Design: This was a prospective observation trial of up to 14 days duration. Setting: A 24-bed MSICU in a tertiary teaching hospital in Toronto, Canada. Patients: We studied 98 mechanically ventilated patients with any diagnosis who were expected to require either enteral nutrition (EN) or parenteral nutrition (PN) for >48 hours. Measurements: We measured nutritional intake, barriers to nutritional intake, and parameters that allowed comparison of our practice to 18 guidelines. Main Results: Mean delivery of protein and energy was 79.3% and 81.1% of goal, respectively. The average time to initiation of EN support was 29.5 ± 23.7 hours. The 3 main reasons for interruption to enteral feeding were airway management issues, procedures, and gastrointestinal intolerance. Enteral feeding during vasopressor therapy was well tolerated. Ten of the 18 guidelines were followed for ≥80% of the time. Protein goals for patients on renal replacement therapy and patients with liver disease were not reached. Head-of-bed positioning was also inadequate. The 13 patients requiring PN all had appropriate indications for this therapy, including gastrointestinal leaks, maldigestion, or malabsorption. Conclusions: Nutrition support delivery was successful for most patients in this study. However, only 10 of the 18 guidelines were adequately followed. This study helped identify NS practices that work well and others that require strategies for improvement.

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 Comparison of Feeding Efficacy and Hospital Mortality Between Small Bowel and Nasogastric Tube Enteral Nutrition in Critical Illness at High Nutritional Risk

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1152-1152 ◽  
Author(s):  
Wei-Ning Wang ◽  
Pin-Kuei Fu ◽  
Chiann-Yi Hsu
Keyword(s):  
Small Bowel ◽  
Enteral Nutrition ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Energy Intake ◽  
Nasogastric Tube ◽  
Critically Ill Patients ◽  
Protein Intake ◽  
Nutritional Risk ◽  
Achievement Rate

Abstract Objectives The current guidelines recommend that early enteral nutrition (EN) support by nasogastric tube enteral nutrition (NGEN) should be initiated within 48 h in the critically ill patients at high nutritional risk. Small bowel EN (SBEN) was suggested for those who are NGEN intolerance. Our previous study showed adjuvant feeding with SBEN at 7th ICU day may improve feeding efficacy and have survival benefit for those energy achievement rate more than 65% at the 3rd day after SBEN. However, the comparison of feeding efficacy and hospital mortality between SBEN and NGEN remains unclear. Methods A retrospective cohort study enrolled 113 critically ill patients at high nutrition risk (modified NUTRIC score≧5) and at inadequate feeding volume (&lt; 750 ml/day) in the first week of ICU stay. Patients were classified into SBEN (N = 48) and NGEN (N = 65) group at 8th ICU day (enrolled day). Daily actual energy intake was recorded after enrolled day in each group and feeding efficiency was compared between two groups. Cox regression analysis was used to assess factors associated with hospital mortality. Results The feeding volume, energy and protein intake, and achievement rate (%) of energy and protein intake increased significantly in the SBEN group at the 3rd following day (P &lt; 0.001). Hospital mortality in this cohort was 43.3%. By univariate analysis, SBEN group (HR: 0.56, 95% CI: 0.31–1.00, P = 0.049), SOFA score at day 7 (HR:1.12, 95% CI: 1.03–1.22, P = 0.009) and energy intake achievement rate &lt; 65% at the 3rd followed-up day (HR: 2.53, 95% CI: 1.25–5.11, P = 0.010) were associated with hospital mortality. By multivariate analysis, the only factor associated hospital mortality in this cohort was energy intake achievement rate &lt; 65% at the 3rd followed-up day (HR: 2.29, 95% CI: 1.12–4.69, P = 0.023). Conclusions SBEN improves energy delivery and might be reduced in hospital mortality in critically ill patients at high nutritional risk after 1 week of stomach enteral nutrition in ICU. Funding Sources None.

scholarly journals Caring for critically ill adults in paediatric intensive care units in England during the COVID-19 pandemic: planning, implementation and lessons for the future

2021 ◽  
pp. archdischild-2020-320962
Author(s):  
Ruchi Sinha ◽  
Angela Aramburo ◽  
Akash Deep ◽  
Emma-Jane Bould ◽  
Hannah L Buckley ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Clinical Care ◽  
Adult Patients ◽  
Paediatric Intensive Care ◽  
Critically Ill Adults ◽  
Care Capacity ◽  
Ill Adults ◽  
Paediatric Intensive Care Units

ObjectiveTo describe the experience of paediatric intensive care units (PICUs) in England that repurposed their units, equipment and staff to care for critically ill adults during the first wave of the COVID-19 pandemic.DesignDescriptive study.SettingSeven PICUs in England.Main outcome measures(1) Modelling using historical Paediatric Intensive Care Audit Network data; (2) space, staff, equipment, clinical care, communication and governance considerations during repurposing of PICUs; (3) characteristics, interventions and outcomes of adults cared for in repurposed PICUs.ResultsSeven English PICUs, accounting for 137 beds, repurposed their space, staff and equipment to admit critically ill adults. Neighbouring PICUs increased their bed capacity to maintain overall bed numbers for children, which was informed by historical data modelling (median 280–307 PICU beds were required in England from March to June). A total of 145 adult patients (median age 50–62 years) were cared for in repurposed PICUs (1553 bed-days). The vast majority of patients had COVID-19 (109/145, 75%); the majority required invasive ventilation (91/109, 85%). Nearly, a third of patients (42/145, 29%) underwent a tracheostomy. Renal replacement therapy was provided in 20/145 (14%) patients. Twenty adults died in PICU (14%).ConclusionIn a rapid and unprecedented effort during the first wave of the COVID-19 pandemic, seven PICUs in England were repurposed to care for adult patients. The success of this effort was underpinned by extensive local preparation, close collaboration with adult intensivists and careful national planning to safeguard paediatric critical care capacity.

scholarly journals Impact of Propofol Sedation upon Caloric Overfeeding and Protein Inadequacy in Critically Ill Patients Receiving Nutrition Support

Pharmacy ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 121
Author(s):  
Roland N. Dickerson ◽  
Christopher T. Buckley
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Enteral Nutrition ◽  
Parenteral Nutrition ◽  
Critically Ill Patients ◽  
Protein Intake ◽  
Lipid Emulsion ◽  
Caloric Intake ◽  
Nutrition Therapy ◽  
Nutrition Support

Propofol, a commonly used sedative in the intensive care unit, is formulated in a 10% lipid emulsion that contributes 1.1 kcals per mL. As a result, propofol can significantly contribute to caloric intake and can potentially result in complications of overfeeding for patients who receive concurrent enteral or parenteral nutrition therapy. In order to avoid potential overfeeding, some clinicians have empirically decreased the infusion rate of the nutrition therapy, which also may have detrimental effects since protein intake may be inadequate. The purpose of this review is to examine the current literature regarding these issues and provide some practical suggestions on how to restrict caloric intake to avoid overfeeding and simultaneously enhance protein intake for patients who receive either parenteral or enteral nutrition for those patients receiving concurrent propofol therapy.

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.

Sleep-Promotion Bundle Development, Implementation, and Evaluation in Critically Ill Adults: Roles for Pharmacists

2021 ◽  
pp. 106002802110484
Author(s):  
Patricia R. Louzon ◽  
Mojdeh S. Heavner ◽  
Kyle Herod ◽  
Ting Ting Wu ◽  
John W. Devlin
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Data Extraction ◽  
Implementation Strategies ◽  
Sleep Time ◽  
Mesh Terms ◽  
Care Protocol ◽  
Quasi Experimental ◽  
Critically Ill Adults ◽  
Ill Adults

Objective: To review evidence for intensive care unit (ICU) sleep improvement bundle use, identify preferred sleep bundle components and implementation strategies, and highlight the role for pharmacists in developing and evaluating bundle efforts. Data Sources: Multiple databases were searched from January 1, 1990, to September 1, 2021, using the MeSH terms sleep, intensive care or critical care, protocol or bundle to identify comparative studies evaluating ICU sleep bundle implementation. Study Selection and Data Extraction: Study screening, data extraction, and risk-of-bias evaluation were conducted in tandem. The ICU quality improvement literature and Institute for Healthcare Improvement bundle improvement guidance were also reviewed to identify recommended strategies for successful sleep bundle use. Data Synthesis: Nine studies (3 randomized, 1 quasi-experimental, 5 before-and-after) were identified. Bundle elements varied and were primarily focused on nonpharmacological interventions designed to be performed during either the day or night; only 2 studies included a medication-based strategy. Five studies were associated with reduced delirium; 2 studies were associated with improved total sleep time and 2 with improved patient-perceived sleep. Pharmacists were involved directly in 4 studies. Relevance to Patient Care and Clinical Practice: Sleep improvement bundles are recommended for use in all critically ill adults; specific bundle elements and ICU team member roles should be individualized at the institution/ICU level. Pharmacists can help lead bundle development efforts and routinely deliver key elements. Conclusions: Pharmacists can play an important role in the development and implementation of ICU sleep bundles. Further research regarding the relative benefit of individual bundle elements on relevant patient outcomes is needed.

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