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      Factors impact on insufficient nutrition and effects of timely adequate nutrition support on patient outcomes in adult intensive care patients

      , , ,

      Intensive Care Medicine Experimental

      Springer International Publishing

      ESICM LIVES 2015

      3-7 October 2015

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          Abstract

          Introduction Most of the studies comparing effects of enteral and parenteral nutrition on morbidity and mortality have been performed on surgery patient groups or in mixed intensive care unit patients. Numbers of studies performed in medical intensive care units are limited and they all include few number of patients. Objectives In the present study we aimed to analyze association of adequacy of nutrition support with infectious complications, length of stay in intensive care unit and hospital, and mortality in medical intensive care unit patients and causes of insufficient nutrition in patients who are not met target daily caloric intake. Methods Data of patients who were hospitalized in medical ICU between January 2012 and December 2013 were reviewed retrospectively. Patients older than 18 years of age and who had been dependent to mechanical ventilation for at least 3 days were included. 220 patients were determined after retrospective review of patient files with laboratory and imaging results. Results 133 male and 87 female patients were included.151 patients reached the target caloric intake.Mean target calorie was 1579 kcal/d in the adequate caloric intake group, and 1739 kcal/d in insufficient caloric intake group (p < 0.001).The number of comorbidities in both groups were similar (1.91 ± 1.07/1.87 ± 1.00; p >0.05).According to logistic regression analysis parenteral nutrition and lymphoma were found to be major independent risk factors for insufficient calorie intake. The most common cause for cessation of nutrition was detection of a residual. Nosocomial infection frequency in adequate and insufficient caloric intake groups were similar, respectively. Enteral nutrition was the most effective feeding way in adequate caloric intake group (p < 0.002). Parenteral nutrition and immunosuppressive treatment were major independent risk factors for mortality based on logistic regression analysis.Mortality of patients in adequate and insufficient caloric intake groups was 53% and 76%, respectively (p < 0.002). Conclusions Enteral nutrition in critical care patients is safe and effective. Patients who were fed enterally were more associated with reaching the target caloric intake.It is far more difficult to reach target caloric intake by parenteral nutrition and it is associated with an increase in mortality. More effort should be sought for the continuity of enteral nutrition.Adequate amounts of nutrition significantly decreases mortality.

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          Most cited references 2

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          Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients.

          This study was conducted to develop evidence-based clinical practice guidelines for nutrition support (ie, enteral and parenteral nutrition) in mechanically ventilated critically ill adults. The following interventions were systematically reviewed for inclusion in the guidelines: enteral nutrition (EN) versus parenteral nutrition (PN), early versus late EN, dose of EN, composition of EN (protein, carbohydrates, lipids, immune-enhancing additives), strategies to optimize delivery of EN and minimize risks (ie, rate of advancement, checking residuals, use of bedside algorithms, motility agents, small bowel versus gastric feedings, elevation of the head of the bed, closed delivery systems, probiotics, bolus administration), enteral nutrition in combination with supplemental PN, use of PN versus standard care in patients with an intact gastrointestinal tract, dose of PN and composition of PN (protein, carbohydrates, IV lipids, additives, vitamins, trace elements, immune enhancing substances), and the use of intensive insulin therapy. The outcomes considered were mortality (intensive care unit [ICU], hospital, and long-term), length of stay (ICU and hospital), quality of life, and specific complications. We systematically searched MEDLINE and CINAHL (cumulative index to nursing and allied health), EMBASE, and the Cochrane Library for randomized controlled trials and meta-analyses of randomized controlled trials that evaluated any form of nutrition support in critically ill adults. We also searched reference lists and personal files, considering all articles published or unpublished available by August 2002. Each included study was critically appraised in duplicate using a standard scoring system. For each intervention, we considered the validity of the randomized trials or meta-analyses, the effect size and its associated confidence intervals, the homogeneity of trial results, safety, feasibility, and the economic consequences. The context for discussion was mechanically ventilated patients in Canadian ICUs. The major potential benefit from implementing these guidelines is improved clinical outcomes of critically ill patients (reduced mortality and ICU stay). Potential harms of implementing these guidelines include increased complications and costs related to the suggested interventions. SUMMARIES OF EVIDENCE AND RECOMMENDATIONS: When considering nutrition support in critically ill patients, we strongly recommend that EN be used in preference to PN. We recommend the use of a standard, polymeric enteral formula that is initiated within 24 to 48 hours after admission to ICU, that patients be cared for in the semirecumbent position, and that arginine-containing enteral products not be used. Strategies to optimize delivery of EN (starting at the target rate, use of a feeding protocol using a higher threshold of gastric residuals volumes, use of motility agents, and use of small bowel feeding) and minimize the risks of EN (elevation of the head of the bed) should be considered. Use of products with fish oils, borage oils, and antioxidants should be considered for patients with acute respiratory distress syndrome. A glutamine-enriched formula should be considered for patients with severe burns and trauma. When initiating EN, we strongly recommend that PN not be used in combination with EN. When PN is used, we recommend that it be supplemented with glutamine, where available. Strategies that maximize the benefit and minimize the risks of PN (hypocaloric dose, withholding lipids, and the use of intensive insulin therapy to achieve tight glycemic control) should be considered. There are insufficient data to generate recommendations in the following areas: use of indirect calorimetry; optimal pH of EN; supplementation with trace elements, antioxidants, or fiber; optimal mix of fats and carbohydrates; use of closed feeding systems; continuous versus bolus feedings; use of probiotics; type of lipids; and mode of lipid delivery. This guideline was peer-reviewed and endorsed by official representatives of the Canadian Critical Care Society, Canadian Critical Care Trials Group, Dietitians of Canada, Canadian Association of Critical Care Nurses, and the Canadian Society for Clinical Nutrition. This guideline is a joint venture of the Canadian Critical Care Society, the Canadian Critical Trials Group, the Canadian Society for Clinical Nutrition, and Dietitians of Canada. The Canadian Critical Care Society and the Institute of Nutrition, Metabolism, and Diabetes of the Canadian Institutes of Health Research provided funding for development of this guideline.
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            Parenteral nutrition in adult inpatients with functioning gastrointestinal tracts: assessment of outcomes.

             Gary Zaloga (2006)
            Malnutrition is a common comorbidity that places inpatients at risk of complications, infections, long length of stay, higher costs, and increased mortality. Thus, nutrition support has become an important therapeutic adjunctive to the care of these patients. For patients unable to feed themselves, nutrition can be delivered via the parenteral or enteral routes. The formulations used to deliver nutrients and the route of nutrient delivery, absorption, and processing differ substantially between parenteral and enteral nutrition. Over the past two decades, many randomised clinical trials have assessed the effects of parenteral versus enteral nutrition on outcomes (ie, complications, infections, length of stay, costs, mortality) in diverse inpatient populations. From a search of medical publications, studies were selected that assessed important clinical outcomes of parenteral versus enteral feeding or intravenous fluids in patients with trauma/burn injuries, surgery, cancer, pancreatic disease, inflammatory bowel disease, critical illness, liver failure, acute renal failure, and organ transplantation. Our goal was to determine the optimum route of feeding in these patient groups. The available evidence lends support to the use of enteral over parenteral feeding in inpatients with functioning gastrointestinal tracts.
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              Author and article information

              Conference
              Intensive Care Med Exp
              Intensive Care Med Exp
              Intensive Care Medicine Experimental
              Springer International Publishing (Cham )
              2197-425X
              1 October 2015
              1 October 2015
              December 2015
              : 3
              Issue : Suppl 1 Issue sponsor : The publication charges for this supplement were funded by Intensive Care Medicine Experimental.
              Affiliations
              [ ]Dokuz Eylul University Faculty of Medicine, Internal Medicine Intensive Care Unit, Izmir, Turkey
              [ ]Dokuz Eylul University Faculty of Medicine, Internal Medicine, Izmir, Turkey
              Article
              728
              10.1186/2197-425X-3-S1-A585
              4798024
              © Savran et al.; 2015

              This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

              ESICM LIVES 2015
              Berlin, Germany
              3-7 October 2015
              Categories
              Poster Presentation
              Custom metadata
              © The Author(s) 2015

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