An evaluation of enteral feeding practices in critically ill children

Tume, Lyvonne N.; Latten, Lynne; Darbyshire, Andy

doi:10.1111/j.1478-5153.2010.00420.x

Cited by 34 publications

(52 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This study found that nutrition is being initiated on average 22.8 hours after admission, which current literature is suggesting is unnecessarily prolonged 1 , 2 . It reveals inconsistent reasons for interrupting and delaying nutrition among health care practitioners and large cumulative caloric deficits over a patient's admission.…”

Section: Clinical Relevancy Statementmentioning

confidence: 77%

“…‐ 12 Despite the importance of nutrition in the PICU population, prolonged time to initiation, 1 , 10 , 11 frequent and potentially avoidable interruptions, 1 , 13 ‐ 15 and controversies surrounding when to withhold nutrition 16 often result in large deficits in nutrition delivery over the length of a patient's admissions 8 . Implementation of nutrition support protocols has led to earlier initiation and reduced deficits of nutrition delivery in the PICU, especially when continually evaluated and adapted for current best practices 1 , 2 . Large variations exist between practitioners as well as hospitals regarding practices related to prescribed nutrition and barriers to optimal delivery 14 , 16 .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Epidemiology of Interruptions to Nutrition Support in Critically Ill Children in the Pediatric Intensive Care Unit

Keehn

O’Brien

Mazurak

et al. 2013

J Parenter Enteral Nutr

View full text Add to dashboard Cite

show abstract

Section: Clinical Relevancy Statementmentioning

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Epidemiology of Interruptions to Nutrition Support in Critically Ill Children in the Pediatric Intensive Care Unit

Keehn

O’Brien

Mazurak

et al. 2013

J Parenter Enteral Nutr

View full text Add to dashboard Cite

show abstract

“…These interruptions to EN may result in a nutrient deprivation for a high proportion of the illness course. EN intolerance remains the most commonly reported barrier to optimizing EN intake in the PICU 3,5,6,17 . However, a unifying definition of EN intolerance does not exist.…”

Section: Discussionmentioning

confidence: 99%

“…However, a unifying definition of EN intolerance does not exist. As a result, a variety of clinical signs and symptoms have been used to determine EN intolerance in critically ill children 17 . Gastric residual volume (GRV) is routinely measured in the intensive care environment despite lack of evidence to support it as a useful marker of EN intolerance 18,19 .…”

Section: Discussionmentioning

confidence: 99%

A Stepwise Enteral Nutrition Algorithm for Critically Ill Children Helps Achieve Nutrient Delivery Goals*

Hamilton¹,

McAleer²,

Ariagno³

et al. 2014

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

Objective To evaluate the impact of implementing an enteral nutrition (EN) algorithm on achieving optimal EN delivery in the Pediatric Intensive Care Unit (PICU). Design Prospective pre/post implementation audit of EN practices. Setting One 29-bed medical/surgical PICU in a free standing, university affiliated children’s hospital. Patients Consecutive patients admitted to the PICU over two 4-week periods pre and post implementation, with a stay of > 24 hours who received EN. Interventions Based on the results of our previous study, we developed and systematically implemented a stepwise, evidence and consensus-based algorithm for initiating, advancing and maintaining EN in critically ill children. Three months after implementation, we prospectively recorded clinical characteristics, nutrient delivery, EN interruptions, parenteral nutrition (PN) use, and ability to reach energy goal in eligible children over a 4-week period. Clinical and nutritional variables were compared between the pre and post-intervention cohorts. Time to achieving energy goal was analyzed using Kaplan Meier statistical analysis. Measurements and Main Results Eighty patients were eligible for this study and were compared to a cohort of 80 patients in the pre-implementation audit. There were no significant differences in median age, gender, need for mechanical ventilation, time to initiating EN, or use of post-pyloric feeding between the 2 cohorts. We recorded a significant decrease in the number of avoidable episodes of EN interruption (3 vs. 51, p0.0001) and the incidence and duration of PN dependence in patients with avoidable EN interruptions in the post-intervention cohort. Median time to reach energy goal decreased from 4 days to 1 (p<0.0001), with a higher proportion of patients reaching this goal (99% vs. 61%, p = 0.01). Conclusions The implementation of an EN algorithm significantly improved EN delivery and decreased reliance on PN in critically ill children. Energy intake goal was reached earlier in a higher proportion of patients.

show abstract

“…(68) Surveys have shown that most bedside PICU providers use GRV measurements and feeding algorithms include GRV measurement as a measure of EN intolerance to guide bedside nutrition practices. (7, 69) The accuracy of GRV measurement to predict delayed GE or EN intolerance has not been studied in critically ill children. Furthermore, GRV measurement is complicated by a lack of standardization in the GRV threshold to define EN intolerance and in measurement techniques that are affected by patient posture and the feeding tube properties.…”

Section: Introductionmentioning

confidence: 99%

Gastric Dysmotility in Critically Ill Children

Martinez

Douglas

Nurko

et al. 2015

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

Objective We aimed to review gastric dysmotility in critically ill children: (a) its pathophysiology, with a focus on critical care diseases and therapies that affect gastric motility, (b) diagnostic methodologies, and (c) current and future potential therapies. Data Sources Eligible studies were identified from PubMed and MEDLINE. Study Selection Literature search included the following key terms, “gastric emptying”, “gastric motility/ dysmotility”, “gastrointestinal motility/ dysmotility”, “nutrition intolerance”, and “gastric residual volume”. Studies since 1995 were identified and reviewed for inclusion by the authors. Data Extraction & Data Synthesis We present a review of the current literature related to the physiology, pathophysiology, diagnostic methodologies and available therapies for gastric dysmotility in the critically ill child with a focus on gastric emptying (GE). Delayed GE, a common presentation of gastric dysmotility, is present in up to 50% of critically ill children. It is associated with the potential for aspiration, ventilator- associated pneumonia, inadequate delivery of enteral nutrition and may affect the efficacy of enteral medications, all of which may be result in poor patient outcomes. Gastric motility is affected by critical illness and its associated therapies. Currently available diagnostic tools to identify GE at the bedside have not been systematically studied and applied in this cohort. Gastric residual volume measurement, used as an indirect marker of delayed GE in pediatric intensive care units around the world, may be inaccurate. Conclusion Gastric dysmotility is common in critically ill children, and impacts patient safety and outcomes. However, it is poorly understood, inadequately defined, and current therapies are limited and based on scant evidence. Understanding gastric motility, and developing accurate bedside measures and novel therapies for GE are highly desirable and need to be further investigated.

show abstract

An evaluation of enteral feeding practices in critically ill children

Abstract: This paper highlights the dearth of research related to enteral feeding in critically ill children. We found that the use of feeding guidelines improved calorie delivery and so units should be encouraged to develop their own guidelines based on the best evidence available.

Cited by 34 publications

References 45 publications

Epidemiology of Interruptions to Nutrition Support in Critically Ill Children in the Pediatric Intensive Care Unit

Epidemiology of Interruptions to Nutrition Support in Critically Ill Children in the Pediatric Intensive Care Unit

A Stepwise Enteral Nutrition Algorithm for Critically Ill Children Helps Achieve Nutrient Delivery Goals*

Gastric Dysmotility in Critically Ill Children

Contact Info

Product

Resources

About