Changing clinical guidelines from delayed to early aperient administration for enterally fed intensive care patients was associated with increased diarrhoea: A before-and-after, intention-to-treat evaluation

Mok, Kammy; Smith, Roger; Reid, David A.; Santamaria, John

doi:10.1016/j.aucc.2015.02.002

Cited by 5 publications

(9 citation statements)

References 9 publications

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“…Regarding outcome data, (13.3%) of patients had diarrhea, (18.3%) had VAP, and (16.7%) suffered mortality. Which came in agreement with Mok et al [9] and Woo et al [8].…”

Section: Discussionsupporting

confidence: 92%

“…We found that; the mean age of all patients was ( 55.4±9.8) years. Regarding gender of the patients, the majority (55%) of patients were males; while ( 45%) were females, which came in agreement with Mok et al Mok et al, reported that, the early group and delayed group were similar in age (median 62.0 years vs. 64.2 years; p=0.17) and sex (males 64.6% vs. 63.4%; p=0.91) [9].…”

Section: Discussionsupporting

confidence: 86%

“…Mok et al, reported that, both groups spent a median of 5 calendar days (whole and part calendar days) in intensive care (p=0.88). Intensive care mortality was 13.1 % in the early group and 15.4% in the late group (p=0.65) [9].…”

Section: Discussionmentioning

confidence: 91%

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Study of the Effect of Early Versus Delayed Enteral Nutrition inCritically Ill Mechanically Ventilated Medical Patients

Shams¹,

Elsedek

2021

The Medical Journal of Cairo University

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Background: At the present time, the optimal timing and use of enteral nutrition for mechanically ventilated medical patients is unknown. The current study will focus on the effect of early versus delayed enteral nutrition in critically ill mechanically ventilated medical patients. Aim of Study: To compare between early versus delayed enteral feeding in Invasive Mechanical Ventilation (IMV) patients. To assess association linking early nutrition (<48 hours after intubation), feeding route and calorie intake to mortality and risk of Ventilator Associated Pneumonia (VAP) in patient with Invasive Mechanical Ventilation (IMV). Patients and Methods: Patients will be scheduled to received their estimated total daily enteral nutritional requirements on either day 1 (early-feeding group) or day 5 (latefeeding group) of mechanical ventilation. Patients in the latefeeding group will be also scheduled to receive 20% of their estimated daily enteral nutritional requirements during the first 4 days of mechanical ventilation. Thirty (50%) consecutive eligible patients will be entered into the early-feeding group and thirty (50%) patients will be enrolled in the late-feeding group. All patients will be received enteral nutrition via continuous infusion by a feeding pump. Eligible patients will be followed in ICU for a maximum of 12 days or until death or discharge from ICU. Results: Logistic regression analysis shows that; after applying (forward method) and entering some predictor variables; the increase in BMI and late feeding technique; had an independent effect on increasing the probability of mortality occurrence; with significant statistical difference (p <0.05 respectively). The increase in BMI and late feeding technique; had an independent effect on increasing the probability of VAP occurrence; with significant statistical difference (p <0.05 respectively). By using ROC-curve analysis, early enteral feeding predicted shortening of hospital stay, with failed (64%) accuracy, sensitivity=63% and specificity=63% (p < 0. 05). Conclusion: Evidence shows improvement in patient outcomes associated with the use of EEN in a diverse population of critically ill patients. The results of our study strengthen our understanding of the benefits of EEN.

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“…Regarding outcome data, (13.3%) of patients had diarrhea, (18.3%) had VAP, and (16.7%) suffered mortality. Which came in agreement with Mok et al [9] and Woo et al [8].…”

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 86%

See 1 more Smart Citation

Study of the Effect of Early Versus Delayed Enteral Nutrition inCritically Ill Mechanically Ventilated Medical Patients

Shams¹,

Elsedek

2021

The Medical Journal of Cairo University

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“…For example, a lower prevalence of constipation has been reported among independent community-dwelling individuals (14–25 %) [2, 28, 29] than among patients in the hospitalized acute care (42–83 %) [30–32], hospice (45–70 %) [33–35], and long-term care settings (47–55 %) [36, 37]. In addition, a longitudinal survey conducted in the community setting revealed that >60 % of those who reported constipation at baseline continued to suffer from the condition at follow-up 10 years later [28].…”

Section: Prevalence Of Constipation and Pain In The Elderlymentioning

confidence: 99%

Constipation in Elderly Patients with Noncancer Pain: Focus on Opioid-Induced Constipation

et al. 2016

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Constipation is a common and often debilitating condition in the elderly, which may be caused by underlying disease conditions, structural abnormalities in the bowel, and a variety of medications such as anticholinergics, antidepressants, and opiates. In this review, we focus on opioid-induced constipation (OIC), which is often underrecognized and undertreated in the elderly. When opioid therapy is initiated, healthcare providers are encouraged to evaluate risk factors for the development of constipation as part of a thorough patient history. To this end, the patient assessment should include the use of validated instruments, such as the Bristol Stool Scale and Bowel Function Index, to confirm the diagnosis and provide a basis for evaluating treatment outcomes. Healthcare providers should use a stepwise approach to the treatment of OIC in the elderly. Conventional laxatives are a first-line option and considered well tolerated with short-term use as needed; however, evidence is lacking to support their effectiveness in OIC. Moreover, because of the risk of adverse events and other considerations, such as chewing difficulties and swallowing disorders, conventional oral laxatives may be inappropriate for the treatment of OIC in the elderly. Thus, the availability of new pharmacologic agents such as the peripherally acting µ-opioid receptor antagonists methylnaltrexone and naloxegol, which target the underlying causes of OIC, and the secretagogue lubiprostone may provide more effective treatment options for elderly patients with OIC.

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“…For example, a study on heart failure guidelines found that the guidelines lacked explicit definitions for symptoms and adverse events; did not account sufficiently for comorbid conditions; and supplemented them with rules and some translations to operationalize them. Based on their experience, they recommended translation of guidelines as necessary for implementation regarding the implementation of nutrition guidelines (Mok, Smith, Reid, & Santamaria, 2015) .…”

Section: Introductionmentioning

confidence: 99%

Perceived Potential Barriers to Implementation of Nutritional Therapy Practice Guidelines in Critically Ill Adults in a District of KwaZulu-Natal, South Africa

Mooi¹,

Ncama²

2019

GJHS

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BACKGROUND: Transitional challenges in the disease profile and healthcare systems have revealed the need for the development of guidelines to assist healthcare practitioners in decision making regarding patient care. Implementing strong evidence‐based guideline recommendations into clinical practice is associated with improved clinical outcomes for patients, and integrated and collaborative nutritional services. PURPOSE: The purpose of this study was to identify perceived barriers to implementing national enteral nutritional therapy practice guidelines in critically ill adults in a district hospital and primary healthcare institutions in South Africa. METHODS: A quantitative descriptive research design was followed in this study. The district and institutions were selected using non-probability deliberate purposive and convenience sampling methods to select healthcare professionals (HCPs) for the study. Data were collected through a self-administered questionnaire and analysed with the IBM Statistical Package for the Social Sciences (SPSS) version 25. RESULTS: Ninety-six HCPs participated in the study which included nurses (76.0%, n = 73), doctors (10.4%, n = 10), pharmacists (7.3%, n = 7), nutrition specialists (5.2%, n = 5), and a speech-language therapist (1.0%, n = 1). Lack of awareness among HCPs and unavailability of enteral nutritional therapy practice guidelines ENTPGs in the institutions were identified as potential high priority barriers to implementation. CONCLUSION: The results of this study indicate the need for introducing guidelines to HCPs and institutions to create awareness of such guidelines and thus encourage adherence to recommendations. There is a strong need for further research on strategies to manage the identified barriers to facilitate adoption and implementation of the national enteral nutritional therapy practice guidelines for adults in a South African context.

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Changing clinical guidelines from delayed to early aperient administration for enterally fed intensive care patients was associated with increased diarrhoea: A before-and-after, intention-to-treat evaluation

Cited by 5 publications

References 9 publications

Study of the Effect of Early Versus Delayed Enteral Nutrition inCritically Ill Mechanically Ventilated Medical Patients

Study of the Effect of Early Versus Delayed Enteral Nutrition inCritically Ill Mechanically Ventilated Medical Patients

Constipation in Elderly Patients with Noncancer Pain: Focus on Opioid-Induced Constipation

Perceived Potential Barriers to Implementation of Nutritional Therapy Practice Guidelines in Critically Ill Adults in a District of KwaZulu-Natal, South Africa

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