Critical care 24 × 7: But, why is critical nutrition interrupted?

Ramakrishnan, Nagarajan; Lovesley, D.; Ranganathan, Lakshmi Narasimhan; Bhuvaneshwari, S

doi:10.4103/0972-5229.128704

Cited by 10 publications

(3 citation statements)

References 29 publications

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“… 9 – 12 We too found that interruptions to feeds were significantly associated with inadequacy of nutrition. Ramakrishnan et al 13 similarly reported 55.7% interruptions of EN for procedures inside ICU. Airway-related procedures (weaning, tracheostomy, and BAL) were the main reasons for withholding EN (67%).…”

Section: Discussionmentioning

confidence: 95%

Nutritional Adequacy in Mechanically Ventilated Patient: Are We Doing Enough?

Kalaiselvan¹,

Arunkumar²,

Renuka³

et al. 2021

Indian Journal of Critical Care Medicine

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A bstract Background Critically ill patients are under stress, leading to a catabolic response and higher energy expenditure. The associated malnutrition leads to adverse outcomes. Aims and objectives This study aims to assess the nutritional adequacy (>80% of prescribed calories) in mechanically ventilated (MV) patients and its effects on patients’ outcomes. It also aims to identify the causes of deviation from the nutrition prescription. Materials and methods This is a prospective observational study involving all adult critically ill patients requiring MV for >48 hours. Patients were prescribed enteral nutrition (EN) targeted to achieve 25 kcal/kg (IBW) of energy and 1.2 g/kg of proteins daily. Standard polymeric formula feeds were initiated as continuous infusion as per the feeding protocol in the intensive care unit (ICU). Data were collected on demography, body mass index (BMI), indication for ICU admission, admission category, and admission APACHE II and SOFA scores, and nutritional risk was captured with mNUTRIC score. Nutritional data on type of feed initiated, amount of calories prescribed/achieved, time taken to initiate feeds, reasons for not starting/delay in the initiation of feeds, time taken to achieve the prescribed calories, and reasons for interruptions of feeds were collected. Primary outcome analyzed was adequacy of nutrition (>80% prescribed dose), and secondary outcomes analyzed were ventilator days and ICU LOS. Results A total of 622 MV patients were analyzed. 36.1% of patients were at nutritional risk (mNUTRIC χ5). 89% of patients received EN, and the time taken to start EN in these patients was 10 hours (6-20) (median [IQR]). Only 29.6% of patients achieved nutritional adequacy. Time taken for this was 36 hours (median). On average, patients on MV received 63% (1025 kcal) and 57% (41 g) of their prescribed calories and proteins, respectively. The most common reasons for withholding feeds were airway-related procedures (68.2%) followed by GI intolerance (15%). Frequent interruptions of EN, patients on >1 vasopressors, and surgical admissions were reasons for nutritional inadequacy. Nutritional adequacy had no impact on clinical outcomes. Conclusion Despite following guidelines and feeding protocols, there exists a wide gap between prescribed nutrition and what is actually delivered in MV patients. How to cite this article Kalaiselvan MS, Arunkumar AS, Renuka MK, Sivakumar RL. Nutritional Adequacy in Mechanically Ventilated Patient: Are We Doing Enough? Indian J Crit Care Med 2021;25(2):166–171.

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Section: Discussionmentioning

confidence: 95%

Nutritional Adequacy in Mechanically Ventilated Patient: Are We Doing Enough?

Kalaiselvan¹,

Arunkumar²,

Renuka³

et al. 2021

Indian Journal of Critical Care Medicine

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“…Although the optimal daily amounts of energy and protein remain uncertain, nutrition delivery by enteral feeding remains suboptimal as a result of interruptions for various reasons. This may impact the provision of calories and proteins and, therefore, the clinical outcome [2]. A challenge in enteral nutrition feeding practices is enteral feeding intolerance (EFI), defined as the inability to provide adequate enteral nutrition to critically ill patients due to delayed gastric emptying without mechanical obstruction.…”

Section: Introductionmentioning

confidence: 99%

Association between Domperidone Administered via Feeding Tube and Feeding Success in Critically Ill Patients with Enteral Feeding Intolerance

Cheng

Chen

Yang

et al. 2021

JPM

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One nutritional challenge in critically ill patients is enteral feeding intolerance (EFI), but current prokinetic agents have uncertain efficacy and safety profiles. We conducted a longitudinal, single-center, retrospective study to evaluate the efficacy and safety of domperidone administered via the feeding tube versus intravenous (IV) metoclopramide among adult patients with EFI. The primary outcome was feeding success, defined as the proportion of patients with average percentage of daily protein prescription >80% of the target dose. The secondary outcomes were safety endpoints. Among 28,814 intensive care unit (ICU) admissions, 552 patients with EFI were included, 38 receiving IV metoclopramide and 514 receiving tube feeding domperidone. The proportion of feeding success in patients receiving tube feeding domperidone and IV metoclopramide was 42.02% and 21.05%, respectively. After 1:2 matching (IV metoclopramide to tube feeding domperidone), the proportion of feeding success was 40.79% in patients receiving tube feeding domperidone. Basically, after matching, there were no differences in any safety endpoints (mortality and length of stay during ICU and hospitalization, organ-support-treatment free days) or adverse events (recurrence of EFI, electrolyte disturbance, abdominal and other symptoms) between the two groups (p > 0.05). A logistic regression analysis in the matched cohort indicated that domperidone administered via the feeding tube was independently associated with feeding success. We found that tube feeding domperidone was efficient in increasing enteral nutrition delivery performance among critically ill adult patients with EFI.

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“…The daily calorie intake and risk of malnutrition of patients are defined by the nutritional therapy in these units. However, it is sometimes possible that nutrition is disrupted due to gastrointestinal symptoms and the procedure that is used inside or outside critical care unit [4,17].…”

Section: Physical Examinationmentioning

confidence: 99%

Stan odżywienia pacjentów Neurochirurgicznego Oddziału Intensywnej Opieki Medycznej

Kaya

Turan

Aydın

2017

PNIN

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Neurosurgical patients present important metabolic alterations that trigger increased energy and protein expenditure. The clinical condition in neuro patients associated with the use of sedatives, steroids, barbiturates and musclerelaxing drugs postpones the use of nutrients in these patients and, thus, complications, including infection and longer hospitalization, may occur. Weight loss, negative nitrogen balance and immune dysfunction constitute a characteristic response in neurosurgical patients. There is a strong relationship between adequate nutritional status and recovery from critical illness. Improved nutritional status is associated with positive clinical outcomes. The health care team, nurses in particular, play a major role in the management and maintenance of an optimal nutritional status in patients who are in the neurosurgical clinic. This compilation aims at highlighting the fact that inadequate nutrition is a serious problem which increases incidence of morbidity and mortality especially in neurosurgical patients. The article also emphasises the importance of nursing assessment. (JNNN 2017;6(1):33-38) Key Words: neuro patients, neurosurgery, nutrition Streszczenie U pacjentów Neurochirurgicznego Oddziału Intensywnej Opieki Medycznej występują istotne zmiany metaboliczne, które powodują zwiększone wydatkowanie energii i białka. Neurochirurgiczny stan kliniczny w wyniku stosowania środków uspokajających, steroidów, barbituranów i leków zwiotczających mięśnie opóźnia wykorzystanie składników pokarmowych w tej grupie pacjentów, a zatem mogą wystąpić powikłania, w tym infekcje i dłuższa hospitalizacja. Utrata masy ciała, ujemny bilans azotu i dysfunkcja układu odpornościowego stanowią charakterystyczną odpowiedź u pacjentów neurochirurgicznych. Istnieje silny związek pomiędzy odpowiednim stanem odżywienia i regeneracją po chorobie krytycznej. Dobry stan odżywienia jest związany z pozytywnymi wynikami klinicznymi. Zespół opieki zdrowotnej, w szczególności pielęgniarki, odgrywają ważną rolę w utrzymaniu optymalnego stanu odżywienia u pacjentów neurochirurgicznych. Przegląd ten ma na celu podkreślenie, że przeciętny stan odżywienia jest poważnym problemem w kontekście zwiększonej zachorowalności i śmiertelności, zwłaszcza u pacjentów neurochirurgicznych. Artykuł zwraca również uwagę na duże znaczenie oceny pielęgniarskiej. (PNN 2017;6(1):33-38) Słowa kluczowe: pacjenci neurologiczni, neurochirurgia, odżywianie

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Critical care 24 × 7: But, why is critical nutrition interrupted?

Cited by 10 publications

References 29 publications

Nutritional Adequacy in Mechanically Ventilated Patient: Are We Doing Enough?

Nutritional Adequacy in Mechanically Ventilated Patient: Are We Doing Enough?

Association between Domperidone Administered via Feeding Tube and Feeding Success in Critically Ill Patients with Enteral Feeding Intolerance

Stan odżywienia pacjentów Neurochirurgicznego Oddziału Intensywnej Opieki Medycznej

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