Dietitians’ opinions regarding refeeding syndrome, clinical guidelines and extended scope of practice

Matthews, Kylie; Palmer, Michelle; Capra, Sandra

doi:10.1111/1747-0080.12429

Cited by 5 publications

(3 citation statements)

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“…Clinical practice guidelines that have been widely adopted into practice and reinforced by institutional care protocols can become resistant to newer evidence, and peer groups whose standards are inconsistent with best practices can make adoption of new knowledge or evidence challenging at an individual level . Mathews et al . explore these phenomena in their examination of dietitians’ opinions regarding the prevalence, diagnosis and effective monitoring of refeeding syndrome in 11 countries.…”

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“…20 Clinical practice guidelines that have been widely adopted into practice and reinforced by institutional care protocols can become resistant to newer evidence, and peer groups whose standards are inconsistent with best practices can make adoption of new knowledge or evidence challenging at an individual level. 18 Mathews et al 21 explore these phenomena in their examination of dietitians' opinions regarding the prevalence, diagnosis and effective monitoring of refeeding syndrome in 11 countries. Their findings of variability in dietitians' assessment of prevalence of refeeding syndrome and differences in the role dietitians play in diagnosing and monitoring this condition lead them to recommend that updated, international, evidence-based clinical practice guidelines are needed.…”

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Thirsk¹

2018

Nutrition & Dietetics

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Thirsk¹

2018

Nutrition & Dietetics

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“…If severe protein depletion occurs, higher doses up to 2.0 g/kg/day may be necessary to maintain or restore the lean body mass [4,8,73]. In malnourished patients or those at risk of refeeding syndrome, feeding should be performed gradually, starting with 25% of the estimated requirements and slowly increasing the rate over 4-7 days [75][76][77][78].…”

Section: Nutritional Intervention For Cancer Patients Without Oral Fementioning

confidence: 99%

Nutritional Support of Cancer Patients without Oral Feeding: How to Select the Most Effective Technique?

Nunes

Fonseca

Barata

et al. 2019

GE Port J Gastroenterol

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Background: Digestive tumours are among the leading causes of morbidity and mortality. Many cancer patients cannot maintain oral feeding and develop malnutrition. The authors aim to: review the endoscopic, radiologic and surgical techniques for nutritional support in cancer patients; address the strategies for nutritional intervention according to the selected technique; and establish a decision-making algorithm to define the best approach in a specific tumour setting. Summary: This is a narrative non-systematic review based on an electronic search through the medical literature using PubMed and UpToDate. The impossibility of maintaining oral feeding is a major cause of malnutrition in head and neck (H&N) cancer, oesophageal tumours and malignant gastric outlet obstruction. Tube feeding, endoscopic stents and gastrojejunostomy are the three main nutritional options. Nasal tubes are indicated for short-term enteral feeding. Percutaneous endoscopic gastrostomy (PEG) is the gold standard when enteral nutrition is expected for more than 3-4 weeks, especially in H&N tumour and oesophageal cancer patients undergoing definite chemoradiotherapy. A gastropexy push system may be considered to avoid cancer seeding. Radiologic and surgical gastrostomy are alternatives when an endoscopic approach is not feasible. Postpyloric nutrition is indicated for patients intolerant to gastric feeding and may be achieved through nasoenteric tubes, PEG with jejunal extension, percutaneous endoscopic jejunostomy and surgical jejunostomy. Oesophageal and enteric stents are palliative techniques that allow oral feeding and improve quality of life. Surgical or EUS-guided gastrojejunostomy is recommended when enteric stents fail or prolonged survival is expected. Nutritional intervention is dependent on the technique chosen. Institutional protocols and decision algorithms should be developed on a multidisciplinary basis to optimize nutritional care. Conclusions: Gastroenterologists play a central role in the nutritional support of cancer patients performing endoscopic techniques that maintain oral or enteral feeding. The selection of the most effective technique must consider the cancer type, the oncologic therapeutic program, nutritional aims and expected patient survival.

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Refeeding-Syndrom: Wo stehen wir 2022?

Schönenberger

Dürig

Huwiler

et al. 2022

Praxis

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Zusammenfassung. Das Refeeding-Syndrom ist ein potenziell lebensbedrohlicher Zustand, welcher beim Wiederernähren von mangelnährten Patientinnen und Patienten auftreten kann. In den letzten Jahren wurden von den wichtigen Fachgesellschaften für klinische Ernährung ESPEN und ASPEN zwei Konsensusmanuskripte publiziert. Pathophysiologische Aspekte, klinische Manifestationen, Präventionsmassnahmen sowie Kriterien zur Diagnosestellung und zum Management wurden ausführlich beschrieben. Ziel dieser Mini-Review ist es, einen evidenzbasierten Überblick zum Refeeding-Syndrom zu geben. Zu diesem Zweck wurde die systematische Literatursuche von Friedli et al. 2015 aktualisiert. Es besteht die Evidenz, dass das Refeeding-Syndrom mit einem negativen klinischen Outcome assoziiert ist. Viele Fragen zu Managementaspekten bleiben weiterhin offen. Eine robuste, randomisierte kontrollierte Studie ist dringend notwendig, um diese Fragen evidenzbasiert zu beantworten und zuverlässige Hinweise über unabhängige Prädiktoren sowie eine Abschätzung des metabolischen Risikos zu eruieren.

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Dietitians’ opinions regarding refeeding syndrome, clinical guidelines and extended scope of practice

Abstract: Our findings suggest that more stringent tools for the identification of RFS are necessary. There was limited uniformity across countries, and updated practice guidelines are needed.

Cited by 5 publications

References 30 publications

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Nutritional Support of Cancer Patients without Oral Feeding: How to Select the Most Effective Technique?

Refeeding-Syndrom: Wo stehen wir 2022?

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