Enteral nutrition administration in a surgical intensive care unit: Achieving goals with better strategies

Wilson, Sara; Madisi, Nagendra; Bassily‐Marcus, Adel; Manasia, Anthony; Oropello, John; Kohli‐Seth, Roopa

doi:10.5492/wjccm.v5.i3.180

Cited by 7 publications

(5 citation statements)

References 19 publications

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“…This is one of the important goals in taking care of these patients [ 2 ]. Feeding with nasogastric (NG) tube is used for patients who are unable to feed through mouth [ 3 ], and in this case, after the inserting the NG tube, during the first 24 h, the gastric residual volume (GRV) is measured every 6 h. If the GRV is greater than 250 cc, the nurse should inform the doctor for further investigation and will not receive a meal in that session [ 4 ]; even this method is omitted based on the newest guidelines, [ 5 ] but it still is implemented in Iran as a routine measure [ 6 ]. Feeding method through NG tube tract helps to maintain peristalsis, improves blood supply, and strengthens the immune system [ 7 ], and timely and adequate nutritional support plays an important role in improving recovery, reducing physiological stress, and increasing the immunity capacity [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Studying the effect of abdominal massage on the gastric residual volume in patients hospitalized in intensive care units

et al. 2018

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BackgroundThe main problem of hospitalized patients in intensive care units is feeding, and if the patient does not receive the daily caloric intake required to his body, he will have malnutrition and problems related to it. Abdominal massage is a method used to improve digestive function in various studies, but few studies have been conducted in intensive care units, and sometimes, contradictory results have been obtained. Therefore, the present study is conducted with the aim of determining the effect of abdominal massage on the gastric residual volume in patients hospitalized in intensive care units.MethodsThis study was conducted as a clinical trial in Ahwaz, in 2017. Samples were 60 patients hospitalized in intensive care units who were randomly divided into case and control groups. The intervention period for the case group was 3 days and twice daily for 20 min. Measuring the gastric residual volume was investigated before the intervention and 1 hour after the second massage each day. Data were entered into the checklist designed by the researcher and were analyzed using SPSS version 24 and descriptive and inferential tests.ResultsThe gastric residual volume on the second and third day after the intervention was less than before the intervention (p value< 0.05), the gastric residual volume before intervention with after intervention in the control group during different days, on each of the 3 days after the intervention, was more than before the intervention (p value< 0.05), and the gastric residual volume after the intervention in different days and the mean of different days in the case group was lower than the control group (p value> 0.05).ConclusionResults represent the effect of abdominal massage on reducing the gastric residual volume in patients hospitalized in intensive care units. Therefore, it is suggested that this method can be considered as a caring method in the daily care program for these patients.Trial registrationIRCT2017062134641N2, registered 26 July 2017.

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Section: Introductionmentioning

confidence: 99%

Studying the effect of abdominal massage on the gastric residual volume in patients hospitalized in intensive care units

et al. 2018

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“…Many of the strategies used here were demonstrated to be effective in other facilities. 3,6,8,11 We "fine-tuned" the interventions to best fit the needs of our hospital. Individual centers should examine their present cultures and own needs prior to implementing new interventions.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Addressing the deficiencies in critical care nutrition support requires universal and local strategies to minimize and possibly prevent complications. 3,4 From a local or single hospital perspective, the strategies within our ICU to address nutrition insufficiency during critical care were developed by an interdisciplinary team and implemented and refined over a multiyear period. After the critical care dietitian identified deficiencies in nutrition provision, it was apparent that study participation was necessary to compare the facility against international nutrition practice.…”

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confidence: 99%

Strategies for the Enhancement of Nutrition Practice in a New York State Level 1 Trauma Center: A Hospital’s Journey

et al. 2017

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Background: Provision of enteral nutrition (EN) support is historically inadequate in the critically ill population. An interdisciplinary approach utilizing various strategies has been shown to improve initiation of timely EN support. The purpose of this study was to examine whether the implementation of a series of interventions led by an interdisciplinary team was associated with changes in the initiation of nutrition support in a level 1 trauma center. Methods: Patients admitted between 2009 and 2013 with isolated closed head trauma injuries were identified through the hospital’s trauma center database. The initial population consisted of 159 patients; after exclusion criteria, 141 patients were included in the statistical analyses. Two statistical analyses were conducted. The first calculated the average days to the initiation of nutrition start by admission year. The second estimated the association between admission year and time to nutrition initiation with a generalized linear model. Results: Time to initiate nutrition therapy was estimated to decrease by 1.46 days (47.31%) from 2009 to 2013. The time to initiate nutrition in 2013 was 1.63 days. A significant association was found between the time to initiate nutrition and the 2012 and 2013 binary variables while controlling for confounding variables. The time frame was estimated to be 1.09 (P = .008) and 1.75 (P = .000) days shorter in 2012 and 2013 relative to 2009. Conclusions: An interdisciplinary effort utilizing multiple strategies identified and addressed barriers, resulting in a reduction of variability and a proactive approach to early EN.

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“…However, there is evidence that a Transition Feeding Protocol (TFP) on neurosurgical wards can optimise the transition from EN to ON by improving consistency and commencement of transition feeding, at the same time as improving nursing staff confidence and knowledge in overall nutrition care. 8 Furthermore, protocols in ICU patient populations, which have largely focussed on the commencement of EN, have contributed to an improved ability to meet nutrition related targets, 9,10 whereas others have helped to optimise transition between different methods of feeding. 11 The Knowledge-to-Action framework provides a structured approach to help move knowledge into practice.…”

Section: Introductionmentioning

confidence: 99%

An evaluation of nasogastric (NG) tube removal practices and nutritional intake parameters in an acute neurosurgical population: The development of an NG Transition Feeding Protocol

McAuliffe,

Archer,

Carter

et al. 2023

J Human Nutrition Diet

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BackgroundAs a result of the complex nature of neurosurgical patients, nasogastric (NG) tube feeding is often implemented for patients who are unable to consume adequate oral intake. During recovery, patients on enteral nutrition (EN) are progressed to oral nutrition, which can result in NGT removal and discontinuation of supportive feeding plans. This is often before patients become established on sufficient oral intake to meet their nutritional requirements.MethodsWe conducted an exploration of current NG removal practices in patients (n = 23) across five neurosurgical wards over a 3‐month period to assess practitioner review response times, NG feeding duration, decision making on NG removal, and the influence of dietary recommendations and differing EN protocols on patients' ability to meet their nutritional requirements. Our aim was to use this data to design and implement a protocol to improve consistency of these practices.ResultsAfter oral intake was commenced, only those receiving supplementary EN achieved nutritional targets immediately. Conversely, no patient who had their NGT removed at this stage achieved these targets. Following NG removal, the likelihood of a patient meeting nutritional targets was influenced by the decision maker, supporting the practice of registered dietitian led cessation of NG feeding. These findings led us to develop an “NG Transition Feeding Protocol” to serve as a simple, clear pathway which treating teams can utilise to guide NG feeding decisions.ConclusionsNG feeding supports neurosurgical patients to meet nutritional requirements in the early stages following commencement of oral intake. The development of an “NG Transition Feeding Protocol” may help to improve consistency of transition feeding on neurosurgical wards, allowing time for nutrition assessment to support informed decisions around NG removal. The aim of this protocol is to improve the efficiency of transition feeding, improve dietetic workload efficiency, nursing staff confidence and avoid compromising nutritional status of patients as a result of the early cessation of EN.

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Enteral nutrition administration in a surgical intensive care unit: Achieving goals with better strategies

Abstract: A protocol delineating the initiation and advancement of EN support coupled with ongoing education can improve administration of nutrition to SICU patients.

Cited by 7 publications

References 19 publications

Studying the effect of abdominal massage on the gastric residual volume in patients hospitalized in intensive care units

Studying the effect of abdominal massage on the gastric residual volume in patients hospitalized in intensive care units

Strategies for the Enhancement of Nutrition Practice in a New York State Level 1 Trauma Center: A Hospital’s Journey

An evaluation of nasogastric (NG) tube removal practices and nutritional intake parameters in an acute neurosurgical population: The development of an NG Transition Feeding Protocol

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