Factors leading to discrepancies between prescription and intake of enteral nutrition therapy in hospitalized patients

Martins, José Carlos Amado; Shiroma, Glaucia Midori; Horie, L.M.; Logullo, L.; Silva, Marcelo Lourenço da; Waitzberg, Dan Linetzky

doi:10.1016/j.nut.2011.07.025

Cited by 34 publications

(31 citation statements)

References 22 publications

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“…Along with higher in-hospital mortality rate and lesser likelihood of improved CRP levels, the ICU unit was associated with a higher likelihood of almost all problems encountered during clinical nutrition compared with the general ward in the present cohort. This appears consistent with the consideration of maximum of 52%-70% of prescribed calories to be actually delivered through EN in the ICU patients due to factors limiting continuity of nutrition, such as frequent radiologic or endoscopic investigations, inadequate routine nursing procedures, surgery, and technical problems regarding nutrition pumps or feeding tubes (26,(34)(35)(36)). …”

Section: Discussionsupporting

confidence: 70%

“…An analysis of factors leading to a reduction in EN prescribed by a nutritional support team in a past study has revealed that 80% of the target feeding volume was achieved on day 4 by 80% of the patients (36). While the nutritional support was implemented by a well-trained and experienced nutrition team based on a protocol insisting on achieving the target calorie intake within the first 3 days of nutritional plan, the intake was achieved at an average of 5 days in our cohort with records of failure to achieve target calorie in 18.8% of feeding days.…”

Section: Discussionmentioning

confidence: 99%

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Importance of target calorie intake in hospitalized patients

Harmandar

Gömceli²,

Yolcular³

et al. 2020

Turk J Gastroenterol

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Importance of target calorie intake in hospitalized patients

Harmandar

Gömceli²,

Yolcular³

et al. 2020

Turk J Gastroenterol

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“…Because other factors could increase the diarrhoea risk, diarrhoea onset in ICU patients treated with EN must not be systematically considered a nonfunctionality of the gastrointestinal tract and should not lead to the systematic discontinuation of EN. The reduction or discontinuation of EN would increase the risk for EN of protein-energy deficit [31,32], which is associated with an increased complication rate [15,33]. Recently, a randomised controlled trial indicated that preventing energy deficit with supplemental parenteral nutrition could decrease the rate of infections in ICU patients with EN failure [18], but its impact on the risk of diarrhoea has never been studied.…”

Section: Discussionmentioning

confidence: 99%

Diarrhoea in the ICU: respective contribution of feeding and antibiotics

et al. 2013

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IntroductionDiarrhoea is frequently reported in the ICU. Little is known about diarrhoea incidence and the role of the different risk factors alone or in combination. This prospective observational study aims at determining diarrhoea incidence and risk factors in the first 2 weeks of ICU stay, focusing on the respective contribution of feeding, antibiotics, and antifungal drugs.MethodsOut of 422 patients consecutively admitted into a mixed medical–surgical ICU during a 2-month period, 278 patients were included according to the following criteria: ICU stay >24 hours, no admission diagnosis of gastrointestinal bleeding, and absence of enterostomy or colostomy. Diarrhoea was defined as at least three liquid stools per day. Diarrhoea episodes occurring during the first day in the ICU, related to the use of laxative drugs or Clostridium difficile infection, were not analysed. Multivariate and stratified analyses were performed to determine diarrhoea risk factors, and the impact of the combination of enteral nutrition (EN) with antibiotics or antifungal drugs.ResultsA total of 1,595 patient-days were analysed. Diarrhoea was observed in 38 patients (14%) and on 83 patient-days (incidence rate: 5.2 per 100 patient-days). The median day of diarrhoea onset was the sixth day, and 89% of patients had ≤4 diarrhoea days. The incidence of C. difficile infection was 0.7%. Diarrhoea risk factors were EN covering >60% of energy target (relative risk = 1.75 (1.02 to 3.01)), antibiotics (relative risk = 3.64 (1.26 to 10.51)) and antifungal drugs (relative risk = 2.79 (1.16 to 6.70)). EN delivery per se was not a diarrhoea risk factor. In patients receiving >60% of energy target by EN, diarrhoea risk was increased by the presence of antibiotics (relative risk = 4.8 (2.1 to 13.7)) or antifungal drugs (relative risk = 5.0 (2.8 to 8.7)).ConclusionDiarrhoea incidence during the first 2 weeks in a mixed population of patients in a tertiary ICU is 14%. Diarrhoea risk factors are EN covering >60% of energy target, use of antibiotics, and use of antifungal drugs. The combination of EN covering >60% of energy target with antibiotics or antifungal drugs increases the incidence of diarrhoea.

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“…Several studies reported the main barriers to achieve the prescribed energy in patients with ENT, such as non-compliance with protocols and logistic failure in nutritional service (5,29,35). The hemodynamic instability, hours to nutritional goal and extubation, for example, also were the main reasons that negatively impact the energy deficit in critical oncologic patients at high nutritional risk (30).…”

Section: Quality Indicators For Enteral and Parenteral Nutrition Thermentioning

confidence: 99%

Quality indicators for enteral and parenteral nutrition therapy: application in critically ill patients "at nutritional risk"

Filho¹

2016

Nutr Hosp

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Palabras clave:Indicadores de calidad. Nutrición enteral. Nutrición parenteral. Paciente crítico. Malnutrición. ResumenIntroducción: los indicadores de calidad en terapia nutricional (ICTN) permiten evaluar la calidad de la terapia nutricional (TN) de forma práctica. Objetivo: implementar y monitorizar los ICTN en pacientes críticos con riesgo nutricional. Métodos: estudio transversal con pacientes críticos > 18 años en riesgo nutricional, en terapia nutricional enteral (TNE) o parenteral (TNP) exclusiva a > 72 horas. Después de 3 años consecutivos, 9 ICTN fueron implementados y monitorizados. El análisis estadístico fue realizado con el software SPSS, versión 17.0. Resultados: fueron incluidos 145 pacientes, siendo 93 en TNE, 65% eran de sexo masculino, con edad promedio de 55,7 años (± 17,4); 52 pacientes que estaban en TNP, 67% eran de sexo masculino, con edad promedio de 58,1 años (± 17,4). Todos los pacientes (TNE y TNP) fueron cribados en la admisión, los cálculos de las necesidades calóricas y proteínicas fueron individualizados. Apenas la TNE fue precoz, > 70% del volumen prescrito fue administrado y fue visto una reducida pérdida de la sonda nasoenteral. Las frecuencias de diarrea y ayuno digestivo no fueron adecuadas en TNE. La administración adecuada de energía fue contemplada apenas en TNP y hubo una signifi cativa tendencia de recuperación en la vía oral en TNE. Conclusión: después de 3 años de estudio, el porcentaje de adecuación de los ICTN varió entre 55%-77% para TNE y 60%-80% para TNP. Los resultados refl ejan los esfuerzos del equipo multiprofesional de TN en mantener la calidad de la asistencia nutricional en los pacientes críticos con riesgo nutricional. AbstractIntroduction: Quality Indicators for Nutritional Therapy (QINT) allow a practical assessment of nutritional therapy (NT) quality. Objective: To apply and monitor QINT for critically ill patients at nutritional risk. Methods: Cross sectional study including critically ill patients > 18 years old, at nutritional risk, on exclusive enteral (ENT) or parenteral nutritional therapy (PNT) for > 72 hours. After three consecutive years, 9 QINT were applied and monitored. Statistical analysis was performed with SPSS version 17.0. Results: A total of 145 patients were included, 93 patients were receiving ENT, among then 65% were male and the mean age was 55.7 years (± 17.4); 52 patients were receiving PNT, 67% were male and the mean age was 58.1 years (± 17.4). All patients (ENT and PNT) were nutritionally screened at admission and their energy and protein needs were individually estimated. Only ENT was early initiated, more than 70% of the prescribed ENT volume was infused and there was a reduced withdrawal of enteral feeding tube. The frequency of diarrhea episodes and digestive fasting were not adequate in ENT patients. The proper supply of energy was contemplated only for PNT patients and there was an expressive rate of oral intake recovery in ENT patients. Conclusion: After three years of research, the percentage of QINT adequacy varied be...

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Factors leading to discrepancies between prescription and intake of enteral nutrition therapy in hospitalized patients

Cited by 34 publications

References 22 publications

Importance of target calorie intake in hospitalized patients

Importance of target calorie intake in hospitalized patients

Diarrhoea in the ICU: respective contribution of feeding and antibiotics

Quality indicators for enteral and parenteral nutrition therapy: application in critically ill patients "at nutritional risk"

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