Nutrition Delivery Affects Outcomes in Pediatric Acute Respiratory Distress Syndrome

Wong, Judith Ju‐Ming; Han, Wee Meng; Sultana, Rehena; Loh, Tsee Foong; Lee, Jan Hau

doi:10.1177/0148607116637937

Cited by 78 publications

(78 citation statements)

References 34 publications

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“…Observational data suggest a positive association between adequacy of energy intake and improved outcomes in the PICU population 8 , 36 , 44 . Intake of > two‐thirds of estimated energy goal in a large multicenter prospective cohort and >80% of estimated energy goal in a smaller single‐center retrospective cohort was significantly associated with reduced mortality in critically ill children receiving mechanical ventilation 8 , 44 . Higher energy intake of 54–58 kcal/kg/d is positively correlated with achieving protein balance and anabolism 36 , 45 .…”

Section: Introductionmentioning

confidence: 99%

“…In a large retrospective multicenter study of 5105 patients from 12 centers, the provision of one‐fourth goal calories enterally over the first 48 hours of admission was associated with reduced PICU mortality 66 . In a retrospective cohort of 107 children with acute respiratory distress syndrome, enteral delivery of adequate calories (≥80% estimated goal) and protein (≥1.5 g/kg/d) was associated with a reduction in ICU mortality 44 . Hence, EN is feasible during acute critical illness and must be prioritized as the preferred route for nutrient delivery.…”

Section: Introductionmentioning

confidence: 99%

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Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition

Mehta

Skillman

Irving

et al. 2017

J Parenter Enteral Nutr

373

515

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This document represents the first collaboration between 2 organizations-the American Society for Parenteral and Enteral Nutrition and the Society of Critical Care Medicine-to describe best practices in nutrition therapy in critically ill children. The target of these guidelines is intended to be the pediatric critically ill patient (>1 month and <18 years) expected to require a length of stay >2-3 days in a PICU admitting medical, surgical, and cardiac patients. In total, 2032 citations were scanned for relevance. The PubMed/MEDLINE search resulted in 960 citations for clinical trials and 925 citations for cohort studies. The EMBASE search for clinical trials culled 1661 citations. In total, the search for clinical trials yielded 1107 citations, whereas the cohort search yielded 925. After careful review, 16 randomized controlled trials and 37 cohort studies appeared to answer 1 of the 8 preidentified question groups for this guideline. We used the GRADE criteria (Grading of Recommendations, Assessment, Development, and Evaluation) to adjust the evidence grade based on assessment of the quality of study design and execution. These guidelines are not intended for neonates or adult patients. The guidelines reiterate the importance of nutrition assessment-particularly, the detection of malnourished patients who are most vulnerable and therefore may benefit from timely intervention. There is a need for renewed focus on accurate estimation of energy needs and attention to optimizing protein intake. Indirect calorimetry, where feasible, and cautious use of estimating equations and increased surveillance for unintended caloric underfeeding and overfeeding are recommended. Optimal protein intake and its correlation with clinical outcomes are areas of great interest. The optimal route and timing of nutrient delivery are areas of intense debate and investigations. Enteral nutrition remains the preferred route for nutrient delivery. Several strategies to optimize enteral nutrition during critical illness have emerged. The role of supplemental parenteral nutrition has been highlighted, and a delayed approach appears to be beneficial. Immunonutrition cannot be currently recommended. Overall, the pediatric critical care population is heterogeneous, and a nuanced approach to individualizing nutrition support with the aim of improving clinical outcomes is necessary.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition

Mehta

Skillman

Irving

et al. 2017

J Parenter Enteral Nutr

373

515

View full text Add to dashboard Cite

show abstract

“…Nutrition in critically ill adults and children is a modifiable factor that is linked to mortality . Provision of fewer calories than are expended is associated with poor wound healing, impaired immunity, increased inflammation, skeletal muscle wasting, and post‐intensive care unit (ICU) morbidity in survivors .…”

Section: Introductionmentioning

confidence: 99%

An Exploratory Retrospective Study of Factors Affecting Energy Expenditure in Critically Ill Children

Mtaweh

Garros

Ashkin

et al. 2019

J Parenter Enteral Nutr

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Background Accurate measurement of energy expenditure is not widely available. Patient and clinical factors associated with energy expenditure have been poorly explored, leading to errors in estimation formulae. The objective of this study was to determine clinical factors associated with measured energy expenditure (MEE), expressed in kcal/kg/d, in critically ill children. Methods This was a retrospective study at 2 Canadian pediatric intensive care units (ICUs). Patients were mechanically ventilated children who had 1 or more MEE using indirect calorimetry. Associations between MEE and 28 clinical factors were evaluated in univariate regression and 16 factors in a multivariate regression model accounting for repeated measurements. Results Data from 239 patients (279 measurements) were analyzed. Median (Q1, Q3) MEE was 34.8 (26.8, 46.2) kcal/kg/d. MEE was significantly associated with weight, heart rate, diastolic blood pressure, ICU day of indirect calorimetry (P = 0.004), minute ventilation, vasoactive inotropic score (P = 0.004), opioids, chloral hydrate, dexmedetomidine, inhaled salbutamol (P = 0.02), and propofol dose (all P < 0.0001 unless otherwise specified) in the final multivariate regression model. Conclusions This study demonstrated association between MEE (kcal/kg/d) and factors not previously explored in pediatric critical illness. Further evaluation of these factors to confirm associations and more precisely quantify the magnitude of effect is required to support refinement of formulae to estimate energy expenditure.

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“…This is problematic because we know that critically ill children rarely receive even half of the energy requirements they are predicted to require [25] and that optimal energy delivery is essential to meet the demands of critical illness. Furthermore, there is increasing evidence to show that inadequate nutrition can prolong the length of mechanical ventilation, intensive care stay, and worsen patient's clinical outcomes [15,49]. Conversely, a more relaxed definition of feeding intolerance could also potentially lead to unsafe feeding practices.…”

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confidence: 99%

A review of feeding intolerance in critically ill children

Tume

Valla

2018

Eur J Pediatr

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Ensuring optimal nutrition is vital in critically ill children and enteral feeding is the main route of delivery in intensive care. Feeding intolerance is the most commonly cited reason amongst pediatric intensive care unit healthcare professionals for stopping or withholding enteral nutrition, yet the definition for this remains inconsistent, nebulous, and entirely arbitrary. Not only does this pose problems clinically, but research in this field frequently uses feeding intolerance as an endpoint and the heterogeneity in this definition makes the comparison of studies difficult and meta-analysis impossible. We reviewed the use of, and definitions of, the term feed intolerance in pediatric intensive care research papers in the last 20 years. Gastric residual volume remains the most common factor used to define feed intolerance, despite the lack of evidence for this. Healthcare professionals would benefit from further education to improve their awareness of the limitations of the markers to define feeding intolerance, and the international PICU community needs to agree a consistent definition of this phenomenon to improve consistency in both practice and research.Conclusion: This paper will provide a narrative review of the definitions of, evidence for, and markers of feeding intolerance in critically ill children.

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Nutrition Delivery Affects Outcomes in Pediatric Acute Respiratory Distress Syndrome

Abstract: Our study demonstrated that adequate nutrition delivery in children with ARDS was associated with improved clinical outcomes. Protein delivery may have potentially more impact than overall caloric delivery.

Cited by 78 publications

References 34 publications

Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition

Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition

An Exploratory Retrospective Study of Factors Affecting Energy Expenditure in Critically Ill Children

A review of feeding intolerance in critically ill children

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