Optimizing early enteral nutrition in severe stroke (OPENS): protocol for a multicentre randomized controlled trial

Yuan, Fang; Yang, Fang; Zhang, Wei; Jia, Yanbin; Ma, Yuying; Qu, Yongcai; Wang, Xinglai; Huo, Kang; Wang, Chengkai; Yuan, Xiangjun; Song, Chaohui; Zhang, Bei; Jiang, Wen

doi:10.1186/s12883-019-1253-2

Cited by 12 publications

(7 citation statements)

References 36 publications

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“…It has been demonstrated that early enteral nutrition support applied to critically ill patients can effectively prevent their secondary injuries and circumvent the occurrence of disability and death (16). Nevertheless, there are controversies regarding the nutrition time, the nutrition program, the nutrition approaches, and the nutrition complications on how to effectively and safely give early enteral nutrition support (17).…”

Section: Discussionmentioning

confidence: 99%

Nursing Practice Based on Evidence-Based Concepts to Prevent Enteral Nutrition Complications for Critically Ill Neurosurgical Patients

et al. 2022

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PurposeTo explore the practical value of enteral nutrition care guided by evidence-based concepts in preventing enteral nutritional complications in critically ill neurosurgical patients.MethodsThree hundred critically ill patients from March 2020 to October 2021 from our neurosurgery department were included in the study. Patients were divided into a control group (March to December 2020, n = 150) and a study group (January to October 2021, n = 150) according to the order of their admission. The control group received conventional enteral nutrition care, and the study group received enteral nutrition care based on evidence-based concept guidance. The levels of serum nutritional indicators [hemoglobin (Hb), albumin (ALB), and total protein (TP)], feeding compliance rate, the incidence of complications (gastric retention, bloating, diarrhea, reflux, vomiting, aspiration, stress ulcers, etc.), and prognosis during the observation period were compared between the two groups. The scores of the questionnaire of knowledge, attitude, and practice on nutrition among neurosurgical nurses before and after the implementation of evidence-based care were compared among nursing staff in the study group.ResultsAt 1 and 2 weeks after enrollment, Hb, ALB, and TP levels were lower in both groups than before enrollment in the same group (P < 0.05). At 2 weeks after enrollment, Hb, ALB, and TP levels were higher in both groups than at 1 week after enrollment in the same group (P < 0.05). At 1 and 2 weeks after enrollment, Hb, ALB, and TP levels were higher in the study group than in the control group (P < 0.05). At 7 days after feeding, the feeding compliance rate was higher in the study group (94.67%) than in the control group (70.00%) (P < 0.05). The total complication rate was lower in the study group (8.00%) than in the control group (16.00%) (P < 0.05). The percentage of good prognosis was higher in the study group (34.00%) than in the control group (23.33%) (P < 0.05). After the implementation of evidence-based care, caregivers in the study group scored higher on nutrition knowledge, nutrition attitudes, and nutrition practices than those before the implementation (P < 0.05).ConclusionThe implementation of evidence-based nursing interventions in critically ill neurosurgical patients based on evidence-based concepts is of great clinical value in correcting their nutritional status, preventing enteral nutritional complications, improving prognosis, and enhancing the nutritional knowledge, attitudes, and practices of nursing staff.

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Section: Discussionmentioning

confidence: 99%

Nursing Practice Based on Evidence-Based Concepts to Prevent Enteral Nutrition Complications for Critically Ill Neurosurgical Patients

et al. 2022

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“…Research suggests enteral feeding rates within the acute stroke population are between 10% and 20% (Rowat, 2015; Martin, 2005; Yuan et al., 2019). Interestingly, this chart review found over a quarter of patients required enteral feeding during their admission.…”

Section: Discussionmentioning

confidence: 99%

The effects of endovascular clot retrieval and thrombolysis on dysphagia in an Australian quaternary hospital: A retrospective review

Minchell

Rumbach

Finch

2021

Intl J Lang & Comm Disor

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Dysphagia (impaired swallowing) is known to contribute to decreased quality of life, and increased length of hospital stay and mortality post‐stroke. Despite the advancements in stroke treatment with the introduction of thrombolysis and endovascular clot retrieval (ECR), patients continue to present with high rates of dysphagia. Speech and language therapists and stroke teams should consider the presence of haemorrhagic transformation, success of reperfusion and presence of communication deficits as risk factors for dysphagia post‐ECR and/or thrombolysis. Purpose To establish incidence rates and patterns of dysphagia following the administration of reperfusion therapies in acute ischaemic stroke management. Method A retrospective review of 193 patients admitted with acute ischaemic stroke to a quaternary stroke unit in Australia over a three year period was completed. Clinical information extracted included demographics, type (thrombolysis and/or endovascular clot retrieval) and success of reperfusion therapy, and the progression of dysphagia and related factors. Results Over half of all patients treated with reperfusion therapies presented with dysphagia on initial assessment by speech‐language pathology (SLP). The type of reperfusion therapy administered was not significantly correlated with the presence of dysphagia. Dysphagia on initial assessment was significantly correlated with the presence of aphasia on initial assessment, the presence of haemorrhagic transformation, and the success of reperfusion. Increased rates of enteral feeding were also found in this study compared to figures reported in literature. Conclusion This study identified ongoing high rates of dysphagia amongst this patient population regardless of treatment type, demonstrating the need for ongoing SLP management post stroke. Further research is required in this area to develop an evidence‐base for SLPs and the wider medical team and to inform clinical practice guidelines. What this paper adds What is already known on the subjectStroke is one of the leading causes of disability and death internationally. Dysphagia (impaired swallowing), a common sequalae of stroke, is known to contribute to decreased quality of life, increased length of hospital stay and mortality. With advancements in technology, treatments for acute ischaemic stroke (endovascular clot retrieval and thrombolysis) are increasing in popularity. However, limited research exists exploring the impact of these therapies on dysphagia. What this paper addsDespite the advancements in stroke treatment, patients continue to present with high rates of dysphagia. Dysphagia following thrombolysis and/or ECR was found to be significantly correlated to the presence of aphasia, haemorrhagic transformation, and the success of reperfusion (regardless of treatment type). Additionally, increased rates of enteral feeding were found amongst this patient population compared to figures reported in the literature for patients following traditional stroke management. Clinical implications ...

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“…A multicenter randomized controlled study Optimizing early enteral nutrition in severe stroke (OPENS) is being performed in China 21) . The results of that study and other similar studies must be considered in the formulation of further nutritional support strategies for the ICU.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, it is mandatory to consider such disease characteristics in the provision of nutritional support. However, few studies have focused on nutritional support for CVA 11,21) .…”

Section: Introductionmentioning

confidence: 99%

Change in Nutrition Strategy after Nutritional Support Team Activities for Cerebrovascular Disease Patients in the Intensive Care Unit

Liu

Kim

Lee

et al. 2019

J Neurointensive Care

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This study was done to introduce a nutrition support strategy and analyze the effect of nutritional support team (NST) activities in a single-center intensive care unit. Methods Between January and June 2017, acute severe cerebrovascular disease (CVA) patients who admitted to the intensive care unit and referred to the NST, were enrolled and assigned to the NST group. Demographics, initial GCS score, needed calorie intake (NCI), type of nutrition, time of switching from parenteral nutrition (PN) to enteral nutrition (EN), NCI satisfaction rate, incidence of feeding intolerance (FI), and clinical outcomes were analyzed, and compared with those in the control group, retrospectively. Results There were 38 patients in the NST group and 39 in the control group. The initial GCS score was 7.03±2.19 in the NST group and 6.82±2.19 in the control group. The average NCI was 1557.9 kcal in the NST group and 1635.9 kcal in the control group. In all patients, the start of PN was possible within 24 hours after admission. The EN start rate was slightly lower in the NST group. EN was initiated earlier in the NST group than in the control group. The NCI satisfaction rate at discharge was higher in the NST group. No statistically significant differences were observed in the rate of good clinical outcomes and incidence of FI between the two groups. Conclusion NST activity enabled the earlier start of EN and achievement of a high NCI satisfaction rate without increasing nutrition support related risks.

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Optimizing early enteral nutrition in severe stroke (OPENS): protocol for a multicentre randomized controlled trial

Cited by 12 publications

References 36 publications

Nursing Practice Based on Evidence-Based Concepts to Prevent Enteral Nutrition Complications for Critically Ill Neurosurgical Patients

Nursing Practice Based on Evidence-Based Concepts to Prevent Enteral Nutrition Complications for Critically Ill Neurosurgical Patients

The effects of endovascular clot retrieval and thrombolysis on dysphagia in an Australian quaternary hospital: A retrospective review

Change in Nutrition Strategy after Nutritional Support Team Activities for Cerebrovascular Disease Patients in the Intensive Care Unit

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