Prevalence and duration of reasons for enteral nutrition feeding interruption in a tertiary intensive care unit

Lee, Zheng‐Yii; Ibrahim, Noor Akma; Yusof, Barakatun Nisak Mohd

doi:10.1016/j.nut.2017.11.014

Cited by 38 publications

(36 citation statements)

References 52 publications

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“…This may prompt early assessment of muscle mass for nutrition risk stratification. 33 Theoretically, appropriate nutrition and rehabilitation intervention may help to improve muscle status, and this may be translated into a survival advantage. 34 Further research is needed in this area.…”

Section: Discussionmentioning

confidence: 99%

Low Muscularity as Assessed by Abdominal Computed Tomography on Intensive Care Unit Admission Is Associated With Mortality in a Critically Ill Asian Population

Lee

Chan

et al. 2019

J Parenter Enteral Nutr

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Background Low muscularity (LM) is associated with high mortality in the Caucasian critically ill population. Muscularity can be accurately measured by the skeletal muscle index (SMI; cm2/m2) generated by computed tomography (CT). This study aimed to establish the overall and sex‐specific cutoff values that predict hospital mortality in an Asian critically ill population. Methods This single‐center, retrospective, observational study included patients aged ≥18 years with an abdominal CT conducted within 72 hours of admission to the intensive care unit. SMI generated from CT images at the level of the mid‐third lumbar vertebra were extracted from the medical records. Area under the receiver operating characteristic curves (AUC) was generated to determine the SMI cutoff values for hospital mortality. Association between LM (defined by SMI cutoff value) and hospital mortality was further evaluated by multivariable logistic regression. Results In a sample of 228 patients, the overall SMI cutoff value (cm2/m2) for hospital mortality was 42.0 (AUC: 0.637; sensitivity: 66.7%, specificity: 56.8%), whereas it was 46.5 in males and 35.3 in females. More males than females had LM (51.4% vs 37.5%), and >40% of overweight/obese patients had LM. Patients with LM were older and had a longer duration of mechanical ventilation and hospitalization. After adjusting for known confounders, LM independently predicted hospital mortality in the overall sample (adjusted odds ratio: 2.42; 95% CI 1.16–5.03; P = 0.003) and in both sexes. Conclusion This study established a set of SMI cutoff values that predict hospital mortality. LM is independently associated with hospital mortality.

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Section: Discussionmentioning

confidence: 99%

Low Muscularity as Assessed by Abdominal Computed Tomography on Intensive Care Unit Admission Is Associated With Mortality in a Critically Ill Asian Population

Lee

Chan

et al. 2019

J Parenter Enteral Nutr

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“…Although the disease process has tremendous impact on the nutrition status of critically ill patients, depending on the patients’ history, the patients may already have features of malnutrition with a reduced or restricted food intake long before intensive care unit (ICU) admission due to the underlying chronic conditions (such as chronic obstructive pulmonary disease, cancer, or chronic renal failure) or have reduced intake from a hospital stay prior to ICU adminssion . Moreover, in the ICU, the patients may continue to have restricted nutrition intake and thus they may experience prolonged fasting or frequent feeding interruptions due to various ICU procedures . These 2 factors, preexisting malnutrition and iatrogenic underfeeding, may further complicate the nutrition status and worsen clinical outcomes.…”

Section: Pathophysiology Of Malnutrition In Critically Ill Patientsmentioning

confidence: 99%

“…6,7 Moreover, in the ICU, the patients may continue to have restricted nutrition intake and thus they may experience prolonged fasting or frequent feeding interruptions due to various ICU procedures. 8 These 2 factors, preexisting malnutrition and iatrogenic underfeeding, may further complicate the nutrition status and worsen clinical outcomes.…”

Section: Pathophysiology Of Malnutrition In Critically Ill Patientsmentioning

confidence: 99%

Determination of Nutrition Risk and Status in Critically Ill Patients: What Are Our Considerations?

Lee

Heyland

2018

Nut in Clin Prac

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The stress catabolism state predisposes critically ill patients to a high risk of malnutrition. This, coupled with inadequate or delayed nutrition provision, will lead to further deterioration of nutrition status. Preexisting malnutrition and iatrogenic underfeeding are associated with increased risk of adverse complications. Therefore, accurate detection of patients who are malnourished and/or with high nutrition risk is important for timely and optimal nutrition intervention. Various tools have been developed for nutrition screening and assessment for hospitalized patients, but not all are studied or validated in critically ill populations. In this review article, we consider the pathophysiology of malnutrition in critical illness and the currently available literature to develop recommendations for nutrition screening and assessment. We suggest the use of the (modified) Nutrition Risk in the Critically Ill (mNUTRIC) for nutrition risk screening and the subjective global assessment (SGA) together with other criteria relevant to the critically ill patients, such as gastrointestinal function, risk of aspiration, determination of sarcopenia and frailty, and risk of refeeding syndrome for nutrition assessment. Further research is needed to identify suitable nutrition monitoring indicators to determine the response to the provision of nutrition.

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“…Negative nitrogen balance has been associated with increased mortality risk among critically ill patients with AKI . Additionally, studies have shown that actual nutrition support provision (particularly with enteral feedings) is often significantly less than what is prescribed by a clinician . For this reason, and the increased catabolism that is associated with critical illness and its myriad of comorbid conditions, the risk of malnutrition in the ICU is high .…”

Section: Discussionmentioning

confidence: 99%

“…The balance of providing protein in an amount that is enough to improve renal perfusion and nitrogen balance but not contribute to azotemia and exacerbate kidney insult can be a challenge for nutrition support clinicians. In addition, a common nutrition obstacle in the ICU is the fact that what is actually provided is often significantly less than what is prescribed …”

Section: Literature Reviewmentioning

confidence: 99%

Acute Kidney Injury Masked by Malnutrition: A Case Report and the Problem of Protein

et al. 2018

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Acute kidney injury (AKI) is common among critically ill patients. There are a number of nutrition considerations in the management of AKI, including fluid balance, electrolyte and acid‐base disturbances, protein provision, and management of comorbid conditions. The optimal amount of protein provision for patients with AKI who are not on renal replacement therapy (RRT) has been a topic of debate for years. Excessive protein provision may contribute to azotemia in these patients, but inadequate protein intake may harm nutrition status and result in poorer clinical outcomes. This review discusses a patient case of AKI masked by malnutrition and muscle loss and reviews the current literature on optimal protein intake in AKI (not on RRT). Based on a structured search strategy, 4 articles were reviewed. We conclude that the available evidence suggests that significant restrictions in protein intake are not necessary for those critically ill patients with AKI. However, the studies reviewed here showed significant heterogeneity in protein dose and delivery, estimation of protein needs, patient population, and definition of AKI, and thus further research is needed to systematically determine the optimal dose of protein for critically ill adults with AKI.

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Prevalence and duration of reasons for enteral nutrition feeding interruption in a tertiary intensive care unit

Abstract: EN FI occurred primarily due to human factors, which may be minimized by adherence to an evidence-based feeding protocol as determined by a nutrition support team.

Cited by 38 publications

References 52 publications

Low Muscularity as Assessed by Abdominal Computed Tomography on Intensive Care Unit Admission Is Associated With Mortality in a Critically Ill Asian Population

Low Muscularity as Assessed by Abdominal Computed Tomography on Intensive Care Unit Admission Is Associated With Mortality in a Critically Ill Asian Population

Determination of Nutrition Risk and Status in Critically Ill Patients: What Are Our Considerations?

Acute Kidney Injury Masked by Malnutrition: A Case Report and the Problem of Protein

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