Safety of Enteral Feedings in Critically Ill Children Receiving Vasoactive Agents

Panchal, Apurva; Manzi, Jennifer; Connolly, Susan; Christensen, Melissa; Wakeham, Martin K.; Goday, Praveen S.; Mikhailov, Theresa A.

doi:10.1177/0148607114546533

Cited by 59 publications

(41 citation statements)

References 35 publications

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“…Interestingly, severity of illness scores have not been shown to predict the safety and tolerance of EN and there is no recognized risk of mortality above which EN is contraindicated (26, 27). In addition, observational studies have described the safety and benefits of EN in children on vasopressors and threats posed by these agents may be related to the particular vasopressor/s or doses employed (28-30)…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Delayed Enteral Nutrition in Critically Ill Children*

Canarie

Barry

Carroll

et al. 2015

Pediatric Critical Care Medicine

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Objective Delayed enteral nutrition (EN), defined as EN started ≥ 48 hours after admission to the pediatric intensive care unit (PICU) is associated with an inability to achieve full EN and worse outcomes in critically ill children. We reviewed nutritional practices in 6 medical-surgical PICUs and determined risk factors associated with delayed EN in critically ill children. Design Retrospective cross-sectional study using medical records as source of data Setting Six medical-surgical PICUs in northeastern United States Patients Children < 21 years old admitted to the PICU for ≥ 72 hours excluding those awaiting or recovering from abdominal surgery. Measurements/Main Results A total of 444 children with a median age of 4.0 years were included in the study. EN was started at a median time of 20 hours after admission to the PICU. There was no significant difference in time to start EN among the PICUs. Of those included, 88 (19.8%) children had delayed EN. Risk factors associated with delayed EN were: non-invasive (odds ratio [OR]: 3.37; 95% CI: 1.69-6.72) and invasive positive pressure ventilation (OR: 2.06; 95% CI: 1.15-3.69), severity of illness, (OR for every 0.1 increase in Pediatric Index of Mortality 2 score: 1.39; 95% CI: 1.14-1.71) as well as procedures (OR 3.33; 95% CI: 1.67-6.64) and; gastrointestinal disturbances (OR: 2.05; 95% CI: 1.14-3.68) within 48 hours after admission to the PICU. Delayed EN was associated with failure to reach full EN while in the PICU (OR 4.09; 95% CI: 1.97-8.53). Nutrition consults were obtained in less than half of the cases and none of the PICUs employed tools to assure the adequacy of energy and protein nutrition. Conclusions Institutions in this study initiated EN for a high percentage of patients by 48 hours of admission. Non-invasive positive pressure ventilation was most strongly associated with delay EN. A better understanding of these risk factors and assessments of nutritional requirements should be explored in future prospective studies.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Delayed Enteral Nutrition in Critically Ill Children*

Canarie

Barry

Carroll

et al. 2015

Pediatric Critical Care Medicine

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“…These studies reported that enteral feeding was tolerated in patients on nonescalating/weaning doses of vasoactive agents without increased adverse effects or gastrointestinal complications [368][369][370]. In another study of 339 critically ill children, there was no association between enteral feeding and the development of severe gastrointestinal outcomes such as vomiting, diarrhea, abdominal distension, bleeding, necrotizing enterocolitis, or perforation [368]. However, in the report, the decision to start enteral nutrition may have been biased by the clinical condition of the patient.…”

Section: Rationalementioning

confidence: 99%

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

et al. 2020

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Objectives: To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction.Design: A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three public members was convened. Panel members assembled at key international meetings (for those The Society of Critical Care Medicine guidelines are intended for general information only, are not medical advice, and do not replace professional advice, which should be sought for any medical condition. The full disclaimer for guidelines can be accessed at https ://www.sccm.org/Resea rch/Guide lines /Guide lines . panel members attending the conference), and a stand-alone meeting was held for all panel members in November 2018. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and group heads, as well as within subgroups, served as an integral part of the guideline development process. Methods:The panel consisted of six subgroups: recognition and management of infection, hemodynamics and resuscitation, ventilation, endocrine and metabolic therapies, adjunctive therapies, and research priorities. We conducted a systematic review for each Population, Intervention, Control, and Outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak, or as a best practice statement. In addition, "in our practice" statements were included when evidence was inconclusive to issue a recommendation, but the panel felt that some guidance based on practice patterns may be appropriate. Results:The panel provided 77 statements on the management and resuscitation of children with septic shock and other sepsis-associated organ dysfunction. Overall, six were strong recommendations, 49 were weak recommendations, and nine were best-practice statements. For 13 questions, no recommendations could be made; but, for 10 of these, "in our practice" statements were provided. In addition, 52 research priorities were identified. Conclusions:A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations. Despite this challenge, these recommendations regarding the management of children with septic shock and other sepsis-associated organ dysfunction provide a foundation for consistent care to improve outcomes and inform future research. S14 the group heads, panel members, and methodologists. Searches utilized ...

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“…2012 [5] Before and after study To test the impact of a feeding protocol Emesis, elevated GRV × 2, or elevated GRV × 1 and abdominal girth increase Panchal et al 2014 [28] Retrospective observational…”

Section: Gastric Residual Volumementioning

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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Safety of Enteral Feedings in Critically Ill Children Receiving Vasoactive Agents

Abstract: Enteral feeding in patients receiving VAs is associated with no difference in GI outcomes and a tendency towards lower mortality. Prospective studies are required to confirm the safety of enteral feedings in patients receiving VAs.

Cited by 59 publications

References 35 publications

Risk Factors for Delayed Enteral Nutrition in Critically Ill Children*

Risk Factors for Delayed Enteral Nutrition in Critically Ill Children*

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

A review of feeding intolerance in critically ill children

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