Successful Enteral Nutritional Support in the Neurocritical Care Unit

Zarbock, Sommer D.; Steinke, Doug; Hatton, Jimmi; Magnuson, Barbara; Smith, Kelly M.; Cook, Aaron M.

doi:10.1007/s12028-008-9120-9

Cited by 20 publications

(12 citation statements)

References 13 publications

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“…The current cohort of patients, on average, received approximately half the amount of calories recommended by the American College of Chest Physicians' guidelines for critically ill patients (approximately 25 calories/kg/day) [20], but is consistent with reports of underfeeding of neurological critically ill patients elsewhere [37]. We speculate that the effect of insulin on brain glucose metabolism in the context of brain injury remains poorly understood and is in need of further study.…”

Section: Discussionsupporting

confidence: 73%

“…Our data suggest that receiving even modest, though typical [37], levels of nutritional support is an effective way to increase serum glucose concentrations in poor-grade SAH patients and, accordingly, results in increased insulin administration to maintain target serum glucose concentrations. Improved algorithms designed to avoid underfeeding will be necessary to fully understand the incidence, mechanism and impact of insulin-induced reductions in brain glucose concentrations.…”

Section: Discussionmentioning

confidence: 89%

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Nutritional support and brain tissue glucose metabolism in poor-grade SAH: a retrospective observational study

Schmidt

Claassen

et al. 2012

Crit Care

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IntroductionWe sought to determine the effect of nutritional support and insulin infusion therapy on serum and brain glucose levels and cerebral metabolic crisis after aneurysmal subarachnoid hemorrhage (SAH).MethodsWe used a retrospective observational cohort study of 50 mechanically ventilated poor-grade (Hunt-Hess 4 or 5) aneurysmal SAH patients who underwent brain microdialysis monitoring for an average of 109 hours. Enteral nutrition was started within 72 hours of admission whenever feasible. Intensive insulin therapy was used to maintain serum glucose levels between 5.5 and 7.8 mmol/l. Serum glucose, insulin and caloric intake from enteral tube feeds, dextrose and propofol were recorded hourly. Cerebral metabolic distress was defined as a lactate to pyruvate ratio (LPR) > 40. Time-series data were analyzed using a general linear model extended by generalized estimation equations (GEE).ResultsDaily mean caloric intake received was 13.8 ± 6.9 cal/kg and mean serum glucose was 7.9 ± 1 mmol/l. A total of 32% of hourly recordings indicated a state of metabolic distress and < 1% indicated a state of critical brain hypoglycemia (< 0.2 mmol/l). Calories received from enteral tube feeds were associated with higher serum glucose concentrations (Wald = 6.07, P = 0.048), more insulin administered (Wald = 108, P < 0.001), higher body mass index (Wald = 213.47, P < 0.001), and lower body temperature (Wald = 4.1, P = 0.043). Enteral feeding (Wald = 1.743, P = 0.418) was not related to brain glucose concentrations after accounting for serum glucose concentrations (Wald = 67.41, P < 0.001). In the presence of metabolic distress, increased insulin administration was associated with a relative reduction of interstitial brain glucose concentrations (Wald = 8.26, P = 0.017), independent of serum glucose levels.ConclusionsIn the presence of metabolic distress, insulin administration is associated with reductions in brain glucose concentration that are independent of serum glucose levels. Further study is needed to understand how nutritional support and insulin administration can be optimized to minimize secondary injury after subarachnoid hemorrhage.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 89%

Nutritional support and brain tissue glucose metabolism in poor-grade SAH: a retrospective observational study

Schmidt

Claassen

et al. 2012

Crit Care

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“…The destruction of skeletal musculature and visceral protein reduction via insufficient oral intake, hyper-catabolism or dysmobility that are minor compared to disease course are potentially prompted by all of these conditions. Because of the characteristics of their diseases and the invasive interferences that are necessary to support the nonsurgical patients while they are treated and recovered, even these patients may suffer from a hyper-catabolic and hypermetabolic status [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“…As demonstrated by the new analyses, the mortality and morbidity ratios of the patients who are severely ill are affected by nutritional support [3,4,11,12]. Among the patients who are severely ill and get nutritional support, the rate of use of parenteral nutrition (PN) is 12-71% while the rate of use of enteral nutrition (EN) is 33-92% [13].…”

Section: Introductionmentioning

confidence: 99%

Stan odżywienia pacjentów Neurochirurgicznego Oddziału Intensywnej Opieki Medycznej

Kaya

Turan

Aydın

2017

PNIN

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Neurosurgical patients present important metabolic alterations that trigger increased energy and protein expenditure. The clinical condition in neuro patients associated with the use of sedatives, steroids, barbiturates and musclerelaxing drugs postpones the use of nutrients in these patients and, thus, complications, including infection and longer hospitalization, may occur. Weight loss, negative nitrogen balance and immune dysfunction constitute a characteristic response in neurosurgical patients. There is a strong relationship between adequate nutritional status and recovery from critical illness. Improved nutritional status is associated with positive clinical outcomes. The health care team, nurses in particular, play a major role in the management and maintenance of an optimal nutritional status in patients who are in the neurosurgical clinic. This compilation aims at highlighting the fact that inadequate nutrition is a serious problem which increases incidence of morbidity and mortality especially in neurosurgical patients. The article also emphasises the importance of nursing assessment. (JNNN 2017;6(1):33-38) Key Words: neuro patients, neurosurgery, nutrition Streszczenie U pacjentów Neurochirurgicznego Oddziału Intensywnej Opieki Medycznej występują istotne zmiany metaboliczne, które powodują zwiększone wydatkowanie energii i białka. Neurochirurgiczny stan kliniczny w wyniku stosowania środków uspokajających, steroidów, barbituranów i leków zwiotczających mięśnie opóźnia wykorzystanie składników pokarmowych w tej grupie pacjentów, a zatem mogą wystąpić powikłania, w tym infekcje i dłuższa hospitalizacja. Utrata masy ciała, ujemny bilans azotu i dysfunkcja układu odpornościowego stanowią charakterystyczną odpowiedź u pacjentów neurochirurgicznych. Istnieje silny związek pomiędzy odpowiednim stanem odżywienia i regeneracją po chorobie krytycznej. Dobry stan odżywienia jest związany z pozytywnymi wynikami klinicznymi. Zespół opieki zdrowotnej, w szczególności pielęgniarki, odgrywają ważną rolę w utrzymaniu optymalnego stanu odżywienia u pacjentów neurochirurgicznych. Przegląd ten ma na celu podkreślenie, że przeciętny stan odżywienia jest poważnym problemem w kontekście zwiększonej zachorowalności i śmiertelności, zwłaszcza u pacjentów neurochirurgicznych. Artykuł zwraca również uwagę na duże znaczenie oceny pielęgniarskiej. (PNN 2017;6(1):33-38) Słowa kluczowe: pacjenci neurologiczni, neurochirurgia, odżywianie

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“…Entretanto, a existência de desafios como a alteração da motilidade gastrointestinal, o aumento da pressão intracraniana e o comprometimento do estado de consciência e da função neurológica geral pode resultar no atraso desses procedimentos e, assim, na piora do prognóstico. 30 Com o objetivo de apresentar um artigo de revisão a respeito do suporte nutricional utilizado em pacientes neurocirúrgicos, foi realizada uma pesquisa no banco de dados Medline incluindo estudos de 1976 a 2010.…”

Section: Introductionunclassified

Nutrição e neurocirurgia: uma revisão

Riboldi¹,

Contini²,

Santos³

et al. 2011

Arq Bras Neurocir

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RESUMO IntroduçãoDesde 1930, têm-se discutido as alterações metabólicas e de composição corporal em decorrência de injúria cirúrgica. Sabe-se que o metabolismo energético bem como o metabolismo dos fluidos, eletrólitos e a função endócrina são afetados. Essas alterações são percebidas pela perda de peso, diminuição da força e atividade muscular e declínio temporário da capacidade intelectual desses pacientes. 5 Pacientes neurocirúrgicos apresentam necessidades especiais, uma vez que, logo após o insulto

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Successful Enteral Nutritional Support in the Neurocritical Care Unit

Abstract: System-based clinical care factors appear to have great impact on the successful provision of EN in the first week of neurocritical illness.

Cited by 20 publications

References 13 publications

Nutritional support and brain tissue glucose metabolism in poor-grade SAH: a retrospective observational study

Nutritional support and brain tissue glucose metabolism in poor-grade SAH: a retrospective observational study

Stan odżywienia pacjentów Neurochirurgicznego Oddziału Intensywnej Opieki Medycznej

Nutrição e neurocirurgia: uma revisão

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