What you think is not what they get: significant discrepancies between prescribed and administered doses of tube feeding

Broek, Paulina W. J. H. van den; Rasmussen-Conrad, Ellen L.; Naber, A.H.J.; Wanten, Geert

doi:10.1017/s0007114508986852

Cited by 24 publications

(24 citation statements)

References 18 publications

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“…The mean energy balance observed in the present study reached -289.9kcal/day, similar to that found by van den Broek et al. (29) in a study with 55 ward and ICU patients (-259.9kcal/day). This energy deficit is believed to be related to the occurrence of health complications.…”

Section: Discussionsupporting

confidence: 92%

Adequacy of energy and protein balance of enteral nutrition in intensive care: what are the limiting factors?

Ribeiro¹,

Filho²,

Caruso³

et al. 2014

Revista Brasileira De Terapia Intensiva

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Objective To determine the factors that influence the adequacy of enteral nutritional therapy in an intensive care unit.Methods This prospective observational study was conducted in an intensive care unit between 2010 and 2012. Patients >18 years of age underwent exclusive enteral nutritional therapy for ≥72 hours. The energy and protein requirements were calculated according to the ICU protocols. The data regarding enteral nutrition, the causes of non-compliance, and the biochemical test results were collected daily.Results Ninety-three patients admitted to the intensive care unit were evaluated. Among these patients, 82% underwent early enteral nutritional therapy, and 80% reached the nutritional goal in <36 hours. In addition, 81.6%±15.4% of the enteral nutrition volume was infused, with an adequacy of 82.2%±16.0% for calories, 82.2%±15.9% for proteins, and a mean energy balance of -289.9±277.1kcal/day. A negative correlation of C-reactive protein with the volume infused and the energy and protein balance was observed. In contrast, a positive correlation was found between C-reactive protein and the time required to reach nutritional goals. Extubation was the main cause for interrupting the enteral nutritional therapy (29.9% of the interruption hours), and the patients >60 years of age exhibited a lower percentage of recovery of the oral route compared with the younger patients (p=0.014).Conclusion Early enteral nutritional therapy and the adequacy for both energy and protein of the nutritional volume infused were in accordance with the established guidelines. Possible inadequacies of energy and protein balance appeared to be associated with an acute inflammatory response, which was characterized by elevated C-reactive protein levels. The main cause of interruption of the enteral nutritional therapy was the time spent in extubation.

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Section: Discussionsupporting

confidence: 92%

Adequacy of energy and protein balance of enteral nutrition in intensive care: what are the limiting factors?

Ribeiro¹,

Filho²,

Caruso³

et al. 2014

Revista Brasileira De Terapia Intensiva

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“…A study in hospitalised patients found 87% of prescribed tube feedings were met, however this was in a group of patients that were entirely dependent on enteral nutrition (Van den Broek et al , 2009). A systematic review on adherence to prescribed oral nutrition supplements, which is perhaps more akin to the supplementary bolus feeds used in this study, found a mean adherence of 79% (Hubbard et al , 2012).…”

Section: Discussionmentioning

confidence: 99%

Randomised controlled trial of early prophylactic feeding vs standard care in patients with head and neck cancer

et al. 2017

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Background:Weight loss remains significant in patients with head and neck cancer, despite prophylactic gastrostomy and intensive dietary counseling. The aim of this study was to improve outcomes utilising an early nutrition intervention.Methods:Patients with head and neck cancer at a tertiary hospital in Australia referred for prophylactic gastrostomy prior to curative intent treatment were eligible for this single centre randomised controlled trial. Exclusions included severe malnutrition or dysphagia. Patients were assigned following computer-generated randomisation sequence with allocation concealment to either intervention or standard care. The intervention group commenced supplementary tube feeding immediately following tube placement. Primary outcome measure was percentage weight loss at three months post treatment.Results:Recruitment completed June 2015 with 70 patients randomised to standard care (66 complete cases) and 61 to intervention (56 complete cases). Following intention-to-treat analysis, linear regression found no effect of the intervention on weight loss (10.9±6.6% standard care vs 10.8±5.6% intervention, P=0.930) and this remained non-significant on multivariable analysis (P=0.624). No other differences were found for quality of life or clinical outcomes. No serious adverse events were reported.Conclusions:The early intervention did not improve outcomes, but poor adherence to nutrition recommendations impacted on potential outcomes.

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“…Although there is clear guidance for protein prescription in UCD, there are surprisingly no publications reporting actual consumption of protein or energy of patient cohorts. It is possible that some patients may under-achieve their prescribed protein intake if they commonly use their protein-free emergency feeds due to illness, experience periodic vomiting, or if they are tube fed [13,14]. Some may consistently over-restrict protein from fear of precipitating hyperammonaemia [5].…”

Section: Dietary Adherencementioning

confidence: 99%

Adherence Issues in Inherited Metabolic Disorders Treated by Low Natural Protein Diets

et al. 2012

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Common inborn errors of metabolism treated by low natural protein diets [amino acid (AA) disorders, organic acidemias and urea cycle disorders] are responsible for a collection of diverse clinical symptoms, each condition presenting at different ages with variable severity. Precursor-free or essential l-AAs are important in all these conditions. Optimal long-term outcome depends on early diagnosis and good metabolic control, but because of the rarity and severity of conditions, randomized controlled trials are scarce. In all of these disorders, it is commonly described that dietary adherence deteriorates from the age of 10 years onwards, at least in part representing the transition of responsibility from the principal caregivers to the patients. However, patients may have particular difficulties in managing the complexity of their treatment because of the impact of the condition on their neuropsychological profile. There are little data about their ability to self-manage their own diet or the success of any formal educational programs that may have been implemented. Trials conducted in non-phenylketonuria (PKU) patients are rare, and the development of specialist l-AAs for non-PKU AA disorders has usually shadowed that of PKU. There remains much work to be done in refining dietary treatments for all conditions and gaining acceptable dietary adherence and concordance, which is crucial for an optimal outcome.

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What you think is not what they get: significant discrepancies between prescribed and administered doses of tube feeding

Cited by 24 publications

References 18 publications

Adequacy of energy and protein balance of enteral nutrition in intensive care: what are the limiting factors?

Adequacy of energy and protein balance of enteral nutrition in intensive care: what are the limiting factors?

Randomised controlled trial of early prophylactic feeding vs standard care in patients with head and neck cancer

Adherence Issues in Inherited Metabolic Disorders Treated by Low Natural Protein Diets

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