Background Enteral feeding intolerance (EFI) is a frequent problem in the Intensive care unit (ICU) and is associated with poor clinical outcomes leading to worse prognosis in terms of mortality and ICU stay. Nowadays, prokinetic drugs are the mainstay of therapy in EFI. However, available prokinetics have uncertain efficacy and safety profiles. Itopride, is a prokinetic agent which is different and unique from the available prokinetics because of its dual mode of action as well as its tolerability and safety. The current study compared the efficacy and safety of Itopride against metoclopramide for EFI in critically ill patients. Moreover, it tested the utility and applicability of ultrasonography to measure gastric residual volume (GRV) in this population. Methods This randomized, double-blind study included 76 EFI patients who were randomly assigned to either Itopride or metoclopramide group. The primary outcome was to measure GRV by ultrasonography. Secondary outcomes included the percentage ratio of enteral feed volume, energy and protein received by patients over 7 days of treatment, ICU length of stay, safety parameters and occurrence of infectious complications or vomiting. Results Thirty-five patients of each group completed the study. At day 7, itopride significantly decreased GRV compared with metoclopramide group (p = 0.001). Moreover, there was a significant increase in the ratios of received enteral nutrition feed volume, calories, and protein after the one-week therapy in the itopride group more than the metoclopramide group (p = 0.001), (p = 0.002), (p = 0.01), respectively and there were no differences in any secondary outcomes or adverse events between the two groups. Conclusion In critically ill patients with EFI, itopride was well tolerated with superior efficacy to metoclopramide. In addition, we demonstrated that ultrasonography is a simple, non-invasive, inexpensive, and undemanding method for GRV measurements and can offer reliable assessments in the gastric emptying modality. Trial registration The trial was registered in ClinicalTrials.gov (NCT03698292). Date: October 5, 2018
Industrial-based application of supercritical CO2 (SCCO2) has emerged as a promising technology in numerous scientific fields due to offering brilliant advantages, such as simplicity of application, eco-friendliness, and high performance. Loxoprofen sodium (chemical formula C15H18O3) is known as an efficient nonsteroidal anti-inflammatory drug (NSAID), which has been long propounded as an effective alleviator for various painful disorders like musculoskeletal conditions. Although experimental research plays an important role in obtaining drug solubility in SCCO2, the emergence of operational disadvantages such as high cost and long-time process duration has motivated the researchers to develop mathematical models based on artificial intelligence (AI) to predict this important parameter. Three distinct models have been used on the data in this work, all of which were based on decision trees: K-nearest neighbors (KNN), NU support vector machine (NU-SVR), and Gaussian process regression (GPR). The data set has two input characteristics, P (pressure) and T (temperature), and a single output, Y = solubility. After implementing and fine-tuning to the hyperparameters of these ensemble models, their performance has been evaluated using a variety of measures. The R-squared scores of all three models are greater than 0.9, however, the RMSE error rates are 1.879 × 10−4, 7.814 × 10−5, and 1.664 × 10−4 for the KNN, NU-SVR, and GPR models, respectively. MAE metrics of 1.116 × 10−4, 6.197 × 10−5, and 8.777 × 10−5errors were also discovered for the KNN, NU-SVR, and GPR models, respectively. A study was also carried out to determine the best quantity of solubility, which can be referred to as the (x1 = 40.0, x2 = 338.0, Y = 1.27 × 10−3) vector.
Background Nutritional support is a vital intervention for critically ill patients. Despite the existence of several clinical practice guidelines focused on enteral nutrition of critically ill, there is still a gap between guideline recommendations and actual nutrition practices. The purpose of this study is to understand the role of the clinical pharmacist in identifying the barriers to applying optimum enteral nutritional practices from the perspective of critical care providers. A descriptive cross-sectional design was utilized using self-administered questionnaire. A total of 90 critical care providers comprising of 3 categories: physicians (n = 30), clinical pharmacists (n = 30), and nurses (n = 30) were recruited. "The barriers to enteral feeding critically ill patients" questionnaire was used to explore the barriers that hinder them from optimal delivery of enteral nutrition. Results Not enough dietitian coverage during holidays was the most important barrier facing the physicians. As for the clinical pharmacists, the most important barrier was waiting for the dietitian to assess the patient. Regarding the nurses, familiarity with nutrition guidelines was the most important barrier. There was a highly significant difference between physicians, clinical pharmacists, and nurses regarding subscales’ scores and overall scores of Barriers Questionnaire except for the resources and provider attitudes. Conclusion Barriers to optimum enteral nutrition practices were explored with more attention on barriers regarding dietitian support and critical care providers' attitudes. This article provides the basis for the creation of interventions intended to overcome these barriers and enhance enteral nutrition practices.
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