BackgroundInadequate delivery of nutrition in critically ill patients has been shown to have adverse outcomes. A surgical trauma intensive care unit provides unique challenges to enteral feeds. Although volume‐based feeding protocols, like Enhanced Protein‐Energy Provision via the Enteral Route Feeding Protocol (PEP uP), have been successfully used in medical intensive care patients, data are sparse on its safety and efficacy in a surgical intensive care unit population.MethodsA PEP uP protocol was recently initiated at our American College of Surgeons Level 1 verified trauma center. Medical records of 197 patients before this change (pre‐PEP uP) were compared with 295 patients after this change (post‐PEP uP).ResultsThe post‐PEP uP group met/exceeded energy goals (defined as 80% of target) more often (57.0% compared with 26.9%, P‐value < .001), with an adjusted odds ratio (OR) of 4.98 (95% CI 3.49‐7.10), and more often met/exceeded protein goals (57.4% compared with 18.6%, P‐value < .001), with an adjusted OR of 11.84 (95% CI 7.94‐17.64). There was no significant difference in emesis during this time. Additionally, patients in the post‐PEP uP arm had less episodes of hyperglycemia (9% compared with 14.4%, P‐value < .001).ConclusionsVolume‐based feeding protocols like PEP uP are safe in critically ill trauma patients and are more effective at delivering energy and protein while limiting hyperglycemic episodes when compared with a traditional delivery method.
Although DES effectively reduces restenosis, a small but significant number of patients suffer complications of in-stent thrombosis. Thus, each patient's health history should be determined before recommending DES. Patients must understand the importance of post-implantation DAT and the need for continued DAT, potentially for life, in order to reduce complications. Current recommendations advocate at least 12 months of uninterrupted clopidogrel and ASA (lifelong ASA if tolerated). With each new generation of stents, patients experience fewer adverse outcomes and improved quality of life. For the present, DES remains a strong therapeutic option for patients with symptomatic CHD.
In critically ill trauma patients, adequate nutrition is essential for the body’s healing process. Currently, there is no clinical standard for initiating feeds after percutaneous endoscopic gastrostomy (PEG) tube placement. We aimed to demonstrate that early enteral nutrition (EN) is as safe as delayed EN in patients who have undergone PEG tube insertion. We conducted a multi-center, retrospective cohort study of 384 patients from the Prisma Health Trauma Registries who received PEGs. Feeding intolerance was defined as high gastric residuals, nausea, emesis, sustained diarrhea, or ileus. The probability that a patient would experience intolerance was 11.7% in those fed within 6 hours, 5.1% among patients fed between 6 and 12 hours, 6.0% among patients fed between 12 and 24 hours, and 7.6% among patients fed after 24 hours, for which no statistically significant difference was detected. These findings support that early EN after PEG placement is safe in critically ill, trauma patients.
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