Achieving energy goals at day 4 after admission in critically ill children; predictive for outcome?

Betue, Carlijn T.I. de; Steenselen, W.N. van; Hulst, Jessie M.; Olieman, Joanne; Augustus, M E; Din, S.H. Mohd; Verbruggen, Sascha; Tibboel, Dick; Joosten, Koen

doi:10.1016/j.clnu.2014.01.019

Cited by 30 publications

(33 citation statements)

References 31 publications

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“…For example, lack of agreement as to what constitutes significant residual volumes or abdominal distension has made it difficult to assess the true impact each has on EN. Recently published protocols defining these common disturbances could promote a more consistent--and testable--approach to managing EN (16, 17, 31). .…”

Section: Discussionmentioning

confidence: 99%

“…Early EN was widely practiced at our institutions even in the absence of nutrition consults for nearly half of the patients and formal feeding protocols in only 1 of the 6 PICUs, both of which have been shown to encourage EN (17, 31). The heterogeneity of tools used to estimate energy requirements among the PICUs is consistent with the variability noted in the literature (33, 34).…”

Section: Discussionmentioning

confidence: 99%

“…The main strength of our study is that it was conducted in settings where most critically ill children in the US receive their care (i.e., medical-surgical PICUs with less than 20 beds), and with a group of children whose breadth of diagnosis is similar to that described in other reports (31, 38). In addition, the severity of illness as represented by a rate of mechanical ventilation of 35% at 48 hours is comparable to that described in other PICU nutrition studies (10).…”

Section: Discussionmentioning

confidence: 99%

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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%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Risk Factors for Delayed Enteral Nutrition in Critically Ill Children*

Canarie

Barry

Carroll

et al. 2015

Pediatric Critical Care Medicine

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“…Delayed gastric emptying is prevalent in critically ill children and has been associated with longer length of stay and enteral nutrition (EN) intolerance, leading to suboptimal EN delivery . Suboptimal EN delivery has itself been associated with longer length of stay, increased days on mechanical ventilation, longer duration of antibiotics, and increased mortality in critically ill children . Gastric emptying in critical illness may be impacted by multiple factors, particularly changes in gastrointestinal hormone levels.…”

Section: Introductionmentioning

confidence: 99%

Gastrointestinal Hormone Profiles Associated With Enteral Nutrition Tolerance and Gastric Emptying in Pediatric Critical Illness: A Pilot Study

Martinez

Panciotti

Pereira

et al. 2019

J Parenter Enteral Nutr

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Background Enteral nutrition (EN) intolerance and delayed gastric emptying are prevalent in pediatric critical illness and limit EN delivery. Gastrointestinal (GI) hormones may be associated with EN intolerance and delayed gastric emptying in this cohort. Methods We determined GI hormone levels, time to achieve 50% of EN goal, and gastric emptying in critically ill children. Total amylin, active ghrelin, total glucagon‐like peptide‐1 (GLP‐1), total gastric inhibitory polypeptide, glucagon, and total peptide‐YY (PYY) were measured by multiplex assay and cholecystokinin by ELISA. Lower concentrations of acetaminophen at 1 hour (C1h, µg/mL) using the acetaminophen absorption test defined delayed gastric emptying. Correlation, regression analyses, and a principal component analysis were used to examine the association between GI hormones and time to 50% EN goal and C1h. Results GI hormones were measured in 14 of 21 patients with gastric emptying testing; median age of 11.2 years (6.74–16.3) and 50% male. Increasing hormone levels from GI hormone profile 1 (GLP‐1, glucagon, and amylin) correlated with greater time to reach 50% EN goal (R2 = 0.296, P = 0.04). Decreasing hormone levels from GI hormone profile 2 (PYY and ghrelin) correlated with lower C1h and slower gastric emptying (R2 = 0.342, P = 0.02). Conclusion GI hormone profiles are associated with time to achieve 50% of EN goal and gastric emptying in critically ill children. We have described a feasible model to study the role of GI hormones in this cohort, including the potential clinical applicability of GI hormone measurement in the management of delayed gastric emptying.

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“…These equations were derived with data from healthy subjects and therefore may not be reliable in critically ill children 3 , 7 . Furthermore, a variety of barriers impede actual nutrient intake in the complex pediatric intensive care unit (PICU) environment 1 , 8 …”

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confidence: 99%