Effect of Evidence-Based Feeding Guidelines on Mortality of Critically Ill Adults

Doig, Gordon S.; Simpson, F. O.; Finfer, Simon; Delaney, Anthony; Davies, Andrew R.; Mitchell, Imogen; Dobb, Geoff

doi:10.1001/jama.2008.826

Cited by 362 publications

(273 citation statements)

References 35 publications

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“…[40][41][42][43][44][45][46][47] Cluster randomized studies could not demonstrate that a protocolized nutritional care can change outcome either. 48,49 Our main contribution was the evaluation of potential and avoidable risk factors related to our inability to reach the selected goals and not to discuss if these goals are relevant for patients' outcomes.…”

Section: Discussionmentioning

confidence: 99%

Nurse to Bed Ratio and Nutrition Support in Critically Ill Patients

Honda

Freitas

Stanich

et al. 2013

American Journal of Critical Care

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Background Inadequate nutrition support is common among critically ill patients, and identification of risk factors for such inadequacy might help in improving nutrition support. Objective To determine how often daily calorie goals are met and the factors responsible for inadequate nutrition support. Methods A single-center prospective cohort study. Each patient's demographic and clinical characteristics, the need for ventilatory support, the use and dosage of medications, the number of nursing staff per bed, the time elapsed from admission to the intensive care unit until the effective start of enteral feeding, and the causes for nonadministration were recorded. Achievement of daily calorie goals was determined and correlated with risk factors. Results A total of 262 daily evaluations were done in 40 patients. Daily calorie goal was achieved in only 46.2% of the evaluations (n = 121), with a mean of 74.8% of the prescribed volume of enteral nutrition infused daily. Risk factors for inadequate nutrition support were the use of midazolam (odds ratio, 1.58; 95% CI, 1.18-2.11) and fewer nursing professionals per bed (odds ratio, 2.56; 95% CI, 1.43-4.57). Conclusion Achievement of daily calorie goals was inadequate, and the main factors associated with this failure were the use and dosage of midazolam and the number of nurses available.

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Section: Discussionmentioning

confidence: 99%

Nurse to Bed Ratio and Nutrition Support in Critically Ill Patients

Honda

Freitas

Stanich

et al. 2013

American Journal of Critical Care

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“…Normal GI function dictates initiation of whole protein formula at rate of 25 mL/h. For subjects with grade I to III acute gastrointestinal injury (AGI), trophic feeding with predigested formula is delivered at rate of [10][11][12][13][14][15] …”

Section: Patient Evaluationmentioning

confidence: 99%

“…Some of these factors can be improved with enteral feeding protocols, therefore preventing underfeeding of critically ill patients. There was evidence that implementation of enteral feeding protocol was associated with more EN intake alone, and early initiation of EN (9)(10)(11). However, there is no evidence suggesting the reduction of mortality or other patient-important outcomes.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of enteral feeding protocol on clinical outcomes in critically ill patients: a study protocol for before-and-after design

Zhang

Jiang

et al. 2016

Ann. Transl. Med.

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Introduction: Enteral feed is an important component of nutritional therapy in critically ill patients and underfeeding has been associated with adverse outcomes. The article developed an enteral feeding protocol and planed a before-and-after comparative trial to explore whether implementation of enteral feeding protocol was able to improve clinical outcomes. Methods and analysis:The study will be conducted in intensive care units (ICUs) of ten tertiary care academic centers. Critically ill patients expected to stay in ICU for over 3 days and require enteral nutrition (EN) were potentially eligible. This is a before-and-after study comprising three phases: The first phase is the period without enteral feeding protocol; the second phase involves four-week training program, and the last phase is to perform the protocol in participating centers. We plan to enroll a total of 350 patients to provide an 80% power and 0.05 error rate to detect a 15% reduction of mortality. The primary outcome is 28-day mortality.Ethics and dissemination: Ethical approval to conduct the research has been obtained from all participating centers. Additionally, the results will be published in peer-reviewed journal.Trial registration: The study was registered at International Standard Registered Clinical/soCial sTudy Number (ISRCTN) registry (ISRCTN10583582).

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“…Level of evidence 2. (14) The use of steroids is not recommended for improving outcome or reducing ICP in patients with TBI. Level of evidence 1.…”

Section: C-severe Head Injuries (Gcs or Pgcs 8)mentioning

confidence: 99%

Management and Rehabilitation of Traumatic Brain Injury in Children

El-Twab

Foaud

youssef

et al. 2013

Zagazig University Medical Journal

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Traumatic brain injury is described as a blow to the head or a penetrating head damage which disturb the normal function of the brain. Traumatic brain injuries, in children are common and sometimes are powerful in threatening the life and are leading causes of acquired disability and death. Traumatic brain injury is responsible for nearly 1.4 million injuries and 52 000 deaths annually in the United States. Therefore, in this paper we reviewed the new and recent advances about the management and neuromonitoring in pediatric traumatic brain injury. And to provide a summary of the empirical research on management and rehabilitation in pediatric traumatic brain injury (TBI). Studies of the effectiveness of interventions with children with TBI are hampered by difficulty with combining subjects with various levels of TBI, problems with random assignment to treatment groups, and varying age levels at injury. While these are areas of concern, there are emerging studies that indicate both applied behavioral analysis (ABA) and positive behavioral interventions are helpful to many children. For some children, ABA is not successful, and a shift to positive behavioral interventions has been found to be helpful. Transitions to home and school can be difficult particularly if there are family issues that predated the injury. This review provides additional information for the pediatric neuropsychologist to assist with transition to school and home. Studies utilizing the Internet for family interventions have revealed promising results. Conclusion: Neuromonitoring technology is still at an early stage in pediatric TBI. These improvements have provided the possibility of true multimodal monitoring for useful treatments. But, using clinical functional neuromonitoring would help clinicians to evaluate the managements in hospitals. Studies have indicated that children with severe TBI show significant difficulties with emotional and behavioral adjustment that pose more challenges for intervention and reentry to home and school compared with cognitive and physical issues.

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Effect of Evidence-Based Feeding Guidelines on Mortality of Critically Ill Adults

Cited by 362 publications

References 35 publications

Nurse to Bed Ratio and Nutrition Support in Critically Ill Patients

Nurse to Bed Ratio and Nutrition Support in Critically Ill Patients

Effectiveness of enteral feeding protocol on clinical outcomes in critically ill patients: a study protocol for before-and-after design

Management and Rehabilitation of Traumatic Brain Injury in Children

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