Effects of Early Enteral Feeding on the Outcome of Critically Ill Mechanically Ventilated Medical Patients

Artinian, Vasken; Krayem, Hicham; DiGiovine, Bruno

doi:10.1378/chest.129.4.960

Cited by 304 publications

(190 citation statements)

References 31 publications

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“…In contrast, few patients who initiated in the first 12 hours of admission presented critical protein deficit. This reinforces the recommendation for early initiation of enteral feeding in critical patients (25)(26)(27)(28)(29).…”

Section: Discussionsupporting

confidence: 80%

Déficit crítico de energía y mortalidad en pacientes críticos

Siqueira-Paese¹,

Dock-Nascimento

Aguilar-Nascimento

2016

Nutr Hosp

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ResumenObjetivo: investigar la infl uencia del défi cit de calorías y proteínas en la mortalidad y la duración de la estancia hospitalaria de pacientes críticos. Métodos: se realizó un estudio prospectivo de cohorte incluyendo 100 pacientes consecutivos en una unidad de cuidados intensivos (UCI) terciaria que recibían nutrición enteral o parenteral. Se registraron diariamente los défi cits de calorías y proteínas durante un máximo de 30 días. Los défi -cit de energía y proteínas fueron divididos en: défi cit crítico de calorías (≥ 480 kcal/día), défi cit calórico no crítico (≤ 480 kcal/día), défi cit crítico de proteínas (≥ 20 g/día) y défi cit de proteínas no crítico (≤ 20 g/día). Los resultados se correlacionaron con la estancia hospitalaria y la mortalidad. Resultados: la tasa de mortalidad fue de 33%. En general, los pacientes recibieron 65,4% y 67,7% de las necesidades calóricas y proteicas. El défi cit calórico crítico se encontró en el 72% de los casos y el défi cit proteico crítico en el 70% de ellos. Hubo una correlación signifi cativa entre la duración de la estancia con el défi cit calórico (R = 0,37; p < 0,001) y el défi cit de proteínas (R = 0,28; p < 0,001). El análisis de sobrevida mostró que la mortalidad fue mayor en los pacientes con défi cit calórico crítico (p < 0,001) o con défi cit proteico crítico (p < 0,01). El análisis de regresión de Cox mostró que el défi cit crítico de proteínas se asoció con mayor mortalidad (HR 0.25, IC 95% 0,07-0,93; p = 0,03). Conclusiones: la incidencia de défi cit de calorías y de proteínas en la UCI es alta. Tanto los défi cit calóricos como proteicos aumentan la duración de la estancia hospitalaria, y el défi cit de proteínas superior a 20 g/día es un factor independiente de mortalidad en la ICU. AbstractObjective: We investigate the infl uence of caloric and protein defi cit on mortality and length of hospital stay of critically ill patients. Methods: A cohort prospective study including 100 consecutive patients in a tertiary intensive care unit (ICU) receiving enteral or parenteral nutrition. The daily caloric and protein defi cit were collected each day for a maximum of 30 days. Energy defi cits were divided into critical caloric defi cit (≥ 480 kcal/day) and non-critical caloric defi cit (≤ 480 kcal/day); and in critical protein defi cit (≥ 20 g/day) and non-critical protein defi cit (≤ 20 g/day). The fi ndings were correlated with hospital stay and mortality. Results: The mortality rate was 33%. Overall, the patients received 65.4% and 67.7% of the caloric and protein needs. Critical caloric defi cit was found in 72% of cases and critical protein defi cit in 70% of them. There was a signifi cant correlation between length of stay and accumulated caloric defi cit (R = 0.37; p < 0.001) and protein defi cit (R = 0.28; p < 0.001). The survival analysis showed that mortality was greater in patients with both critical caloric (p < 0.001) and critical protein defi cits (p < 0.01). The Cox regression analysis showed that critical protein defi cit was associated w...

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Section: Discussionsupporting

confidence: 80%

Déficit crítico de energía y mortalidad en pacientes críticos

Siqueira-Paese¹,

Dock-Nascimento

Aguilar-Nascimento

2016

Nutr Hosp

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“…[52][53][54] Monitoring for gastric intolerance is of pivotal importance as gastric intolerance puts patients at risk for VAP. Current guidelines state that a residual volume of 250 to 500 mL should raise concern and should incite measures to reduce the risk of aspiration.…”

Section: Nutritionmentioning

confidence: 99%

Insights and Advances in Multidisciplinary Critical Care: A Review of Recent Research

Blot

Afonso

Labeau

2014

American Journal of Critical Care

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The intensive care unit is a work environment where superior dedication is pivotal to optimize patients' outcomes. As this demanding commitment is multidisciplinary in nature, it requires special qualities of health care workers and organizations. Thus research in the field covers a broad spectrum of activities necessary to deliver cutting-edge care. However, given the abundance of research articles and education activities available, it is difficult for modern critical care clinicians to keep up with the latest progress and innovations in the field. This article broadly summarizes new developments in multidisciplinary intensive care, providing elementary information about advanced insights in the field by briefly describing selected articles bundled in specific topics. Issues considered include cardiovascular care, monitoring, mechanical ventilation, infection and sepsis, nutrition, education, patient safety, pain assessment and control, delirium, mental health, ethics, and outcomes research.

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“…Enteral nutrition is the best model of feeding in the critically ill patients as it favors intestinal trophism, stimulates the immune system, reduces bacterial translocation and the incidence of sepsis and multisystem failure and has few side effects (Hadfield et al, 1995;De Lucas et al, 2000;Galbán et al, 2000;Artinian et al, 2006). However, oral or nasogastric feeding is sometimes poorly tolerated, particularly in the patients on mechanical ventilation, owing to the reduced gastric motility secondary to the administration of drugs or to the disease itself, with the onset of distension, the accumulation of gastric residues and an increased risk of pulmonary aspiration (Montejo, 1999;Mentec et al, 2001;(Montejo et al, 2002).…”

Section: Introductionmentioning

confidence: 99%

Risk factors for gastrointestinal complications in critically ill children with transpyloric enteral nutrition

et al. 2007

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Objective: To study the risk factors for gastrointestinal complications related to enteral nutrition in critically ill children. Design: A prospective, observational study. Setting: Pediatric intensive care unit Subjects: Five hundred and twenty-six critically ill children who received transpyloric enteral nutrition(TEN). Methods: Univariate and multivariate logistic regression analysis were used to identify risk factors for gastrointestinal complications Results: Sixty six patients (11.5%) presented gastrointestinal complications, 33 (6.2%) abdominal distension and/or excessive gastric residue, 34 (6.4%) diarrhea, one gastrointestinal bleeding, three necrotizing enterocolitis and one duodenal perforation. Enteral nutrition was definitively suspended because of gastrointestinal complications in 11 (2.1%) patients. Fifty patients (9.5%) died. Gastrointestinal complications were more frequent in the patients who died. Death was related to complications of the nutrition in only one patient. The frequency of gastrointestinal complications was significantly higher in children with shock, acute renal failure, hypokalemia, hypophosphatemia and in those receiving dopamine, epinephrine and vecuronium. The stepwise multivariate logistic regression analysis showed that the most important factors associated with gastrointestinal complications were shock, epinephrine at a rate higher than 0.3 mg/kg/min and hypophosphatemia. Conclusions: The tolerance of TEN in critically ill children is good, although the incidence of gastrointestinal complications is higher in patients with shock, acute renal failure, hypokalemia, hypophosphatemia, and those receiving epinephrine, dopamine, and vecuronium.

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Effects of Early Enteral Feeding on the Outcome of Critically Ill Mechanically Ventilated Medical Patients

Cited by 304 publications

References 31 publications

Déficit crítico de energía y mortalidad en pacientes críticos

Déficit crítico de energía y mortalidad en pacientes críticos

Insights and Advances in Multidisciplinary Critical Care: A Review of Recent Research

Risk factors for gastrointestinal complications in critically ill children with transpyloric enteral nutrition

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