Effects of enteral nutrition on clinical outcomes among mechanically ventilated and sedated patients in the pediatric intensive care unit

Tripathi, Sandeep; Kaur, Harsheen; Varayil, Jithinraj Edakkanambeth; Hurt, Ryan T.

doi:10.22514/sv102.122015.8

Cited by 3 publications

(3 citation statements)

References 10 publications

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“…In the study of Lew et al [1] on 285 intensive care patients, no significant difference was found between patients with malnutrition and patients that do not have malnutrition in terms of dependence on mechanical ventilator. In another study conducted on 245 patients, it was shown that the duration of detachment from the mechanical ventilator was earlier and the mortality was lower in patients who started enteral nutrition early [14]. In our study, we see that both the duration of adherence to the mechanical ventilator and the stay in intensive care unit increased with low MNA-SF, high NRS 2002 and high CRP/ Albumin values.…”

Section: Discussionsupporting

confidence: 63%

The effect of malnutrition on prognosis in surgical inpatients in the intensive care unit

Yılmaz

Doğu²

2020

J Clin Med Kaz

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Introduction: Malnutrition, which is a clinical process starting with systemic inflammation and extending to immune deficiency is a common problem in intensive care units. In this study, we aimed to investigate the effect of malnutrition on prognosis in surgical patients followed in intensive care unit.Material and methods: The study is retrospective, and the files of the surgical patients hospitalized in the intensive care units of Aydin State Hospital between January 2018 and January 2020 were reviewed. The demographic data of the patients, the duration of hospitalization in the intensive care unit and the hospital, the type of surgery being urgent-elective, and the ex-discharge status of the patients were recorded. For malnutrition screening, in addition to NRS-2002 and MNA-SF scores at the time of hospitalization, statistical analysis was performed by recording C-reactive protein, albumin, total protein and C-reactive protein/albumin values as markers.Results: A total of 160 patients were included in this study. The mean NRS-2002 score was 2.20±1.85, while the MNA-SF score was 11.39±2.99. The mean C-reactive protein/albumin value was 39.10, the hospital stay in intensive care was 3.4 days, and hospital stay was 13.58 days. It was observed that as the NRS-2002 scores at the time of hospitalization increased and MNA-SF scores decreased, the duration of hospitalization in the intensive care and the hospital increased (p<0.001). However, as the NRS-2002 scores increased and MNA-SF scores decreased, the need for mechanical ventilator and mortality rate increased (p <0.001). Conclusion:Malnutrition is a condition that triggers the inflammatory cascade in surgical patients and has a negative effect on prognosis. Its effect is more pronounced in patients who need intensive care for surgical reasons. We think that the early identification of the risk of malnutrition and providing the necessary nutritional support in the perioperative period, especially in surgical patients who need intensive care, would affect the prognosis positively.

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Section: Discussionsupporting

confidence: 63%

The effect of malnutrition on prognosis in surgical inpatients in the intensive care unit

Yılmaz

Doğu²

2020

J Clin Med Kaz

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“…The association between early EN and improved outcomes has been shown in both general PICU populations and specifically in respiratory failure; however, the potential benefits in children categorized as at-risk for PARDS have not been previously demonstrated in the literature (1-9). Because of the high morbidity and mortality associated with PARDS, identifying (19,20), while others found no difference at all (21). These inconsistencies highlight the need to design prospective studies with protocolized nutrition delivery to better understand the potential benefits of this therapy in children with acute respiratory failure.…”

Section: Discussionmentioning

confidence: 99%

“…Children receiving early EN in our cohort had a median PICU LOS 2 days shorter than children receiving late EN. Previous studies examining the association between LOS and timing of EN initiation in children with acute respiratory failure have suggested an inconsistent benefit of early EN, with some demonstrating a reduced PICU LOS (19, 20), while others found no difference at all (21). These inconsistencies highlight the need to design prospective studies with protocolized nutrition delivery to better understand the potential benefits of this therapy in children with acute respiratory failure.…”

Section: Discussionmentioning

confidence: 99%

Nutritional Support in Children Meeting the At-Risk for Pediatric Acute Respiratory Distress Syndrome Criteria

Pei

Shein

Cheifetz

et al. 2023

Critical Care Explorations

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IMPORTANCE: Pediatric acute respiratory distress syndrome (PARDS) is a prevalent condition in the PICU with a high morbidity and mortality, but effective preventative strategies are lacking. OBJECTIVES: To examine associations between early enteral nutrition (EN) and PICU outcomes in a cohort of children meeting the 2015 Pediatric Acute Lung Injury Consensus Conference “at-risk” for pediatric acute respiratory distress syndrome (ARF-PARDS) criteria. DESIGN, SETTING, AND PARTICIPANTS: This was a single-center, electronic health record-based retrospective chart review. We included children less than or equal to 18 years-old admitted to our mixed medical-surgical PICU from January 2017 to December 2018 who met ARF-PARDS criteria within 48 hours of admission. Children were categorized as receiving “early” EN if feeds were initiated within 48 hours of admission. All others were categorized as “delayed” EN. MAIN OUTCOMES AND MEASURES: Extracted data included demographics, illness characteristics including primary diagnosis and Pediatric Risk of Mortality (PRISM) III score, respiratory support and oxygenation indices, nutritional data, and PICU length of stay (LOS). The primary outcome of interest was subsequent diagnosis of PARDS. RESULTS: Of 201 included children, 152 (75.6%) received early EN. The most common admission diagnoses were pneumonia, bronchiolitis, and influenza. Overall, 21.4% (n = 43) of children developed PARDS. Children receiving early EN had a subsequent diagnosis of PARDS less often then children receiving delayed EN (15.1% vs 40.8%; p < 0.001), an association that persisted after adjusting for patient demographics and illness characteristics, including PRISM III and diagnosis (adjusted odds ratio, 0.24; 95% CI, 0.10–0.58; p = 0.002). Early EN was also associated with a shorter PICU LOS in univariate analysis (2.2 d [interquartile range, 1.5–3.4 d] vs 4.2 d [2.7–8.9 d]; p < 0.001). CONCLUSIONS AND RELEVANCE: In this single-center, retrospective cohort study, compared with children with ARF-PARDS who received late EN, those who received early EN demonstrated a reduced odds of subsequent diagnosis of PARDS, and an unadjusted reduction in PICU LOS when compared with delayed EN. Prospective studies should be designed to confirm these findings.

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Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations

et al. 2020

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Background: Nutritional support is considered essential for the outcome of paediatric critical illness. There is a lack of methodologically sound trials to provide evidence-based guidelines leading to diverse practices in PICUs worldwide. Acknowledging these limitations, we aimed to summarize the available literature and provide practical guidance for the paediatric critical care clinicians around important clinical questions many of which are not covered by previous guidelines. Objective:To provide an ESPNIC position statement and make clinical recommendations for the assessment and nutritional support in critically ill infants and children. Design: The metabolism, endocrine and nutrition (MEN) section of the European Society of Pediatric and NeonatalIntensive Care (ESPNIC) generated 15 clinical questions regarding different aspects of nutrition in critically ill children. After a systematic literature search, the Scottish Intercollegiate Guidelines Network (SIGN) grading system was applied to assess the quality of the evidence, conducting meta-analyses where possible, to generate statements and clinical recommendations, which were then voted on electronically. Strong consensus (> 95% agreement) and consensus (> 75% agreement) on these statements and recommendations was measured through modified Delphi voting rounds. Results:The final 15 clinical questions generated a total of 7261 abstracts, of which 142 publications were identified relevant to develop 32 recommendations. A strong consensus was reached in 21 (66%) and consensus was reached in 11 (34%) of the recommendations. Only 11 meta-analyses could be performed on 5 questions. Conclusions:We present a position statement and clinical practice recommendations. The general level of evidence of the available literature was low. We have summarised this and provided a practical guidance for the paediatric critical care clinicians around important clinical questions.There is a lack of high-quality evidence to guide nutrition in paediatric critical illness. This position statement and clinical recommendations summarise the existing evidence around 15 of the most important clinical questions, and where no evidence is available, suggest good clinical practice.

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Effects of enteral nutrition on clinical outcomes among mechanically ventilated and sedated patients in the pediatric intensive care unit

Cited by 3 publications

References 10 publications

The effect of malnutrition on prognosis in surgical inpatients in the intensive care unit

The effect of malnutrition on prognosis in surgical inpatients in the intensive care unit

Nutritional Support in Children Meeting the At-Risk for Pediatric Acute Respiratory Distress Syndrome Criteria

Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations

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