Enteral Nutrition Safety With Advanced Treatments: Extracorporeal Membrane Oxygenation, Prone Positioning, and Infusion of Neuromuscular Blockers

Al‐Dorzi, Hasan M.; Arabi, Yaseen M.

doi:10.1002/ncp.10621

Cited by 16 publications

(31 citation statements)

References 49 publications

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“…The increasing utilization of extra corporeal membrane oxygenation (ECMO) in persons with obesity is not a contraindication to the use of enteral feeding that has been found to be safe. However, in patients in shock or severe gastrointestinal dysfunction, enteral feeding should not be administered [175]. [176].…”

Section: Hospitalized Persons With Obesity With Covid-19 Withmentioning

confidence: 99%

Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance

et al. 2022

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The COVID-19 pandemics has created unprecedented challenges and threats to patients and healthcare systems worldwide. Acute respiratory complications that require intensive care unit (ICU) management are a major cause of morbidity and mortality in COVID-19 patients. Among other important risk factors for severe COVID-19 outcomes, obesity has emerged along with undernutrition-malnutrition as a strong predictor of disease risk and severity. Obesity-related excessive body fat may lead to respiratory, metabolic and immune derangements potentially favoring the onset of COVID-19 complications. In addition, patients with obesity may be at risk for loss of skeletal muscle mass, reflecting a state of hidden malnutrition with a strong negative health impact in all clinical settings. Also importantly, obesity is commonly associated with micronutrient deficiencies that directly influence immune function and infection risk. Finally, the pandemic-related lockdown, deleterious lifestyle changes and other numerous psychosocial consequences may worsen eating behaviors, sedentarity, body weight regulation, ultimately leading to further increments of obesity-associated metabolic complications with loss of skeletal muscle mass and higher non-communicable disease risk. Therefore, prevention, diagnosis and treatment of malnutrition and micronutrient deficiencies should be routinely included in the management of COVID-19 patients in the presence of obesity; lockdown-induced health risks should also be specifically monitored and prevented in this population. In the current document, the European Society for Clinical Nutrition and Metabolism (ESPEN) aims at providing clinical practice guidance for nutritional management of COVID-19 patients with obesity in various clinical settings.

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Section: Hospitalized Persons With Obesity With Covid-19 Withmentioning

confidence: 99%

Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance

et al. 2022

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“…EN can be initiated during the prone position, and the use of hypocaloric or dense EN is suggested 78 …”

Section: Timing Of Enmentioning

confidence: 99%

“…The routine use of prokinetics should be considered, and feeding intolerance should be closely monitored 78 …”

Section: Timing Of Enmentioning

confidence: 99%

“…Another study of 150 patients undergoing venoarterial ECMO observed that early EN was negatively associated with acute mesenteric ischemia (OR, 0.15; 95% CI, 0.03–0.69; P = .02) 77 . A weight‐based formula, rather than indirect calorimetry, to determine the energy target and a stepwise EN advancement are suggested in patients on venovenous or venoarterial ECMO 78 …”

Section: Nutrition Support In Special Situationsmentioning

confidence: 99%

“…EN can be initiated during the prone position, and the use of hypocaloric or dense EN is suggested. 78 The bed should be tilted to a maximum of 30 • . The routine use of prokinetics should be considered, and feeding intolerance should be closely monitored.…”

Section: Prone Position For Acute Respiratory Distress Syndromementioning

confidence: 99%

See 2 more Smart Citations

Nutrition support for critically ill patients

Al‐Dorzi

Arabi

2021

J Parenter Enteral Nutr

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Nutrition support is an important aspect of the management of critically ill patients.This review highlights the emerging evidence on critical care nutrition and focuses on the pathophysiologic interplay between critical illness, the gastrointestinal tract, and nutrition support and the evidence on the best route, dose, and timing of nutrition.Although indirect calorimetry is recommended to measure energy expenditure, predictive equations are commonly used but are limited by their inaccuracy in individual patients. The current evidence supports early enteral nutrition (EN) in most patients, with a gradual increase in the daily dose over the first week. Delayed EN is warranted in patients with severe shock. According to recent trials, parenteral nutrition seems to be as effective as EN and may be started if adequate EN is not achieved by the first week of critical illness. A high protein dose has been recommended, but the best timing is unclear. Immuno-nutrition should not be routinely provided to critically ill patients.Patients receiving artificial nutrition should be monitored for metabolic derangements.

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Medical nutrition therapy in patients receiving ECMO: Evidence‐based guidance for clinical practice

Dresen

Naidoo²,

Hill

et al. 2022

J Parenter Enteral Nutr

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Patients receiving extracorporeal membrane oxygenation (ECMO) inherit substantial disease‐associated metabolic, endocrinologic, and immunologic modifications. Along with the technical components of ECMO, the aforementioned alterations may affect patients' needs and feasibility of adequate macronutrient and micronutrient supply and intake. Thus, patients receiving ECMO are at increased risk for iatrogenic malnutrition and require targeted individual medical nutrition therapy (MNT). However, specific recommendations for MNT in patients receiving ECMO are limited and, with some exceptions, based on an evidence base encompassing general patients who are critically ill. Consequently, clinician decision‐making for MNT in patients receiving ECMO is unguided, which may further increase nutrition risk, culminating in iatrogenic malnutrition and ultimately affecting patient outcomes. The purpose of this article is to provide educational background and highlight specific points for MNT in adult patients receiving ECMO, which might serve as evidence‐based guidance to develop institutional standard operating procedures and nutrition protocols for daily clinical practice.

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Enteral Nutrition Safety With Advanced Treatments: Extracorporeal Membrane Oxygenation, Prone Positioning, and Infusion of Neuromuscular Blockers

Cited by 16 publications

References 49 publications

Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance

Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance

Nutrition support for critically ill patients

Medical nutrition therapy in patients receiving ECMO: Evidence‐based guidance for clinical practice

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