Nutrition Support in Mechanically Ventilated, Critically Ill Adult Patients: Are We Ready for Evidence‐Based Clinical Practice Guidelines?

Heyland, Daren K.; Dhaliwal, Rupinder; Drover, John W.

doi:10.1177/0115426504019003193

Cited by 10 publications

(10 citation statements)

References 64 publications

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“…The gap between evidence and practice identified in this survey is consistent with findings from health services research overall. 27,28 Several sets of enteral nutrition guidelines for critically ill patients are available and should be reviewed…”

Section: Discussionmentioning

confidence: 99%

Monitoring for Intolerance to Gastric Tube Feedings: A National Survey

Metheny

Mills

Stewart

2012

American Journal of Critical Care

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BackgroundConfusion about how to assess for intolerance to feedings often results in unnecessary feeding interruptions.ObjectivesTo report findings from a national survey of methods used by critical care nurses to assess tolerance to gastric tube feedings and to discuss the findings in light of current enteral nutrition guidelines.MethodsA paper-and-pencil survey was mailed to 1909 members of the American Association of Critical-Care Nurses. In addition, the same survey was posted online in a newsletter circulated to association members. Results from both surveys were pooled for data analysis.ResultsA total of 2298 responses were obtained; most respondents reported using a combination of methods to assess tolerance to gastric tube feedings (listening for bowel sounds, measuring gastric residual volumes, observing for abdominal distention/discomfort and for nausea and vomiting). More than 97% of the nurses reported measuring gastric residual volumes; the most frequently cited threshold levels for interrupting feedings were 200 mL and 250 mL. About 25% of the nurses reported interrupting feedings for gastric residual volumes of 150 mL or less; only 12.6% of the respondents reported allowing gastric residual volumes of up to 500 mL before interrupting feedings.ConclusionsPractice among the 2298 critical care nurses varied widely. Many of the survey respondents are practicing in ways that can unnecessarily diminish the delivery of calories to patients. Protocols based on current enteral nutrition guidelines must be developed and implemented in practice settings.

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Section: Discussionmentioning

confidence: 99%

Monitoring for Intolerance to Gastric Tube Feedings: A National Survey

Metheny

Mills

Stewart

2012

American Journal of Critical Care

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“…(20). Ancak biz bu çalışmada, kılavuz önerilerine (9,21,22) ve YBÜ protokolümüze uygun olarak, enerji gereksinimini 25 kcal/kg/gün formülüne göre hesapladık. 7-10 gün sonra hedef kalorinin %100'ünü tolere edemeyen hastalar da dahil, çalışma grubundaki hiçbir hastaya parenteral nütrisyon veya ek intravenöz dekstroz başlanmamıştır.…”

Section: Gereç Ve Yöntemunclassified

Association of Energy Adequacy with 28-Day Mortality in Mechanically Ventilated Critically Ill

Bilgili¹,

Haliloğlu²,

Sayan³

et al. 2019

tybd

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This study investigates the relationship of nutritional risk status with 28-day mortality in critically ill. Materials and Methods: This retrospective study included critically ill adult patients receiving >48 hours receiving mechanical ventilation. Data on baseline characteristics and the modified Nutritional Risk in Critically ill (mNUTRIC) score were collected on day 1. Energy intake was recorded daily until death, discharge or until twelfth evaluable days. Patients were divided into 2 groups: a) received <75% of prescribed energy, b) received ≥75% of prescribed energy. Results: One hundred and fifty patients were included in the study. Patients with <75% of prescribed energy intake had longer length of ICU stay, duration of mechanical ventilation (p<0.001) and higher 28-day mortality (p<0.001). In the multi-logistic regression analysis, BMI (OR 0.87, CI 0.85-0.95, p<0.001) and mNUTRIC score (OR 2.3, CI 1.4-2.93, p<0.001) were associated with 28-day mortality. In subgroup analysis, the decrease in daily energy intake was associated with an increase in 28-day mortality in patients with a high mNUTRIC score (high mNUTRIC score OR 1.65, CI 1.20-1.70, p<0.001), but this relationship was not observed in the low mNUTRIC score group. Conclusion: The mNUTRIC score is associated with 28-day mortality in mechanically ventilated critically ill. In patients with a high mNUTRIC score, receiving ≥75% of the prescribed energy may positively affect patient outcomes.

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“…In adult studies carried out in critically ill patients, the results are equivocal, and the recommendation is to use polymeric formulas (Heyland et al 2004). …”

Section: Nutrients: In What Form?mentioning

confidence: 99%

Short bowel syndrome in infants: the critical role of luminal nutrients in a management program

Roy

Groleau

Bouthillier

et al. 2014

Appl. Physiol. Nutr. Metab.

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Short bowel syndrome develops when the remnant mass of functioning enterocytes following massive resections cannot support growth or maintain fluid-electrolyte balance and requires parenteral nutrition. Resection itself stimulates the intestine's inherent ability to adapt morphologically and functionally. The capacity to change is very much related to the high turnover rate of enterocytes and is mediated by several signals; these signals are mediated in large part by enteral nutrition. Early initiation of enteral feeding, close clinical monitoring, and ongoing assessment of intestinal adaptation are key to the prevention of irreversible intestinal failure. The length of the functional small bowel remnant is the most important variable affecting outcome. The major objective of intestinal rehabilitation programs is to achieve early oral nutritional autonomy while maintaining normal growth and nutrition status and minimizing total parenteral nutrition related comorbidities such as chronic progressive liver disease. Remarkable progress has been made in terms of survivability and quality of life, especially in the context of coordinated multidisciplinary programs, but much work remains to be done.

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Nutrition Support in Mechanically Ventilated, Critically Ill Adult Patients: Are We Ready for Evidence‐Based Clinical Practice Guidelines?

Cited by 10 publications

References 64 publications

Monitoring for Intolerance to Gastric Tube Feedings: A National Survey

Monitoring for Intolerance to Gastric Tube Feedings: A National Survey

Association of Energy Adequacy with 28-Day Mortality in Mechanically Ventilated Critically Ill

Short bowel syndrome in infants: the critical role of luminal nutrients in a management program

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