Reducing Costs and Patient Morbidity in the Enterally Fed Intensive Care Unit Patient

Farber, Mitchell S.; Moses, Julia; Korn, Margaret

doi:10.1177/01486071050290s1s62

Cited by 13 publications

(7 citation statements)

References 67 publications

(78 reference statements)

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“…Physician staffing [20,21] Noninvasive ventilation [22,23] Ventilator associated pneumonia [24-27] Patient-to-nurse ratio [16,[28][29][30][31] SDD [32] Deep venous thrombosis [33][34][35] Mattresses or pressure-relieving beds [9] TISS score by discharge [36] Pulmonary embolism [33][34][35] Daily sedation interruption policy [37] Unplanned extubation [38,39] Decubitus [9] Use of case management approach [40] Continuous lateral rotational therapy [24,41,42] Stress ulcer [43] Computerized physician order entry [44] Interclinical transport [45][46][47] Quality of life [15] Pharmacist participation during daily rounds [16] Red cell concentrate transfusion [48,49] Hospital mortality rate [32,50] Weaning following a protocol [10] Nutrition support [51][52][53][54] Berenholtz et al: Protocol for admission and discharge [11] Glucose regulation [55,…”

Section: Indicator Selectionmentioning

confidence: 99%

Quality measurement at intensive care units: which indicators should we use?

Vos

Graafmans

Keesman

et al. 2007

Journal of Critical Care

131

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Section: Indicator Selectionmentioning

confidence: 99%

Quality measurement at intensive care units: which indicators should we use?

Vos

Graafmans

Keesman

et al. 2007

Journal of Critical Care

131

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“…The PUFA content of these commercially available diets is provided in Supplemental Table 1 . Over the past 25 years, these diets have been used by hospitals and tested in several clinical trials ( 10 – 15 ).…”

Section: Introductionmentioning

confidence: 99%

“…For example, blunt force trauma patients receiving IMPACT experienced a decrease in major organ failure with no differences in ventilator-free days (VENT-free days), length of stay in the ICU, or length of stay in the hospital ( 10 ). In contrast, ARDS patients given Oxepa, a similar formulation enriched in ω-3 fatty acids, experienced a significant reduction in the number of VENT-free and ICU-free days, suggesting a greater need for mechanical ventilation and time in the ICU ( 11 , 12 ).…”

Section: Introductionmentioning

confidence: 99%

Impact of rs174537 on Critically Ill Patients with Acute Lung Injury: A Secondary Analysis of the OMEGA Randomized Clinical Trial

Dosso

Waits

Simms

et al. 2020

Current Developments in Nutrition

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Background Nutrition in the intensive care unit (ICU) is vital for patient care; however, immunomodulatory diets rich in polyunsaturated fatty acids (PUFAs) like γ-linolenic acid (GLA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) remain controversial among patients with acute respiratory distress syndrome (ARDS). We postulate that genetic variants impacting PUFA metabolism contribute to mixed responses to PUFA-rich diets. Objective In this study, we aimed to test the effects of single nucleotide polymorphism (SNP) rs174537 on differential responses to PUFA-rich diets. Design We performed a secondary analysis of the OMEGA trial (NCT00609180) where 129 subjects received placebo and 143 received omega-oil. DNA was extracted from buffy coats and used to genotype rs174537; plasma was used to quantitate PUFAs. We tested for SNP-diet interactions on PUFA levels, inflammatory biomarkers, and patient outcomes. Results We observed that all individuals receiving omega-oil, displayed significantly higher levels of GLA, EPA, and DHA (all P < 0.0001), but they did not vary by genotype at rs174537. Statistically significant SNP-diet interactions were observed on circulating DHA levels in African Americans. Specifically, African American T-allele carriers on placebo illustrated elevated DHA levels. Additionally, all individuals receiving omega-oil had higher levels of EPA-derived urinary F3-Isoprostane (Caucasians: P = 0.0011; African Americans: P = 0.0002). Despite these findings, we did not detect any significant SNP-diet interactions on pulmonary functional metrics, clinical outcomes, and mortality. Conclusions This study highlights the importance of genetic and racial contributions to PUFA metabolism and inflammation. In particular, rs174537 had a significant impact on circulating DHA and urinary isoprostane levels. Given our relatively small sample size, further investigations in larger multi-ethnic cohorts are needed to evaluate the impact of rs174537 on fatty acid metabolism and downstream inflammation.

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“…Various studies have shown that it reduces infectious morbidity, duration of mechanical ventilation, length of stay, impaired functional capacity and the overall cost of care. [2][3][4][5][6] Despite this evidence, prevalence of malnutrition in intensive care unit (ICU) patients remains high. [7,8] This suggests that nutrition support practices (NSPs) are still suboptimal in many clinical settings.…”

mentioning

confidence: 99%

Nutrition support practices in South African ICUs: Results from a nationwide pilot survey

Hill

2015

S Afr J Crit Care

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Background. Nutrition support of the critically ill can positively affect clinical outcomes. International audit data of nutrition practices in intensive care units (ICUs) suggest that inconsistent application of recommended nutrition support practices (NSPs) occurs. There are no data on NSPs in South African (SA) ICUs. Objective. To perform a national pilot survey of NSPs in private SA adult ICUs. Methods. A descriptive, observational, cross-sectional survey was performed among prescribers of nutrition support in private ICU facilities. Participants were targeted through non-randomised convenience sampling and invited to complete a 51-item electronic questionnaire covering ICU demographics, profile of nutrition prescribers, and nutrition assessment support, delivery and monitoring practices. Results. Responses were received from 125 practitioners in 60% of representative private hospitals with ICU facilities, mainly general/ mixed ICUs. Forty-six percent of respondents reported structured nutrition support teams and 61% reported that practices were governed by formal nutrition support protocols. Enteral nutrition was reported to be based upon published guidelines by 72% of dietitians, while parenteral nutrition decisions were reportedly based mainly on clinical judgement (43%). For both enteral and parenteral feeding practices, compliance with guidelines was inconsistent. There was a disjuncture between various NSPs as reported by dietitians and by nurses. Nurses generally appeared unaware of published nutrition guidelines. Conclusion. Various disparities in reported nutrition practices were revealed, suggesting that the organisation and operations of teams and the implementation of protocols informed by published nutrition guidelines may not be well established in private SA ICUs.

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Reducing Costs and Patient Morbidity in the Enterally Fed Intensive Care Unit Patient

Cited by 13 publications

References 67 publications

Quality measurement at intensive care units: which indicators should we use?

Quality measurement at intensive care units: which indicators should we use?

Impact of rs174537 on Critically Ill Patients with Acute Lung Injury: A Secondary Analysis of the OMEGA Randomized Clinical Trial

Nutrition support practices in South African ICUs: Results from a nationwide pilot survey

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