Safety and efficacy of three enteral feeding strategies in patients with severe stroke in China (OPENS): a multicentre, prospective, randomised, open-label, blinded-endpoint trial

Zhao, Jingjing; Yuan, Fang; Song, Changgeng; Yin, Rong; Chang, Mingze; Zhang, Wei; Zhang, Bei; Yu, Liping; Jia, Yanbin; Ma, Yuying; Song, Yuanlin; Wang, Chengkai; Song, Chaohui; Wang, Xinlai; Shang, Lei; Yang, Fang; Jiang, Wen

doi:10.1016/s1474-4422(22)00010-2

Cited by 11 publications

(6 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Rapid enteral nutrition administration can be used safely and has the potential to decrease the time required for feeding in acute stroke cases with severe dysphagia [42]. Hypocaloric enteral nutrition presented higher mortality at 90 days when compared to modified complete enteral nutrition (with prokinetic agents), with 34% versus 17% (OR: 2.89; 95% CI: 1.46 -5.72; p = 0.0023), whereas the difference was less significant between hypocaloric enteral nutrition and complete enteral nutrition: 23% (OR: 1.92; 95% CI: 1.00 -3.69; p = 0.049) [43]. Enteral nutrition support can improve nutritional status, even in the perioperative period of aged patients with gastrointestinal tumors, improving immune function and promoting intestinal peristalsis [44].…”

Section: Discussionmentioning

confidence: 92%

“…The nutritional supplementation effects were evaluated in burn patients [37], in feedback protocols [41] [43], in reducing the enteral diet administration time in aged people with acute stroke [42], in aged patients in general [35], in malnourished patients [15], in aged people with gastrointestinal tumors [44], in older adults aged at least 80 years old [40], in hip surgery patients [20] and in cases of hip arthroplasty with hypoalbuminemia [36].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Elderly Feeding and Nutrition during Hospitalization: An Integrative Review

Belzarez Guedez,

Helena Lenardt,

Cechinel

et al. 2023

OJN

View full text Add to dashboard Cite

Objective: to search in the current literature the elements that exert an influence on feeding and nutrition in hospitalized aged people. Method: the following strategies were used for the integrative review stages: research question (Population or Patients; Exposure; Outcomes); analysis flowchart (Preferred Reporting Items for Systematic Reviews and Meta-analyses); and levels of evidence corresponding to the studies (Oxford Centre for Evidence-Based Medicine). The searches were conducted in the MEDLINE/PubMed, Biblioteca Virtual em Saúde, Embase, CINAHL and Scopus databases. Results: the initial search yielded 1808 studies, of which 34 comprised the analysis corpus after applying the inclusion/exclusion criteria. The assessments corresponding to nutritional status and to the risk factors for hospitalized aged people are fundamental in defining the diet. An association was found between inadequate energy intake, lack of appetite, infections, malignity, delirium and need for assistance in feeding. Dysphagia affected nutritional status and was associated with multimorbidities, cognitive impairment, malnutrition, higher dependence for the activities of daily living, and greater care need. Nutritional support improved the perioperative nutritional status, in addition to reducing the hospitalization times and the number of infectious complications. Conclusion: the main disorder that hinders meeting the nutritional needs is dysphagia, and is associated with aged people's multimorbidity and dependence. The results provide geriatric and gerontological knowledge about elderly nutrition, in addition to targeting preventive and intervention treatments and care during hospitalization.

show abstract

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Elderly Feeding and Nutrition during Hospitalization: An Integrative Review

Belzarez Guedez,

Helena Lenardt,

Cechinel

et al. 2023

OJN

View full text Add to dashboard Cite

show abstract

“…The work of Kraaijenbrink et al [ 14 ] revealed similar findings in that the SNAQ had a low positive predictive value but a significant negative predictive value, although there were some differences between Kraaijenbrink’s and our study in terms of study population and the definition of RFS. This means that a low SNAQ score may facilitate the exclusion of RFS in daily practice, and encourage nutritionists and NCU physicians to provide adequate nutrition to low-risk populations promptly, potentially reducing the incidence of infection in NCU patients and mortality in the early phase of severe stroke [ 26 ]. As for GLIM, there has been no study to validate the predictive value of RFS, but a prospective study showed that the GLIM criteria performed excellently for diagnosing malnutrition, with a sensitivity of 86.6% and a specificity of 81.6% [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

The Performances of SNAQ, GLIM, mNICE, and ASPEN for Identification of Neurocritically Ill Patients at High Risk of Developing Refeeding Syndrome

et al. 2022

View full text Add to dashboard Cite

We previously found that neurocritically ill patients are prone to refeeding syndrome (RFS), a potentially life-threatening complication. However, there is no unified or validated consensus on the screening tool for RFS so far. We aimed to validate and compare the performance of four screening tools for RFS in neurocritically ill patients. We conducted a single-center, observational, retrospective cohort study among neurocritically ill adult patients who were admitted to the neurocritical care unit (NCU), and who received enteral nutrition for 72 h or longer. They were scored on the Short Nutritional Assessment Questionnaire (SNAQ), the Global Leadership Initiative on Malnutrition (GLIM), the modified criteria of the Britain’s National Institute for Health and Care Excellence (mNICE), and ASPEN Consensus Recommendations for Refeeding Syndrome (ASPEN) scales to predict RFS risk via admission data. The performance of each scale in predicting RFS was evaluated. Logistic regression analysis was used to identify the independent risk factors for RFS, and they were added to the above scales to strengthen the identification of RFS. Of the 478 patients included, 84 (17.57%) developed RFS. The sensitivity of the SNAQ and GLIM was only 20.2% (12.6–30.7%), although they had excellent specificities of 84.8% (80.8–88.1%) and 86.0% (82.1–89.2%), respectively; mNICE predicted RFS with a sensitivity of 48.8% (37.8–59.9%) and a specificity of 65.0% (60.0–69.9%); ASPEN had the highest Youden index, with a sensitivity and specificity of 53.6% (42.4–64.4%) and 64.7% (59.8–69.4%), respectively. The Area Under the receiver operating characteristic Curves (AUC) of SNAQ, GLIM, mNICE, and ASPEN to predict RFS were 0.516 (0.470–0.561), 0.533 (0.487–0.579), 0.568 (0.522–0.613), and 0.597 (0.551–0.641), respectively. We identified age, Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), and Glasgow Coma Scale (GCS) score as independent risk factors of RFS, and the combination of GCS and age can improve the AUC of ASPEN to 0.664 (0.620–0.706) for predicting RFS. SNAQ, GLIM, mNICE, and ASPEN do not perform well in identifying neurocritically ill patients at high risk of RFS, although ASPEN appears to have relatively a good validity among them. Combining GCS and age with ASPEN slightly improves RFS recognition, but it still leaves a lot of room for improvement.

show abstract

“…The trial terminated early because of excess mortality in the hypocaloric nutrition arm, reinforcing the importance of early feeding. 108 Questions therefore remain about the optimal approach to feeding, beyond meeting caloric needs early and completely. Initially, enteral nutrition should be delivered via a nasogastric tube in patients with swallowing difficulties, with percutaneous endoscopic gastrostomy offered for those with persistent dysphagia.…”

Section: Key Pointsmentioning

confidence: 99%

“…Rates of pneumonia were the same between groups. The trial terminated early because of excess mortality in the hypocaloric nutrition arm, reinforcing the importance of early feeding 108 . Questions therefore remain about the optimal approach to feeding, beyond meeting caloric needs early and completely.…”

Section: Medical Complications After Stroke Due To Large Vessel Occlu...mentioning

confidence: 99%

Neurocritical Care for Patients With Ischemic Stroke

Leslie-Mazwi

2024

CONTINUUM: Lifelong Learning in Neurology

View full text Add to dashboard Cite

OBJECTIVE Management of stroke due to large vessel occlusion (LVO) has undergone unprecedented change in the past decade. Effective treatment with thrombectomy has galvanized the field and led to advancements in all aspects of care. This article provides a comprehensive examination of neurologic intensive care unit (ICU) management of patients with stroke due to LVO. The role of the neurocritical care team in stroke systems of care and the importance of prompt diagnosis, initiation of treatment, and continued monitoring of patients with stroke due to LVO is highlighted. LATEST DEVELOPMENTS The management of complications commonly associated with stroke due to LVO, including malignant cerebral edema and respiratory failure, are addressed, stressing the importance of early identification and aggressive treatment in mitigating negative effects on patients’ prognoses. In the realm of medical management, this article discusses various medical therapies, including antithrombotic therapy, blood pressure management, and glucose control, outlining evidence-based strategies for optimizing patient outcomes. It further emphasizes the importance of a multidisciplinary approach to provide a comprehensive care model. Lastly, the critical aspect of family communication and prognostication in the neurologic ICU is addressed. ESSENTIAL POINTS This article emphasizes the multidimensional aspects of neurocritical care in treating patients with stroke due to LVO.

show abstract

Safety and efficacy of three enteral feeding strategies in patients with severe stroke in China (OPENS): a multicentre, prospective, randomised, open-label, blinded-endpoint trial

Cited by 11 publications

References 27 publications

Elderly Feeding and Nutrition during Hospitalization: An Integrative Review

Elderly Feeding and Nutrition during Hospitalization: An Integrative Review

The Performances of SNAQ, GLIM, mNICE, and ASPEN for Identification of Neurocritically Ill Patients at High Risk of Developing Refeeding Syndrome

Neurocritical Care for Patients With Ischemic Stroke

Contact Info

Product

Resources

About