The effectiveness of caloric value of enteral nutrition in patients with major burns

Rimdeika, Rytis; Gudavičienė, Daiva; Adamonis, Kęstutis; Barauskas, Giedrius; Pavalkis, Dainius; Endzinas, Žilvinas

doi:10.1016/j.burns.2005.08.003

Cited by 39 publications

(29 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Two of these were randomized controlled studies showing that patients with enhanced enteral feeding had subsequent decreased infection, hospital length of stay, and a trend toward reduced mortality, respectively, compared to patients receiving standard nutrition with lower amounts of nutrition [21,22]. Two observational studies, one in 207 medical-surgical ICU patients [36] and the other in 103 critically ill patients with burns [37] consistently showed that those who enterally received greater amounts of energy and protein had significantly lower infectious morbidity or mortality, respectively. Randomized controlled trials are considered to represent most valid evidence to inform clinical guidelines.…”

Section: Discussionmentioning

confidence: 99%

Close to recommended caloric and protein intake by enteral nutrition is associated with better clinical outcome of critically ill septic patients: secondary analysis of a large international nutrition database

Elke¹,

Wang

Weiler³

et al. 2014

Crit Care

181

144

View full text Add to dashboard Cite

IntroductionCurrent international sepsis guidelines recommend low-dose enteral nutrition (EN) for the first week. This contradicts other nutrition guidelines for heterogenous groups of ICU patients. Data on the optimal dose of EN in septic patients are lacking. Our aim was to evaluate the effect of energy and protein amount given by EN on clinical outcomes in a large cohort of critically ill septic patients.MethodsWe conducted a secondary analysis of pooled data collected prospectively from international nutrition studies. Eligible patients had a diagnosis of sepsis and/or pneumonia and were admitted to the ICU for ≥3 days, mechanically ventilated within 48 hours of ICU admission and only receiving EN. Patients receiving parenteral nutrition were excluded. Data were collected from ICU admission up to a maximum of 12 days. Regression models were used to examine the impact of calorie and protein intake on 60-day mortality and ventilator-free days.ResultsOf the 13,630 patients included in the dataset, 2,270 met the study inclusion criteria. Patients received a mean amount of 1,057 kcal/d (14.5 kcal/kg/day) and 49 g protein/day (0.7 g/kg/d) by EN alone. Patients were mechanically ventilated for a median of 8.4 days and 60-day mortality was 30.5%. An increase of 1,000 kcal was associated with reduced 60-day mortality (odds ratio (OR) 0.61; 95% confidence interval (CI) 0.48 to 0.77, P <0.001) and more ventilator-free days (2.81 days, 95% CI 0.53 to 5.08, P = 0.02) as was an increase of 30 g protein per day (OR 0.76; 95% CI 0.65 to 0.87, P <0.001 and 1.92 days, 95% CI 0.58 to 3.27, P = 0.005, respectively).ConclusionsIn critically ill septic patients, a calorie and protein delivery closer to recommended amounts by EN in the early phase of ICU stay was associated with a more favorable outcome.

show abstract

Section: Discussionmentioning

confidence: 99%

Close to recommended caloric and protein intake by enteral nutrition is associated with better clinical outcome of critically ill septic patients: secondary analysis of a large international nutrition database

Elke¹,

Wang

Weiler³

et al. 2014

Crit Care

181

144

View full text Add to dashboard Cite

show abstract

“…The specific complications selected for this project were recommended by the expert clinical staff and supported by current literature as those particularly related to nasoenteral feedings 12,13 or those potentially affected by nutritional status. 14 The complication variables analyzed included the number of respiratory complications per tube day and 4 dichotomous outcome variables: infection, gastrointestinal complication, metabolic complication, and integumentary complication. Because patients who have nasal tubes who receive enteral feedings are at greater risk for aspiration pneumonia and sinusitis than are patients who do not, rates of these complications in the control group and the bridle group were also compared.…”

Section: Methodsmentioning

confidence: 99%

Outcomes of nasal bridling to secure enteral tubes in burn patients

Parks¹,

Klaus

Staggs

et al. 2013

American Journal of Critical Care

View full text Add to dashboard Cite

Background Reliable securement of nasally inserted enteral tubes is a problem in patients with facial burns that make use of traditional adhesive tape ineffective. Objective To implement the nasal bridle as a way to decrease inadvertent removal of nasally inserted enteral tubes and improve subsequent patient outcomes. Methods The nasal bridle was implemented in the burn unit of the University of Kansas Hospital, Kansas City, Kansas, as a quality improvement project. Outcomes for the calendar year 2010 were measured in patients treated before use of the bridle (prebridle control group) and in patients for whom the bridle was used. The groups were compared on measures of tube insertions per tube day, abdominal radiographs per tube day, and a number of complications. Results A total of 50 patients were studied: 33 in the control group and 17 in the bridle group. Baseline characteristics of age and sex did not differ between the groups. The bridle group had significantly fewer tube insertions and abdominal radiographs per tube day than the control group. Although complications were generally less common in the bridle group, the differences were not statistically significant. Conclusions In burn patients, use of a nasal bridle to secure nasally inserted tubes had clinical advantages over securement with traditional adhesive tape. (American Journal of Critical Care. 2013;22:136–142)

show abstract

“…It is, therefore, not surprising that the level of energy intake required to prevent problems is higher in patients with major burns as shown by a prospective Finnish study: The intake cut-off separating patients with and without nutrition-related complications was shown to be about 30 kcal/kg/day [35]; the lower delivery was associated with a 32.6% death rate versus a rate of 5.3% (p < 0.01) in those receiving adequate feeding; the pneumonia rate doubled, sepsis rate increased 1.8-fold (p < 0.05), and the length of stay was prolonged by 12.6 days ( p = 0.01).…”

Section: Consequences Of Under- and Over-feedingmentioning

confidence: 99%