Clinical nutrition ESPEN
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Clinical nutrition ESPEN · Oct 2016
Observational StudyDo PICU patients meet technical criteria for performing indirect calorimetry?
Indirect calorimetry (IC) is considered gold standard for assessing energy needs of critically ill children as predictive equations and clinical status indicators are often unreliable. Accurate assessment of energy requirements in this vulnerable population is essential given the high risk of over or underfeeding and the consequences thereof. The proportion of patients and patient days in pediatric intensive care (PICU) for which energy expenditure (EE) can be measured using IC is currently unknown. In the current study, we aimed to quantify the daily proportion of consecutive PICU patients who met technical criteria to perform indirect calorimetry and describe the technical contraindications when criteria were not met. ⋯ In the current study, technical criteria to perform IC in the PICU were not met for 27% of patients and were not met on 66% of patient days. Moreover, criteria were met on only 29% of days for infants 6 months and younger where children 24 months of age and older still only met criteria on 40% of patient days. This data represents a major gap in the feasibility of current recommendations for assessing energy requirements of this population. Future studies are needed to improve methods of predicting and measuring energy requirements in critically ill children who do not meet current criteria for indirect calorimetry.
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Clinical nutrition ESPEN · Oct 2016
The relationship between malnutrition risk and clinical outcomes in a cohort of frail older hospital patients.
Malnutrition has an adverse effect on clinical outcomes and frail older people may be at greater risk of malnutrition. The purpose and aims of this study was to investigate the relationship between markers of malnutrition risk and clinical outcomes in a cohort of frail older hospital patients. ⋯ This study highlights a potential relationship between indicators of malnutrition risk and clinical outcomes in frail older hospital patients which should be studied in larger cohorts with an aim to improve patient care.
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Clinical nutrition ESPEN · Aug 2016
Randomized Controlled TrialA randomised controlled feasibility and proof-of-concept trial in delayed gastric emptying when metoclopramide fails: We should revisit nasointestinal feeding versus dual prokinetic treatment: Achieving goal nutrition in critical illness and delayed gastric emptying: Trial of nasointestinal feeding versus nasogastric feeding plus prokinetics.
Delayed gastric emptying (DGE) commonly limits the use of enteral nutrition (EN) and may increase ventilator-associated pneumonia. Nasointestinal feeding has not been tested against dual prokinetic treatment (Metoclopramide and Erythromycin) in DGE refractory to metoclopramide. This trial tests the feasibility of recruiting this 'treatment-failed' population and the proof of concept that nasointestinal (NI) feeding can increase the amount of feed tolerated (% goal) when compared to nasogastric (NG) feeding plus metoclopramide and erythromycin treatment. ⋯ EudraCT number: 2012-001374-29.
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Clinical nutrition ESPEN · Apr 2016
Route of nutrition and risk of blood stream infections in critically ill patients; a comparative study.
The association of nutritional support practices with intensive care unit (ICU) - acquired infections is a current field of interest. The objective of this study was to determine whether different routes of delivery of nutritional support are associated with a different risk of bloodstream infection (BSI) in critically ill patients. ⋯ In this retrospective analysis of 249 consecutively enrolled ICU patients, we found that in critically ill patients EN + PN feeding strategy was associated with a significantly reduced hazard of BSI development, compared to EN or PN route of nutritional support.
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Clinical nutrition ESPEN · Feb 2016
Effects of implementation of a computerized nutritional protocol in mechanically ventilated critically ill patients: A single-centre before and after study.
Optimal nutrition, defined as adequate intake of energy, macronutrients -especially proteins- and micronutrients impacts on outcome of patients admitted to the Intensive Care Unit (ICU). However, both nutrition below and over target have been associated with increased morbidity and mortality. Computerized nutrition protocols may help to improve nutrition adequacy. In July 2014 a computerized nutritional protocol was implemented in our ICU. We designed a study to address the effects of this protocol implementation on energy and protein adequacy and outcome. ⋯ The implementation of an electronic nutritional protocol to initiate feeding with hourly feedback in our ICU reduced the rate of mechanically ventilated patients fed above target without reducing protein intake or increasing the rates of feeding below target, while reducing the incidence of electrolyte abnormalities. No statistical significant differences in other clinical outcomes were observed.