Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
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Meta Analysis Comparative Study
Nasal bridles for securing nasoenteric tubes: a meta-analysis.
Nasoenteric feeding tubes may easily become dislodged due to patient mental status, transfers, or positional changes. Nasal bridles were introduced to provide a better, more reliable system to secure these tubes. This meta-analysis was performed to evaluate the effectiveness of nasal bridles compared with the traditional method of adhesive tape alone in securing enteral feeding tubes. ⋯ Nasal bridles appear to be more effective at securing nasoenteric tubes and preventing dislodgement than traditional use of tape alone.
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Despite the research supporting adequate enteral nutrition (EN) in intensive care unit (ICU) patients, underfeeding is still common. This quality improvement (QI) project was done to determine the effect of "volume-based" feeding on adequacy of EN delivery and provision of calories and protein in a surgical/trauma ICU (STICU). ⋯ A change in standard of practice to an EN volume-based feeding approach in a STICU led to a significant improvement in adequacy of calories and protein delivered, with only a slight increase in diarrhea.
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Placement of a nasogastric enteral access device (NG-EAD), often referred to as a nasogastric tube, is a common practice and largely in the domain of nursing care. Most often an NG-EAD is placed at the bedside without radiographic assistance. Correct initial placement and ongoing location verification are the primary challenges surrounding NG-EAD use and have implications for patient safety. ⋯ Its mission is to identify and promote best practices with the potential of technology development that will enable accurate determination of NG-EAD placement for both the inpatient and outpatient pediatric populations. This article presents the challenges of bedside NG-EAD placement and ongoing location verification in children through an overview of the current state of the science. It is important for all healthcare professionals to be knowledgeable about the current literature, to be vigilant for possible complications, and to avoid complacency with NG-EAD placement and ongoing verification of tube location.
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Delivery of adequate nutrients during illness to counteract the metabolic stress response and facilitate healing and tissue repair is an important goal in the care of critically ill children. With recent advances in technology, accurate minute-to-minute gas exchange and energy expenditure measurements are now available in intensive care units. The bedside availability of these devices may allow a titrated approach to energy delivery for patients, ushering in a new era of individualized nutrition therapy. Basic concepts, available monitoring devices, indications, pitfalls, and bedside application of metabolic monitoring are discussed in this article.
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Multicenter Study
Nutrition algorithms and bedside nutrient delivery practices in pediatric intensive care units: an international multicenter cohort study.
Enteral nutrition (EN) delivery is associated with improved outcomes in critically ill patients. We aimed to describe EN practices, including details of algorithms and individual bedside practices, in pediatric intensive care units (PICUs). ⋯ A minority of PICUs employ EN algorithms; recommendations were variable and not in agreement with national guidelines. Optimal EN delivery was achieved in less than one-third of our cohort. EN adjunct therapies were not associated with increased EN delivery. Studies aimed at promoting early EN and decreasing interruptions may optimize energy delivery in the PICU.