Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
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Although nutrition support is essential in intensive care units, optimal energy intake remains unclear. Here, we assessed the influence of energy intake on outcomes of critically ill, underweight patients. ⋯ Reduced energy intake during the first week in EICU was associated with a reduced MVD in clinically ill patients with BMI <20.0 kg/m(2).
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Patients with severe acute pancreatitis complicated by organ failure and/or pancreatic necrosis or fluid collections should have placement of a double-lumen nasogastric-jejunal tube to be used for both gastric decompression and jejunal feeding. These patients are at risk for gastric outlet obstruction, which may be treated so that complications such as aspiration and reflux are avoided. Furthermore, early enteral feeding can prevent ileus, suppress further organ failure, and ultimately restore gut function if continued in an uninterrupted manner. Ultimately, this patient population will benefit from pancreatic rest and jejunal feeding specifically when compared with patients using nasogastric feeding tubes.
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The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) and the Society of Critical Care Medicine (SCCM) published guidelines in 2009 recommending against the use of intravenous lipids for parenteral nutrition (PN) within the first week of hospitalization in critically ill patients. This grade D recommendation is controversial as it is based on the results of 2 studies that evaluated approximately 100 patients and did not evaluate glycemic control. The purpose of this study was to evaluate outcomes associated with the receipt of lipids within the first week in the intensive care unit (ICU) compared with withholding lipids. ⋯ Withholding lipids within the first 7 days of hospitalization in the ICU was not associated with a significant reduction in infections, ICU or total LOS, or mortality. A multicenter, randomized, controlled trial is needed to further evaluate the effects of lipid administration in the critically ill.
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Extracorporeal membrane oxygenation (ECMO) is used to treat patients with severe acute respiratory distress syndrome or severe cardiac and/or respiratory failure that is unresponsive to conventional ventilator therapy. Provision of adequate nutrition support can be challenging due to hemodynamic alterations encountered in these critically ill patients. ⋯ Review of published reports and personal experience indicates that early enteral nutrition support can be well tolerated by transplant patients receiving either venovenous or venoarterial ECMO, if care is taken to adequately assess potential barriers to optimal nutrition support. Until specific guidelines are developed for patients receiving ECMO, it appears that the guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient provide the best guidance for the nutrition support clinician who is caring for the patient receiving ECMO support.
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The purpose was to review our experiences and determine if applying the sky blue method is reliable in confirming gastric tube (GT) placement in neonates. ⋯ Based on the results, the sky blue method can be considered to be reliable method for the confirmation of GT placement. These results also suggest that the number of radiologic evaluations performed to confirm correct replacement of the GT in infants can be reduced in the future.