Jpen Parenter Enter
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Jpen Parenter Enter · Nov 2002
ReviewOptimizing the benefits and minimizing the risks of enteral nutrition in the critically ill: role of small bowel feeding.
Strategies that maximize the delivery of enteral nutrition while minimizing the associated risks have the potential to improve the outcomes of critically ill patients. By delivering enteral feeds in the small bowel, beyond the pylorus, the frequency of regurgitation and the risk of aspiration is thought to be decreased while at the same time, nutrient delivery is maximized. The purpose of this paper is to systematically review those studies that compare gastric with small bowel feeding. ⋯ Small bowel feeding may be associated with a reduction in gastroesophageal regurgitation, an increase in nutrient delivery, a shorter time to achieve desired target nutrition, and a lower rate of ventilator-associated pneumonia.
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After assessing the critically ill patient for risk of aspiration, the clinician still must decide if the patient is ready to be fed. The goal is to identify critically ill patients who are likely to tolerate enteral nutrition and attempt to minimize complications. ⋯ Most critically ill patients should be ready for enteral nutrition within 24 to 48 hours of intensive care unit admission. Critically ill patients who need catecholamine support, heavy sedation, or therapeutic neuromuscular blockade should probably not receive enteral nutrition until they have been stabilized.
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Jpen Parenter Enter · Nov 2002
ReviewClinical use of gastric residual volumes as a monitor for patients on enteral tube feeding.
The use of gastric residual volumes (GRVs) as a clinical monitor for patients receiving enteral tube feeding (ETF) is based on presumptions that are not physiologically sound and practice that is poorly standardized. ⋯ Modifying interpretation and the response by healthcare providers to GRV data are needed to preserve any clinical use for this practice.
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Jpen Parenter Enter · Nov 2002
ReviewMethods for decreasing risk of aspiration pneumonia in critically ill patients.
Pneumonia is a significant clinical concern in critically ill hospitalized patients, leading to increase in the use of antibiotics, length of hospital stay, and the risk of mortality. Pneumonia caused by aspiration of gastric contents is of particular concern in patients who need mechanical ventilation and feeding through a nasogastric tube. Therefore, methods for decreasing the risk of aspiration are very important. ⋯ Elevating the head of the bed (45 degrees), continuous subglottic suctioning, and oral decontamination seem to be effective in the prevention of aspiration pneumonia.
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Jpen Parenter Enter · Nov 2002
Body cell mass repletion and improved quality of life in HIV-infected individuals receiving oxandrolone.
The aim of this study was to measure changes in body cell mass (BCM) and quality of life in HIV-infected individuals undergoing oxandrolone therapy. Previous studies on oxandrolone have neither quantified changes in BCM using criterion methods nor quality of life using an HIV-specific instrument. ⋯ This is the first study involving oxandrolone therapy in HIV infection to document changes in quality of life and BCM, the metabolically active component of lean body mass that reflects nutritional status better than other more global body composition parameters. Nutritional status and quality of life can improve in HIV-infected individuals receiving a combined therapeutic approach that includes oxandrolone.