Jpen Parenter Enter
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Jpen Parenter Enter · Jan 2009
Use of a nasal bridle prevents accidental nasoenteral feeding tube removal.
Reinserting feeding tubes that are accidentally removed exposes patients to risk and consumes hospital resources. We were interested to know if using a bridle to secure tubes would be more effective than tape at preventing accidental tube removal. This was a quality improvement project with a before-and-after design. ⋯ The rate of accidental tube removal (per 100 tube-days) was 6.4 (18 in 281 tube-days) in the tape group and 1.6 (4 in 248 tube-days) in the bridle group; P<.05. Survival analysis showed a significant difference between the groups with a log-rank test for equality of survivor function of P<.05. Using a bridle to secure feeding tubes significantly reduces the proportion and rate of accidental tube removal and results in increased tube survival by Kaplan-Meier analysis.
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Jpen Parenter Enter · Jan 2009
Analysis of estimation methods for resting metabolic rate in critically ill adults.
Prediction of metabolic rate is an important part of the nutrition assessment of critically ill patients, yet there are limited data regarding the best equation to use to make this prediction. ⋯ The Penn State equation provides the most accurate assessment of metabolic rate in critically ill patients if indirect calorimetry is unavailable. An alternate form of this equation for elderly obese patients is presented, but has yet to be validated.
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Intensive insulin therapy (IIT) is the standard of care in the ICU, but precise implementation of insulin protocols has been difficult in clinical practice. The authors' objective was to quantify adherence to an IIT protocol in a practice setting, and to describe how adherence impacts overall blood glucose (BG) control. ⋯ IIT is difficult to implement precisely in a complex ICU environment. Measurement timing impacts overall BG control, with late measurements more often associated with severe hyperglycemic (BG>150 mg/dL) and hypoglycemic (BG<60 mg/dL) episodes.
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Jpen Parenter Enter · Jan 2009
Randomized Controlled Trial Multicenter StudyGlycemic control in patients with type 2 diabetes mellitus with a disease-specific enteral formula: stage II of a randomized, controlled multicenter trial.
Stage I of a preplanned 2-stage study has provided good evidence for improved glycemic control with a disease-specific enteral formula low in carbohydrates and high in monounsaturated fatty acids (MUFAs), fish oil, chromium, and antioxidants in insulin-treated type 2 diabetes. The study was continued with stage II to give confirmatory proof of these beneficial effects. ⋯ Long-term tube feeding with a disease-specific enteral formula was safe and well tolerated in type 2 diabetic patients with neurological disorders. When compared with a standard diet, TI requirement decreased significantly with less hypoglycemia whereas FG and AG were significantly lowered, resulting in improved glycemic control.