Jpen Parenter Enter
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Jpen Parenter Enter · Sep 2004
Early enteral feedings in adults receiving venovenous extracorporeal membrane oxygenation.
For over 20 years extracorporeal membrane oxygenation (ECMO) has been an advanced treatment for adults, children and neonates with severe respiratory failure that has failed to respond or improve with conventional therapy. Withholding enteral feeding in patients on ECMO is common practice in many centers, based partly on the risk of splanchnic ischemia resulting in loss of intestinal integrity, predisposing to bacterial translocation and sepsis. We report one center's experience with early enteral nutrition in adult patients receiving venovenous (VV) ECMO for severe respiratory failure. ⋯ Enteral nutrition started within the first 24 to 36 hours of initiating venovenous ECMO support is safe and well-tolerated in adults. No serious adverse events were attributable to enteral nutrition in these patients.
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Jpen Parenter Enter · Sep 2004
Enteral nutrition and cardiovascular medications in the pediatric intensive care unit.
Enteral nutrition has multiple benefits for critically ill patients. However, the administration of enteral nutrition to patients requiring medications for cardiovascular support is controversial secondary to concerns of altered splanchnic perfusion. The objective of this study is to evaluate the tolerance of enteral nutrition in pediatric patients receiving cardiovascular medications. ⋯ This study suggests that many pediatric patients receiving cardiovascular medications tolerate enteral nutrition without adverse events. Further prospective studies are needed to determine whether enteral nutrition can consistently benefit these critically ill pediatric patients.
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Jpen Parenter Enter · Jul 2004
Comparative StudyValidation of 2 approaches to predicting resting metabolic rate in critically ill patients.
Indirect calorimetry is the criterion method for determining resting metabolic rate for nutrition support in critically ill patients. However, calculation equations are more commonly used. In the current study we tested the validity of 2 such calculation systems. ⋯ The Penn State equation for resting metabolic rate in mechanically ventilated intensive care patients receiving nutrition support appears to be a valid clinical tool for determining energy goals in the absence of or as a supplement to indirect calorimetry. The Ireton-Jones equation performed less well, especially in that a higher number of large errors occurred.
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Jpen Parenter Enter · May 2004
Randomized Controlled Trial Clinical TrialA randomized trial of endoscopic and fluoroscopic placement of postpyloric feeding tubes in critically ill patients.
Early postpyloric feeding is considered the accepted method of nutrition support in critically ill patients. Endoscopic and fluoroscopic techniques are associated with the highest percentage of successful placement. The purpose of this study was to compare endoscopic vs fluoroscopic placement of postpyloric feeding tubes in critically ill patients. ⋯ Endoscopic and fluoroscopic placement of postpyloric feeding tubes can safely and accurately be performed at the bedside in critically ill patients. Our results showed no significant difference in the success rate or time of placement between endoscopic vs fluoroscopic placement of postpyloric feeding tubes.
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Jpen Parenter Enter · May 2004
Accuracy of methods to estimate ionized and "corrected" serum calcium concentrations in critically ill multiple trauma patients receiving specialized nutrition support.
The purpose of this study was to determine the accuracy of 22 published methods to estimate serum ionized calcium (iCa) and "corrected" total serum calcium (totCa) concentrations in critically ill, multiple trauma patients. Seven of these formulas estimated iCa and 15 were directed toward predicting a "corrected" totCa. ⋯ Aberrations in calcium homeostasis are frequent (27%) in postresuscitative critically ill multiple trauma patients. Methods for predicting hypocalcemia lack sensitivity and are often associated with an unacceptable rate of false negatives. Predictive methods for estimating ionized or corrected serum concentrations should not be used. Direct measurement of serum iCa concentration is indicated for assessing calcium status for this population.