RESUMEN
In the Emergency Department (ED) actual body weight (ABW) is essential for accurate drug dosing. Frequently, the ABW is unknown and direct measurement troublesome. A method using the mid-arm circumference (MAC) to estimate ABW has been developed and validated in the United States of America (USA). This study aimed to validate the MAC-formula for estimating ABW in the Dutch population and compare its performance within the American population.Data were obtained from the Dutch National Institute for Public Health and the Environment (RIVM) and extracted from the American National Health and Nutrition Examination Survey (NHANES) datasets. We included all subjects' ≥70 years whose MAC and weight were recorded and obtained additional anthropometric data. We used the equation: kgâ=â4â×âMAC-50 to estimate the ABW of all subjects and compared results.We retrieved 723 and 972 subjects from the Dutch and American dataset, respectively. The MAC is better correlated with ABW in the American dataset when compared with the Dutch dataset (Pearson râ=â0.84 and 0.68, respectively). Bland-Altman bias was -7.49âkg (Limits-of-Agreement [LOA] -27.5 to 12.27âkg) and -0.50âkg (LOA -20.99 to 19.99âkg) in the Dutch and American datasets, respectively.The MAC based formula to estimate ABW is a promising tool for the elderly American population. However it is not accurate within the Dutch elderly ED population. Consequently, it is not applicable to Dutch EDs. This study highlights that the results of anthropometric studies performed within the USA are not per se generalizable to the European population.
Asunto(s)
Antropometría/métodos , Brazo , Peso Corporal , Anciano , Anciano de 80 o más Años , Servicio de Urgencia en Hospital , Femenino , Humanos , Masculino , Países Bajos , Reproducibilidad de los Resultados , Estados UnidosRESUMEN
PURPOSE OF REVIEW: To provide an overview of recent findings concerning refeeding syndrome (RFS) among critically ill patients and recommendations for daily practice. RECENT FINDINGS: Recent literature shows that RFS is common among critically ill ventilated patients. Usual risk factors for non-ICU patients addressed on ICU admission do not identify patients developing RFS. A marked drop of phosphate levels (>0.16âmmol/l) from normal levels within 72âh of commencement of feeding, selects patients that benefit from hypocaloric or restricted caloric intake for at least 48âh resulting in lower long-term mortality. SUMMARY: RFS is a potentially life-threatening condition induced by initiation of feeding after a period of starvation. Although a uniform definition is lacking, most definitions comprise a complex constellation of laboratory markers (i.e. hypophosphatemia, hypokalemia, hypomagnesemia) or clinical symptoms, including cardiac and pulmonary failure. Recent studies show that low caloric intake results in lower mortality rates in critically ill RFS patients compared with RFS patients on full nutritional support. Therefore, standard monitoring of RFS-markers (especially serum phosphate) and caloric restriction when RFS is diagnosed should be considered. Furthermore, standard therapy with thiamin and electrolyte supplementation is essential.
Asunto(s)
Restricción Calórica , Enfermedad Crítica/terapia , Hipofosfatemia/sangre , Fosfatos/sangre , Síndrome de Realimentación/sangre , Humanos , Hipofosfatemia/dietoterapia , Hipofosfatemia/fisiopatología , Unidades de Cuidados Intensivos , Apoyo Nutricional , Guías de Práctica Clínica como Asunto , Valor Predictivo de las Pruebas , Síndrome de Realimentación/fisiopatología , Síndrome de Realimentación/prevención & controlRESUMEN
BACKGROUND: Adequate nutrition is essential during critical illness. However, providing adequate nutrition is often hindered by gastro-intestinal complications, including feeding intolerance. It is suggested that hyperosmolar medications could be causally involved in the development of gastro-intestinal complications. The aims of the present study were 1) to determine the osmolality of common enterally administered dissolved medications and 2) to study the associations between nasogastric and nasoduodenal administered hyperosmolar medications and nutritional adequacy as well as food intolerance and gastro-intestinal symptoms. METHODS: This retrospective observational cohort study was performed in a medical-surgical ICU in the Netherlands. Adult critically ill patients receiving enteral nutrition and admitted for a minimum ICU duration of 7 days were eligible. The osmolalities of commonly used enterally administrated medications were measured using an osmometer. Patients were divided in two groups: Use of hyperosmolar medications (>500 mOsm/kg) on at least one day during the first week versus none. The associations between the use of hyperosmolar medications and nutritional adequacy were assessed using multiple logistic regression analysis. The associations between hyperosmolar medication and food intolerance as well as gastrointestinal symptoms were assessed using ordinal logistic regression. RESULTS: In total 443 patients met the inclusion criteria. Of the assessed medications, only three medications were found hyperosmolar. We observed no associations between the use of hyperosmolar medications and nutritional adequacy in the first week of ICU admission (caloric intake ß -0.27 95%CI -1.38; 0.83, protein intake ß 0.32 95%CI -0.90; 1.53). In addition, no associations were found for enteral feeding intolerance, diarrhea, obstipation, gastric residual volume, nausea and vomiting in ICU patients receiving hyperosmolar medications via a nasogastric tube. A subgroup analysis of patients on duodenal feeding showed that postpyloric administration of hyperosmolar medications was associated with increased risk of diarrhea (OR 138.7 95%CI 2.33; 8245). CONCLUSIONS: Our results suggest that nasogastric administration of hyperosmolar medication via a nasogastric tube does not affect nutritional adequacy, development of enteral feeding intolerance and other gastro-intestinal complications during the first week after ICU admission. During nasoduodenal administration an increased diarrhea incidence may be encountered.
Asunto(s)
Enfermedad Crítica/terapia , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Nutrición Enteral/efectos adversos , Intolerancia Alimentaria/epidemiología , Alimentos Formulados , Enfermedades Gastrointestinales/epidemiología , Pacientes Internos , Intubación Gastrointestinal/efectos adversos , Administración Oral , Anciano , Composición de Medicamentos , Ingestión de Energía , Nutrición Enteral/métodos , Femenino , Alimentos Formulados/efectos adversos , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Valor Nutritivo , Concentración Osmolar , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
PURPOSE OF REVIEW: The narrative review aims to summarize the relevant studies from the last 2 years and provide contextual information to understand findings. RECENT FINDINGS: Recent ICU studies have provided insight in the pathophysiology and time course of catabolism, anabolic resistance, and metabolic and endocrine derangements interacting with the provision of calories and proteins.Early provision of high protein intake and caloric overfeeding may confer harm. Refeeding syndrome warrants caloric restriction and to identify patients at risk phosphate monitoring is mandatory.Infectious complications of parenteral nutrition are associated with overfeeding. In recent studies enteral nutrition is no longer superior over parenteral nutrition.Previously reported benefits of glutamine, selenium, and fish oil seem to have vanished in recent studies; however, studies on vitamin C, thiamine, and corticosteroid combinations show promising results. SUMMARY: Studies from the last 2 years will have marked impact on future nutritional support strategies and practice guidelines for critical care nutrition as they challenge several old-fashioned concepts.
Asunto(s)
Cuidados Críticos/tendencias , Enfermedad Crítica/terapia , Unidades de Cuidados Intensivos/tendencias , Apoyo Nutricional/tendencias , Síndrome de Realimentación/etiología , Restricción Calórica/efectos adversos , Restricción Calórica/métodos , Cuidados Críticos/métodos , Cuidados Críticos/normas , Enfermedad Crítica/mortalidad , Suplementos Dietéticos , Metabolismo Energético/fisiología , Humanos , Unidades de Cuidados Intensivos/normas , Apoyo Nutricional/efectos adversos , Apoyo Nutricional/métodos , Apoyo Nutricional/normas , Fosfatos/sangre , Guías de Práctica Clínica como Asunto , Síndrome de Realimentación/sangre , Síndrome de Realimentación/fisiopatología , Resultado del TratamientoRESUMEN
PURPOSE OF REVIEW: To summarize recent relevant studies regarding nutrition during critical illness and provide recommendations for clinical practice. RECENT FINDINGS: Recently acquired knowledge regarding nutritional status and risk assessment, body composition, gastric residual volume, prokinetics, tube positioning, enteral vs parenteral nutrition, nutritional dose and timing of initiation, pharmaconutrition, dysbiosis and probiotics are discussed. SUMMARY: Body composition especially lean body mass is associated with clinical outcomes. The modified NUTrition Risk in the Critically ill score was validated for nutritional risk assessment and identifies patients that benefit from higher nutritional intake; however, caloric restriction decreases mortality in refeeding syndrome. Gastric residual volume monitoring is debated, as abandoning its application doesn't worsen outcome. There is no consensus regarding benefits of gastric vs postpyloric tube placement. Current prokinetics temporarily reduce feeding intolerance, new prokinetics are developed. Enteral remains preferable over parenteral nutrition, although no inferiority of parenteral nutrition is reported in recent studies. Studies imply no harm of hypocaloric feeding when protein requirements are met. Optimal protein provision may be more important than caloric adequacy. Pharmaconutrition confers no superior outcomes and may even confer harm. Dysbiosis is frequently encountered and associated with worse outcomes. Probiotics reduce infectious complications, but not mortality, and may contribute to earlier recovery of gut function.