Preventing diarrhoea in enteral nutrition: the impact of the delivery set hang time.

BACKGROUND: To meet the current recommendations for enteral tube feeding (ETF), we updated our previous practice in 2011 and began to use a 24-h delivery set hang time (DSHT). We evaluated the impact of this update on the risk of diarrhoea and in diarrhoea-free survival. METHODS: Observational, retrospective study with historical controls on ischaemic and haemorrhagic stroke patients undergoing ETF. Diarrhoea occurrence (≥ 3 liquid stools in 24 h) was compared between patients with a 24 h DSHT (2011-2014) and a 72/96 h DSHT (2010-2011). The analysis was conducted using Kaplan-Meier curves and a Cox regression model. RESULTS: A total of 175 patients were included [median age 81 years (IQR = 12), 46.9% males], 103 in the group with a 24 h DSHT and 72 in the group with a 72/96 h DSHT. The group with a 24 h DSHT had a lower diarrhoea frequency (13.6% vs. 34.7%, risk ratio: 0.39, 95% CI: 0.22-0.70, p = 0.001) and a lower diarrhoea incidence rate (0.87 vs. 2.32 cases of diarrhoea/100 patient*day, rate ratio: 0.37, 95% CI: 0.19-0.72, p = 0.004). The Kaplan-Meier curves showed a longer diarrhoea-free survival for this group (p = 0.003, log-rank test). A 24 h DSHT was associated with a lower risk of diarrhoea (HR = 0.27, 95% CI: 0.12-0.61, p = 0.002), adjusted by albumin, stroke severity, intravenous thrombolysis, the administration of clindamycin and cefotaxime, and the administration of an enteral formula for diabetic patients. CONCLUSIONS: The 24 h DSHT was independently associated with a lower risk of diarrhoea and longer diarrhoea-free survival in hospitalised patients with acute stroke under ETF, compared with a 72/96 h DSHT.

Enteral tube feeding of patients with acute stroke: when does the risk of diarrhoea increase?

BACKGROUND/AIM: We aimed to evaluate the relationship between the length of time acute stroke patients underwent enteral tube feeding (ETF) and episodes of diarrhoea, and to investigate the temporal cut-off point at which diarrhoea risk increases. METHODS: An observational, retrospective study was conducted on patients with acute stroke admitted to a Stroke Centre. Patients undergoing ETF (ETF group) and those not undergoing ETF (control group) were analysed and matched by age and stroke severity. Data regarding demographic and clinical variables were recorded. The analysis was conducted using a receiver operating characteristic (ROC) curve and multivariate analyses. RESULTS: A total of 130 inpatients was included (age 75.08 ± 11.53 years, 56.2% men). The ETF group had higher diarrhoea frequency (27.7% vs 6.2%, P = 0.001). The length of time on ETF was associated with diarrhoea development (odds ratio (OR), 1.12 increment per day; 95% confidence interval (CI) 1.05-1.18; P < 0.001), after adjusting for confounders. The ROC curve showed 7 days on ETF as a cut-off point for diarrhoea risk. Seven days or more on ETF was independently associated with diarrhoea (OR, 6.26; 95% CI 1.66-23.62; P = 0.007), whereas less than 7 days was not when compared with the control group (OR, 0.38; 95% CI 0.04-3.91; P = 0.413). CONCLUSIONS: The length of time on ETF is associated with diarrhoea development in patients with acute stroke, demonstrating a temporal cut-off point. Seven days or longer on ETF is related to the occurrence of diarrhoea, whereas less than 7 days on ETF does not show this effect.

Precisión diagnóstica de un dispositivo automático en la determinación del índice tobillo-brazo en pacientes con ictus isquémico / Diagnostic accuracy of an automatic blood pressure device for ankle brachial index determination in ischemic stroke patients

Introducción. El uso del índice tobillo-brazo (ITB) no está extendido en la práctica clínica por la necesidad de equipo y formaciónespecíficos. Poder realizarlo sin estos requisitos, en menos tiempo y con menor coste, facilitaría su uso habitual. Objetivo. Evaluar el rendimiento de un esfigmomanómetro automático en la identificación de pacientes con un ITB < 0,90, cuando la técnica es realizada por diplomados en Enfermería. Secundariamente, evaluar la concordancia de esta técnica con el método de referencia.Pacientes y métodos. Estudio de precisión diagnóstica en 30 pacientes con ictus isquémico. En cada paciente se realizarontres determinaciones del ITB con un esfigmomanómetro automático y una con el método de referencia.Resultados. El rendimiento del método automático en la detección de ITB < 0,90 obtuvo valores aceptables en las tres determinaciones (sensibilidad: 78%, 87% y 100%; especificidad: 95%, 100% y 100%; valor predictivo positivo: 87%, 100% y100%; valor predictivo negativo: 91%, 96% y 100%; exactitud: 90%, 97% y 100%). Los cocientes de correlación intraclase intraobservador, interobservador e intermétodo del dispositivo automático presentaron niveles aceptables, con resultadosde 0,64, 0,83 y 0,75, respectivamente. En el test de Bland y Altman sólo la comparativa intermétodo mostró menosdel 5% de los valores fuera de rango. Conclusión. El rendimiento del esfigmomanómetro Omron HEM-907 ® en la identificación de pacientes con un ITB < 0,90presenta valores aceptables cuando la técnica es realizada por diplomados en Enfermería. Esto sugiere su posible utilidadcomo herramienta de cribado en pacientes con ataque isquémico transitorio/ictus isquémico (AU)

Introduction. Ankle brachial index (ABI) is not widespread in clinical practice because the need for specific equipment and training. Doing it without these requirements, quicker and with a cheaper method would facilitate their routine use.Aims. To evaluate sensitivity and specificity of an automatic blood pressure device detecting ABI < 0.90, when technique is performed by nurses. To evaluate agreement between two techniques for the ABI determination Patients and methods. Diagnostic accuracy study in 30 ischemic stroke patients. For each patient, three measurementswere performed with the automatic device, and one with the reference method. Results. The automatic blood pressure device performance detecting ABI < 0.90 was acceptable for each of the threemeasurements (sensitivity: 78%, 87% and 100%; specificity: 95%, 100% and 100%; positive predictive value: 87%, 100% and 100%; negative predictive value: 91%, 96% y 100%; accuracy: 90%, 97% y 100%). The intraclass correlation coefficients for intra-observer, inter-observer and inter-method variability showed acceptable levels, with results of 0.64, 0.83 and 0.75, respectively. In the Bland Altman test only inter-method comparison had less than 5% of its values out of range. Conclusions. Sensitivity and specificity of an automatic blood pressure device detecting ABI < 0.90 shows acceptable levels when technique is performed by nurses. This suggests its potential as screening tool in transient ischemic attack/ischemicstroke patients (AU)