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1.
Z Gastroenterol ; 58(9): 890-894, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32947634

RESUMO

Epidemiological an clinical observations as well as results from animal studies indicate that nutrition can play a role in the development of inflammatory bowel disease (IBD). Exclusive enteral nutrition therapy represents an example for modulating inflammatory responses solely through diet modification. Therefore, caretakers, patients, families, doctors and nutritionists seek for more dietary options to control IBD. These options include partial enteral nutrition therapy as for example the socalled Crohn's disease exclusion diet. The following statement summarizes existing data and provides recommendations for the current management of enteral nutrition therapy in pediatric Crohn's disease.


Assuntos
Doença de Crohn/dietoterapia , Nutrição Enteral/métodos , Guias de Prática Clínica como Assunto , Adolescente , Criança , Dieta , Humanos , Doenças Inflamatórias Intestinais/dietoterapia , Sociedades Médicas
2.
Emerg Med Clin North Am ; 38(4): 807-818, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981619

RESUMO

Sepsis care has evolved significantly since the initial early goal-directed therapy (EGDT) trials. Early fluid resuscitation, source control, and antibiotic therapy remain cornerstones of care but overall understanding is more nuanced, particularly regarding fluid selection, vasopressors, and inotropic support. Timely nutrition therapy and ventilatory support tend to receive less attention but also are important. Recent research has explored immunomodulation, ß-blockade, and vitamin supplementation. A renewed emphasis on early, aggressive resuscitation reaffirms the importance of emergency medicine providers knowledgeable and skilled in sepsis management.


Assuntos
Ressuscitação/métodos , Sepse/terapia , Angiotensina II/uso terapêutico , Antibacterianos/uso terapêutico , Antioxidantes/uso terapêutico , Ácido Ascórbico/uso terapêutico , Glicemia/análise , Pressão Sanguínea , Cardiomiopatias/etiologia , Cardiomiopatias/terapia , Cardiotônicos/uso terapêutico , Estado Terminal , Serviço Hospitalar de Emergência , Nutrição Enteral , Hidratação , Glucocorticoides/uso terapêutico , Hemodinâmica , Humanos , Escores de Disfunção Orgânica , Ensaios Clínicos Controlados Aleatórios como Assunto , Respiração Artificial , Vasoconstritores/uso terapêutico
6.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32994178

RESUMO

BACKGROUND AND OBJECTIVES: Postpyloric feeding tube placement is a time-consuming procedure associated with multiple attempts and radiation exposure. Our objective with this study is to compare the time, attempts, and radiation exposure using the electromagnetic versus blind method to place a postpyloric feeding tube in critically ill children. Our hypothesis is that using electromagnetic guidance decreases the procedure time, number of x-rays, and number of attempts, compared to the blind method. METHODS: Eleven pediatric nurses participated in a randomized controlled intention-to-treat study at an academic pediatric medical, surgical, and congenital cardiac ICU. University of Texas Health Epidemiology and Biostatistics generated a randomization sequence with sealed envelopes. A standard (2-sided) F-test of association between the electromagnetic and blind method yielded 40 subjects with 86% power. Data were analyzed with Fisher's exact test for categorical variables and the Wilcoxon rank test for continuous variables, with data documented as median (interquartile range [IQR]). RESULTS: We randomly assigned 52 patients to either the electromagnetic (n = 28) or blind method (n = 24). The number of attempts and radiographs was at a median of 2 (IQR: 1-2.25) using the blind method, compared to the electromagnetic method at a median of 1 (IQR: 1.0-1.0; P = .001). Successful guidance was 96.4% with the electromagnetic method, compared to only 66.7% with the blind technique (P = .008). The total time required was 2.5 minutes (IQR: 2.0-7.25) with the electromagnetic method, compared to 19 minutes (IQR: 9.25-27.0) for the blind method (P = .001). CONCLUSIONS: Electromagnetic guidance is a superior, faster, and overall safer method to place a postpyloric feeding tube in critically ill children.


Assuntos
Intubação Gastrointestinal/métodos , Imãs , Piloro , Adolescente , Adulto , Criança , Pré-Escolar , Estado Terminal , Campos Eletromagnéticos , Nutrição Enteral/métodos , Feminino , Humanos , Análise de Intenção de Tratamento , Intubação Gastrointestinal/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Piloro/diagnóstico por imagem , Exposição à Radiação/prevenção & controle , Radiografia Abdominal/estatística & dados numéricos , Estatísticas não Paramétricas , Fatores de Tempo , Adulto Jovem
7.
Medicine (Baltimore) ; 99(36): e21988, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899043

RESUMO

BACKGROUND: Not only has the placement rate of enteral feeding tubes during operations for esophageal cancer increased, but also has number of patients who choose to continue enteral feeding at home instead of removing the feeding tube at discharge. The impacts of home enteral nutrition (HEN) after esophagectomy in esophageal cancer patients are analyzed. METHODS: A systematic review was conducted in accordance with PRISMA and Cochrane guidelines. English and Chinese databases, including PubMed, Embase, Web of Science, The Cochrane Library, Scopus, CBM, CNKI, and Wan Fang were searched from inception to December 7, 2019. Randomized controlled trials evaluating the short-term outcomes of HEN following esophagectomy in cancer patients were included. The risk of bias of the included studies was appraised according to the Cochrane risk of bias tool. The summary of relative risk/weighted mean difference (WMD) estimates and corresponding 95% confidence interval (95% CI) were calculated using fixed- and random-effects models. RESULTS: Nine randomized controlled trials involving 757 patients were included in the meta-analysis. Compared with oral diet, HEN was associated with significantly increased body weight (WMD 3 kg, 95% CI 2.36-3.63, P < .001), body mass index (WMD 0.97 kg/m, 95% CI 0.74-1.21, P < .001), albumin (WMD 3.43 g/L, 95% CI 2.35-4.52, P < .001), hemoglobin (WMD 7.23 g/L, 95% CI 5.87-8.59, P < .001), and total protein (WMD 5.13 g/L, 95% CI 3.7-6.56, P < .001). No significant differences were observed in prealbumin and gastrointestinal adverse reactions. Physical (WMD 8.82, 95% CI 6.69-10.95, P < .001) and role function (WMD 12.23, 95% CI 2.72-21.74, P = .01) were also significantly better in the HEN group. The nausea/vomiting (WMD -5.43, 95% CI -8.29 to -2.57, P = .002) and fatigue symptoms (WMD -11.76, 95% CI -16.21 to -7.32, P < .001) were significantly reduced. Appetite loss (WMD -8.48, 95% CI -14.27 to -4.88, P = .001), diarrhea (WMD -3.9, 95% CI -7.37 to -0.43, P = .03), and sleep disturbance (WMD -7.64, 95% CI -12.79 to -2.5, P = .004) in the HEN group were also significantly less than the control group. CONCLUSIONS: HEN improved nutrition status, physical and role function, and reduced nausea/vomiting, fatigue, appetite loss, diarrhea, and sleep disturbance compared with an oral diet in esophageal cancer patients postsurgery. HEN did not increase adverse reactions.


Assuntos
Nutrição Enteral , Esofagectomia/reabilitação , Serviços de Assistência Domiciliar , Neoplasias Esofágicas/cirurgia , Humanos
8.
Zhonghua Shao Shang Za Zhi ; 36(8): 710-717, 2020 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-32829610

RESUMO

Objective: To compare the effects of supplemental parenteral nutrition (SPN) and enteral nutrition (EN) on prognosis of critically ill patients in intensive care unit (ICU) using meta-analysis. Methods: Foreign language databases including PubMed, Embase, Cochrane Library, and Cochrane Central Register of Controlled Trials were retrieved with the search terms of " supplemental parenteral nutrition, parenteral nutrition, enteral nutrition, critically ill" , and Chinese database SinoMed database was retrieved with the search terms of ",,," to obtain the publicly published randomized controlled trials about the effects of SPN and EN supportive treatment on prognosis of critically ill patients in ICU from the establishment of each database to December 2018. The Google Scholar was retrieved for supplement. The outcome indexes included the infection rate, anti-infection time, antibiotic-free time, ICU overall mortality, overall mortality during hospitalization, mechanical ventilation time, length of ICU stay, and length of hospital stay. RevMan 5.3 and Stata 14.0 statistical software were used to conduct a meta-analysis of eligible studies. Results: A total of 794 patients were included in 8 studies, including 387 patients in SPN group who received SPN and EN and 407 patients in EN group who only received EN. The bias risks of the eight studies included were uncertain. Compared with that of EN group, the infection rate of patients in SPN group was significantly decreased (relative risk=0.79, 95% confidence interval=0.66-0.94, P<0.01). However, there were no statistically significant differences in ICU overall mortality, overall mortality during hospitalization, mechanical ventilation time, length of ICU stay, and length of hospital stay of patients between SPN group and EN group. The subgroup analysis showed that the risks of bias of studies and follow-up time might be sources of the heterogeneity of mechanical ventilation time. There was publication bias in ICU overall mortality (P<0.05), while no publication bias in the other outcome indexes (P>0.05). Conclusions: SPN supportive treatment can decrease the infection rate of critically ill patients in ICU, but it has no obvious influences on overall mortality, mechanical ventilation time, and length of hospital stay.


Assuntos
Estado Terminal , Nutrição Parenteral , Nutrição Enteral , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Prognóstico
9.
Medicine (Baltimore) ; 99(32): e21569, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769901

RESUMO

BACKGROUND: This study aims to assess the effect of early enteral nutrition support (EENS) for the management of acute severe pancreatitis (ASP). METHODS: This study will search Cochrane Library, PUBMED, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, CNKI, and WANGFANG from their inception to the present without language limitations. In addition, this study will also search clinical trial registry and reference lists of included trials. Eligible comparators will be standard care, medications, and any other interventions. Two authors will independently scan all citations, titles/abstracts, and full-text studies. The study methodological quality will be appraised using Cochrane risk of bias tool. If it is possible, we will pool out data and perform meta-analysis. Strength of evidence for each main outcome will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation. RESULTS: This study will summarize the most recent evidence to assess the effect of EENS for the management of ASP. CONCLUSION: The findings of this study will help to determine whether EENS is effective for patients with ASP. STUDY REGISTRATION: INPLASY202070009.


Assuntos
Protocolos Clínicos , Nutrição Enteral/normas , Apoio Nutricional/normas , Pancreatite/dietoterapia , Gerenciamento Clínico , Nutrição Enteral/métodos , Humanos , Apoio Nutricional/métodos , Pancreatite/fisiopatologia , Revisões Sistemáticas como Assunto
10.
Medicine (Baltimore) ; 99(34): e21795, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846813

RESUMO

The objective of this study was to investigate the quality of life in stroke patients using a swallowing quality of life (SWAL-QOL) questionnaire. The correlation between SWAL-QOL questionnaire outcome and videofluoroscopic dysphagia scale (VDS) scores in stroke patients was also determined.This cross-sectional study was retrospectively conducted with 75 stroke patients with dysphagia symptoms. Videofluoroscopic swallowing study (VFSS) and SWAL-QOL questionnaires were performed for all patients. These patients were divided into an oral feeding group and a tube feeding group. SWAL-QOL scores were compared between the 2 groups. The severity of dysphagia was estimated by VDS scores according to the videofluoroscopic swallowing study results. The relationships between SWAL-QOL scores and VDS scores were also investigated.The composite score was 48.82 ±â€Š19.51 for the tube feeding group and 53.17 ±â€Š25.42 for the oral feeding group. There were significant differences in burden and sleep subdomains of the SWAL-QOL between the 2 groups (P = .005 and P = .012, respectively). There was a significant negative correlation between the composite score of SWAL-QOL outcome and the total VDS score (r = -0.468, P = .012). The pharyngeal-phase score of the VDS had significant negative correlations with the SWAL-QOL subdomains of burden (r = -0.327, P = .013), mental health (r = -0.348, P = .008), and social functioning (r = -0.365, P = .029).To improve the quality of life of stroke patients, dysphagia rehabilitation should focus on the pharyngeal phase of dysphagia.


Assuntos
Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/etiologia , Qualidade de Vida , Índice de Gravidade de Doença , Acidente Vascular Cerebral/complicações , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Deglutição , Transtornos de Deglutição/fisiopatologia , Nutrição Enteral , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Nutrição Parenteral , Estudos Retrospectivos , Inquéritos e Questionários
12.
Nutr Clin Pract ; 35(5): 792-799, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32786117

RESUMO

Worldwide, as of July 2020, >13.2 million people have been infected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. The spectrum of coronavirus disease 2019 (COVID-19) ranges from mild illness to critical illness in 5% of cases. The population infected with SARS-CoV-2 requiring an intensive care unit admission often requires nutrition therapy as part of supportive care. Although the various societal guidelines for critical care nutrition meet most needs for the patient with COVID-19, numerous factors, which impact the application of those guideline recommendations, need to be considered. Since the SARS-CoV-2 virus is highly contagious, several key principles should be considered when caring for all patients with COVID-19 to ensure the safety of all healthcare personnel involved. Management strategies should cluster care, making all attempts to bundle patient care to limit exposure. Healthcare providers should be protected, and the spread of SARS-CoV-2 should be limited by minimizing procedures and other interventions that lead to aerosolization, avoiding droplet exposure through hand hygiene and use of personal protective equipment (PPE). PPE should be preserved by decreasing the number of individuals providing direct patient care and by limiting the number of patient interactions. Enteral nutrition (EN) is tolerated by the majority of patients with COVID-19, but a relatively low threshold for conversion to parenteral nutrition should be maintained if increased exposure to the virus is required to continue EN. This article offers relevant and practical recommendations on how to optimize nutrition therapy in critically ill patients with COVID-19.


Assuntos
Infecções por Coronavirus/terapia , Cuidados Críticos/métodos , Apoio Nutricional/métodos , Pacotes de Assistência ao Paciente/métodos , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Betacoronavirus , Cuidados Críticos/normas , Nutrição Enteral/métodos , Nutrição Enteral/normas , Humanos , Apoio Nutricional/normas , Pandemias
13.
Mymensingh Med J ; 29(3): 638-645, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32844806

RESUMO

Optimal enteral nutrition is essential for growth restricted preterm infants because if nutrition remains suboptimal during early days of life, physical and neuro-developmental outcome might be in danger. However, chronic hypoxia during antenatal period makes them susceptible for feeding intolerance and necrotising enterocolitis during post natal period. So this randomized clinical trial was conducted in the department of Neonatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2018 to June 2019; to evaluate the effect of early versus delayed enteral feeding on preterm growth-restricted infants. During the study period, out of 127 infants with small for gestational age, 50 babies were enrolled and randomly assigned to either early feeding group (n=25) or late feeding group (n=25). Clinical characteristics at trial entry were well balanced between groups. Newborn enrolled in early feeding group reached full feed significantly faster than late feeding group (p=0.001; Hazard ratio 1.24). Early feeding group regained birth weight faster; experienced lesser incidence of neonatal sepsis, experienced less number of feed intolerance, had shorter mean duration of hospital stay and achieved higher weight on post natal age 16th days. All values were statistically significant. Early enteral feeding found to be safe and beneficial in reducing the time to reach full enteral feeding and better weight gain in growth restricted preterm infants.


Assuntos
Nutrição Enteral , Recém-Nascido Prematuro , Bangladesh , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Pessoa de Meia-Idade , Nutrição Parenteral , Gravidez
14.
Geriatr Gerontol Int ; 20(10): 961-966, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32812703

RESUMO

AIM: Studies of medication use in patients with a percutaneous endoscopic gastrostomy (PEG) tube have not been conducted adequately. The aim of this study was to describe medication use of care-dependent older adults with PEG and evaluate whether potential prescribing omissions (PPO) would affect the cause of death or acute illness. METHODS: In a geriatric long-term care hospital, 116 inpatients aged ≥65 years with insertion of a PEG tube because of dysphagia were enrolled and followed for 2 years: 2016-2018. The patients were divided into two groups, i.e., group A (who died between 2016 and 2018) and group B (who continued to be hospitalized in 2018). Clinical data and prescribed medications were recorded. Logistic regression models were conducted to assess the associations between survival and variables: age, gender, serum albumin level, serum creatinine level, body mass index (BMI), number of drugs and PPO. RESULTS: The patients' mean age was 85.3 ± 10.2 years, 57.8% were women and the mean number of drugs was 6.8 ± 3.5. Medications for managing symptoms, such as constipation and gastrointestinal symptoms, were commonly prescribed. The most common PPO medications were antiplatelet agents and anticoagulants. On logistic regression analysis, PPO had no influence on the cause of death or acute illness. Lower age, higher serum albumin level and body mass index were associated with survival in both univariate and multivariate models. CONCLUSIONS: Polypharmacy was prevalent in patients with PEG. Given the finding that PPO had no influence on health outcome, rational deprescribing could be warranted. Geriatr Gerontol Int 2020; 20: 961-966.


Assuntos
Causas de Morte , Desprescrições , Prescrições de Medicamentos/estatística & dados numéricos , Gastrostomia , Intubação Gastrointestinal , Idoso , Idoso de 80 Anos ou mais , Nutrição Enteral , Feminino , Humanos , Japão , Assistência de Longa Duração , Masculino , Polimedicação , Estudos Retrospectivos
15.
Geriatr Gerontol Int ; 20(10): 932-937, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32857477

RESUMO

OBJECTIVES: Percutaneous endoscopic gastrostomy (PEG) is one of the methods of tube feeding in patients who are incapable of oral intake. There are no reports on risk factors for bleeding at PEG construction. Our main objective was to investigate the risks and predictors of bleeding associated with PEG construction. METHODS: This retrospective, observational study included patients who had undergone PEG construction at our institution. To investigate the risks of bleeding associated with PEG construction, we compared the baseline characteristics between bleeding and non-bleeding patients. In terms of early predictors of post-PEG bleeding, we evaluated whether there had been a decrease from baseline of >10% in hemoglobin levels on the day after the procedure. RESULTS: The median preoperative albumin levels were 22.5 g/L (range 20-29 g/L) and 30 g/L (range 18-40 g/L) in the bleeding and non-bleeding groups, respectively (P = 0.014, Mann-Whitney U-test). The median preoperative platelet counts were 177 500 (range 87 000-265 000) and 271 000 (83 000-749 000) in the bleeding and non-bleeding groups, respectively (P = 0.043, Mann-Whitney U-test). The number of patients for whom hemoglobin levels decreased >10% from baseline on the day after the procedure differed significantly between the bleeding and non-bleeding groups (2/4, 50% and 3/58, 5.45%), respectively (P = 0.002, Pearson's χ2 -test). CONCLUSIONS: Low serum albumin and preoperative platelet counts might be risk factors for bleeding. Rigorous follow up is necessary for patients showing a decrease in hemoglobin level ≥10% of their baseline the day after the procedure. Geriatr Gerontol Int 2020; 20: 932-937.


Assuntos
Perda Sanguínea Cirúrgica/estatística & dados numéricos , Nutrição Enteral , Gastrostomia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Plaquetas/metabolismo , Feminino , Gastroscopia , Hemoglobinas/metabolismo , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Albumina Sérica Humana/metabolismo , Adulto Jovem
16.
Am J Nurs ; 120(9): 67, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32858704

RESUMO

Editor's note: The mission of Cochrane Nursing is to provide an international evidence base for nurses involved in delivering, leading, or researching nursing care. Cochrane Corner provides summaries of recent systematic reviews from the Cochrane Library. For more information, see https://nursing.cochrane.org.


Assuntos
Desenvolvimento Infantil , Nutrição Enteral/métodos , Fórmulas Infantis , Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Recém-Nascido Prematuro/crescimento & desenvolvimento , Leite Humano , Humanos , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Ganho de Peso
17.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32788268

RESUMO

BACKGROUND: Studies have increasingly challenged the traditional management of acute pancreatitis (AP) with bowel rest. However, these studies used a low-fat diet or transgastric feeding and only included adults. Aiming to generate higher-quality prospective pediatric data, we compared the traditional approach of fasting and intravenous fluids and early enteral feeding with standard diet or formula. METHODS: Randomized controlled trial of children (2-18 years) with mild-moderate AP. Patients were randomly assigned 1:1 to initial fasting and intravenous fluids or an immediate, unrestricted diet. Pain scores, blood measures, and cross-sectional imaging were recorded throughout admission and follow-up. The primary outcome was time to discharge, and secondary outcomes were clinical and biochemical resolution and local and systemic complication rates. RESULTS: Of 33 patients (17 [52%] boys, mean age of 11.5 [±4.8] years), 18 (55%) were randomly assigned to early feeding and 15 (45%) were randomly assigned to initial fasting. We recorded the median (interquartile range [IQR]) time to discharge (2.6 [IQR 2.0 to 4.0] vs 2.9 [IQR 1.8 to 5.6]; P = .95), reduction in serum lipase levels by day 2 (58% [IQR 2% to 85%] vs 48% [IQR 3% to 71%]; P = .65), and readmission rates (1 of 18 [6%] vs 2 of 15 [13%]; P = .22) between the early feeding and fasting cohorts, respectively. Immediate or delayed complication rates did not differ. Patients randomly assigned to early feeding had weight gain of 1.3 kg (IQR 0.29 to 3.6) at follow-up, compared with weight loss of 0.8 kg (IQR -2.1 to 0.7) in fasted patients (P = .028). CONCLUSIONS: This is the first randomized controlled trial in pediatric AP. There was no difference between early commencement of a standard oral diet and initial fast in any of the major outcome measures.


Assuntos
Dieta/normas , Nutrição Enteral , Jejum , Hidratação/métodos , Fórmulas Infantis , Pancreatite/terapia , Doença Aguda , Adolescente , Amilases/sangue , Criança , Pré-Escolar , Feminino , Humanos , Lipase/sangue , Masculino , Avaliação de Resultados em Cuidados de Saúde , Pancreatite/sangue , Readmissão do Paciente/estatística & dados numéricos , Estudos Prospectivos , Ganho de Peso
18.
Am Surg ; 86(6): 635-642, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32683978

RESUMO

OBJECTIVES: The purpose of this study was to identify trauma patients who would benefit from surgical placement of an enteral feeding tube during their index abdominal trauma operation. METHODS: We performed a retrospective analysis of all patients admitted to 2 level I trauma centers between January 2013 and February 2018 requiring urgent exploratory abdominal surgery. RESULTS: Six-hundred and one patients required exploratory abdominal surgery within 24 hours of admission after trauma activation. Nineteen (3% of total) patients underwent placement of a feeding tube after their initial exploratory surgery. On multivariate analysis, an intracranial Abbreviated Injury Scale ≥4 (odds ratio [OR] = 9.24, 95% CI 1.09-78.26, P = .04) and a Glasgow Coma Scale ≤8 (OR = 4.39, 95% CI 1.38-13.95, P = .01) were associated with increased odds of requiring a feeding tube. All patients who required a feeding tube had an Injury Severity Score ≥15. While not statistically significant, patients with an open surgical feeding tube compared with interventional radiology/percutaneous endoscopic gastrostomy placement had lower median intensive care unit length of stay, fewer ventilator days, and shorter median total hospital length of stay. CONCLUSIONS: Trauma patients with severe intracranial injury already requiring urgent exploratory abdominal surgery may benefit from early, concomitant placement of a feeding tube during the index abdominal operation, or at fascial closure.


Assuntos
Traumatismos Abdominais , Lesões Encefálicas Traumáticas/terapia , Nutrição Enteral/estatística & dados numéricos , Intubação Gastrointestinal/estatística & dados numéricos , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/cirurgia , Adulto , Nutrição Enteral/métodos , Feminino , Humanos , Escala de Gravidade do Ferimento , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos
19.
Pediatr Blood Cancer ; 67 Suppl 3: e28378, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32614140

RESUMO

Nutrition therapy is a therapeutic approach to treating medical conditions and symptoms via diet, which can be done by oral, enteral or parenteral routes. It is desirable to include nutritional interventions as a standard of care in pediatric cancer units (PCUs) at all levels of care. The interventions are dependent on available resources and personnel across all clinical settings. Enteral nutrition is easy, inexpensive, uses the gastrointestinal tract, maintains gut mucosal integrity, and allows for individualized nutritional strategies. This narrative review describes enteral nutritional interventions for children undergoing cancer treatment and is aimed at PCUs of all levels of care located in a low- and middle-income country.


Assuntos
Nutrição Enteral/métodos , Desnutrição/terapia , Neoplasias/dietoterapia , Neoplasias/tratamento farmacológico , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Criança , Nutrição Enteral/normas , Humanos , Masculino , Desnutrição/prevenção & controle
20.
Clin Nutr ESPEN ; 38: 196-200, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32690158

RESUMO

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a worldwide rapidly spreading illness, Coronavirus Disease 2019 (COVID-19). Patients fed enterally and parenterally at home are exposed to the same risk of infection as the general population, but more prone to complications than others. Therefore the guidance for care-givers and care-takers of these patients is needed. METHODS: The literature search identified no relevant systematic reviews or studies on the subject. Therefore a panel of 21 experts from 13 home medical nutrition (HMN) centres in Poland was formed. Twenty-three key issues relevant to the management of SARS-CoV-2 infection or COVID-19 in the HMN settings were identified and discussed. Some statements diverge from the available nutrition, surgical or ICU guidelines, some are based on the best available experience. Each topic was discussed and assessed during two Delphi rounds subsequently. Statements were graded strong or weak based on the balance between benefit and harm, resource and cost implications, equity, and feasibility. RESULTS: the panel issued 23 statements, all of them were graded strong. Two scored 85.71% agreement, eleven 95.23%, and ten 100%. The topics were: infection control, enrolment to HMN, logistics and patient information. CONCLUSIONS: the position paper present pragmatic statements for HMN to be implemented in places without existing protocols for SARS-CoV-2 pandemic. They represent the state of knowledge available at the moment and may change should new evidence occurs.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Nutrição Enteral/métodos , Serviços de Assistência Domiciliar , Nutrição Parenteral/métodos , Pneumonia Viral/complicações , Cuidadores/educação , Técnicas de Laboratório Clínico , Consenso , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Assistência à Saúde , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Equipe de Assistência ao Paciente , Isolamento de Pacientes , Assistência Centrada no Paciente/métodos , Equipamento de Proteção Individual , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Fatores de Risco
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