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1.
Isr Med Assoc J ; 23(9): 563-568, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34472231

RESUMO

BACKGROUND: Infants born very prematurely have functionally and structurally immature gastrointestinal tracts. OBJECTIVES: To assess the safety and tolerability of administration of enteral recombinant human (rh) insulin on formula fed preterm infants and to assess whether enteral administration of rh-insulin enhances gastrointestinal tract maturation by reducing the time to reach full enteral feeding. METHODS: A phase 2, multicenter, double-blind, placebo-controlled, randomized study was conducted. Premature infants (26-33 weeks gestation) were randomized 1:1 to receive insulin 400 µU/ml mixed with enteral feeding or placebo added to their formula. The primary efficacy outcome measure was the number of days required to achieve full enteral feeding. Safety outcomes included adverse events and blood glucose levels. RESULTS: The study consisted of 33 infants randomized for the safety population and 31 for efficacy analysis. The mean time to full enteral feeding was 6.37 days (95% confidence interval [95%CI] 4.59-8.15) in the enteral rh-insulin treatment group (n=16) and 8.00 days (95%CI 6.20-9.80) in the placebo group (n=15), which represents a statistically significant reduction of 1.63 days (95%CI 0.29-2.97; P = 0.023). There was no difference in blood glucose levels between the groups and none of the participants experienced hypoglycemia. Adverse events occurred in 9/17 (53%) infants in the enteral rh-insulin group and 12/16 (75%) in the placebo group. CONCLUSIONS: Our trial demonstrated that administration of enteral rh-insulin as supplement to enteral nutrition significantly reduced time to achieve full enteral feeding in preterm infants with a gestational age of 26-33 weeks.


Assuntos
Nutrição Enteral/estatística & dados numéricos , Hipoglicemiantes/administração & dosagem , Recém-Nascido Prematuro , Insulina/administração & dosagem , Glicemia/efeitos dos fármacos , Método Duplo-Cego , Feminino , Idade Gestacional , Humanos , Hipoglicemiantes/efeitos adversos , Recém-Nascido , Insulina/efeitos adversos , Masculino , Fatores de Tempo
2.
Nutrients ; 13(8)2021 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-34444643

RESUMO

Medical ketogenic diets (KDs) are effective yet resource-intensive treatment options for drug-resistant epilepsy (DRE). We investigated dietetic care contact time, as no recent data exist. An online survey was circulated to ketogenic dietitians in the UK and Ireland. Data were collected considering feeding route, KD variant and type of ketogenic enteral feed (KEF), and the estimated number of hours spent on patient-related activities during the patient journey. Fifteen dietitians representing nine KD centres responded. Of 335 patients, 267 (80%) were 18 years old or under. Dietitians spent a median of 162 h (IQR 54) of care contact time per patient of which a median of 48% (IQR 6) was direct contact. Most time was required for the classical KD taken orally (median 193 h; IQR 213) as a combined tube and oral intake (median 211 h; IQR 172) or a blended food KEF (median 189 h; IQR 148). Care contact time per month was higher for all KDs during the three-month initial trial compared to the two-year follow-up stage. Patients and caregivers with characteristics such as learning or language difficulties were identified as taking longer. Twelve out of fifteen (80%) respondents managed patients following the KD for more than two years, requiring an estimated median contact care time of 2 h (IQR 2) per patient per month. Ten out of fifteen (67%) reported insufficient official hours for dietetic activities. Our small survey gives insight into estimated dietetic care contact time, with potential application for KD provision and service delivery.


Assuntos
Atenção à Saúde , Dieta Cetogênica , Dietética , Epilepsia Resistente a Medicamentos/dietoterapia , Nutricionistas , Adolescente , Adulto , Cuidadores , Criança , Pré-Escolar , Ingestão de Alimentos , Nutrição Enteral , Humanos , Lactente , Irlanda , Inquéritos e Questionários , Tempo , Fatores de Tempo , Reino Unido , Adulto Jovem
3.
Nutrients ; 13(8)2021 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-34444915

RESUMO

The feeding of colostrum and mother's transitional milk improves immune protection and neurodevelopmental outcomes. It also helps with gut maturation and decreases the risks of infection. The supply of nutrients from human milk (HM) is not adequate for preterm infants, even though preterm mother's milk contains higher concentrations of protein, sodium, zinc, and calcium than mature HM. The human milk fortifiers, particularly those with protein, calcium, and phosphate, should be used to supplement HM to meet the necessities of preterm infants. The management of fluid and electrolytes is a challenging aspect of neonatal care of preterm infants. Trace minerals such as iron, zinc, copper, iodine, manganese, molybdenum, selenium, chromium, and fluoride are considered essential for preterm infants. Vitamins such as A, D, E, and K play an important role in the prevention of morbidities, such as bronchopulmonary dysplasia, retinopathy of prematurity, and intraventricular hemorrhage. Therefore, supplementation of HM with required nutrients is recommended for all preterm infants.


Assuntos
Nutrição Enteral/métodos , Fenômenos Fisiológicos da Nutrição do Lactente/fisiologia , Doenças do Prematuro/prevenção & controle , Recém-Nascido Prematuro/crescimento & desenvolvimento , Recém-Nascido Prematuro/imunologia , Suplementos Nutricionais , Feminino , Alimentos Fortificados , Humanos , Lactente , Recém-Nascido , Masculino , Necessidades Nutricionais
4.
Ann Palliat Med ; 10(7): 7406-7415, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34353034

RESUMO

BACKGROUND: Nutrition supports is essential to the prognosis of stroke patients with dysphagia. It's necessary to evaluate the effects and safety of intermittent tube feeding for stroke patients with dysphagia, to provide evidence for the management of dysphagia. METHODS: Cochrane Library et al. databases were searched for randomized controlled trials (RCTs) on the intermittent tube feeding for stroke patients with dysphagia up to Feb 15, 2021. Bias risk assessment tool recommended by Cochrane was used for quality assessment, and Revman5.3 software was used for data analysis. RESULTS: A total of 11 RCTs involving 762 stroke patients with dysphagia were included. Meta-analysis indicated that intermittent tube feeding could significantly increase the rate of dysphagia function improvement [odd ratio (OR ) = 5.22, 95% confidence interval (CI): 3.38-8.07], serum albumin level [mean difference (MD) = 3.07, 95% CI: 1.65-4.49], hemoglobin level (MD =1.55, 95% CI: 1.19-1.95), prealbumin level (MD =1.79, 95% CI: 1.46-2.12), and reduce the incidence of aspiration pneumonia (OR = 0.28, 95% CI: 0.15-0.53), incidence of aspiration (OR =0.27, 95% CI: 0.08-0.93) for stroke patients with dysphagia (all P<0.05), o significant difference in the triceps skinfold thickness (TSF) (MD =0.46, 95% CI: -0.24 to 1.19) and arm muscle circumference (MD =0.04, 95% CI: -0.28 to 0.36) between two groups were found (all P>0.05). Egger regression tests indicated that there was no publication bias between included RCTs (all P>0.05). DISCUSSION: Intermittent tube feeding for stroke patients with dysphagia during the recovery period can not only ensure the nutritional supply, but also promote the recovery of swallowing function and reduce the occurrence of aspiration and aspiration associated pneumonia.


Assuntos
Transtornos de Deglutição , Acidente Vascular Cerebral , Transtornos de Deglutição/etiologia , Nutrição Enteral , Humanos , Estado Nutricional , Acidente Vascular Cerebral/complicações
5.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(7): 844-848, 2021 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-34412755

RESUMO

OBJECTIVE: To compare the effects of intermittent feeding and continuous feeding on muscle atrophy, nutritional status and nutritional intolerance of critically ill patients, and to provide a reference for critically ill patients to select more suitable nutritional support in clinic. METHODS: An observational study was conducted. The clinical data of 59 critically ill patients who received enteral nutrition admitted to anesthesia intensive care unit (ICU) of the Second Affiliated Hospital of Air Force Military Medical University of the Chinese People's Liberation Army from January 2019 to December 2020 were analyzed. According to different feeding methods, the patients were divided into intermittent feeding group (n = 32, 200-250 mL nutrient solution was pumped each time, 4-5 times a day, 5-6 hours interval each time) and continuous feeding group (n = 27, nutrient solution was pumped continuously and evenly). The changes of related indexes before and 7 days after enteral nutrition in ICU were recorded, including rectus femoris thickness and cross-sectional area, nutritional status related indexes [hemoglobin (Hb), albumin (ALB), prealbumin (PA) and blood glucose], incidence of aspiration, diarrhea, constipation, vomiting, abnormal gastric residue volume (gastric residue volume > 250 mL), other nutritional intolerance and the length of ICU stay. RESULTS: After nutritional support for 7 days, the thickness and cross-sectional area of rectus femoris decreased in both groups, indicating muscle atrophy occurred in both groups, and there was no significant difference in change value of thickness or cross-sectional area of rectus femoris between intermittent feeding group and continuous feeding group [the change value of rectus femoris thickness (cm): -0.06±0.04 vs. -0.07±0.03, the change value of rectus femoris cross-sectional area (cm2): -0.71±0.23 vs. -0.81±0.24, both P > 0.05]. There were no significant differences in nutritional status related indicators after nutritional support for 7 days between intermittent feeding group and continuous feeding group [Hb (g/L): 102.2±10.9 vs. 103.2±11.3, ALB (g/L): 34.1±3.6 vs. 32.9±4.0, PA (mg/L): 209.8±10.6 vs. 205.9±13.7, blood glucose (mmol/L): 6.34±1.91 vs. 6.93±3.54, all P > 0.05]. The patients in both groups had intestinal nutrition intolerance such as aspiration, diarrhea, constipation and vomiting. However, the incidence of abnormal gastric residual volume in intermittent feeding group was significantly lower than that in continuous feeding group [9.4% (3/32) vs. 33.3% (9/27), P < 0.05]. There was no significant difference in the length of ICU stay between intermittent feeding group and continuous feeding group (days: 21.03±11.51 vs. 21.41±9.74, P > 0.05). CONCLUSIONS: Compared with continuous feeding, intermittent feeding does not improve the muscle atrophy and nutritional status of critically ill patients, but reduce the symptoms of enteral nutrition intolerance caused by abnormal increase of gastric residual volume. It is an easy-to-implement, safe and feasible feeding method.


Assuntos
Estado Terminal , Estado Nutricional , Nutrição Enteral , Humanos , Unidades de Terapia Intensiva , Atrofia Muscular/etiologia
6.
World J Gastroenterol ; 27(29): 4900-4912, 2021 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-34447234

RESUMO

BACKGROUND: Intestinal mucosal barrier injury and gastrointestinal dysfunction are important causes of sepsis. However, few studies have investigated the effects of enteral underfeeding on gastrointestinal function in sepsis. Moreover, no consensus on goal enteral caloric intake has been reached in sepsis. AIM: To investigate the effects of different goal caloric requirements of enteral nutrition on the gastrointestinal function and outcomes in the acute phase of sepsis. METHODS: Patients were randomly assigned to receive 30% (defined as group A), 60% (group B), or 100% (group C) of goal caloric requirements of enteral nutrition in this prospective pilot clinical trial. The acute gastrointestinal injury (AGI) grades, incidence of feeding intolerance (FI), daily caloric intake, nutritional and inflammatory markers, and biomarkers of mucosal barrier function were collected during the first 7 d of enteral feeding. The clinical severity and outcome variables were also recorded. RESULTS: A total of 54 septic patients were enrolled. The days to goal calorie of group C (2.55 ± 0.82) were significantly longer than those of group A (3.50 ± 1.51; P = 0.046) or B (4.85 ± 1.68; P < 0.001). The FI incidence of group C (16.5%) was higher than that of group A (5.0%) or B (8.7%) (P = 0.009). No difference in the incidence of FI symptoms was found between groups A and B. The serum levels of barrier function biomarkers of group B were significantly lower than those of group A (P < 0.05) on the 7th day of feeding. The prealbumin and IL-6 levels of group A were lower than those of group B (P < 0.05) on the 7th day of feeding. No significant differences in the clinical outcome variables or 28-d mortality were found among the three groups. CONCLUSION: Early moderate enteral underfeeding (60% of goal requirements) could improve the intestinal barrier function and nutritional and inflammatory status without increasing the incidence of FI symptoms in sepsis. However, further large-scale prospective clinical trials and animal studies are required to test our findings. Moreover, the effects of different protein intake on gastrointestinal function and outcomes should also be investigated in future work.


Assuntos
Gastroenteropatias , Sepse , Ingestão de Energia , Nutrição Enteral/efeitos adversos , Gastroenteropatias/diagnóstico , Gastroenteropatias/epidemiologia , Gastroenteropatias/terapia , Humanos , Recém-Nascido , Estudos Prospectivos , Sepse/epidemiologia , Sepse/terapia
7.
Am J Case Rep ; 22: e932075, 2021 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-34347761

RESUMO

BACKGROUND Cerebral palsy may be accompanied by gastrointestinal disorders. Percutaneous endoscopic gastrostomy (PEG) tube placement is an increasingly performed procedure in these patients. While PEG tube feeding can result in weight gain and a decrease in aspiration episodes, this insertion of a PEG tube is not without complications. Specifically, intestinal volvulus following PEG tube insertion is an exceedingly rare complication. CASE REPORT A 34-year-old man with cerebral palsy was brought to the emergency department with a history of recurrent vomiting. He had a history of PEG tube insertion 2 months prior to his presentation. The physical examination was non-contributory. Abdominal computed tomography was suggestive of an intestinal volvulus around the PEG tube. Subsequently, the patient underwent an exploratory laparotomy, which confirmed the diagnosis and enabled successful management. Unexpectedly, the patient suffered cardiac arrest 5 days following the operation. Cardiopulmonary resuscitation was performed with pharmacological intervention and defibrillation in accordance with the advanced cardiac life support guidelines. He recovered successfully and was discharged after a 4-day observation. CONCLUSIONS Clinicians should have a high index of suspicion for small bowel volvulus in patients who had a PEG tube inserted, along with intestinal obstruction. Furthermore, caregivers should be educated to recognize the early signs of intestinal obstruction and seek medical attention, since a delay can result in fatal outcomes.


Assuntos
Paralisia Cerebral , Volvo Intestinal , Adulto , Paralisia Cerebral/complicações , Nutrição Enteral , Gastrostomia/efeitos adversos , Humanos , Volvo Intestinal/etiologia , Volvo Intestinal/cirurgia , Intubação Gastrointestinal , Masculino
9.
Nutrients ; 13(7)2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34371799

RESUMO

Enteral feeding is the preferred method of nutrient provision for preterm infants. Though parenteral nutrition remains an alternative to provide critical nutrition after preterm delivery, the literature suggests that enteral feeding still confers significant nutritional and non-nutritional benefits. Therefore, the purpose of this narrative review is to summarize health and clinical benefits of early enteral feeding within the first month of life in preterm infants. Likewise, this review also proposes methods to improve enteral delivery in clinical care, including a proposal for decision-making of initiation and advancement of enteral feeding. An extensive literature review assessed enteral studies in preterm infants with subsequent outcomes. The findings support the early initiation and advancement of enteral feeding impact preterm infant health by enhancing micronutrient delivery, promoting intestinal development and maturation, stimulating microbiome development, reducing inflammation, and enhancing brain growth and neurodevelopment. Clinicians must consider these short- and long-term implications when caring for preterm infants.


Assuntos
Nutrição Enteral/métodos , Fenômenos Fisiológicos da Nutrição do Lactente/fisiologia , Recém-Nascido Prematuro/crescimento & desenvolvimento , Desenvolvimento Infantil/fisiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estado Nutricional/fisiologia
10.
Nutrients ; 13(7)2021 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-34371872

RESUMO

The aim of this exploratory study was to investigate gastrointestinal tolerance and protein absorption markers with a new enteral peptide formula (PF) compared to an isocaloric enteral intact protein standard formula (SF) containing the same amount of protein in ICU patients. Patients admitted to a cardio-thoracic intensive care unit expected to receive tube feeding for ≥5 days were randomized to receive either PF (1.5 kcal/mL) or SF in a double-blind manner for ≤14 days. Twenty-six patients were randomized (13 SF and 13 PF) and 23 (12 SF and 11 PF) completed at least 5 days of product administration. There were no statistically significant differences between the feeds during the first 5 days of intervention for diarrhea (SF:3 (23%); PF:5 (39%), p = 0.388), vomiting (SF:1 (8%); PF:2 (15%), p = 0.549), constipation (SF:7 (54%), PF:3 (23%), p = 0.115), and high gastric residual volume (>500 mL: SF:1 (8%); PF: 2 (15%), p = 0.535). There were no differences in plasma amino acids or urinary markers of protein absorption and metabolism. In conclusion, no major differences were found in tolerability and protein absorption markers between the standard intact protein formula and the peptide formula.


Assuntos
Estado Terminal/terapia , Proteínas na Dieta/administração & dosagem , Nutrição Enteral , Alimentos Formulados , Absorção Intestinal , Valor Nutritivo , Hidrolisados de Proteína/administração & dosagem , Adulto , Idoso , Biomarcadores/sangue , Biomarcadores/urina , Proteínas na Dieta/efeitos adversos , Método Duplo-Cego , Ingestão de Energia , Nutrição Enteral/efeitos adversos , Feminino , Alimentos Formulados/efeitos adversos , Humanos , Londres , Masculino , Pessoa de Meia-Idade , Hidrolisados de Proteína/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
11.
Nutrients ; 13(7)2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34371910

RESUMO

The management of patients with spinal muscular atrophy type 1 (SMA1) is constantly evolving. In just a few decades, the medical approach has switched from an exclusively palliative therapy to a targeted therapy, transforming the natural history of the disease, improving survival time and quality of life and creating new challenges and goals. Many nutritional problems, gastrointestinal disorders and metabolic and endocrine alterations are commonly identified in patients affected by SMA1 during childhood and adolescence. For this reason, a proper pediatric multidisciplinary approach is then required in the clinical care of these patients, with a specific focus on the prevention of most common complications. The purpose of this narrative review is to provide the clinician with a practical and usable tool about SMA1 patients care, through a comprehensive insight into the nutritional, gastroenterological, metabolic and endocrine management of SMA1. Considering the possible horizons opened thanks to new therapeutic frontiers, a nutritional and endo-metabolic surveillance is a crucial element to be considered for a proper clinical care of these patients.


Assuntos
Fenômenos Fisiológicos da Nutrição Infantil , Metabolismo Energético , Sistema Nervoso Entérico/fisiopatologia , Trato Gastrointestinal/inervação , Estado Nutricional , Atrofias Musculares Espinais da Infância/terapia , Adolescente , Animais , Criança , Pré-Escolar , Terapia Combinada , Suplementos Nutricionais , Nutrição Enteral , Absorção Gastrointestinal , Humanos , Lactente , Fármacos Neuroprotetores/uso terapêutico , Atrofias Musculares Espinais da Infância/metabolismo , Atrofias Musculares Espinais da Infância/fisiopatologia , Resultado do Tratamento
12.
Chin Med J (Engl) ; 134(14): 1695-1700, 2021 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-34397596

RESUMO

BACKGROUND: Glucose control is an important aspect in managing critically ill patients. The goal of this study was to compare the effects of sequential feeding (SF) and continuous feeding (CF) on the blood glucose of critically ill patients. METHODS: A non-inferiority randomized controlled trial was adopted in this study. A total of 62 patients who were fed enteral nutritional suspension through gastric tubes were enrolled. After achieving 80% of the nutrition target calories (25 kcal·kg-1·day-1) through CF, the patients were then randomly assigned into SF and CF groups. In the SF group, the feeding/fasting time was reasonably determined according to the circadian rhythm of the human body as laid out in traditional Chinese medicine theory. The total daily dosage of the enteral nutritional suspension was equally distributed among three time periods of 7 to 9 o'clock, 11 to 13 o'clock, and 17 to 19 o'clock. The enteral nutritional suspension in each time period was pumped at a uniform rate within 2 h by an enteral feeding pump. In the CF group, patients received CF at a constant velocity by an enteral feeding pump throughout the study. Blood glucose values at five points (6:00/11:00/15:00/21:00/1:00) were monitored and recorded for seven consecutive days after randomization. Enteral feeding intolerance was also recorded. Non-inferiority testing was adopted in this study, the chi-square test or Fisher test was used for qualitative data, and the Mann-Whitney U test was used for quantitative data to determine differences between groups. In particular, a repeated measure one-way analysis of variance was used to identify whether changes in glucose value variables across the time points were different between the two groups. RESULTS: There were no significant demographic or physiological differences between the SF and CF groups (P > 0.050). The average glucose level in SF was not higher than that in CF (8.8 [7.3-10.3] vs. 10.7 [9.1-12.1] mmol/L, Z = -2.079, P for non-inferiority = 0.019). Hyperglycemia incidence of each patient was more common in the CF group than that in the SF group (38.4 [19.1-63.7]% vs. 11.8 [3.0-36.7]%, Z = -2.213, P = 0.027). Hypoglycemia was not found in either group. Moreover, there was no significant difference during the 7 days in the incidence of feeding intolerance (P > 0.050). CONCLUSIONS: In this non-inferiority study, the average blood glucose in SF was not inferior to that in CF. The feeding intolerance in SF was similar to that in CF. SF may be as safe as CF for critically ill patients. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03439618; https://clinicaltrials.gov/ct2/show/record/NCT03439618.


Assuntos
Glicemia , Hiperglicemia , Estado Terminal , Ingestão de Energia , Nutrição Enteral , Humanos , Recém-Nascido
13.
Nan Fang Yi Ke Da Xue Xue Bao ; 41(7): 1114-1118, 2021 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-34308865

RESUMO

OBJECTIVE: To explore the incidence of enteral feeding intolerance and its risk factors in patients with malignant oral and maxillofacial tumors. METHODS: We conducted a retrospective analysis of 122 patients with malignant oral and maxillofacial tumor admitted in a general hospital for enteral nutrition between March, 2018 and March, 2021. The incidence of intolerance to enteral nutrition was analyzed, and the two groups of patients with and without intolerance were compared for age, gender, height, weight, pathological staging, types of enteral nutrition preparations, clinical treatment (physical hypothermia and nasal delivery), drug usage (sedatives, vasoactive drugs, acid suppressant, potassium preparation, antibiotics and hormones) and biochemical parameters (serum total protein, serum albumin, blood glucose and serum potassium concentration). Logistic regression analysis was used to analyze the influencing factors of enteral nutritional feeding intolerance in patients. RESULTS: Of the 122 patients, 52 had enteral feeding intolerance with an incidence rate of 42.6%. Logistic regression analysis showed that potassium preparation (OR=4.125, P=0.027, 95%CI: 1.178-14.444), sedatives (OR=4.125, P=0.000, 95%CI: 2.007-11.765) and hypoproteinemia (OR=3.557, P=0.010, 95%CI: 1.351-9.366) were independent risk factors of feeding intolerance in patients with malignant oral and maxillofacial tumors, while adding dietary fiber was a protective factor (OR= 0.108, P=0.015, 95%CI: 0.018-0.643). CONCLUSION: The incidence of enteral feeding intolerance is high in patients with malignant oral and maxillofacial tumors. Enteral nutrition preparations with dietary fiber are recommended for these patients. The patients with potassium preparations, sedatives and hypoproteinemia should be closely monitored for enteral feeding intolerance, and timely intervention should be administered to reduce its incidence.


Assuntos
Nutrição Enteral , Neoplasias , Humanos , Incidência , Recém-Nascido , Estudos Retrospectivos , Fatores de Risco
14.
J Vet Emerg Crit Care (San Antonio) ; 31(5): 668-673, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34259376

RESUMO

OBJECTIVE: To describe refeeding syndrome in an equid without a history of recognized risk factors. CASE SUMMARY: Refeeding syndrome with marked hypophosphatemia developed in an aged miniature donkey gelding during treatment of suspected enterocolitis. Hypophosphatemia (manifested clinically as ileus and neuromuscular weakness) developed despite a short (3 day) history of hyporexia, increased body condition (7/9), and adherence to nutritional recommendations for critically ill equids. Nutritional support included nasogastric enteral feeding with a commercial equine nutrition product claiming to provide 100% of the National Research Council's daily recommended protein, vitamin, and mineral requirements for equids. Hypophosphatemia developed despite this enteral supplementation and was ultimately corrected by intravenous administration of sodium phosphate solution. NEW OR UNIQUE INFORMATION PROVIDED: This case report suggests that risk factors for refeeding syndrome in equids may be broader than previously recognized. Specifically, critically ill equids at risk for insulin dysregulation may have unique nutritional co-morbidities and requirements. This report highlights the need for both broader recognition of risk factors for refeeding syndrome, and revised best-practice nutritional guidelines and supplementation products to improve equine critical care.


Assuntos
Doenças dos Cavalos , Hipofosfatemia , Síndrome da Realimentação , Animais , Estado Terminal , Nutrição Enteral/veterinária , Equidae , Cavalos , Hipofosfatemia/veterinária , Masculino , Síndrome da Realimentação/veterinária
15.
J Stroke Cerebrovasc Dis ; 30(9): 105971, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34280690

RESUMO

PURPOSE: This study aimed to describe recovery of dysphagia after stroke. We determined the proportion of stroke survivors with dysphagia on admission, discharge, and 6 months after stroke. Additionally, the factors affecting oral feeding 6 months after stroke were explored. METHODS: A total of 427 acute stroke patients were recruited prospectively. Presence of dysphagia was evaluated on admission, weekly until recovery was achieved, and at discharge. We compared stroke survivors with dysphagia who had complete recovery, who had dysphagia but achieved oral feeding, and who required tube feeding. Patient-reported eating ability was evaluated at 6 months. Patients who achieved oral feeding by 6 months were compared to those who had persistent tube feeding need. RESULTS: Fifty-five percent of stroke survivors had dysphagia on initial evaluation (3.1 ± 1.4 days after admission) and 37% at discharge (21.1 ± 12.4 days). At 6 months, 5% of patients required tube feeding. Among those who had dysphagia at initial evaluation, 32% had resolution of dysphagia within two weeks, 44% had dysphagia but started oral feeding before discharge, and 23% required alternative means of alimentation (nasogastric tube feeding, percutaneous endoscopic gastrostomy, parental nutrition) throughout hospitalization. At 6 months, 90% of stroke survivors who achieved oral feeding by discharge continued with oral feeding. Patients who achieved oral feeding after discharge had less cognitive impairments on admission and a higher speech therapist intervention rate after discharge. CONCLUSIONS: More than half of stroke survivors had dysphagia but the vast majority were able to return to oral feeding by 6 months. Cognitive function and dysphagia rehabilitation interventions were associated with return to oral feeding after hospital discharge.


Assuntos
Transtornos de Deglutição/reabilitação , Deglutição , Ingestão de Alimentos , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/terapia , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição/fisiopatologia , Nutrição Enteral , Feminino , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Alta do Paciente , Prognóstico , Estudos Prospectivos , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo
16.
BMJ Case Rep ; 14(7)2021 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-34301696

RESUMO

A term male infant was born to a healthy 24-year-old mother with antenatally diagnosed liver-up, left congenital diaphragmatic hernia (CDH) and gastroschisis. The infant was stabilised in the neonatal intensive care unit and then underwent primary repair of the CDH via left subcostal incision and silo placement for the gastroschisis. Serial silo reductions were started postoperatively and umbilical flap closure for the gastroschisis was performed on day of life 6. The patient was weaned from respiratory support, started on enteral feeds, and discharged home at 1 month of age. He was weaned from supplemental nasogastric feeds by 6 weeks of age and is currently well and thriving at 11 months of age.


Assuntos
Gastrosquise , Hérnias Diafragmáticas Congênitas , Adulto , Nutrição Enteral , Gastrosquise/diagnóstico por imagem , Gastrosquise/cirurgia , Hérnias Diafragmáticas Congênitas/diagnóstico por imagem , Hérnias Diafragmáticas Congênitas/cirurgia , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Umbigo , Adulto Jovem
17.
Br J Nurs ; 30(13): S12-S18, 2021 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-34251849

RESUMO

The need to offer nutritional support to children and young people is commonplace for health professionals. This article explores the use and indication of nasogastric tubes (NGT) in children and young people, before explaining the process of inserting NGTs and the ongoing management of this method of nutritional support.


Assuntos
Nutrição Enteral , Intubação Gastrointestinal , Apoio Nutricional , Adolescente , Criança , Nutrição Enteral/enfermagem , Humanos , Intubação Gastrointestinal/enfermagem , Apoio Nutricional/métodos , Apoio Nutricional/enfermagem
18.
Acta Gastroenterol Belg ; 84(2): 283-288, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34217176

RESUMO

Background and study aims: Percutaneous endoscopic gastrostomy (PEG) is a procedure that provides long term enteral nutrition. To investigate the predictors of PEG-related complications and 30-day mortality rates and evaluate the indicators for deciding whether to recommend elective PEG insertions, we sought to determine the complications and early mortality rates of patients who underwent PEG. Patients and methods: We performed a retrospective analysis of consecutive adult patients who had undergone PEG for the first time between October 2016 and January 2019. The predictors of complications and 30-day mortality were analyzed with receiver operating characteristic (ROC) and logistic regression analysis. Results: This study included 309 patients. Patients were excluded from the study if they were < 18 years of age or there were missing data about them. Out of 253 patients, 33 (13%) had complications and 32 (12.6%) died within one month after PEG insertion. A higher C-reactive protein (CRP) to albumin ratio was the only independent factor predicting the complications (odds ratio (OR) : 3.17 ; 95% CI : 1.26-8.00 ; p = 0.014). The independent predictive factors for 30-day mortality after PEG placement included higher urea levels and higher CRP to albumin ratios (OR : 3.78 ; 95% CI : 1.41-10.17 ; p = 0.008) (OR : 6.67 ; 95% CI : 1.87- 23.75 ; p = 0.003). The only predictor for both complications and 30-day mortality was the CRP to albumin ratio. Conclusions: When appropriate, the PEG procedure can provide a safe and effective method for enteral feeding. The CRP to albumin ratio can be used to predict complications and early mortality after PEG insertion. Because PEG is elective, higher CRP to albumin ratios can be helpful in deciding to select patients for the procedure.


Assuntos
Proteína C-Reativa , Gastrostomia , Adulto , Proteína C-Reativa/análise , Nutrição Enteral , Humanos , Estudos Retrospectivos , Fatores de Risco
19.
Emerg Med Clin North Am ; 39(3): 641-660, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34215407

RESUMO

There are a growing number of medically complex children with implanted devices. Emergency physicians with a basic knowledge of these devices can troubleshoot and fix many of the issues that may arise. Recognition of malfunction of these devices can reduce morbidity and mortality among this special population. In this article, we review common issues that may arise in children with gastrostomy tubes, central nervous system shunts, cochlear implants, and vagal nerve stimulators.


Assuntos
Derivações do Líquido Cefalorraquidiano/efeitos adversos , Implantes Cocleares/efeitos adversos , Nutrição Enteral/efeitos adversos , Estimulação do Nervo Vago/efeitos adversos , Encéfalo/diagnóstico por imagem , Criança , Serviço Hospitalar de Emergência , Falha de Equipamento , Gastrostomia/efeitos adversos , Humanos , Infecções/diagnóstico , Infecções/etiologia , Anamnese , Medicina de Emergência Pediátrica , Exame Físico , Estimulação do Nervo Vago/instrumentação
20.
Ann Palliat Med ; 10(6): 6760-6767, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34237976

RESUMO

BACKGROUND: Postoperative patients with esophageal carcinoma (EC) are prone to malnutrition. Studies have shown that the incidence of malnutrition after EC surgery reaches 60-80%, and deaths due to malnutrition account for about 22%. Patients with EC need at least 3 months to establish a new dietary pattern after surgery, so short-term enteral nutrition is of great significance. The aim of the present study was to investigate the effects of family enteral nutrition (FEN) on nutritional status in elderly patients with EC after minimally invasive radical surgery (MIS). METHODS: A total of 106 elderly patients with EC, who had undergone MIS at the 904th Hospital of the Joint Service Support Center of the Chinese People's Liberation Army and Taixing People's Hospital from January 2017 to July 2019 were selected to participate in the present study and randomly divided into the observation group and control group. There were 53 cases in each group. Patients in the control group were given regular meals after they were discharged from hospital, and the observation group was given FEN support based on the intervention of the control group. Body mass index (BMI), nutritional risk screening, nutritional status, and the incidence of complications were compared between the two groups at discharge and 1 month after discharge. RESULTS: The BMI of the observation group was higher than that of the control group 1 month after discharge (P<0.05). The nutritional risk ratio of the observation group was lower than that of the control group 1 month after discharge (P<0.05). Hemoglobin, serum albumin, serum total protein, transferrin, and serum prealbumin of the observation group were higher than the control group 1 month after discharge (P<0.05). There was no significant difference in the incidence of total complications between the two groups (P>0.05). CONCLUSIONS: FEN could improve the nutritional status of elderly patients with EC after MIS and reduce the risk of postoperative malnutrition and incidence of complications. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2100046121.


Assuntos
Carcinoma , Neoplasias Esofágicas , Desnutrição , Idoso , Nutrição Enteral , Humanos , Desnutrição/etiologia , Desnutrição/prevenção & controle , Estado Nutricional
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