Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 758
Filtrar
1.
Crit Care ; 24(1): 35, 2020 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-32019607

RESUMO

Nutrition therapy during critical illness has been a focus of recent research, with a rapid increase in publications accompanied by two updated international clinical guidelines. However, the translation of evidence into practice is challenging due to the continually evolving, often conflicting trial findings and guideline recommendations. This narrative review aims to provide a comprehensive synthesis and interpretation of the adult critical care nutrition literature, with a particular focus on continuing practice gaps and areas with new data, to assist clinicians in making practical, yet evidence-based decisions regarding nutrition management during the different stages of critical illness.


Assuntos
Estado Terminal , Apoio Nutricional , Adulto , Cuidados Críticos/normas , Estado Terminal/terapia , Nutrição Enteral/normas , Humanos , Estado Nutricional , Apoio Nutricional/normas , Nutrição Parenteral/normas
2.
Am J Health Syst Pharm ; 76(19): 1492-1510, 2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31532507

RESUMO

PURPOSE: Current clinical practice guidelines on management of enteral nutrition (EN) and parenteral nutrition (PN) in pediatric patients are reviewed. SUMMARY: The provision of EN and PN in pediatric patients poses many unique considerations and challenges. Although indications for use of EN and PN are similar in adult and pediatric populations, recommended EN and PN practices differ for pediatric versus adult patients in areas such as selection of EN and PN formulations, timing of EN and PN initiation, advancement of nutrition support, and EN and PN goals. Additionally, provision of EN and PN to pediatric patients poses unique compounding and medication administration challenges. This article provides a review of current EN and PN best practices and special nutrition considerations for neonates, infants, and other pediatric patients. CONCLUSION: The provision of EN and PN to pediatric patients presents many unique challenges. It is important for pharmacists to keep current with pediatric- and neonatal-specific guidelines on nutritional management of various disease states, as well as strategies to address compounding and medication administration challenges, in order to optimize EN and PN outcomes.


Assuntos
Desenvolvimento Infantil/fisiologia , Nutrição Enteral/normas , Necessidades Nutricionais/fisiologia , Nutrição Parenteral/normas , Serviço de Farmácia Hospitalar/organização & administração , Adulto , Fatores Etários , Criança , Pré-Escolar , Composição de Medicamentos/normas , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro/fisiologia , Farmacêuticos/organização & administração , Serviço de Farmácia Hospitalar/normas , Guias de Prática Clínica como Assunto
3.
Zhonghua Gan Zang Bing Za Zhi ; 27(5): 330-342, 2019 May 20.
Artigo em Chinês | MEDLINE | ID: mdl-31177656

RESUMO

Malnutrition is common in patients with end-stage liver disease (ESLD) and is an independent risk factor for survival, therefore it should be treated as the same important guideline as ascites and hepatic encephalopathy. However, up to now, there is no clinical nutrition guideline for patients with ESLD in China. In order to standardize the nutrition treatment, Chinese Society of Hepatology (CSH) and Chinese Society of Gastroenterology (CSGE), Chinese Medical Association(CMA) co-organized and co-developed this guideline. Recommendations on nutritional screening and assessment as well as principles of intervention and management in patients with ESLD were provided to help clinicians make rational decisions on clinical malnutrition.


Assuntos
Doença Hepática Terminal/complicações , Gastroenterologia/normas , Encefalopatia Hepática , Cirrose Hepática/complicações , Desnutrição/dietoterapia , Guias de Prática Clínica como Assunto , Ascite , China , Doença Hepática Terminal/fisiopatologia , Nutrição Enteral/normas , Humanos , Desnutrição/fisiopatologia , Avaliação Nutricional , Estado Nutricional
4.
Rev Chil Pediatr ; 90(2): 222-228, 2019 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-31095240

RESUMO

The use of home enteral or parenteral nutrition has been a necessary step in the optimization of nu tritional support in patients who, due to several diseases, fail to meet their nutritional requirements by oral feeding. This article presents the recommendations of the Chilean Pediatric Society Nutritio nal Branch, aimed at health teams that treat pediatric patients who require enteral feeding for a long time. The general objective is to provide guidelines for the proper management of these patients. It describes the ideal conformation of the health team for the care and follow-up of those patients, the program admission criteria, and its evaluation method over time. In addition, it describes general characteristics of enteral feeding, routes of administration, available enteral formulas, complications, and patient follow-up.


Assuntos
Nutrição Enteral/normas , Serviços de Assistência Domiciliar/normas , Adolescente , Assistência ao Convalescente/métodos , Assistência ao Convalescente/normas , Criança , Chile , Doença Crônica , Nutrição Enteral/efeitos adversos , Nutrição Enteral/métodos , Humanos , Pediatria , Sociedades Médicas
5.
Nutr Hosp ; 36(3): 734-742, 2019 Jul 01.
Artigo em Espanhol | MEDLINE | ID: mdl-31144978

RESUMO

Introduction: The Management Working Group of SENPE has among its objectives the development of evaluation processes in Clinical Nutrition. Previously, the document entitled "Process of nutritional care: self-evaluation guide" was prepared as a tool designed to help assess the quality of nutritional therapy in hospitalized patients, mainly from the perspective of artificial nutrition. Now a complementary text of the previous one is presented, that describes the process by which hospitalized patients are fed. We have divided the hospital feeding process into six sections, for which a general description is made and quality indicators are proposed. We hope that this work will serve to improve the quality of hospital food and to help hospital food professionals to make their work more satisfactory and effective.


Assuntos
Serviço Hospitalar de Nutrição/normas , Terapia Nutricional/normas , Nutrição Enteral/normas , Alimentos Formulados/normas , Humanos , Pacientes Internados , Apoio Nutricional , Indicadores de Qualidade em Assistência à Saúde
6.
Rev Bras Enferm ; 72(suppl 1): 235-242, 2019 Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30942368

RESUMO

OBJECTIVE: To identify the nonconformities of the enteral diet therapy process. METHOD: Exploratory case study, using as a theoretical framework the philosophy of Lean Healthcare in an inpatient unit of a large hospital in Minas Gerais State. The sample consisted of 19 professionals from the multidisciplinary team involved in the enteral nutritional therapy process and the unit's documentary sample. For the data collection, we used a semi-structured script, participant observation and documentary analysis. RESULTS: There were eight nonconformities related to enteral diet therapy. During the participant observation, there was a lack of a management model that seeks the continuous improvement of the process, as well as resistance to change. CONCLUSION: Although enteral diet therapy is important in the patient's evolution, there are adverse events that could be prevented and the Lean philosophy assists in the identification of process nonconformities.


Assuntos
Nutrição Enteral/normas , Melhoria de Qualidade , Gestão da Qualidade Total/métodos , Adulto , Nutrição Enteral/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
7.
Medicine (Baltimore) ; 98(11): e14864, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30882688

RESUMO

BACKGROUND: Controversy persists about whether early enteral nutrition administration is related to worse prognosis than delayed enteral nutrition for patients with gastrointestinal bleeding. OBJECTIVES: To systematically evaluate the effect of early enteral nutrition on the patient with gastrointestinal bleeding through the meta-analysis. METHODS: Such electronic databases including PubMed, EMBASE, Cochrane Library, CNKI, and CBM were searched from 1985 to March 2018. Randomized controlled trials that compared early enteral nutrition versus delayed enteral nutrition in patients with gastrointestinal bleeding were considered eligible. Data extraction and the methodological quality assessment of the included trials were carried out according to the Cochrane Handbook. We calculated the pooled risk ratio, weighted mean difference, and the corresponding 95% confidential interval using RevMan5.3. RESULT: A total of 5 trials involving 313 patients were included. Compared with delayed enteral nutrition, there was a tendency for a decreased rebleeding rate in the early enteral nutrition group, but the trend was not statistically significant (risk ratio = 0.75, 95% confidential interval: 0.34-1.64, I = 0). As for mortality within 30 days, no significant difference was found between the 2 groups (risk ratio = 0.74, 95% confidential interval: 0.23-2.39, I = 0). In addition, the pooled analysis showed that early enteral nutrition was related to reduced hospitalized days (weighted mean difference = -1.69, 95% confidential interval: -2.15 to -1.23; I = 27%) CONCLUSION:: For patients with gastrointestinal bleeding, early enteral nutrition within 24 hours does not result in the significantly higher risk of rebleeding and mortality compared with delayed enteral nutrition, but decrease hospitalized days. Patients who are at low risk for rebleeding can be fed early and discharged early. However, larger, high-quality randomized controlled trials are needed to verify these findings, and when the gastrointestinal bleeding patient start enteral nutrition is worth studying.


Assuntos
Nutrição Enteral/métodos , Nutrição Enteral/normas , Hemorragia Gastrointestinal/dietoterapia , Fatores de Tempo , Resultado do Tratamento , Humanos , Razão de Chances
8.
Rev Bras Enferm ; 72(1): 73-80, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30916270

RESUMO

OBJEVECT: To evaluate the Nutritional Status (NS) and follow the Enteral Nutritional Therapy (ENT) of patients in neurosurgical intervention. METHOD: Cohort study in emergency or elective surgery patients with exclusive ENT. Anthropometric measurements (Arm Circumference (AC and Triceps Skinfold (TSF)) were measured on the first, seventh and 14th day. For the ENT monitoring, caloric/protein adequacy, fasting, inadvertent output of the enteral probe and residual gastric volume were used. RESULTS: 80 patients, 78.7% in emergency surgery and 21.3% in elective surgery. There was a reduction in AC and Body Mass Index (BMI) (p>0.01), especially for the emergency group. The caloric/protein adequacy was higher in the emergency group (86.7% and 81.8%). CONCLUSION: The EN change was greater in the emergency group, even with better ENT adequacy. Changes in body composition are frequent in neurosurgical patients, regardless of the type of procedure.


Assuntos
Nutrição Enteral/métodos , Procedimentos Neurocirúrgicos/métodos , Estado Nutricional , Idoso , Antropometria/métodos , Índice de Massa Corporal , Estudos de Coortes , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/normas , Nutrição Enteral/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/normas , Escores de Disfunção Orgânica , Estudos Prospectivos , Estatísticas não Paramétricas
9.
Curr Opin Anaesthesiol ; 32(3): 405-411, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30893119

RESUMO

PURPOSE OF REVIEW: As many as two of every three major surgery patients are malnourished preoperatively - a diagnosis rarely made and treated even less frequently. Unfortunately, perioperative malnutrition is perhaps the least often identified surgical risk factor and is among the most treatable to improve outcomes. RECENT FINDINGS: Two important perioperative nutrition guidelines were published recently. Both emphasize nutrition assessment as an essential component of preoperative screening. The recently published perioperative nutrition screen (PONS) readily identifies patients at malnutrition risk, allowing for preoperative nutritional optimization. The use of computerized tomography scan and ultrasound lean body mass (LBM) evaluation to identify sarcopenia associated with surgical risk and guide nutrition intervention is garnering further support. Preoperative nutrition optimization in malnourished patients, use of immunonutrition in all major surgery, avoidance of preoperative fasting, inclusion of postoperative high-protein nutritional supplements, and early postoperative oral intake have all recently been shown to improve outcomes and should be utilized. SUMMARY: The recent publication of new surgical nutrition guidelines, the PONS score, and use of LBM assessments will allow better identification and earlier intervention on perioperative malnutrition. It is essential that in the future no patient undergoes elective surgery without nutrition screening and nutrition intervention when malnutrition risk is identified.


Assuntos
Nutrição Enteral/normas , Desnutrição/diagnóstico , Avaliação Nutricional , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Nutrição Enteral/métodos , Jejum/efeitos adversos , Jejum/fisiologia , Humanos , Desnutrição/epidemiologia , Desnutrição/fisiopatologia , Desnutrição/terapia , Assistência Perioperatória/normas , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Guias de Prática Clínica como Assunto , Período Pré-Operatório , Prevalência , Fatores de Risco , Procedimentos Cirúrgicos Operatórios/efeitos adversos
11.
Crit Care ; 23(1): 3, 2019 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-30616675

RESUMO

BACKGROUND: ICU patients must be kept conscious, calm, and cooperative even during the critical phases of illness. Enteral administration of sedative drugs might avoid over sedation, and would be as adequate as intravenous administration in patients who are awake, with fewer side effects and lower costs. This study compares two sedation strategies, for early achievement and maintenance of the target light sedation. METHODS: This was a multicenter, single-blind, randomized and controlled trial carried out in 12 Italian ICUs, involving patients with expected mechanical ventilation duration > 72 h at ICU admission and predicted mortality > 12% (Simplified Acute Physiology Score II > 32 points) during the first 24 h on ICU. Patients were randomly assigned to receive intravenous (midazolam, propofol) or enteral (hydroxyzine, lorazepam, and melatonin) sedation. The primary outcome was percentage of work shifts with the patient having an observed Richmond Agitation-Sedation Scale (RASS) = target RASS ±1. Secondary outcomes were feasibility, delirium-free and coma-free days, costs of drugs, length of ICU and hospital stay, and ICU, hospital, and one-year mortality. RESULTS: There were 348 patients enrolled. There were no differences in the primary outcome: enteral 89.8% (74.1-100), intravenous 94.4% (78-100), p = 0.20. Enteral-treated patients had more protocol violations: n = 81 (46.6%) vs 7 (4.2%), p < 0.01; more self-extubations: n = 14 (8.1%) vs 4 (2.4%), p = 0.03; a lighter sedative target (RASS = 0): 93% (71-100) vs 83% (61-100), p < 0.01; and lower total drug costs: 2.39 (0.75-9.78) vs 4.15 (1.20-20.19) €/day with mechanical ventilation (p = 0.01). CONCLUSIONS: Although enteral sedation of critically ill patients is cheaper and permits a lighter sedation target, it is not superior to intravenous sedation for reaching the RASS target. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01360346 . Registered on 25 March 2011.


Assuntos
Sedação Profunda/normas , Nutrição Enteral/normas , Hipnóticos e Sedativos/administração & dosagem , Idoso , Anestesia/métodos , Antipruriginosos/administração & dosagem , Antipruriginosos/uso terapêutico , Depressores do Sistema Nervoso Central/administração & dosagem , Depressores do Sistema Nervoso Central/uso terapêutico , Estado Terminal/terapia , Sedação Profunda/métodos , Nutrição Enteral/métodos , Feminino , Humanos , Hidroxizina/administração & dosagem , Hidroxizina/uso terapêutico , Hipnóticos e Sedativos/uso terapêutico , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Melatonina/administração & dosagem , Melatonina/uso terapêutico , Pessoa de Meia-Idade , Distribuição de Poisson , Escala Psicológica Aguda Simplificada , Método Simples-Cego
12.
Nutrition ; 57: 275-281, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30219684

RESUMO

OBJECTIVES: The aim of this study was to evaluate the effect of the nutritional support team (NST) activities on the quality of enteral nutrition administration in intensive care units. METHODS: An observational, analytical, and cross-sectional study was performed in nine hospitals in the Brazilian Federal District through the administration of two questionnaires. One questionnaire focused on the activities of the NST and the other on the quality of enteral nutrition administration in intensive care units. RESULTS: There was a strong correlation between the scores of the two questionnaires, which was confirmed by a linear regression model (R2 = 0.623; P = 0.007). The results suggest that high scores in the NST activities questionnaire predict a better performance in enteral nutrition administration. The sections of the NST activity questionnaire that most strongly affected enteral nutrition administration were the protocols (r = 0.895; P < 0.01), quality control (r = 0.779; P < 0.05), and continuing education (r = 0.753; P < 0.05). CONCLUSIONS: The NST has the potential to positively influence enteral nutrition management in intensive care units and investments could be directed to the areas of continuing education, protocols, and quality control to maximize the effect of NST in intensive care units.


Assuntos
Nutrição Enteral/normas , Pessoal de Saúde , Unidades de Terapia Intensiva , Equipe de Assistência ao Paciente , Qualidade da Assistência à Saúde , Brasil , Protocolos Clínicos , Estudos Transversais , Educação Continuada , Nutrição Enteral/métodos , Pessoal de Saúde/educação , Hospitais , Humanos , Controle de Qualidade , Melhoria de Qualidade , Inquéritos e Questionários
13.
Nutr Clin Pract ; 34(1): 123-130, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30452094

RESUMO

BACKGROUND: In a previous audit, 81% of enteral protein prescriptions failed to meet protein guidelines. To address this, a very high-protein enteral formula and protein supplements were introduced, and protein prescriptions were adjusted to account for nonnutrition energy sources displacing enteral formula. This follow-up audit compared protein provision in critically ill adults requiring exclusive enteral nutrition (EN), first, with local and international guidelines, and second, after changes to practice, with the previous audit in the same intensive care unit (ICU). METHODS: Data were collected from 106 adults consecutively admitted to the ICU of a U.K. tertiary hospital and requiring exclusive EN ≥3 days. Protein targets based on local guidelines (1.25, 1.5, or 2.0 g/kg/d), nutrition prescription, and delivery were recorded for 24 hours between days 1-3, 5-7, 8-10, and 18-20 post-ICU admission. RESULTS: The proportion of day 1-3 protein prescriptions meeting protein targets increased from 19% in 2015 to 69% in 2017 (P < .0005, φ = 0.50). The median percentage of protein target delivered was lower than prescribed (79% vs 103%; (P < .0005; r = 0.53) and EN delivery only met the target of 22% of patients. The proportion of protein prescriptions meeting protein targets was similar for days 1-3 (69%), 5-7 (71%), and 8-10 (68%), but increased slightly by days 18-20 (74%). The proportion of patients for which EN delivery met protein targets increased with the number of days post-ICU admission (22%, 26%, 37%, and 53% for days 1-3, 5-7, 8-10, and 18-20, respectively). CONCLUSION: The proportion of protein prescriptions meeting guideline targets was higher after changes to practice.


Assuntos
Estado Terminal/terapia , Proteínas na Dieta/uso terapêutico , Nutrição Enteral/estatística & dados numéricos , Nutrição Enteral/normas , Adulto , Idoso , Auditoria Clínica , Feminino , Seguimentos , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Avaliação Nutricional , Guias de Prática Clínica como Assunto , Melhoria de Qualidade
14.
Nutr Clin Pract ; 34(2): 257-263, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30511371

RESUMO

BACKGROUND: Many healthcare facilities and providers prohibit blenderized tube feeding (BTF) for patients who request it due to concerns of high microbial load. The current project compared microbial loads of a standard ready-to-feed polymeric commercial formula (CF), a BTF made using baby food (BTF-BF), and a BTF prepared from blending whole food (BTF-WF), following food safety standards expected of U.S. hospitals. METHODS: Three tube-feeding formulas (CF, BTF-BF, BTF-WF) were prepared in a U.S. hospital and delivered in vitro to an unoccupied patient room. Samples were collected at zero hour, 2 hours, and 4 hours and compared for growth of aerobic microorganisms, Staphylococus aureus, coliforms, and Escherichia coli. The experiment was conducted in triplicate, 1 week apart. RESULTS: No S. aureus or coliform/E. coli were detected at any time point following preparation, and total bacterial count was well below acceptable limits. All 3 feeding formulas at zero hour, 2 hours, and 4 hours for each of the 3 sampling dates were acceptable for human consumption. CONCLUSION: Judicious BTF recipe selection and adherence to safe food handling provide a safe feeding substrate equivalent to CF in the hospital setting. Due to increased use and interest in BTF by patients and their caregivers, healthcare facilities may need to reexamine their policies prohibiting BTF use.


Assuntos
Nutrição Enteral , Alimentos Formulados/microbiologia , Carga Bacteriana , Contagem de Colônia Microbiana , Nutrição Enteral/métodos , Nutrição Enteral/normas , Escherichia coli , Manipulação de Alimentos , Inocuidade dos Alimentos , Humanos , Segurança do Paciente , Staphylococcus aureus
15.
Crit Care Nurs Clin North Am ; 30(4): 457-466, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30447806

RESUMO

Although a unit-adopted standardized feeding protocol (SFP) for neonates is standard of care, implementation strategies for SFPs vary across neonatal and pediatric intensive care. Besides improving growth and reducing feeding interruptions, SFPs reduce risk for necrotizing enterocolitis in infants with heart disease or born premature. The purpose of this article is to bridge the gap between recommended and actual care using SFPs.


Assuntos
Protocolos Clínicos/normas , Enterocolite Necrosante/prevenção & controle , Cardiopatias/congênito , Ciência da Implementação , Recém-Nascido Prematuro , Sistemas de Apoio a Decisões Clínicas/normas , Nutrição Enteral/métodos , Nutrição Enteral/normas , Comportamento Alimentar , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Gravidez , Fatores de Risco , Estados Unidos
17.
Clin Nurse Spec ; 32(6): 299-306, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30299332

RESUMO

PURPOSE/OBJECTIVES: The purpose of this clinical nurse specialist-led initiative was to redefine the standard of care to reduce the deficit that exists between the daily amount of tube feedings prescribed versus received by patients in a surgical-trauma intensive care unit. DESCRIPTION OF THE PROJECT: Nutrition plays a vital role in health and wellness. Although nutritional recommendations are not always met by individuals on a daily basis-the presence of in-hospital malnutrition presents greater risks and complications after a surgery or traumatic event. An evidence-based algorithm for initiating and maintaining tube feedings was developed and incorporated into morning bedside report. A preintervention and postintervention chart analysis was done to calculate the amount of tube feedings received by patients during their first 5 days of admission. OUTCOMES: Preintervention data revealed that 29 patients received a mean 49.8% (SD, 21.6%) of tube feedings prescribed, and postintervention data showed 31 patients received 60.4% (SD, 18.5%) of tube feedings prescribed (P = .04). CONCLUSION: Through the implementation of a tube feeding algorithm, there was a reduction of tube feed interruptions and volume deficits during the first 5 days of admission.


Assuntos
Nutrição Enteral/estatística & dados numéricos , Enfermeiras Clínicas , Melhoria de Qualidade/organização & administração , Algoritmos , Nutrição Enteral/normas , Humanos , Unidades de Terapia Intensiva , Pesquisa em Avaliação de Enfermagem , Centro Cirúrgico Hospitalar , Centros de Traumatologia
18.
Crit Care ; 22(1): 261, 2018 10 25.
Artigo em Inglês | MEDLINE | ID: mdl-30360760

RESUMO

The rationale for the provision of nitrogen from proteins given via the enteral route or from intravenous amino acids is to boost the synthesis of muscle proteins, and thereby to limit the severity of intensive care unit-acquired weakness by the prevention of muscle loss. However, the optimal timing for supplemental nitrogen provision is a matter of debate and controversy. Indeed, consistent data from retrospective studies support an association between high early protein intakes and better outcomes, while recent post-hoc findings from prospective studies raise safety concerns. This pro-con paper details the arguments of both sides and highlights the need for large-scale prospective studies assessing the safety and efficacy of different levels of protein intake in combination with physical activity and summarizes the currently recruiting clinical trials.


Assuntos
Estado Terminal/terapia , Proteínas na Dieta/administração & dosagem , Nutrição Enteral/normas , Proteínas na Dieta/uso terapêutico , Nutrição Enteral/tendências , Humanos , Estudos Prospectivos , Fatores de Tempo
19.
Crit Care ; 22(1): 229, 2018 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-30244686

RESUMO

BACKGROUND: There is a lack of large-scale epidemiological data on the clinical practice of enteral nutrition (EN) feeding in China. This study aimed to provide such data on Chinese hospitals and to investigate factors associated with EN delivery. METHODS: This cross-sectional study was launched in 118 intensive care units (ICUs) of 116 mainland hospitals and conducted on April 26, 2017. At 00:00 on April 26, all patients in these ICUs were included. Demographic and clinical variables of patients on April 25 were obtained. The dates of hospitalization, ICU admission and nutrition initiation were reviewed. The outcome status 28 days after the day of investigation was obtained. RESULTS: A total of 1953 patients were included for analysis, including 1483 survivors and 312 nonsurvivors. The median study day was day 7 (IQR 2-19 days) after ICU entry. The proportions of subjects starting EN within 24, 48 and 72 h after ICU entry was 24.8% (84/352), 32.7% (150/459) and 40.0% (200/541), respectively. The proportion of subjects receiving > 80% estimated energy target within 24, 48, 72 h and 7 days after ICU entry was 10.5% (37/352), 10.9% (50/459), 11.8% (64/541) and 17.8% (162/910), respectively. Using acute gastrointestinal injury (AGI) 1 as the reference in a Cox model, patients with AGI 2-3 were associated with reduced likelihood of EN initiation (HR 0.46, 95% CI 0.353-0.599; p < 0.001). AGI 4 was significantly associated with lower hazard of EN administration (HR 0.056; 95% CI 0.008-0.398; p = 0.004). In a linear regression model, greater Sequential Organ Failure Assessment scores (coefficient - 0.002, 95% CI - 0.008 to - 0.001; p = 0.024) and male gender (coefficient - 0.144, 95% CI - 0.203 to - 0.085; p < 0.001) were found to be associated with lower EN proportion. As compared with AGI 1, AGI 2-3 was associated with lower EN proportion (coefficient - 0.206, 95% CI - 0.273 to - 0.139; p < 0.001). CONCLUSIONS: The study showed that EN delivery was suboptimal in Chinese ICUs. More attention should be paid to EN use in the early days after ICU admission.


Assuntos
Nutrição Enteral/normas , Resultado do Tratamento , APACHE , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , China , Estudos Transversais , Nutrição Enteral/métodos , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Modelos de Riscos Proporcionais
20.
Ann Nutr Metab ; 73(3): 169-176, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30179861

RESUMO

BACKGROUND/AIMS: The current study was undertaken to assess if the semi-solid formulas could be used with a new ENFit connector with similar force to current percutaneous endoscopic gastrostomy (PEG) tubes. METHODS: Experiment 1: We measured the applied pressure (force) needed to compress the syringe containing 7 viscous semi-solid formulas with a 20 Fr PEG tube and low-profile tube through the ENFit connector or the current connector. Experiment 2: This experiment was conducted to evaluate the compression force through 2 connectors in 3 infusion velocity, 7 PEG tube types with 2 semi-solid formulas. RESULTS: Experiment 1: The force needed to compress the syringe through the ENFit connector was higher in 3 semi-solid formulas with a 20 Fr low-profile tube; otherwise, there were no significant differences. Experiment 2: Each formula required a higher force in the ENFit connector in 6 settings out of 21. CONCLUSIONS: The ENFit connector will likely not show any remarkable change in the force to administer the semi-solid formula. However, a higher force was required under some conditions in the prototype ENFit connector. Further investigation of sensory test is needed to confirm the feasibility of the ENFit connector for using the semi-solid formulas.


Assuntos
Nutrição Enteral/instrumentação , Nutrição Enteral/normas , Estudos de Viabilidade , Alimentos Formulados , Alimentos Formulados/análise , Humanos , Pressão , Viscosidade
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA