Nutrition Adequacy of Eternal Nutritional Support in Critically Ill Patient at King Abdulaziz Hospital Al-Ahsa (original) (raw)
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Journal of the Pakistan Medical Association, 2022
Objective: To evaluate improvement in nutrition support therapy after the implementation of nutritional protocols in critically ill surgical patients. Methods: The ambidirectional study was conducted at the surgical intensive care unit of Aga Khan University Hospital, Karachi, using an evidenced-based nutritional protocol. The pre-protocol retrospective data group A comprised patient records from July to September 2018, while the post-protocol prospective data group B related to the period between October and December 2018. Both data sets involved patients of either gender aged at least 18 years who needed admission to surgical intensive care unit and were unable to take oral nutrition for >2 days and remained under intensive care for up to seven days. Data was analysed using SPSS 21. Results: Of the 65 patients, 30(46.2%) were in group A; 21(70%) males and 9(30%) females with mean age 40±16.55 years (range: 18-80 years). The remaining 35(53.8%) were in group B; 27(77%) males and...
Enteral Nutrition in Intensive Care Units Factors that Hinder Adequate (1) (1)
Enteral nutrition (EN) is the most efficient nutritional support (NS) method in the intensive care units (ICUs). It has gained popularity over other methods in terms of promoting patient's immunity and enhancing better clinical outcomes in addition to its cost effectiveness. However, delivery of EN remains inadequate due to interruptions for various reasons, some of which are avoidable. Frequent interruptions may impact provision of nutrients and therefore, patient's clinical outcome. The aim of this study was to identify factors that hinder the adequate delivery of EN in the ICUs. A descriptive research design was used. Fifty critically ill entirely fed patients were included in the study. The study was carried at Alexandria Main University Hospital ICUs. One tool was used to collect the data namely "Factors Impeding Adequate Delivery of Enteral Nutrition for Critically Ill Patient Assessment Tool". A significant discrepancy between required, prescribed and delivered nutrients was demonstrated during seven consecutive days from ICU admission. Unscheduled basic nursing procedures followed by gastrointestinal complications (GICs) were the most frequent reasons for EN interruption. While interruptions due to diagnostic procedures or airway management were the lowest frequent reasons for EN interruption. In conclusion, multiple factors have been caused inadequate delivery of EN in the current study. It is recommended to develop EN protocol and follow evidence-based EN practices to maximize the delivery of EN.
Nutritional intake in the critically ill: Improving practice through research
Australian Critical Care, 2004
This article seeks to review the literature related to commencing enteral feeding, with particular reference to the suitability of enteral nutrition, methods of enteral feeding and adjustment of enteral feeding rates. Issues relating to feeding intolerance, including the assessment of gastric residual volume and the development of diarrhoea, will also be explored.
Journal of Research & Innovation in Anesthesia, 2019
Critically ill patients need appropriate nutritional supplementation for their energy requirements during their intensive care unit (ICU) stay and even after ICU stay. 1 Any critical illness is a catabolic state and all critically ill patients have an ongoing low-grade inflammation and protein catabolism referred to as persistent inflammatory catabolism syndrome (PICS). 2 Adequate supplementation of nutrition attenuates the stress response and modulates immune responses. The aim of nutritional supplementation is to supplement both macro-and micronutrient requirements. Careful supplementation of protein and caloric intake can avoid under-and overfeeding and will decrease the hospital stay and morbidity. Route of supplementation, that is, oral, enteral, or parenteral depends on the patient's hemodynamic status and gastrointestinal functioning. Initiation of feeding within 24-48 hours of critical illness has been recommended. Also, early start of physical exercise has favorable effect on muscle preservation and reduces protein catabolism. The patient's outcome in intensive care depends upon the timing of nutrition, amount, and type of nutrition.
Journal of Clinical Nursing, 2006
To test whether a feeding algorithm could improve the nutritional support of intensive care patients. Numerous factors may impede delivery of both enteral and parenteral nutrition to patients in the intensive care unit. Often there is a discrepancy between what is prescribed and actual delivery of nutrients. The purpose of this study was to test the effect of a nutritional support algorithm in an intensive care unit mainly by using the enteral route and if necessary by combining enteral and parenteral nutrition. In this prospective study, nutritional data were collected from routinely fed critically ill patients (controls, n=21) during the first three days following admission to the intensive care unit. A nutritional support algorithm was then implemented and nutritional data were collected from critically ill patients who participated in this intervention (intervention group, n=21). Data collected included the total amount of calories prescribed vs. received, onset of delivery of enteral nutrition, enteral vs. parenteral nutrition, and the use and size of enteral feeding tubes. Patients in the intervention group were both prescribed and actually received significantly larger amounts of nutrients than patients in the control group. They also received a larger proportion of their nutrients in the form of enteral nutrition. In addition, the nutritional support algorithm led to greater consistency in nursing practices with respect to aspiration of gastric content and rate of increment in enteral feeding. The study confirms that a nutritional support algorithm improved the delivery of nutrients to critically ill patients. The algorithm was most effective with respect to the delivery of enteral nutrition. The effect was primarily because of early and more rapid increment in the delivery of enteral nutrition administered by nurses based on improved physician orders. The combination of enteral and parenteral nutrition may contribute to meeting adequate nutritional requirements. By using a nutritional algorithm focused on enteral nutrition, but including parenteral nutrition as a supplement, it is possible to improve the delivery of clinical nutrition in the intensive care unit patients.
Intensive Care Medicine, 2009
Purpose: The objective of this study was to examine the relationship between the amount of energy and protein administered and clinical outcomes, and the extent to which pre-morbid nutritional status influenced this relationship. Methods: We conducted an observational cohort study of nutrition practices in 167 intensive care units (ICUs) across 37 countries. Patient demographics were collected, and the type and amount of nutrition received were recorded daily for a maximum of 12 days. Patients were followed prospectively to determine 60-day mortality and ventilator-free days (VFDs). We used body mass index (BMI, kg/m 2 ) as a marker of nutritional status prior to ICU admission. Regression models were developed to evaluate the relationship between nutrition received and 60day mortality and VFDs, and to examine how BMI modifies this relationship. Results: Data were collected on 2,772 mechanically ventilated patients who received an average of 1,034 kcal/day and 47 g protein/day. An increase of 1,000 cal per day was associated with reduced mortality [odds ratio for 60-day mortality 0.76; 95% confidence intervals (CI) 0.61-0.95, p = 0.014] and an increased number of VFDs (3.5 VFD, 95% CI 1.2-5.9, p = 0.003). The effect of increased calories associated with lower mortality was observed in patients with a BMI\25 and C35 with no benefit for patients with a BMI 25 to \35. Similar results were observed when comparing increasing protein intake and its effect on mortality. Conclusions: Increased intakes of energy and protein appear to be associated with improved clinical outcomes in critically ill patients, particularly when BMI is \25 or C35.
Nutrition in the Intensive Care Unit
Critical Care, 2005
Nutritional support has become a routine part of the care of the critically ill patient. It is an adjunctive therapy, the main goal of which is to attenuate the development of malnutrition, yet the effectiveness of nutritional support is often thwarted by an underlying hostile metabolic milieu. This requires that these metabolic changes be taken into consideration when designing nutritional regimens for such patients. There is also a need to conduct large, multi-center studies to acquire more knowledge of the cost-benefit and cost effectiveness of nutritional support in the critically ill.