Enteral nutrition in the critically ill - a nursing update (original) (raw)
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Trial of the Route of Early Nutritional Support in Critically Ill Adults
New England Journal of Medicine, 2014
In reporting the results of the CALORIES trial, Harvey and colleagues (Oct. 30 issue) 1 indicate that the route of delivery of early nutritional support in the intensive care unit (ICU) does not alter patient outcomes. This message contradicts the widely held belief that the enteral route, which is more physiological, is to be preferred. However, we think that there is another implicit message: this study suggests that the role of nutritional support in the ICU should be reconsidered. Past evidence has led researchers to implement an overzealous approach to nutritional support in patients in the ICU. Given the results from the present study, we should probably take a step backward. There is still an unanswered question regarding which critically ill patients should receive early nutritional support. Some recent trials 1-3 suggest that such patients may be those with depleted body stores due to malnutrition rather than all those who are at nutritional risk as a consequence of critical illness. We believe that targeting early nutritional support to the right patients constitutes a key point that should be addressed. Once that question is addressed, we could focus again on timing, the route of delivery, protein and caloric targets, and nutrients that have putative pharmacologic activity.
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.
پرستاری مراقبت ویژه, 2019
Context: Nutrition support is part of the standard care in the intensive care unit. There is a paradox in the use of enteral and parenteral nutrition methods in ICU patients. Objectives: The aim of this study was to compare the effects of enteral and parenteral nutrition methods in patients admitted to the ICU. Data Sources: This article is a narrative review. A total of 619 articles, were extracted during the years of 2000-2018, on nutrition methods in ICU patients, with keywords enteral nutrition, parenteral nutrition, and nutrition in critical patients in databases of internal (SID, Iran Medex, Medlib) and external publications (PubMed, Scopus, Web of Science, Google Scholar); finally, 19 articles were analyzed. Results: Enteral administration reduced the associated infectious morbidity, hospitalization time, mortality, costs, non-infectious complications, multiple organ failure, systemic infections, local septic complications, and the need for surgery. It also causes early returning of intestinal movements, faster preoperative weight gain, easier fluid and electrolyte management, reduction of hyper metabolic responses, more complete nutrition, preservation of the gastrointestinal mucosa, and the ability to complete the program by the patient. Parenteral nutrition increases infectious complications, hyperglycemia, coagulation disorders and duration of hospital stay, as well as effects on invasive ventilation. Conclusions: Enteral nutrition is safer and less complicated. By improving the awareness of careers through education, patients can be improved faster.
Critical Care, 2023
Bonnet 12,13 on behalf of the FRANS study group Abstract Background Current guidelines suggest the introduction of early nutrition support within the first 48 h of admission to the intensive care unit (ICU) for patients who cannot eat. In that context, we aimed to describe nutrition practices in the ICU and study the association between the introduction of early nutrition support (< 48 h) in the ICU and patient mortality at day 28 (D28) using data from a multicentre prospective cohort. Methods The 'French-Speaking ICU Nutritional Survey' (FRANS) study was conducted in 26 ICUs in France and Belgium over 3 months in 2015. Adult patients with a predicted ICU length of stay > 3 days were consecutively included and followed for 10 days. Their mortality was assessed at D28. We investigated the association between early nutrition (< 48 h) and mortality at D28 using univariate and multivariate propensity-score-weighted logistic regression analyses. Results During the study period, 1206 patients were included. Early nutrition support was administered to 718 patients (59.5%), with 504 patients receiving enteral nutrition and 214 parenteral nutrition. Early nutrition was more frequently prescribed in the presence of multiple organ failure and less frequently in overweight and obese patients. Early nutrition was significantly associated with D28 mortality in the univariate analysis (crude odds ratio (OR) 1.69, 95% confidence interval (CI) 1.23-2.34) and propensity-weighted multivariate analysis (adjusted OR (aOR) 1.05, 95% CI 1.00-1.10). In subgroup analyses, this association was stronger in patients ≤ 65 years and with SOFA scores ≤ 8. Compared with no early nutrition, a significant association was found of D28 mortality with early enteral (aOR 1.06, 95% CI 1.01-1.11) but not early parenteral nutrition (aOR 1.04, 95% CI 0.98-1.11). Conclusions In this prospective cohort study, early nutrition support in the ICU was significantly associated with increased mortality at D28, particularly in younger patients with less severe disease. Compared to no early nutrition, only early enteral nutrition appeared to be associated with increased mortality. Such findings are in contrast with current guidelines on the provision of early nutrition support in the ICU and may challenge our current practices, particularly concerning patients at low nutrition risk.
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.
Archives of Anesthesia and Critical Care, 2019
Background: With regard to critical illness and stress, medication side effects, decreased appetite, and increased nausea and vomiting; patients admitted to intensive care units (ICUs) are at particular risk of malnutrition. Feeding behavior i.e. time and method in these patients has still remained as an unresolved issue. Thus; enteral and parenteral nutrition, with their own benefits and complications, are two commonly used methods for such individuals. The present systematic review was to compare the effects of enteral and parenteral nutrition in patients admitted to ICUs. Methods: This systematic review investigated a total number of 1642 articles on nutrition methods in ICU patients during 2010-2019 using keywords of “enteral nutrition, parenteral nutrition solutions, parenteral nutrition, critical care outcomes, critical illness, intensive care unit, and ICU” in the databases of SID, Iranmedex, MEDLIB-ED, PubMed, Scopus, Medline, Embase, Cochrane, Web of Science, and Google Sch...