Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
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Multicenter Study
Nutrition algorithms and bedside nutrient delivery practices in pediatric intensive care units: an international multicenter cohort study.
Enteral nutrition (EN) delivery is associated with improved outcomes in critically ill patients. We aimed to describe EN practices, including details of algorithms and individual bedside practices, in pediatric intensive care units (PICUs). ⋯ A minority of PICUs employ EN algorithms; recommendations were variable and not in agreement with national guidelines. Optimal EN delivery was achieved in less than one-third of our cohort. EN adjunct therapies were not associated with increased EN delivery. Studies aimed at promoting early EN and decreasing interruptions may optimize energy delivery in the PICU.
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Although nutrition support is essential in intensive care units, optimal energy intake remains unclear. Here, we assessed the influence of energy intake on outcomes of critically ill, underweight patients. ⋯ Reduced energy intake during the first week in EICU was associated with a reduced MVD in clinically ill patients with BMI <20.0 kg/m(2).
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Patients with severe acute pancreatitis complicated by organ failure and/or pancreatic necrosis or fluid collections should have placement of a double-lumen nasogastric-jejunal tube to be used for both gastric decompression and jejunal feeding. These patients are at risk for gastric outlet obstruction, which may be treated so that complications such as aspiration and reflux are avoided. Furthermore, early enteral feeding can prevent ileus, suppress further organ failure, and ultimately restore gut function if continued in an uninterrupted manner. Ultimately, this patient population will benefit from pancreatic rest and jejunal feeding specifically when compared with patients using nasogastric feeding tubes.
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Extracorporeal membrane oxygenation (ECMO) is used to treat patients with severe acute respiratory distress syndrome or severe cardiac and/or respiratory failure that is unresponsive to conventional ventilator therapy. Provision of adequate nutrition support can be challenging due to hemodynamic alterations encountered in these critically ill patients. ⋯ Review of published reports and personal experience indicates that early enteral nutrition support can be well tolerated by transplant patients receiving either venovenous or venoarterial ECMO, if care is taken to adequately assess potential barriers to optimal nutrition support. Until specific guidelines are developed for patients receiving ECMO, it appears that the guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient provide the best guidance for the nutrition support clinician who is caring for the patient receiving ECMO support.
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Despite the abundance of evidence to the contrary, 6-8 hours of total preoperative fasting is still considered essential by many surgeons and anesthesiologists, based on the strength of old concepts. Patients frequently end up fasting for 12 hours or more because of delays and changes in operating room schedules. ⋯ In fact, there has not been any evidence indicating that a shorter fast of 2-3 hours, which includes oral clear or carbohydrate (CHO)-rich (12.5% carbohydrates, 50 kcal/100 mL) fluids, results in an increased risk of aspiration, regurgitation, or related morbidity compared with the standard policy of "nil by mouth after midnight." In addition, preoperative treatment with CHO-rich fluids may reduce postoperative discomfort and, for patients undergoing major abdominal surgery, may decrease the duration of postoperative hospitalization. New formulas for preoperative oral fluids containing amino acid or protein such as glutamine or whey protein are also potential candidates for early preoperative treatment and merit further study.