Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
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This study determined whether nutrition outcomes of neonates who were receiving neonatal intensive care were improved with the implementation of a fully functioning multidisciplinary team that included a registered dietitian. A medical record review was conducted of neonates with birth weights of 1500 g or less who were cared for in Sanford Children's Hospital neonatal intensive care unit from January 1 to December 31, 2001 (prior to functioning multidisciplinary team establishment) and January 1 to December 31, 2004 (subsequent to establishment of a multidisciplinary team). Data from charts in the 2 time periods were examined for differences in nutrition outcomes. ⋯ The mean weight at the beginning of enteral feeding was significantly less in the period prior to the establishment of the multidisciplinary team (1099 g, 95% CI: 955-1165 vs 1164 g, 95% CI: 1067-1211, respectively). Weight at discharge, total weight gained, total daily weight gained, daily weight gain from birth to the initiation of enteral feeds, daily weight gain from birth to full feeds, and head circumference growth were significantly greater for neonates in the postgroup than in the pre-multidisciplinary team group. Implementation of a multidisciplinary team that included a registered dietitian improved the nutrition outcomes of low birth weight infants in a neonatal intensive care unit.
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The provision of adequate nutrition support for patients with traumatic brain injury (TBI) has been a clinical challenge for decades. The primary and secondary injuries create unique metabolic derangements along with accompanying issues such as optimal timing and route of nutrition, appropriate fluid and electrolytes, drug administration, rehabilitation, and dysphagia. Enteral nutrition is clearly established as the preferential route of nutrition support for this population vs parenteral nutrition. ⋯ Drug-nutrient and adverse drug reactions such as diarrhea should be routinely evaluated in patients receiving enteral nutrition. Monitoring for dysphagia is critical to avoid the costly negative aspects associated with aspiration and to capitalize on quality of life and appropriate oral nutrition. Emphasizing the priority of early nutrition support within a multi-disciplinary team may be the critical key for successful provision and tolerance of nutrition support in the TBI population.
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The 2003 Canadian clinical practice guidelines (CPGs) for nutrition support in mechanically ventilated, critically ill patients recommended early EN and maintaining a 45-degree head-of-bed (HOB) angle during EN administration. Current practices at University Health Network have not been examined with regard to these guidelines. The purpose of this study was to determine the proportion of mechanically ventilated, enterally fed intensive care unit patients meeting the CPG recommendations for early EN and HOB elevation. ⋯ The proportion of patients meeting clinical practice guidelines compares favorably to similar studies. In some cases, patients' clinical conditions or unit HOB angle protocol explained not meeting guidelines. However, there were cases where reasons for not meeting guidelines were unknown.
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Lymphatic injury leading to leakage of chyle is a potential complication that may arise from trauma or surgery in the chest, abdomen, or neck. Although the incidence of chyle leak post surgery is low (1%-4%), this complication can present significant challenges. ⋯ Although there are strong feelings among clinicians about the use of bowel rest, parenteral nutrition, or a low-fat enteral formula for the treatment of chyle leak, definitive evidence supporting one nutrition therapy over another does not exist. The lack of a clear consensus on the optimal management of chyle leaks makes this an area that is ripe for prospective analysis.
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Cardiovascular disease is a common preexisting condition among hospitalized patients. Acute myocardial infarction and cardiac surgery account for 2 of the most common reasons patients are admitted to the intensive care unit. Determining how and when to feed these patients is a constant challenge presented to nutrition support practitioners. ⋯ However, obstacles such as upper gastrointestinal intolerance, hypoperfusion vasopressor support, and glycemic control make the task of initiating feeds a challenge. Once a patient has successfully tolerated feeds, the nutrition support clinician must still determine how much to feed and if specialty formulas such as those containing omega-3 fatty acids are beneficial for their patient. The purpose of this review is to present recent research on the feeding challenges in the critical care population with a focus on the cardiothoracic population and an emphasis on improving patient outcomes.