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Experience with Early Enteral Nutrition Application in Critically ill Patients in Medical Intensive Care Unit


Authors: J. Charvát;  J. Kratochvíl;  V. Martínková;  J. Masopust;  S. Pálová
Authors place of work: Interní klinika 2. LF UK a FNM, Praha
Published in the journal: Čas. Lék. čes. 2008; 147: 106-111
Category: Original Article

Summary

Background.
Early enteral nutrition is recommended in patients with critical illness. Generally implementing of nutritional support algorithm is advised. The aim of study was evaluation of early enteral nutrition application in critically ill patients in medical intensive care unit.

Methods and Results.
Early enteral nutrition was given according to written protocol in medical intensive care unit. During the first 96 hours hypocaloric nutrition 20–25 calories/kg was applied, followed by increase to 25–30 calories/kg at the end of the first week of admission. Apart from the patients who reached 25–30 calories/kg we recorded the number of patients who tolerated hypocaloric enteral nutrition and evaluated the number of patients with complications due to enteral nutrition. Early enteral nutrition was given to 44 out of 99 patients admitted to intensive care unit with life threatening diasese and indication for nutrition support. Out of 44 critically ill patients (35 with sepsis, 9 with another medical emergency) 22 died during admisssion in intensive care unit (50%). Hypocaloric enteral nutrition during the first 96 hours was given to 36 patients (82%). In 8 patients enteral nutrition had to be stopped and substituted for parenteral one due to complications. Three patients suffered from abdominal distension, 2 from profused diarrhea, 1 from combination of diarrhea and abdominal distension and 2 from aspiration. Twenty seven patients tolerated the application of enteral nutrition via nasogastric tube. In 10 patients nasogastric tube had to be replaced for nasojejunal one for high gastric aspirate volume. The caloric intake of 25–30 calories/kg was reached by the end of the first week of admission in 26 patients (60%).

Conclusions.
Early enteral nutrition applied according to protocol was given succesfully to the substantial number of the critical patients. In 18% of the patients enteral nutrition had to be replaced for parenteral one due to complications. The caloric intake 25-30 calories/kg was reached in 60% of patients.

Key words:
intensive care unit, critically ill patient, early enteral nutrition, nasogastric tube.


Zdroje

1. Sandstrom, R., Drott, C., Hyltander, A. et al.: The effect of postoperative intravenous feeding (TPN) on outcome following major surgery evaluated in a randimized study. Ann. Surg., 1993, 217, s. 185–195.

2. Novák, F.: Riziko malnutrice a úloha umělé výživy. Čas. Lék. čes., 2005, 144 (Suppl. 1), s. 67–72.

3. Zadák, Z.: Výživa v intenzivní péči. Grada Publishing, Praha, 2002, s. 487.

4. Kreymann, K. G., Berger, M. M., Beutz, N. E. P. et al.: ESPEN Guidelines on Enteral Nutrition: Intensive care. Clin. Nutr., 2006, 25, s. 210–223.

5. Marik, P. E., Zaloga, G. P.: Early enteral nutrition in acutely ill patients; a systematic review. Crit. Care Med., 2001, 29, s. 2264–2270.

6. Heyland, D. K.: Nutritional support in the critically ill patients. A critical review of evidence. Crit. Care Med., 1998, 14. s. 423–440.

7. Krishnen, J. A., Parce, P. B., Martinez, A. et al.: Caloric intake in medical ICU patients: consistency of care with guidelines and relationship to clinical outcomes. Chest, 2003, 124, s. 297–305.

8. Zaloga, C. P.: Early enteral nutritional support improves ourcome: hypothesis or fact? Crit. Care Med., 1999, 27, s. 259–261.

9. Villet, S., Chiolero, R. L., Bollmann, M. D. et al.: Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients. Clin. Nutr., 2005, 24, s. 502–509.

10. Galban, C., Montejo, J. C., Mesejo, A. et al.: An immune-enhancing enteral diet reduces mortality rate and episodes of bacteremia in septic intensive care patients. Crit. Care Med., 2000, 28, s. 643–648.

11. Bower, R. H., Cerra, F. B., Bershadsky, B. et al.: Early enteral administration of formula (impact) supplemented with arginine, nucleotides, and fish oil in intensive care unit patients; results of muticenter, prospective, randomized clinical trial. Clin. Care Med., 1995, 23, s. 436–439.

12. Bertolini, G., Iapichino, G., Radrizzani, D. et al.: Early enteral immunonutrition in patients with severe sepsis; results of an interim analysis of a randomized multicenter clinical trial. Intensive Care Med., 2003, 29, s. 834–840.

13. Boivin, M. A., Levy, H.: Gastric feeding with erythromycin in equivalent to transpyloric feeding in the critically ill. Crit. Care Med., 2001, 29, s. 1916–1919.

14. Day, L., Stotts, N. A, Frankfurt, A. et al.: Gastric versus duodenal feeding in patients with neurological disease: a pilot study. J. Neurosci. Nurs., 2001, 33, s. 148–149.

15. Montejo, J. C., Grau, T., Acosta, J. et al.: Multicenter, prospective, randomized, single-blind study comparing the efficacy and gastrointestinal complications of early jujunal feeding with early gastric feeding in critically ill patients. Crit. Care Med., 2002, 30, s. 796–800.

16. Montecalvo, M. A., Steger, K. A., Farber, H. W. et al.: Nutritional outcome and pneumonia in critical care patients randomized to gastric versus jejunal feedings The Critical Care Research Team. Crit. Care Med., 1992, 20, s. 1377–1387.

17. Taylor, S. J., Fettes, S. B., Jewkes, C., Nelson, R. J.: Prospective, randomized, controlled trial to determine the effect of early enhanced enteral nutrition on clinical outcome in mechanically ventilated patients suffering head injury. Crit. Care Med., 1999, 27, s. 2525–2531.

18. Woien, H.: Nutrition of the critically ill patient and effects of implementing a nutritional support algorithm in ICU. J. Clin. Nurs., 2006, 15, s. 168–177.

Štítky
Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management Dental Hygienist

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Journal of Czech Physicians

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