Clinical Nutrition Research

  • 제7권2호
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  • Pages.136-145
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  • 2018
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  • 2287-3732(pISSN)
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  • 2287-3740(eISSN)
한국임상영양학회 (The Korean Society of Clinical Nutrition)
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Nutritional Care in Iranian Intensive Care Units

  • Shabanpur, Maryam (Student Research Committee, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences) ;
  • Nachvak, Seyed Mostafa (Nutritional Sciences Department, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences) ;
  • Moradi, Shima (Student Research Committee, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences) ;
  • Hedayati, Safora (Student Research Committee, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences) ;
  • Hosseinikia, Mahboobe (Student Research Committee, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences) ;
  • Pasdar, Yahya (Nutritional Sciences Department, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences) ;
  • Gholizadeh, Shahrbanoo (Student Research Committee, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences) ;
  • Samadi, Mehnoosh (Nutritional Sciences Department, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences)
  • 투고 : 2018.02.21
  • 심사 : 2018.04.18
  • 발행 : 2018.04.30
⟨ 이전 논문 다음 논문 ⟩

초록

Intensive care units (ICUs) provides intensive treatment medicine to avoid complications such as malnutrition, infection and even death. As very little is currently known about the nutritional practices in Iranian ICUs, this study attempted to assess the various aspects of current nutrition support practices in Iranian ICUs. We conducted a cross-sectional study on 150 critically ill patients at 18 ICUs in 12 hospitals located in 2 provinces of Iran from February 2015 to March 2016. Data were collected through interview with supervisors of ICUs, medical record reviews and direct observation of patients during feeding. Our study showed that hospital-prepared enteral tube feeding formulas are the main formulas used in Iranian hospitals. None of the dietitians worked exclusively an ICU and only 30% of patients received diet counselling. Regular monitoring of nutritional status, daily energy and protein intake were not recorded in any of the participating ICUs. Patients were not monitored for anthropometric measurements such as mid-arm circumference (MAC) and electrolyte status. The nasogastric tube was not switched to percutaneous endoscopic gastrostomy or jejunostomy (PEG/PEGJ) in approximately 85% of patients receiving long-term enteral nutrition (EN) support. Our findings demonstrated that the quality of nutritional care was inappropriate in Iranian ICUs and improvement of nutritional care services within Iranian ICUs is necessary.

키워드

과제정보

연구 과제 주관 기관 : Kermanshah University of Medical Sciences

참고문헌

  1. Priestley G, Watson W, Rashidian A, Mozley C, Russell D, Wilson J, Cope J, Hart D, Kay D, Cowley K, Pateraki J. Introducing Critical Care Outreach: a ward-randomized trial of phased introduction in a general hospital. Intensive Care Med 2004;30:1398-404.
  2. Badjatia N, Vespa PParticipants of the International Multi-disciplinary Consensus Conference on Multimodality Monitoring. Monitoring nutrition and glucose in acute brain injury. Neurocrit Care 2014;21 Suppl 2:S159-67. https://doi.org/10.1007/s12028-014-0036-2
  3. Anwar F. Nutritional management in critically ill trauma patients is challenging. Trauma 2016;18:231-6. https://doi.org/10.1177/1460408615615598
  4. Ghorabi S, Shariatpanahi ZV. Effect of early enteral nutrition on clinical outcomes in an intensive care unit. Thrita 2014;3:e20905.
  5. Martindale RG, McClave SA, Vanek VW, McCarthy M, Roberts P, Taylor B, Ochoa JB, Napolitano L, Cresci GAmerican College of Critical Care MedicineA.S.P.E.N. Board of Directors. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition: Executive Summary. Crit Care Med 2009;37:1757-61. https://doi.org/10.1097/CCM.0b013e3181a40116
  6. Lee ZY, Barakatun-Nisak MY, Airini IN, Heyland DK. Enhanced protein-energy provision via the enteral route in critically ill patients (PEP uP Protocol): a review of evidence. Nutr Clin Pract 2016;31:68-79. https://doi.org/10.1177/0884533615601638
  7. Caporossi FS, Caporossi C, Borges Dock-Nascimento D, de Aguilar-Nascimento JE. Measurement of the thickness of the adductor pollicis muscle as a predictor of outcome in critically ill patients. Nutr Hosp 2012;27:490-5.
  8. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003;22:415-21. https://doi.org/10.1016/S0261-5614(03)00098-0
  9. Prins A. Nutritional assessment of the critically ill patient. South Afr J Clin Nutr 2010;23:11-8.
  10. Ferrie S, Allman-Farinelli M. Commonly used "nutrition" indicators do not predict outcome in the critically ill: a systematic review. Nutr Clin Pract 2013;28:463-84. https://doi.org/10.1177/0884533613486297
  11. O'Hanlon C, Dowsett J, Smyth N. Nutrition assessment of the intensive care unit patient. Top Clin Nutr 2015;30:47-70. https://doi.org/10.1097/TIN.0000000000000019
  12. Heyland DK, Schroter-Noppe D, Drover JW, Jain M, Keefe L, Dhaliwal R, Day A. Nutrition support in the critical care setting: current practice in canadian ICUs--opportunities for improvement? JPEN J Parenter Enteral Nutr 2003;27:74-83. https://doi.org/10.1177/014860710302700174
  13. Hegazi RA, Wischmeyer PE. Clinical review: optimizing enteral nutrition for critically ill patients-a simple data-driven formula. Crit Care 2011;15:234. https://doi.org/10.1186/cc10430
  14. Mokhalalati JK, Druyan ME, Shott SB, Comer GM. Microbial, nutritional and physical quality of commercial and hospital prepared tube feedings in Saudi Arabia. Saudi Med J 2004;25:331-41.
  15. Anderton A. Bacterial contamination of enteral feeds and feeding systems. Clin Nutr 1993;12:S16-32. https://doi.org/10.1016/S0261-5614(09)90005-X
  16. Jalali M, Sabzghabaee MA, Badri S, Soltani HA, Maracy MR. Bacterial contamination of hospital-prepared enteral tube feeding formulas in Isfahan, Iran. J Res Med Sci 2009;14:149-56.
  17. McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, McCarthy MS, Davanos E, Rice TW, Cresci GA, Gervasio JM, Sacks GS, Roberts PR, Compher CSociety of Critical Care MedicineAmerican Society for Parenteral and Enteral Nutrition. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr 2016;40:159-211. https://doi.org/10.1177/0148607115621863
  18. Weijs PJ, Stapel SN, de Groot SD, Driessen RH, de Jong E, Girbes AR, Strack van Schijndel RJ, Beishuizen A. Optimal protein and energy nutrition decreases mortality in mechanically ventilated, critically ill patients: a prospective observational cohort study. JPEN J Parenter Enteral Nutr 2012;36:60-8. https://doi.org/10.1177/0148607111415109
  19. Fraipont V, Preiser JC. Energy estimation and measurement in critically ill patients. JPEN J Parenter Enteral Nutr 2013;37:705-13. https://doi.org/10.1177/0148607113505868
  20. McClave SA, Sexton LK, Spain DA, Adams JL, Owens NA, Sullins MB, Blandford BS, Snider HL. Enteral tube feeding in the intensive care unit: factors impeding adequate delivery. Crit Care Med 1999;27:1252-6. https://doi.org/10.1097/00003246-199907000-00003
  21. Yousefzadeh E, Pitchumoni C. Percutaneous endoscopic gastrostomy. In: Clavien PA, Sarr M, Fong Y, Miyazaki M, editors. Atlas of upper gastrointestinal and hepato-pancreato-biliary surgery. Berlin: Springer; 2016. p. 255-9.
  22. Davies AR, Morrison SS, Bailey MJ, Bellomo R, Cooper DJ, Doig GS, Finfer SR, Heyland DKENTERIC Study InvestigatorsANZICS Clinical Trials Group. A multicenter, randomized controlled trial comparing early nasojejunal with nasogastric nutrition in critical illness. Crit Care Med 2012;40:2342-8. https://doi.org/10.1097/CCM.0b013e318255d87e
  23. Acosta-Escribano J, Fernandez-Vivas M, Grau Carmona T, Caturla-Such J, Garcia-Martinez M, Menendez-Mainer A, Solera-Suarez M, Sanchez-Paya J. Gastric versus transpyloric feeding in severe traumatic brain injury: a prospective, randomized trial. Intensive Care Med 2010;36:1532-9. https://doi.org/10.1007/s00134-010-1908-3
  24. Hsu CW, Sun SF, Lin SL, Kang SP, Chu KA, Lin CH, Huang HH. Duodenal versus gastric feeding in medical intensive care unit patients: a prospective, randomized, clinical study. Crit Care Med 2009;37:1866-72. https://doi.org/10.1097/CCM.0b013e31819ffcda
  25. White H, Sosnowski K, Tran K, Reeves A, Jones M. A randomised controlled comparison of early post-pyloric versus early gastric feeding to meet nutritional targets in ventilated intensive care patients. Crit Care 2009;13:R187. https://doi.org/10.1186/cc8181
  26. Dhaliwal R, Cahill N, Lemieux M, Heyland DK. The Canadian critical care nutrition guidelines in 2013: an update on current recommendations and implementation strategies. Nutr Clin Pract 2014;29:29-43. https://doi.org/10.1177/0884533613510948
  27. Ellett ML. What is known about methods of correctly placing gastric tubes in adults and children. Gastroenterol Nurs 2004;27:253-9. https://doi.org/10.1097/00001610-200411000-00002
  28. Metheny NA, Titler MG. Assessing placement of feeding tubes. Am J Nurs 2001;101:36-45.
  29. Ibrahim EH, Mehringer L, Prentice D, Sherman G, Schaiff R, Fraser V, Kollef MH. Early versus late enteral feeding of mechanically ventilated patients: results of a clinical trial. JPEN J Parenter Enteral Nutr 2002;26:174-81. https://doi.org/10.1177/0148607102026003174
  30. MacLeod JB, Lefton J, Houghton D, Roland C, Doherty J, Cohn SM, Barquist ES. Prospective randomized control trial of intermittent versus continuous gastric feeds for critically ill trauma patients. J Trauma 2007;63:57-61. https://doi.org/10.1097/01.ta.0000249294.58703.11
  31. Shahriari M, Rezaei E, Bakht LA, Abbasi S. Comparison of the effects of enteral feeding through the bolus and continuous methods on blood sugar and prealbumin levels in ICU inpatients. J Educ Health Promot 2015;4:95.
  32. Steevens EC, Lipscomb A, Poole GV, Sacks GS. Comparison of continuous vs intermittent nasogastric enteral feeding in trauma patients: perceptions and practice. Nutr Clin Pract 2002;17:118-22. https://doi.org/10.1177/0115426502017002118
  33. Rees RG, Keohane PP, Grimble GK, Frost PG, Attrill H, Silk DB. Elemental diet administered nasogastrically without starter regimens to patients with inflammatory bowel disease. JPEN J Parenter Enteral Nutr 1986;10:258-62. https://doi.org/10.1177/0148607186010003258
  34. Ciocon JO, Galindo-Ciocon DJ, Tiessen C, Galindo D. Continuous compared with intermittent tube feeding in the elderly. JPEN J Parenter Enteral Nutr 1992;16:525-8. https://doi.org/10.1177/0148607192016006525
  35. Montejo JC, Minambres E, Bordeje L, Mesejo A, Acosta J, Heras A, Ferre M, Fernandez-Ortega F, Vaquerizo CI, Manzanedo R. Gastric residual volume during enteral nutrition in ICU patients: the REGANE study. Intensive Care Med 2010;36:1386-93. https://doi.org/10.1007/s00134-010-1856-y
  36. Reignier J, Mercier E, Le Gouge A, Boulain T, Desachy A, Bellec F, Clavel M, Frat JP, Plantefeve G, Quenot JP, Lascarrou JBClinical Research in Intensive Care and Sepsis (CRICS) Group. Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial. JAMA 2013;309:249-56. https://doi.org/10.1001/jama.2012.196377
  37. Kuppinger DD, Rittler P, Hartl WH, Ruttinger D. Use of gastric residual volume to guide enteral nutrition in critically ill patients: a brief systematic review of clinical studies. Nutrition 2013;29:1075-9. https://doi.org/10.1016/j.nut.2013.01.025
  38. Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med 2001;344:665-71. https://doi.org/10.1056/NEJM200103013440908
  39. Poulard F, Dimet J, Martin-Lefevre L, Bontemps F, Fiancette M, Clementi E, Lebert C, Renard B, Reignier J. Impact of not measuring residual gastric volume in mechanically ventilated patients receiving early enteral feeding: a prospective before-after study. JPEN J Parenter Enteral Nutr 2010;34:125-30. https://doi.org/10.1177/0148607109344745

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