AIM To determine the effects of implementing an enteral feeding protocol on the nutritional delivery and outcomes of intensive care patients.METHODS An uncontrolled, observational before-and-after study was performed ...AIM To determine the effects of implementing an enteral feeding protocol on the nutritional delivery and outcomes of intensive care patients.METHODS An uncontrolled, observational before-and-after study was performed in a tertiary mixed medical-surgical intensive care unit(ICU). In 2013, a nurse-driven enteral feeding protocol was developed and implemented in the ICU. Nutrition and outcome-related data from patients who were treated in the study unit from 2011-2012(the Before group) and 2014-2015(the After group) were obtained from a local electronic database, the national Population Registry and the hospital's Infection ControlService. Data from adult patients, readmissions excluded, who were treated for at least 7 d in the study unit were analysed. RESULTS In total, 231 patients were enrolled in the Before and 249 in the After group. The groups were comparable regarding demographics, patient profile, and severity of illness. Fewer patients were mechanically ventilated on admission in the After group(86.7% vs 93.1% in the Before group, P = 0.021). The prevalence of hospitalacquired infections, length of ICU stay and ICU, 30-and 60-d mortality did not differ between the groups. Patients in the After group had a lower 90-d(P = 0.026) and 120-d(P = 0.033) mortality. In the After group, enteral nutrition was prescribed less frequently(P = 0.039) on day 1 but significantly more frequently on all days from day 3. Implementation of the feeding protocol resulted in a higher cumulative amount of enterally(P = 0.049) and a lower cumulative amount of parenterally(P < 0.001) provided calories by day 7, with an overall reduction in caloric provision(P < 0.001). The prevalence of gastrointestinal symptoms was comparable in both groups, as was the frequency of prokinetic use. Underfeeding(total calories < 80% of caloric needs, independent of route) was observed in 59.4% of the study days Before vs 76.9% After(P < 0.001). Inclusion in the Before group, previous abdominal surgery, intraabdominal hypertension and the sum of gastr展开更多
目的分析早产儿营养领域的研究现状,为早产儿营养研究方向提供参考。方法以Web of Science核心合集为数据来源,检索1975年至2023年12月收录的早产儿营养研究相关文献,应用CiteSpace软件对文献进行可视化分析。结果经筛选后纳入2661篇文...目的分析早产儿营养领域的研究现状,为早产儿营养研究方向提供参考。方法以Web of Science核心合集为数据来源,检索1975年至2023年12月收录的早产儿营养研究相关文献,应用CiteSpace软件对文献进行可视化分析。结果经筛选后纳入2661篇文献,整体发文量呈上升趋势。发文量较多的国家有美国、英国、意大利等,主要研究机构有贝勒医学院和哥本哈根大学等;国内发文量最多的机构是上海交通大学。高频关键词有肠外营养、母乳、坏死性小肠结肠炎等;关键词聚类形成18个聚类标签。研究主要内容有早产儿肠外营养、肠内营养、坏死性小肠结肠炎及喂养不耐受等。结论早产儿营养研究呈上升趋势,早产儿的营养支持方案、降低早产儿并发症及营养护理等是未来早产儿营养研究的主要内容。展开更多
Gastroenterology(GE) used to be considered a subspecialty of internal medicine. Today, GE is generally recognized as a wide-ranging specialty incorporating capacities, such as hepatology, oncology and interventional e...Gastroenterology(GE) used to be considered a subspecialty of internal medicine. Today, GE is generally recognized as a wide-ranging specialty incorporating capacities, such as hepatology, oncology and interventional endoscopy, necessitating GEexpert differentiation. Although the European Board of Gastroenterology and Hepatology has defined specific expertise areas in Advanced endoscopy, hepatology, digestive oncology and clinical nutrition, training for the latter topic is lacking in the current hepatogastroenterology(HGE) curriculum. Given its relevance for HGE practice, and being at the core of gastrointestinal functioning, there is an obvious need for training in nutrition and related issues including the treatment of disease-related malnutrition and obesity and its associated metabolic derangements. This document aims to be a starting point for the integration of nutritional expertise in the HGE curriculum, allowing a central role in the management of malnutrition and obesity. We suggest minimum endpoints for nutritional knowledge and expertise in the standard curriculum and recommend a focus period of training in nutrition issues in order to produce well-trained HGE specialists. This article provides a road map for the organization of such a training program. We would highly welcome the World Gastroenterology Organisation, the European Board of Gastroenterology and Hepatology, the American Gastroenterology Association and other(inter)national Gastroenterology societies support the necessary certifications for this item in the HGE-curriculum.展开更多
BACKGROUND: Total parenteral nutrition (TPN) has been recognized as the mainstay of nutritional support in patients with severe hepatopancreatobiliary (HPB) diseases for decades. However, recent studies advocate the u...BACKGROUND: Total parenteral nutrition (TPN) has been recognized as the mainstay of nutritional support in patients with severe hepatopancreatobiliary (HPB) diseases for decades. However, recent studies advocate the utilization of endoscopic nasojejunal feeding tube placement (ENFTP), rather than the conventional approach. This study was designed to compare the clinical value of ENFTP and TPN in patients with severe HPB diseases. METHODS: Two groups of patients with severe HPB diseases were analyzed retrospectively. One group of 88 patients received ENFTP, and the other 96 received TPN. Routine blood levels, serum glucose and prealbumin, hepatic and renal function, serum lipid, and calcium were measured at baseline and after 1, 2, and 4 weeks of nutritional support. Also, complication rate, mortality, nutritional support time, mechanical ventilation time, mean length of time in intensive care unit, and duration of hospital stay were analyzed. RESULTS: After 4 weeks of nutritional support, the degree of recovery of red blood cells, prealbumin, and blood glucose was greater in the ENFTP than in the TPN group (P<0.05). Furthermore, the ENFTP group showed a lower incidence of septicemia, multiple organ dysfunction syndrome, peripancreatic infection, biliary infection, and nosocomial infection, in addition to shorter nutritional support time and hospital stay (P<0.05). CONCLUSIONS: ENFTP is much more effective than TPN in assisting patients with severe HPB diseases to recover from anemia, low prealbumin level, and high serum glucose, as well as in decreasing the rates of various infections (pulmonary infection excluded), multiple organ dysfunction syndrome rate, nutrition support time, and length of hospital stay. Therefore, ENFTP is safer and more economical for clinical application.展开更多
早期肠内营养(EEN)定义为患者住院后48 h内启动的肠内营养(EN),无关乎其剂量与类型。最近欧洲危重病学会(ESICM)聚焦成年重症患者经常被延迟肠内营养(DEN)的24种特殊临床情况,通过循证医学方法比较EEN与早期肠外营养及DEN的利弊,提出7...早期肠内营养(EEN)定义为患者住院后48 h内启动的肠内营养(EN),无关乎其剂量与类型。最近欧洲危重病学会(ESICM)聚焦成年重症患者经常被延迟肠内营养(DEN)的24种特殊临床情况,通过循证医学方法比较EEN与早期肠外营养及DEN的利弊,提出7条利于DEN推荐建议和17条利于EEN推荐建议,制定了《重症患者早期肠内营养:ESICM临床实践指南》并于2017年3月在Intensive Care Medicine杂志上发表。本文将介绍该指南的制定背景、推荐建议与理由。展开更多
目的探讨早产儿早期肠内微量喂养减少胃肠外营养相关性胆汁淤积(PNAC)的可行性和有效性。方法选择2012年1月至2013年12月成都市妇女儿童中心医院新生儿重症监护室(neonatal intensive care unit,NICU)需进行胃肠外静脉营养的早产儿63例...目的探讨早产儿早期肠内微量喂养减少胃肠外营养相关性胆汁淤积(PNAC)的可行性和有效性。方法选择2012年1月至2013年12月成都市妇女儿童中心医院新生儿重症监护室(neonatal intensive care unit,NICU)需进行胃肠外静脉营养的早产儿63例作为研究对象,其中,男38例,女25例,随机分为静脉营养加早期肠内微量喂养组(干预组)和完全静脉营养组(对照组)。干预前及干预后14d分别进行血清总胆红素(TBIL)、结合胆红素(DBIL)、血清总胆汁酸(TBA)、丙氨酸氨基转移酶(ALT)和天冬氨酸氨基转移酶(AST)检测,同时监测PNAC各项危险因素以及PNAC和喂养不耐受发病率。结果干预组PNAC主要危险因素均较对照组明显改善(P<0.05)。干预后,干预组TBIL、TBA以及肝酶各项指标均低于对照组(P<0.05)。两组PNAC和喂养不耐受发病率比较,差异无统计学意义(P>0.05)。结论早产儿早期肠内微量喂养可明显改善PNAC发病的危险因素,减轻胆汁淤积程度。展开更多
基金Supported by the Ministry of Education and Research of Estonia(IUT34-24)
文摘AIM To determine the effects of implementing an enteral feeding protocol on the nutritional delivery and outcomes of intensive care patients.METHODS An uncontrolled, observational before-and-after study was performed in a tertiary mixed medical-surgical intensive care unit(ICU). In 2013, a nurse-driven enteral feeding protocol was developed and implemented in the ICU. Nutrition and outcome-related data from patients who were treated in the study unit from 2011-2012(the Before group) and 2014-2015(the After group) were obtained from a local electronic database, the national Population Registry and the hospital's Infection ControlService. Data from adult patients, readmissions excluded, who were treated for at least 7 d in the study unit were analysed. RESULTS In total, 231 patients were enrolled in the Before and 249 in the After group. The groups were comparable regarding demographics, patient profile, and severity of illness. Fewer patients were mechanically ventilated on admission in the After group(86.7% vs 93.1% in the Before group, P = 0.021). The prevalence of hospitalacquired infections, length of ICU stay and ICU, 30-and 60-d mortality did not differ between the groups. Patients in the After group had a lower 90-d(P = 0.026) and 120-d(P = 0.033) mortality. In the After group, enteral nutrition was prescribed less frequently(P = 0.039) on day 1 but significantly more frequently on all days from day 3. Implementation of the feeding protocol resulted in a higher cumulative amount of enterally(P = 0.049) and a lower cumulative amount of parenterally(P < 0.001) provided calories by day 7, with an overall reduction in caloric provision(P < 0.001). The prevalence of gastrointestinal symptoms was comparable in both groups, as was the frequency of prokinetic use. Underfeeding(total calories < 80% of caloric needs, independent of route) was observed in 59.4% of the study days Before vs 76.9% After(P < 0.001). Inclusion in the Before group, previous abdominal surgery, intraabdominal hypertension and the sum of gastr
文摘目的分析早产儿营养领域的研究现状,为早产儿营养研究方向提供参考。方法以Web of Science核心合集为数据来源,检索1975年至2023年12月收录的早产儿营养研究相关文献,应用CiteSpace软件对文献进行可视化分析。结果经筛选后纳入2661篇文献,整体发文量呈上升趋势。发文量较多的国家有美国、英国、意大利等,主要研究机构有贝勒医学院和哥本哈根大学等;国内发文量最多的机构是上海交通大学。高频关键词有肠外营养、母乳、坏死性小肠结肠炎等;关键词聚类形成18个聚类标签。研究主要内容有早产儿肠外营养、肠内营养、坏死性小肠结肠炎及喂养不耐受等。结论早产儿营养研究呈上升趋势,早产儿的营养支持方案、降低早产儿并发症及营养护理等是未来早产儿营养研究的主要内容。
文摘Gastroenterology(GE) used to be considered a subspecialty of internal medicine. Today, GE is generally recognized as a wide-ranging specialty incorporating capacities, such as hepatology, oncology and interventional endoscopy, necessitating GEexpert differentiation. Although the European Board of Gastroenterology and Hepatology has defined specific expertise areas in Advanced endoscopy, hepatology, digestive oncology and clinical nutrition, training for the latter topic is lacking in the current hepatogastroenterology(HGE) curriculum. Given its relevance for HGE practice, and being at the core of gastrointestinal functioning, there is an obvious need for training in nutrition and related issues including the treatment of disease-related malnutrition and obesity and its associated metabolic derangements. This document aims to be a starting point for the integration of nutritional expertise in the HGE curriculum, allowing a central role in the management of malnutrition and obesity. We suggest minimum endpoints for nutritional knowledge and expertise in the standard curriculum and recommend a focus period of training in nutrition issues in order to produce well-trained HGE specialists. This article provides a road map for the organization of such a training program. We would highly welcome the World Gastroenterology Organisation, the European Board of Gastroenterology and Hepatology, the American Gastroenterology Association and other(inter)national Gastroenterology societies support the necessary certifications for this item in the HGE-curriculum.
文摘BACKGROUND: Total parenteral nutrition (TPN) has been recognized as the mainstay of nutritional support in patients with severe hepatopancreatobiliary (HPB) diseases for decades. However, recent studies advocate the utilization of endoscopic nasojejunal feeding tube placement (ENFTP), rather than the conventional approach. This study was designed to compare the clinical value of ENFTP and TPN in patients with severe HPB diseases. METHODS: Two groups of patients with severe HPB diseases were analyzed retrospectively. One group of 88 patients received ENFTP, and the other 96 received TPN. Routine blood levels, serum glucose and prealbumin, hepatic and renal function, serum lipid, and calcium were measured at baseline and after 1, 2, and 4 weeks of nutritional support. Also, complication rate, mortality, nutritional support time, mechanical ventilation time, mean length of time in intensive care unit, and duration of hospital stay were analyzed. RESULTS: After 4 weeks of nutritional support, the degree of recovery of red blood cells, prealbumin, and blood glucose was greater in the ENFTP than in the TPN group (P<0.05). Furthermore, the ENFTP group showed a lower incidence of septicemia, multiple organ dysfunction syndrome, peripancreatic infection, biliary infection, and nosocomial infection, in addition to shorter nutritional support time and hospital stay (P<0.05). CONCLUSIONS: ENFTP is much more effective than TPN in assisting patients with severe HPB diseases to recover from anemia, low prealbumin level, and high serum glucose, as well as in decreasing the rates of various infections (pulmonary infection excluded), multiple organ dysfunction syndrome rate, nutrition support time, and length of hospital stay. Therefore, ENFTP is safer and more economical for clinical application.
文摘早期肠内营养(EEN)定义为患者住院后48 h内启动的肠内营养(EN),无关乎其剂量与类型。最近欧洲危重病学会(ESICM)聚焦成年重症患者经常被延迟肠内营养(DEN)的24种特殊临床情况,通过循证医学方法比较EEN与早期肠外营养及DEN的利弊,提出7条利于DEN推荐建议和17条利于EEN推荐建议,制定了《重症患者早期肠内营养:ESICM临床实践指南》并于2017年3月在Intensive Care Medicine杂志上发表。本文将介绍该指南的制定背景、推荐建议与理由。
文摘目的探讨早产儿早期肠内微量喂养减少胃肠外营养相关性胆汁淤积(PNAC)的可行性和有效性。方法选择2012年1月至2013年12月成都市妇女儿童中心医院新生儿重症监护室(neonatal intensive care unit,NICU)需进行胃肠外静脉营养的早产儿63例作为研究对象,其中,男38例,女25例,随机分为静脉营养加早期肠内微量喂养组(干预组)和完全静脉营养组(对照组)。干预前及干预后14d分别进行血清总胆红素(TBIL)、结合胆红素(DBIL)、血清总胆汁酸(TBA)、丙氨酸氨基转移酶(ALT)和天冬氨酸氨基转移酶(AST)检测,同时监测PNAC各项危险因素以及PNAC和喂养不耐受发病率。结果干预组PNAC主要危险因素均较对照组明显改善(P<0.05)。干预后,干预组TBIL、TBA以及肝酶各项指标均低于对照组(P<0.05)。两组PNAC和喂养不耐受发病率比较,差异无统计学意义(P>0.05)。结论早产儿早期肠内微量喂养可明显改善PNAC发病的危险因素,减轻胆汁淤积程度。
