Research Article
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Factors Affecting Nutrition Intolerance in Intensive Care Patients and Their Relationship with Mortality: A Prospective Observational Clinical Research

Year 2020, Volume: 22 Issue: 1, 20 - 29, 30.04.2020
https://doi.org/10.24938/kutfd.634079

Abstract

Objective: Nutrition is of great importance in intensive care patients. Adequate nutritional support increases recovery rates while decreasing mortality/morbidity. The aim of this study was to identify the factors that prevent patients from reaching the targeted calories when they receive nutritional support and to demonstrate the effects of nutritional intolerance/insufficiency on mortality and morbidity.
Material and Methods: This is an observational study involving 80 patients over the age of 18 who were admitted to the intensive care unit between September 2017-September 2018. Thirteen of the 80 patients were excluded from the study because only parenteral support was given. Patients were divided into two groups as the patients who did not receive 50%or more of the targeted calories for the first 4 days by enteral pathway (Group 1) and patients who did (Group 2). Demographic data, Apache II, SOFA, Glasgow scores, reason for admission, vasopressor /nutritional support, nausea-vomiting, reflux, diarrhea, the accession to four day calorie needs and access path, respiratory support, dialysis requirement, ulcer prophylaxis and mortality of the patients were recorded.
Results: In Group1 (n=30), the target calories could not be reached by the enteral way, while enteral nutrition was sufficient in Group 2 (n=37). There was no difference between the groups in demographic data. Also, 80.5% (n=54) of the patients received ventilator support and 12.9% (n=7) tracheostomy support. There was no significant difference between the groups in terms of respiratory support, bacterial culture, vasopressor support, mortality and length of hospitalization.
Conclusion: Nutrition is of great importance for healing. It was observed that enteral nutrition helps to reach the need for energy without adding additional morbidity in a way that does not lead to nutritional intolerance/insufficiency. Although it is associated with mortality in studies on nutritional intolerance, there was no relationship of nutritional intolerance with mortality and intensive care hospitalization.

Project Number

-

References

  • 1. Deane A, Chapman MJ, Fraser RJ, Bryant LK, Burgstad C, Nguyen NQ. Mechanisms underlying feed intolerance in the critically ill: implications for treatment. World J Gastroenterol. 2007;13(29):3909-17.
  • 2. Singer P, Weinberger H, Tadmor B. Which nutritional regimen for the comorbid complex intensive care unit patient? World Rev Nutr Diet. 2013;105(1):169-78.
  • 3. Reintam Blaser A, Malbrain ML, Starkopf J, Fruhwald S, Jakob SM, De Waele J et al. Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems. Intensive Care Med. 2012;38(3):384-94.
  • 4. Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38(1):48-79.
  • 5. Singer P, Hiesmayr M, Biolo G, Felbinger TW, Berger MM, Goeters C et al. Pragmatic approach to nutrition in the ICU: expert opinion regarding which calorie protein target. Clin Nutr. 2014;33(2):246-51.
  • 6. Gungabissoon U, Hacquoil K, Bains C, Irizarry M, Dukes G, Williamson R et al. Prevalence, risk factors, clinical consequences, and treatment of enteral feed intolerance during critical illness. JPEN J Parenter Enteral Nutr. 2015;39(4):441-8.
  • 7. Reintam A, Parm P, Kitus R, Starkopf J, Kern H. Gastrointestinal failure score in critically ill patients: a prospective observational study. Crit Care. 2008;12(4):R90.
  • 8. Reignier J, Mercier E, Le Gouge A, Boulain T, Desachy A, Bellec F et al. 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(3):249-56.
  • 9. Tsai CL, Lin YH, Wang MT, Chien LN, Jeng C, Chian CF et al. Gastro-oesophageal reflux disease increases the risk of intensive care unit admittance and mechanical ventilation use among patients with chronic obstructive pulmonary disease: a nationwide population-based cohort study. Crit Care. 2015;19(1):110.
  • 10. Casaer MP, Mesotten D, Hermans G, Wouters PJ, Schetz M, Meyfroidt G et al. Early versus late parenteral nutrition in critically ill adults. N Engl J Med. 2011;365(6):506-17.
  • 11. Secombe P, Harley S, Chapman M, Aromataris E. Feeding the critically ill obese patient: a systematic review protocol. JBI Database System Rev Implement Rep. 2015;13(10):95-109.
  • 12. Jakob SM, Butikofer L, Berger D, Coslovsky M, Takala J. A randomized controlled pilot study to evaluate the effect of an enteral formulation designed to improve gastrointestinal tolerance in the critically ill patient-the SPIRIT trial. Crit Care. 2017;21(1):140.
  • 13. Nasiri M, Farsi Z, Ahangari M, Dadgari F. Comparison of intermittent and bolus enteral feeding methods on enteral feeding intolerance of patients with sepsis: A triple-blind controlled trial in intensive care units. Middle East J Dig Dis. 2017;9(4):218-27.
  • 14. Lavrentieva A, Kontakiotis T, Bitzani M. Enteral nutrition intolerance in critically ill septic burn patients. J Burn Care Res. 2014;35(4):313-8.
  • 15. Reintam Blaser A, Poeze M, Malbrain ML, Bjorck M, Oudemans-van Straaten HM, Starkopf J et al. Gastrointestinal symptoms during the first week of intensive care are associated with poor outcome: a prospective multicentre study. Intensive Care Med. 2013;39(5):899-909.
  • 16. Reintam A, Parm P, Kitus R, Kern H, Starkopf J. Gastrointestinal symptoms in intensive care patients. Acta Anaesthesiol Scand. 2009;53(3):318-24.
  • 17. Kusunoki H, Kusaka M, Kido S, Yamauchi R, Fujimura Y, Watanabe Y et al. Comparison of the effects of omeprazole and famotidine in treatment of upper abdominal symptoms in patients with reflux esophagitis. J Gastroenterol. 2009;44(4):261-70.
  • 18. Lanas-Gimeno A, Hijos G, Lanas A. Proton pump inhibitors, adverse events and increased risk of mortality. Expert Opin Drug Saf. 2019;18(11):1043-53.

YOĞUN BAKIM HASTALARINDA BESLENME İNTOLERANSINA ETKİ EDEN FAKTÖRLER VE MORTALİTE İLE İLİŞKİSİ: PROSPEKTİF GÖZLEMSEL KLİNİK ARAŞTIRMA

Year 2020, Volume: 22 Issue: 1, 20 - 29, 30.04.2020
https://doi.org/10.24938/kutfd.634079

Abstract

Amaç: Yoğun bakım hastalarında beslenme büyük bir öneme sahiptir. Hastaların yeterli beslenme desteği alması iyileşme oranlarını artırdığı gibi mortalite ve morbiditeyi de düşürmektedir. Bu çalışmanın amacı hastaların yoğun bakımda beslenme desteği aldığında, hedeflenen kaloriye ulaşmasına engel olan faktörlerini ortaya koymak, varsa beslenme intoleransı ve yetersizliğinin mortalite ve morbitide üzerine etkilerini belirlemektir.
Gereç ve Yöntemler: Eylül 2017- Eylül 2018 tarihleri arasında yoğun bakım ünitesine kabul edilen 18 yaş üstü 80 hastanın dâhil edildiği prospektif gözlemsel bir araştırmadır. Seksen hastanın 13’üne sadece parenteral destek verildiğinden çalışma dışı bırakıldı. Hastalar enteral yolla ilk 4 gün hedeflenen kalorinin %50 ve fazlasını alamayan (Grup 1) ve alan (Grup 2) olarak ikiye ayrıldı. Hastaların yaş cinsiyet, boy, kilo, APACHE II, SOFA, Glaskow skorları, yatış nedeni, vazopressör desteği, beslenme desteği, bulantı-kusma, reflü, diyare varlığı, dört günlük kalori ihtiyacına erişimi, solunum desteği, bası yarası, diyaliz gereksinimi, dört günlük kaloriye erişim yolu, ülser proflaksisi, yatış süresi ve mortalite kayıt altına alındı.
Bulgular: Grup 1 (n=30) hastada, hedef kaloriye enteral yol ile ulaşılamazken Grup 2 (n=37) hastada enteral beslenmenin yeterli olduğu görüldü. Gruplar arasında yaş, cinsiyet, boy, kilo, VKİ, APACHE II, SOFA ve Glaskow skorları arasında fark olmadığı tespit edildi. Hastaların %80.5 (n=54) mekanik ventilatör desteği, %12.9 (n=7) trakeostomi ile destek aldığı görüldü. Mekanik ventilatör desteği almayan hastalarda %19.5 (n=13) hastanın noninvaziv ventilatasyon desteği aldığı görüldü. Solunum desteği açısından gruplar arasında anlamlı fark saptanmadı. Hastaların kültürde üreme, vazopressör desteği, mortalite ve yatış süresi açısından anlamlı fark saptanmadı.
Sonuç: Hastaların iyileşme sürecine katkıda bulunmak için beslenme büyük önem arz eder. Bu çalışmada da enteral beslenmenin, beslenme intoleransı ve yetersizliğine yol açmayacak şekilde hastanın gereksinimi olan enerji ihtiyacına ek morbidite eklemeden ulaşmasına yardımcı olduğu görülmüştür. Beslenme intoleransı hakkında yapılan çalışmalarda mortalite ile ilişkilendirilse de çalışmanın sonuçlarında mortalite ve yoğun bakım yatış süreleri ile beslenme intoleransı arasında ilişki bulunmamıştır.

Supporting Institution

Destekleyen Kurum / Kuruluş yoktur

Project Number

-

Thanks

Yazarlar, cerrahi yoğun bakım sorumlu hekimi Doç. Dr. İbrahim Tayfun Şahiner’e çalışma süresince vermiş olduğu değerli katkılardan dolayı teşekkür eder.

References

  • 1. Deane A, Chapman MJ, Fraser RJ, Bryant LK, Burgstad C, Nguyen NQ. Mechanisms underlying feed intolerance in the critically ill: implications for treatment. World J Gastroenterol. 2007;13(29):3909-17.
  • 2. Singer P, Weinberger H, Tadmor B. Which nutritional regimen for the comorbid complex intensive care unit patient? World Rev Nutr Diet. 2013;105(1):169-78.
  • 3. Reintam Blaser A, Malbrain ML, Starkopf J, Fruhwald S, Jakob SM, De Waele J et al. Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems. Intensive Care Med. 2012;38(3):384-94.
  • 4. Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38(1):48-79.
  • 5. Singer P, Hiesmayr M, Biolo G, Felbinger TW, Berger MM, Goeters C et al. Pragmatic approach to nutrition in the ICU: expert opinion regarding which calorie protein target. Clin Nutr. 2014;33(2):246-51.
  • 6. Gungabissoon U, Hacquoil K, Bains C, Irizarry M, Dukes G, Williamson R et al. Prevalence, risk factors, clinical consequences, and treatment of enteral feed intolerance during critical illness. JPEN J Parenter Enteral Nutr. 2015;39(4):441-8.
  • 7. Reintam A, Parm P, Kitus R, Starkopf J, Kern H. Gastrointestinal failure score in critically ill patients: a prospective observational study. Crit Care. 2008;12(4):R90.
  • 8. Reignier J, Mercier E, Le Gouge A, Boulain T, Desachy A, Bellec F et al. 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(3):249-56.
  • 9. Tsai CL, Lin YH, Wang MT, Chien LN, Jeng C, Chian CF et al. Gastro-oesophageal reflux disease increases the risk of intensive care unit admittance and mechanical ventilation use among patients with chronic obstructive pulmonary disease: a nationwide population-based cohort study. Crit Care. 2015;19(1):110.
  • 10. Casaer MP, Mesotten D, Hermans G, Wouters PJ, Schetz M, Meyfroidt G et al. Early versus late parenteral nutrition in critically ill adults. N Engl J Med. 2011;365(6):506-17.
  • 11. Secombe P, Harley S, Chapman M, Aromataris E. Feeding the critically ill obese patient: a systematic review protocol. JBI Database System Rev Implement Rep. 2015;13(10):95-109.
  • 12. Jakob SM, Butikofer L, Berger D, Coslovsky M, Takala J. A randomized controlled pilot study to evaluate the effect of an enteral formulation designed to improve gastrointestinal tolerance in the critically ill patient-the SPIRIT trial. Crit Care. 2017;21(1):140.
  • 13. Nasiri M, Farsi Z, Ahangari M, Dadgari F. Comparison of intermittent and bolus enteral feeding methods on enteral feeding intolerance of patients with sepsis: A triple-blind controlled trial in intensive care units. Middle East J Dig Dis. 2017;9(4):218-27.
  • 14. Lavrentieva A, Kontakiotis T, Bitzani M. Enteral nutrition intolerance in critically ill septic burn patients. J Burn Care Res. 2014;35(4):313-8.
  • 15. Reintam Blaser A, Poeze M, Malbrain ML, Bjorck M, Oudemans-van Straaten HM, Starkopf J et al. Gastrointestinal symptoms during the first week of intensive care are associated with poor outcome: a prospective multicentre study. Intensive Care Med. 2013;39(5):899-909.
  • 16. Reintam A, Parm P, Kitus R, Kern H, Starkopf J. Gastrointestinal symptoms in intensive care patients. Acta Anaesthesiol Scand. 2009;53(3):318-24.
  • 17. Kusunoki H, Kusaka M, Kido S, Yamauchi R, Fujimura Y, Watanabe Y et al. Comparison of the effects of omeprazole and famotidine in treatment of upper abdominal symptoms in patients with reflux esophagitis. J Gastroenterol. 2009;44(4):261-70.
  • 18. Lanas-Gimeno A, Hijos G, Lanas A. Proton pump inhibitors, adverse events and increased risk of mortality. Expert Opin Drug Saf. 2019;18(11):1043-53.
There are 18 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Articles
Authors

Yeliz Şahiner 0000-0002-5377-3870

Cihangir Doğu 0000-0003-2581-541X

Serhat Özçiftçi 0000-0002-9699-4374

Güvenç Doğan This is me 0000-0001-7351-8968

Özgür Yağan This is me 0000-0003-1596-1421

Emre Demir This is me 0000-0002-3834-3864

Project Number -
Publication Date April 30, 2020
Submission Date October 16, 2019
Published in Issue Year 2020 Volume: 22 Issue: 1

Cite

APA Şahiner, Y., Doğu, C., Özçiftçi, S., Doğan, G., et al. (2020). YOĞUN BAKIM HASTALARINDA BESLENME İNTOLERANSINA ETKİ EDEN FAKTÖRLER VE MORTALİTE İLE İLİŞKİSİ: PROSPEKTİF GÖZLEMSEL KLİNİK ARAŞTIRMA. The Journal of Kırıkkale University Faculty of Medicine, 22(1), 20-29. https://doi.org/10.24938/kutfd.634079
AMA Şahiner Y, Doğu C, Özçiftçi S, Doğan G, Yağan Ö, Demir E. YOĞUN BAKIM HASTALARINDA BESLENME İNTOLERANSINA ETKİ EDEN FAKTÖRLER VE MORTALİTE İLE İLİŞKİSİ: PROSPEKTİF GÖZLEMSEL KLİNİK ARAŞTIRMA. Kırıkkale Uni Med J. April 2020;22(1):20-29. doi:10.24938/kutfd.634079
Chicago Şahiner, Yeliz, Cihangir Doğu, Serhat Özçiftçi, Güvenç Doğan, Özgür Yağan, and Emre Demir. “YOĞUN BAKIM HASTALARINDA BESLENME İNTOLERANSINA ETKİ EDEN FAKTÖRLER VE MORTALİTE İLE İLİŞKİSİ: PROSPEKTİF GÖZLEMSEL KLİNİK ARAŞTIRMA”. The Journal of Kırıkkale University Faculty of Medicine 22, no. 1 (April 2020): 20-29. https://doi.org/10.24938/kutfd.634079.
EndNote Şahiner Y, Doğu C, Özçiftçi S, Doğan G, Yağan Ö, Demir E (April 1, 2020) YOĞUN BAKIM HASTALARINDA BESLENME İNTOLERANSINA ETKİ EDEN FAKTÖRLER VE MORTALİTE İLE İLİŞKİSİ: PROSPEKTİF GÖZLEMSEL KLİNİK ARAŞTIRMA. The Journal of Kırıkkale University Faculty of Medicine 22 1 20–29.
IEEE Y. Şahiner, C. Doğu, S. Özçiftçi, G. Doğan, Ö. Yağan, and E. Demir, “YOĞUN BAKIM HASTALARINDA BESLENME İNTOLERANSINA ETKİ EDEN FAKTÖRLER VE MORTALİTE İLE İLİŞKİSİ: PROSPEKTİF GÖZLEMSEL KLİNİK ARAŞTIRMA”, Kırıkkale Uni Med J, vol. 22, no. 1, pp. 20–29, 2020, doi: 10.24938/kutfd.634079.
ISNAD Şahiner, Yeliz et al. “YOĞUN BAKIM HASTALARINDA BESLENME İNTOLERANSINA ETKİ EDEN FAKTÖRLER VE MORTALİTE İLE İLİŞKİSİ: PROSPEKTİF GÖZLEMSEL KLİNİK ARAŞTIRMA”. The Journal of Kırıkkale University Faculty of Medicine 22/1 (April 2020), 20-29. https://doi.org/10.24938/kutfd.634079.
JAMA Şahiner Y, Doğu C, Özçiftçi S, Doğan G, Yağan Ö, Demir E. YOĞUN BAKIM HASTALARINDA BESLENME İNTOLERANSINA ETKİ EDEN FAKTÖRLER VE MORTALİTE İLE İLİŞKİSİ: PROSPEKTİF GÖZLEMSEL KLİNİK ARAŞTIRMA. Kırıkkale Uni Med J. 2020;22:20–29.
MLA Şahiner, Yeliz et al. “YOĞUN BAKIM HASTALARINDA BESLENME İNTOLERANSINA ETKİ EDEN FAKTÖRLER VE MORTALİTE İLE İLİŞKİSİ: PROSPEKTİF GÖZLEMSEL KLİNİK ARAŞTIRMA”. The Journal of Kırıkkale University Faculty of Medicine, vol. 22, no. 1, 2020, pp. 20-29, doi:10.24938/kutfd.634079.
Vancouver Şahiner Y, Doğu C, Özçiftçi S, Doğan G, Yağan Ö, Demir E. YOĞUN BAKIM HASTALARINDA BESLENME İNTOLERANSINA ETKİ EDEN FAKTÖRLER VE MORTALİTE İLE İLİŞKİSİ: PROSPEKTİF GÖZLEMSEL KLİNİK ARAŞTIRMA. Kırıkkale Uni Med J. 2020;22(1):20-9.

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