Gastrointestinal Dysfunction During Enteral Nutrition in Critically Ill Patients
Ключови думи
Резюме
Описание
Critical illness is typically associated with a catabolic stress state in which patients demonstrate a systemic inflammatory response coupled with complications of increased infectious morbidity, multiple organ dysfunction, prolonged hospitalization, and disproportionate mortality. Suspension of feeding and the resultant inability to reach nutritional goals is one complication of gastrointestinal (GI) dysfunction, but there are others (mucosal barrier disruption, altered motility, atrophy of the mucosa, and reduced mass of gut-associated lymphoid tissue) that may explain the greater length of stay (LOS) and death rate with GI dysfunction. In Europe and the United States, nutritional administration guidelines recommend primarily enteral nutrition (EN) for hemodynamically stable intensive care unit (ICU) patients. Providing EN in these patients has been shown to be superior to parenteral nutrition. GI complications such as constipation, delayed gastric emptying, diarrhea, and vomiting may occur in up to 50% of mechanically ventilated patients and adversely affect ICU mortality and LOS. Nevertheless, there is no consensus for obtaining a precise assessment of GI function.Diagnosis of GI dysfunction in ICU patients is complex and relies on clinical symptoms. Lack of validated markers of GI system dysfunction is often misdiagnosed and poorly managed in the ICU. The role of nutrition in critical illness is important, but there is an increasing evidence and broadening consensus that aggressive early feeding as well as prolonged underfeeding both should be avoided. Avoidance of complications like malnutrition, aspiration of gastric contents, wound infections, and decubitus through GI dysfunction is an important part of management of patients with GI failure.
Дати
Последна проверка: | 06/30/2019 |
Първо изпратено: | 07/03/2019 |
Очаквано записване подадено: | 07/08/2019 |
Първо публикувано: | 07/09/2019 |
Изпратена последна актуализация: | 07/08/2019 |
Последна актуализация публикувана: | 07/09/2019 |
Действителна начална дата на проучването: | 12/31/2014 |
Приблизителна дата на първично завършване: | 06/30/2015 |
Очаквана дата на завършване на проучването: | 06/30/2015 |
Състояние или заболяване
Интервенция / лечение
Other: MDR bacteria positivity
Other: negative fluid balance
Фаза
Групи за ръце
Arm | Интервенция / лечение |
---|---|
Group I Patients who had GI dysfunction (Group I) for one or more occasions. | |
Group II Patients who had normal GI function (Group II) for one or more occasions. |
Критерии за допустимост
Възрасти, отговарящи на условията за проучване | 18 Years Да се 18 Years |
Полове, допустими за проучване | All |
Метод за вземане на проби | Probability Sample |
Приема здрави доброволци | Да |
Критерии | Inclusion Criteria: Older than 18 years old. Stay longer than 48 hours at ICU. Exclusion Criteria: Has enterostomy/colostomy or diagnosis of GI bleeding. Prone position. Laxative drug use. Clostridium Difficile infection positivity. |
Резултат
Първични изходни мерки
1. The incidence of GI dysfunction [up to 14 days.]
Вторични изходни мерки
1. The sequential organ failure assessment(SOFA) score [at admission.]
2. Hypoalbuminemia [up to 14 days.]
3. Catecholamine use [up to 14 days.]
4. Length of hospital stay [through study completion, which is 6 months time period.]