Rate Of Feeding Intolerance Research Articles

Feeding intolerance during prolonged prone position in overweight and obese patients with severe COVID-19.

the aim of this study was to compare the incidence rate of feeding intolerance (FI) during supine (SP) or prone positioning (PP) in critically ill COVID-19 patients. this was a retrospective cohort study of critically ill patients with overweight or obesity who received enteral nutrition (EN) in prone or supine positioning continuously during the first five days of mechanical ventilation. Nutritional risk, anthropometric measurements and body composition were assessed at the first 24 hours upon Intensive Care Unit (ICU) admission. Biochemical and clinical variables (Sequential Organ Failure Assessment [SOFA], Acute Physiology and Chronic Health Evaluation II [APACHE II], Acute Kidney Injury [AKI] or comorbidities diagnosis) were collected. Pharmacotherapy (prokinetics, sedatives or neuromuscular blocking agents) and FI incidence (gastric residual volume [GRV] ≥ 200 ml or ≥ 500 ml, vomiting or diarrhea) were daily recorded. Constipation was defined as the absence of evacuation for five consecutive days. eighty-two patients were included. Higher rate of prophylactic prokinetic prescription was observed in PP (42.8 vs 12.5 %, p = 0.002). GRV ≥ 200 in supine position was not different when compared to PP (p = 0.47). Vomiting episodes in supine compared to PP showed no difference between groups (15 % vs 24 %, p = 0.31). No differences in diarrhea events were detected (10 % vs 4.7 %, p = 0.36). Constipation was common in both groups (95 % vs 82 %, p = 0.06). FI during prone position was not different in comparison to supine position. Routinely use of prokinetics in continuous prone position may help to prevent FI incidence. Algorithm development is necessary for FI prevention and treatment so to avoid EN interruptions and adverse clinical outcomes.

Effects of Preoperative Oral Nutritional Supplements on Improving Postoperative Early Enteral Feeding Intolerance and Short-Term Prognosis for Gastric Cancer: A Prospective, Single-Center, Single-Blind, Randomized Controlled Trial.

Background: Early enteral nutrition (EN) after abdominal surgery can improve the prognosis of patients. However, the high feeding intolerance (FI) rate is the primary factor impeding postoperative EN. Methods: Sixty-seven patients who underwent radical subtotal or total gastrectomy for gastric cancer (GC) were randomly allocated to the preoperative oral nutritional supplement group (ONS group) or dietary advice alone (DA group). Both groups were fed via nasojejunal tubes (NJs) from the first day after surgery to the fifth day. The primary endpoint is the FI rate. Results: Of the patients, 66 completed the trial (31 in the ONS group, 35 in the DA group). The FI rate in the ONS group was lower than that in the DA group (25.8% vs. 31.4%, p = 0.249). The postoperative five-day 50% energy compliance rate in the ONS group was higher than that in the DA group (54.8% vs. 48.6%, p = 0.465). The main gastrointestinal intolerance symptoms were distension (ONS vs. DA: 45.2% vs. 62.9, p = 0.150) and abdominal pain (ONS vs. DA: 29.0% vs. 45.7%, p = 0.226). Postoperative nausea/vomiting rate and heartburn/reflux rate were similar between the two groups. We noted no difference in perioperative serum indices, short-term prognosis or postoperative complication rates between the two groups. Conclusions: The study shows that short-term preoperative ONS cannot significantly improve FI and the energy compliance rate in the early stage after radical gastrectomy.

Hypermagnesemia and feeding intolerance in preterm infants: A cohort study.

Feeding intolerance (FI) is a common clinical problem in preterm infants often caused by some neonatal disorders and drugs, including antenatal exposure to magnesium sulfate (MgSO4 ). To evaluate the association between hypermagnesemia at birth and FI in preterm infants during the first 72 h of life. This was a cohort study conducted with preterm infants aged <34 weeks' gestation. Infants presenting at least two of the following signs were considered as having FI: vomiting, abdominal distension, the need for continuous intermittent feeding, and delayed meconium passage. Hypermagnesemia was characterized by umbilical serum Mg levels > 2.5 mEq/L. A total 251 infants were evaluated. The median birth weight and gestational age were 1390 g (IQR, 1020-1070) and 31 weeks (IQR, 28-32). The FI rate was 17.5%. The exposure rate to MgSO4 was similar in the tolerant and intolerant groups (53.1% × 63.6%; P = 0.204), but hypermagnesemia was more frequent in the FI group (40.9% × 24.2%; P = 0.024). The univariate analysis showed that infants with hypermagnesemia were twofold more likely to present FI (odds ratio [OR], 2.16; 95% CI, 1.09-4.26). In the multiple logistic regression analysis, we found that hypermagnesemia was independently associated with FI (OR, 2.51; 95% CI, 1.06-5.91), as well as maternal diabetes mellitus (OR, 2.56; 95% CI, 1.07-6.14), Score for Neonatal Acute Physiology-Perinatal Extension II (OR, 1.051; 95% CI, 1.025-1.078), and brain hemorrhage (OR, 3.61; 95% CI, 1.31-9.91). In addition to other factors, hypermagnesemia at birth was independently associated with early FI in preterm infants.

Early feeding after percutaneous endoscopic gastrostomy tube placement in patients who require trauma and surgical intensive care: A retrospective cohort study.

Critically ill patients experience interruptions in enteral nutrition (EN). For ventilated patients who undergo percutaneous endoscopic gastrostomy (PEG) tube placement, postprocedure fasting times vary from 1 to 24 h depending on the surgeon's preference. There is no evidence to support delayed feeding (DF) after PEG placement. This study's purpose was to determine if there is an increased complication rate associated with early feeding (EF) after PEG. 150 adult ventilated patients in the trauma and surgical intensive care unit (TSICU) at a level I trauma center underwent PEG placement in March 2015 through May 2018 by one of six surgical intensivists. Retrospective review revealed variable post-PEG fasting practices: one started EN at 1 h, two started at 4 h, two started at 6 h, and one started at 24 h. Time to initiation of EN and complication rates were assessed. Patients were divided into EF (<4) and DF (≥4 h) groups. Median postprocedure fasting time was 5.5 h. The overall complication rate was 3.3%, with a feeding intolerance rate of 0.7% and aspiration rate of 0%. There was no difference in complication rate for EF (3.1%) as compared with DF (3.4%) (odds ratio, 0.92; 95% CI, 0.10-8.52; P = 0.7). Complication rates following PEG placement in ventilated TSICU patients are low and do not change with EF compared with DF. EF is probably safe.

Effects of Family Participatory Nursing on Clinical Outcomes of Premature Infants in NICU and Families' Psychological Status.

The purpose of this study was to explore the effects of family participatory nursing on the clinical outcomes of premature infants in the neonatal intensive care unit (NICU) and their families' psychological status. Total of 150 premature infants were admitted to the NICU of our hospital from December 2019 to December 2021, and their families were selected by convenience sampling method and divided into control group (n = 78, from December 2019 to December 2020) and observation group (n = 72, from January 2020 to December 2021) according to the admission time. The infants in the control group were given routine nursing, while those in the observation group received family participatory nursing. In the observation group, the length of stay and duration of oxygen therapy were shorter, the weight gain speed was higher, and the incidence rate of nosocomial infection was lower than those in control groups (P < 0.05). The time of reaching full gastrointestinal feeding was earlier, the daily milk intake and exclusive breastfeeding rate were higher, and the feeding intolerance rate was lower in observation group than those in control group (P < 0.05). Observation group exhibited significantly higher body weight, Z-value of body weight, NBNA score at 7 d after hospitalization, 15-month mental development index (MDI), and psychomotor development index (PDI) scores than control group (P < 0.05). In addition, the families' somatization, depression and anxiety factor scores, and total score of SCL-90 in the observation group were lower than those in the control group, while each dimension score and total score of MPOC-20 were higher than those in control groups (P < 0.05). Family participatory nursing is of great significance in ameliorating the clinical outcomes of premature infants in the NICU, which can shorten the length of stay, improve feeding conditions, facilitate infant growth and development, and enhance their families' psychological status and nursing satisfaction.

Effects of immediate or early oral feeding on acute pancreatitis: A systematic review and meta-analysis

BackgroundThe timing of oral refeeding can affect length of stay (LOS) and recovery of acute pancreatitis (AP). However, the optimal timing for oral refeeding is still controversial for AP. This meta-analysis investigated the effects of immediate or early versus delayed oral feeding on mild and moderate AP, regardless of improvement in clinical signs or laboratory indicators. MethodsThis systematic review and meta-analysis of randomized controlled trials (RCTs) based on data from Embase, Cochrane Library, PubMed, Web of science, and CBM before August 2021. Two researchers independently used Stata16 to extract and analyse study data. Random effect model was performed for meta-analysis to calculate the risk ratio (RR) and standardized mean difference (SMD). Results8 RCTs were selected, including 748 patients with mild to moderate AP. Patients in IOR (Immediate or early Oral Refeeding) group had less costs [SMD -0.83, 95%CI (−1.17, −0.5), P < 0.001] and shorter LOS [SMD -1.01, 95%CI (−1.17, −0.85), P < 0.001] than the DOR (Delayed Oral Refeeding) group patients. However, there was no difference in mortality [RR 0.54, 95%CI (0.11, 2.62), P = 0.44], pain relapse rate [RR 0.58, 95%CI (0.25, 1.35), P = 0.27], feeding intolerance rate [RR 0.61, 95%CI (0.28, 1.3), P = 0.2], AP progression rate [RR 0.21, 95%CI (0.04, 1.07), P = 0.06] and overall complications rate [RR 0.41, 95%CI (0.17, 1.01), P = 0.05] between the IOR and DOR groups. ConclusionsLimited data suggest that IOR could reduce LOS and costs without increasing adverse events in mild to moderate AP.

The Effects of Early Oropharyngeal Administration of Microdosed Colostrum on Feeding Status in Ventilated Extremely Low-Birth-Weight Infants.

Background: For extremely low-birth-weight infants (ELBWIs), mechanical ventilation and total parenteral nutrition are generally required in the early stages and lose the protective effect of early gastrointestinal nutrition of colostrum. We conducted a prospective randomized controlled trial to explore the effectiveness of early colostrum oropharyngeal administration on the feeding status of ELBWIs on mechanical ventilation. Materials and Methods: We randomly divided mechanically ventilated ELBWIs into an intervention group and a control group. In the intervention group, we provided oropharyngeal administration of colostrum during mechanical ventilation. The first colostrum oropharyngeal administration ended within 24 hours of birth. In the control group, we gave colostrum only for gastrointestinal nutrition, and other interventions were the same as for the intervention group. We collected the 1st and 6th day of life airway secretions and urine specimens from both groups. We recorded feeding status, including corrected gestational age at onset of enteral nutrition, corrected gestational age of no gastric retention during feeding, corrected gestational age of full enteral nutrition, corrected gestational age of sucking began, and corrected gestational age of per oral feeding. We also recorded growth of body mass, the incidence of feeding intolerance, and necrotizing enterocolitis (NEC). Results: On the 6th day of life, concentrations of secretory immunoglobulin A, and lactoferrin in airway secretions and urine of the intervention group were significantly higher than those of the control group (p < 0.05). The intervention group showed younger corrected gestational age of no gastric retention during feeding, corrected gestational age of full enteral nutrition, the corrected gestational age of sucking began and per oral feeding than those in the control group (p < 0.05). The day of recovery to birth weight was earlier than those in the control group (p < 0.05). The rate of feeding intolerance and NEC incidence in the intervention group was significantly lower than in the control group (p < 0.05). Conclusions: Early oropharyngeal administration of colostrum improves immune function of the gastrointestinal tract and the systemic anti-infective capability in ELBWI on mechanical ventilation, promoting the maturity of gastrointestinal function, improving feeding condition, and reducing the risk of feeding intolerance and NEC.

Effect of early supplemental parenteral nutrition on outcomes of critically ill patients

Objective To explore the effect of early supplemental parenteral nutrition on the outcomes of critically ill patients. Methods Totally 302 patients admitted in the intensive care unit (ICU) of Taizhou Hospital of Zhejiang Province from 2015 to March 2017 were enrolled and divided into two groups: the enteral nutrition group and the supplemental parenteral nutrition group. The clinical data of the two groups were retrospectively analyzed and the outcomes was compared between the two groups. Results The time of ICU stay, mechanical ventilation days, nosocomial infections in ICU and the rate of feeding intolerance were significantly lower in the supplemental parenteral nutrition group than in the enteral nutrition group (P<0.05). There was no statistically significant difference in the mortality rate in 28 days between the two groups. Conclusion Supplemental parenteral nutrition has many advantages like reduce the duration of ventilation, ICU stay and the rate of feeding intolerance, and it does not affect the 28-day mortality rate of critically ill patients with NRS2002 score>5, or increase the complication of infection. Key words: Nutritional therapy; Early enteral nutrition; Supplemental parenteral nutrition; Intensive care unit

Effect of Rhubarb on Gastrointestinal Dysfunction in Critically Ill Patients

Background:Gastrointestinal dysfunction plays a critical role in the prognosis of critically ill patients. Previous studies showed rhubarb, a traditional Chinese herb, can protect the intestinal barrier function, prevent intestinal bacterial translocation, and promote gastrointestinal peristalsis, but the clinical studies are less. The aim of this study was to evaluate the effects of rhubarb on gastrointestinal dysfunction in critically ill patients.Methods:From June 2015 to May 2017, a total of 368 critically ill patients with Grade I–III acute gastrointestinal injury (AGI) were enrolled in this study. Patients were divided into two groups according to the exposure factors (whether the patients received rhubarb treatment): the rhubarb group and the usual treatment group. Clinical data were collected within the first 24 h of the Intensive Care Unit (ICU) admission and 7 days after treatment. Survival data on day 28 after ICU admission and the durations of ICU and total hospitalization were also collected. Propensity score matching (PSM) was conducted to reduce confounding bias between the groups. The logistic regression was conducted to screen the influence factors.Results:The eligible patients were divided into rhubarb group (n = 219, 59.5%) and usual treatment group (n = 149, 40.5%). Before PSM, the remission rate of feeding intolerance in rhubarb group and usual treatment group were 59.8% and 39.6%, respectively. After PSM, the remission rate of feeding intolerance in rhubarb group and usual treatment group was 77.9% and 30.9%, respectively. The remission rates of feeding intolerance in rhubarb group were significantly higher than those in the usual treatment group (all P < 0.05). Compared with the usual treatment group, the rhubarb group had a higher rate of AGI improvement, lower level of C-reactive protein, shorter stay in ICU before and after PSM (P < 0.05). There was no significant difference in 28-day mortality between rhubarb and usual treatment groups before and after PSM (48 vs. 33, P = 0.959; and 16 vs. 21, P = 0.335). The logistic regression analysis showed that the single factor, whether receiving rhubarb therapy, affected the proportion of patients whose enteral nutrition needs ≥83.7 kJ·kg−1·d−1 after 7 days of treatment (odds ratio: 7.908, 95% confidence interval: 3.661–17.083, P < 0.001). No serious adverse effects were found in two groups.Conclusions:The rhubarb might significantly improve feeding tolerance and relieve gastrointestinal dysfunction in critically ill patients, without serious adverse reactions. It provided proof for the treatment of gastrointestinal dysfunction with rhubarb during clinical practice.

Mosapride combined with probiotics on gastrointestinal function and growth in premature infants.

The aim of this study was to investigate the effects of mosapride combined with probiotics on gastrointestinal function and growth and development in premature infants. A total of 240 premature infants treated at Weifang People's Hospital between June 2012 and May 2015 who matched our criteria were randomly divided into three groups of 80 cases each. Group A received routine treatment, group B received routine treatment combined with live B. subtilis and E. faecium granules with multivitamins (Medilac-Vita), and group C received routine treatment and Saccharomyces boulardii sachets (Bioflor). Mosapride was administered to patients in groups B and C to promote intestinal peristalsis. Gastrin and bilirubin levels, as well as jaundice fade time, were recorded. Growth and development condition (i.e., head circumference and weight), duration and incidence of feeding intolerance (FI), as well as other symptoms were also analyzed. By day 14, gastrin concentrations in groups B and C were significantly higher than those in group A (P<0.05). Serum bilirubin levels in groups B and C showed a progressive decline from day 7 to day 14, and jaundice duration in group A was significantly longer (P<0.05). Furthermore, at 2 weeks, the average weight growth rate and head circumference were significantly greater in groups B and C, weight loss recovery time was shorter, and EUGR incidence was lower (P<0.05). The incidence rate of gastric retention and FI were lower in groups B and C than group A (P<0.05), and neonatal hyperbilirubinemia, parenteral nutrition-associated cholestasis, necrotizing enterocolitis, and neonatal sepsis incidence was significantly lower in groups B and C (P<0.05). Mosapride combined with probiotics can effectively reduce FI incidence in premature infants, shorten enteral feeding time, promote the absorption of required nutrients, and promote the development and recovery of early physiological weight loss in preterm infants.

The association between feeding intolerance and clinical outcome in critically ill patients admitted to ICU: a multi-center prospective, observational study

Objective To investigate the prevalence of feeding intolerance (FI), and to explore the FI within 7 days of ICU admission in association with clinical outcome in critically ill patients. Methods The adult patients from 14 general ICUs in Zhejiang Province with an expected admission to ICU for at least 24h were recruited from March 2014 to August 2014, and all clinical, laboratory, and survival data were prospectively collected. The AGI (acute gastrointestinal injury) grade was daily assessed based on gastrointestinal (GI) symptoms, feeding details and organ dysfunction within the first week of ICU stay. The intra-abdominal pressures (IAP) was measured using AbViser device. Results Of 550 patients enrolled, 418 were assessed in GI symptoms and feeding details within 7 days of ICU stay. The mean age and SOFA score were (65.1±18.3) years and (8.96±4.10), respectively. Of them, 355 patients (84.9%) were under mechanical ventilation support, and 37 (8.85%) received renal replacement therapy. The mean length of time for enteral feeding was (30.8±26.2) h, and the prevalence of FI on the 3rd and 7th day of ICU stay accounted for 39.2%and 25.4%, respectively. Compared to those with FI within 7 days of ICU stay, the patients without FI had higher rate of successively weaning from mechanical ventilation (21.3% vs. 5.7%, P=0.003) and higher rate of withdrawal of vasoactive medication (45.5% vs. 20.0%, P=0.037), as well as lower mortality rate of 28-day (24.4% vs. 38.7%, P=0.004) and 60-day (29.6% vs. 44.3%, P=0.005). In multivariate Cox regression model with adjustment for age, sex, participant center, serum creatinine and lactate, AGI grade on the first day of ICU stay, and comorbidities, the FI within 7 days of ICU stay (χ2≥7.24, P<0.01) remained to be independent predictors for 60-day mortality. After further adjusted for SOFA score, the FI within 7 days of ICU stay (HR=1.71, 95%CI: 1.18-2.49; P=0.006) and AGI grade on the first day of ICU stay (HR=1.33, 95%CI: 1.07-1.65; P=0.009) could provide independent prognostic values of 60-day mortality. Conclusions There is high rate of FI occurred within 7 days of ICU stay, and is significantly associated with worse outcome. In addition, this study also provides evidence to further support that measurement of gastrointestinal dysfunction could increase value of SOFA score in outcome prediction for the risk of 60-day mortality. Key words: Critically ill patient; Feeding intolerance; Acute gastrointestinal injury; SOFA score; Prognosis

Clinical Evaluation of "Shock Bowel" Using Intestinal Fatty Acid Binding Protein.

"Shock bowel" is one of the computed tomographic (CT) signs of hypotension, yet its clinical implications remain poorly understood. We evaluated how shock bowel affects clinical outcomes and the extent of intestinal epithelial damage in trauma patients by measuring the level of intestinal fatty acid binding protein (I-FABP). We reviewed the initial CT scans, taken in the emergency room, of 92 patients with severe blunt torso trauma who were consecutively admitted during a 24-month period. The data collected included CT signs of hypotension, I-FABP, feeding intolerance, and other clinical outcomes. Demographic and clinical outcomes were compared in patients with and without hemodynamic shock and shock bowel. Shock bowel was found in 16 patients (17.4%); of them 7 patients (43.8%) did not have hemodynamic shock. Certain CT signs of hypotension, namely free peritoneal fluid, contrast extravasation, small-caliber aorta, and shock bowel, were significantly more common in patients with hemodynamic shock than in patients without (P < 0.05). Injury severity score and the rate of consciousness disturbance were significantly higher in patients with shock bowel than in patients without (P < 0.05). The rate of feeding intolerance and median plasma I-FABP levels were significantly higher in patients with shock bowel than in patients without (75.0% vs. 22.4%, P < 0.001 and 17.0 ng/mL vs. 3.7 ng/mL, P < 0.001, respectively). There was no difference in mortality. In conclusion, shock bowel is not always due to hemodynamic shock. It does, however, indicate severe intestinal mucosal damages and may predict feeding intolerance.

Intravenous glutamine supplementation improves gut mucosal function in burn patients: a randomized controlled trial

Background Glutamine supplementation in burned adults was found to improve the overall immune functions and gut integrity, and shortens overall hospital stay after burn injury with better clinical outcome. Glutamine depletion jeopardizes the functional integrity of the gut and leads to immunosuppression. Enteral intolerance is a clinical sign of defective gut mucosal integrity and is considered as a major complication along the course of treatment of burned patients. It is associated with the development of sepsis and increased mortality. We aimed in this study to find out whether intravenous glutamine supplementation will improve tolerance to enteral feeding and eventually clinical outcome of burn patients. Patients and methods Sixty critically ill burn patients were included in this study. They were randomly allocated into two groups. Group A received intravenous glutamine, and group B received placebo. Both groups were assessed as regards inflammatory and nutritional markers. Tolerance to enteral nutrition was observed and compared between the two groups, in addition to development of bacteremia. Results Group A patients were found to be more tolerant to enteral feeding compared with group B patients, with a statistically significant drop in enteral feeding intolerance rate in group A (P=0.048). As regards nutritional markers, a drop in serum transferrin and serum prealbumin with statistical significance was noticed among group B patients compared with group A patients after day 7, whereas no difference of statistical significance was noticed in serum albumin values. Positivity of blood culture for gram-negative organisms was less frequent among patients in group A, with high statistical significance. Conclusion Early use of intravenous glutamine in severely burned patients might provide a gut mucosal protective value reflected on its function. This was evident with improvement in enteral feeding intolerance, in addition to improvement in the barrier function of the gut mucosa that limits bacterial translocation.

Effect of early administration of probiotics on gut microflora and feeding in pre-term infants: a randomized controlled trial

Background: This study aimed to evaluate the effect of early probiotic administration on gut microflora and influence on feeding in pre-term infants.Methods: A double-blind, randomized, controlled clinical study was conducted to assess the effect of probiotics [live, combined lactobacillus and bifidobacterium (LCB)] supplementation in pre-term infants. Sixty hospitalized pre-term babies were randomly assigned to two groups: a probiotics-supplemented group and the control group. The primary endpoint was measurement of lactobacillus and bifidobacterium in the gut. The secondary outcome was the rate of feeding intolerance.Results: In the first weekend, the quantity of gut lactobacillus and bifidobacterium was significantly higher in the probiotics-supplemented group than in the control group [7.84 ± 0.35 versus 6.39 ± 0.53 (log copy number/g wet fecal weight), p = 0.013; 8.52 ± 0.23 versus 7.01 ± 0.48, p = 0.024, respectively]. In the second weekend, the amount of gut lactobacillus and bifidobacterium in the probiotics-supplemented group remained significantly higher (8.62 ± 0.28 versus 7.34 ± 0.59, p = 0.036 and 9.45 ± 0.64 versus 7.85 ± 0.43, p = 0.007, respectively). Fewer patients in the probiotics-supplemented group developed a feeding intolerance (13.3% versus 46.7%, p = 0.013).Conclusions: Probiotic supplementation in the hospitalized pre-term infants in the first 2 weeks of life resulted in higher amounts of lactobacillus and bifidobacterium in the gut and a concomitant lower rate of feeding intolerance.