جستجوی مقالات مرتبط با کلیدواژه "nutritional support" در نشریات گروه "پزشکی"

Gastrointestinal tube feeding is one of the most important and beneficial methods of nutrition in patients admitted to the intensive care unit. There is still no consensus on the best nutritional method that will lead to fewer complications. This study aimed to investigate the disadvantages of different methods of tube feeding in patients admitted to the adult intensive care unit.

The present study is a review study conducted in 2022. Articles published in the English language databases including Web of Science, Scopus, Science Direct, and PubMed, between 2000 and 2022 were used.

In the initial search phase, 2893 articles were obtained. In the next step, after the review of titles and abstracts, 760 articles remained. Finally, based on inclusion criteria and full text review, 14 related articles were selected. Disadvantages of tube feeding methods were classified into four categories: "respiratory complications", "gastrointestinal complications", "metabolic complications" and "bed occupancy".

Based on the results of this study, in terms of complications, intermittent and continuous methods are safer and more preferable than the bolus method. However, low-speed bolus feeding has fewer side effects.

Malnutrition is so common among hospitalized patients, especially those in intensive care units (ICUs). Providing adequate nutritional support for these patients is of utmost significance.

The present study was conducted with aim to investigate the nutritional status of patients hospitalized in the ICUs of Iranian hospitals.

This systematic review was performed according to recommendations from the Cochrane Handbook. A search was conducted on Medline, Web of Sciences, PubMed, Scopus, and SID databases to find the articles on nutritional support for ICU patients hospitalized in Iran until April 9, 2023, using the keywords of "intensive care unit" OR "ICU" AND "nutritional support" and "Iran".

Finally, 19 original, cross-sectional, prospective cohort, and retrospective articles conducted on human samples were entered in this study. Except for one study, all articles reported that the dietary intake was significantly lower among ICU admitted patients. Nutrition Risk in Critically Ill score, Acute Physiology and Chronic Health Evaluation (APACHE II), Nutritional Risk Screening-2002 (NRS), and Subjective Global Assessment (SGA) measurement tools were used to predict the rate of malnutrition among the patients. Recorded reports indicate low calorie and nutrient intake among patients during ICU stay.

Implications for Practice: 

The analyzed hospitals have unsuitable and inadequate nutritional care services. In addition, the patient's intake of calories, protein, and other daily nutrients was significantly lower than the recommended amount leading to a cascade of undesirable patient outcomes.

Epidermolysis bullosa (EB) represents a diverse set of disorders that affect the skin and mucous membranes. Ensuring proper nutrition for children and adolescents with Epidermolysis Bullosa is a vital aspect of their treatment plan. The objective of this study is to demonstrate how nutritional intervention in a specialized nutrition clinic can enhance their well-being.

Methods and material: 

This longitudinal study was conducted over a 3-year period at Akbar Children Hospital, a tertiary facility affiliated with Mashhad University of Medical Sciences in Iran. The study included all patients diagnosed with EB based on clinical symptoms and genetic studies.

In the present study, the median (25-75 IQR) age of the participants was 81.0 (36.0-156.0) months, and 19% of the participants were girls. The median (25-75 IQR) weight was 17.5 (10.8-24.5) kg, and the mean ± SD of height was 109.9 ± 31.1 cm. Among all types of malnutrition, there was only a significant association between gastrointestinal complications and BMI-for-age z-score (OR: 0.08, P-value=0.039) in the crude model. After adjustment, there was no significant association between gastrointestinal complications and malnutrition. The mean values of weight at the baseline, the first, and the second appointment of the study were 21.3, 21.2, and 24.8 kg, respectively. Moreover, the mean height at the baseline, the first, and the second appointment of the study were 109.4, 121.0, and 123.4 cm, respectively.

Regular clinic visits and tailored nutritional interventions positively impact EB patients, emphasizing the importance of managing anemia and deficiencies for their well-being.

Critically ill patients admitted to the intensive care unit are often hyper-metabolic, hyper-catabolic, and at malnutrition risk. This study aimed to evaluate the amount of energy and protein intake and its correlation with the required amount in critically ill patients.  A total of 70 patients with critical conditions admitted to the ICU were eligible (age≥18 years and over a 3-day stay in ICU). Basic characteristics, medical history, and laboratory test results were extracted from the patient’s medical records. Anthropometric indicators and the APACHE II questionnaire were assessed. Patients’ energy and protein requirements were 25kcal/kg/day and 1.2g/kg/day, respectively.  The mean age in the target population was 57.69±20.81 years, and 48.6% were men. The mean actual energy intake was significantly lower than the requirement (531.27±365.40 vs. 1583.77±329.36 Kcal/day, P˂0.001). The mean actual protein intake was significantly lower than the requirement (14.94±18.33 vs. 74.11±17.89 gr/day, respectively, P˂0.001). Energy and protein provision to the patients had a growing trend over time. There was a significant reverse correlation between the age of patients and total lymphocyte count (r= -0.38, P=0.003). In addition, there was a significant reverse correlation between the Glasgow coma scale and mechanical ventilation duration (r=-0.49, P˂0.001). The lowest average energy and protein intake were in patients with poisoning.  The energy and protein intake in critically ill patients is significantly less than recommended, requiring routine nutritional assessments.

The world is currently in a large scale outbreak, also referred to as pandemic for the novel coronavirus SARS-CoV-2 (CoVID-19) and its variants. Patients having cancer not only have to combat their disease and its complications, but also they have to suffer lists of side effects due to the use of chemotherapy. This article is written to suggest a list of nutritional consideration for chemotherapeutic patients at this stage of CoVID-19 pandemic for enhancement of their immune system. Since, nutrition has a decisive role in immune response, specifically in immuno-suppressed patients such as the ones undergoing chemotherapy. Due to the complexity of designing a diet for the mentioned patients, we recommend a balanced and varied diet in the CoVID-19 pandemic which include, zinc, omega-3, vitamin D, whole grains, skimmed dairy which were discussed in great detail in the article.

A significant proportion of patients undergoing major gastrointestinal operations suffer from malnutrition. Although the benefit of postoperative nutritional support is well established, the effects of energy intake during pre-operative period is less reported. The present study was designed to test the effect of structured pre-operative nutritional therapy on the postoperative recovery of patients undergoing major gastrointestinal operations.

A randomized clinical trial was conducted among 80 patients of the surgical gastroenterology department of a tertiary care center in south India. A simple random sampling method was used. The nutritional status of all participants was assessed by subjective global assessment (SGA). While control group received standard energy intake nutrition, the experimental group received calculated nutrition with an extra 50 g of soy protein for seven days pre operatively. Data were analysed using SPSS version 20.

The median day of removal of abdominal drainage tube was 3 (0-5) compared to 5 (2.5-7.5) in the control group. In the intervention group, the median time for the appearance of bowel sounds and starting of enteral feeding was 1.1 (0.5) days and 2 (1-2) days, while in the control group, it was 1.6 (0.9) days, 3 (1-4) days, respectively which was significant at P < 0.05. Similarly, the mean (SD) postoperative serum albumin on third day was 3.6 (0.4) g/dL vs 3.4 (0.4) g/dL experimental and in the control group.

Preoperative nutrition protocol improved the patients’ clinical outcomes in terms of post-operative serum albumin, the timing of bowel sounds, and early initiation of enteral feeds.

Non-governmental organizations’ (NGOs) are one of the financial providers of the health sector and one of the key factors in development of social partnership in the community. In this study, the role of NGOs was evaluated in improvement of the dietary intake of burn patients. In this case-control study, nutritional indices of 30 burn patients who received nutritional support by NGOs were compared with nutritional indices in 30 matched burn patients who were treated before the start of nutritional support by NGOs. Dietary intake for the three-day record was provided. Finally, the amount of macro- and micronutrients intake was analyzed by Nutritionist IV software. Laboratory and clinicaldata were compared between the two groups. Burn percentage in the intervention group was 39±20.27% and in the control group was 28.91±16.40%. The mean age of case group was 40.74±17.02 years and of the control group was 41.60±20.80 years. Charity aid increased calorie intake in the case group (1425.77±432.93 vs. 1038.12±438.40 Kcal, p=0.002). Patients in the case group received a significantly higher amount of protein (60.28±16.32 vs. 45.03±17.16 g, p= 0.002). The changes in blood urea nitrogen (BUN) and creatinine were higher in cases, when compared to the controls: BUN: (2.34±16.67 vs. -6.9±12.55 mg/dL, p=0.03); creatinine (0.1±0.36 vs. -0.21±0.4 mg/dL, p=0.002). NGOs’ support can be effective in improvement of nutritional indices in severely burn patients, especially in developing countries, where hospital and families are not able to supply expensive nutritional supplements.

Proper nutrition is a basic requirement for all hospitalized patients, particularly critically ill patients who, for various reasons, are not able to maintain their nutritional status. Nutritional support is an essential component of care in the Intensive Care Unit (ICU) patients and it is commonly performed in two ways of enteral and parenteral nutrition. The present investigation aimed to investigate the nutritional status of this group of patients in comparison with existing standards.

In this study, 50 critically ill patients receiving nutritional support (42 patients were on enteral nutrition and 8 on parenteral) in a referral teaching hospital of Iran were investigated. Each patient was assessed individually and nutritional requirements including calorie and protein were calculated based on age, sex, height, weight, and the stress and activity factors. The total daily energy and protein were compared to standard calculated values. T-test was used to evaluate the differences between separate groups and p

Data showed that 70% of patients in the enteral group did not receive enough calories while only 7% obtained the required protein. In the parenteral group, none of the patients received enough calories or protein.

According to the results of this study, it seems that hospitalized ICU patients receive very poor nutritional support and greater attention should be paid to preventing possible malnutrition-related complications.

Malnutrition is a prevalent complication among critically ill patients. It has very detrimental effects on the patients' clinical course. This study aimed to investigate the impact of nutrition in the intensive care unit (ICU) patients.

In this epidemiologic-analytic study conducted in the surgical ICU of Imam Khomeini hospital, Ahvaz, Iran, 34 patients were selected and divided into two groups. The first group of patients received the appropriate nutrition. The second group received an inappropriate diet, and the nutritional risk was evaluated according to the modified- Nutrition Risk in Critically ill (m-NUTRIC) score. The energy was calculated by using 25 Kcal/kg, also the two groups were compared in terms of ICU mortality, ICU stays, Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II Scoring, and the Sequential Organ Failure Assessment (SOFA) Score.

Baseline data, such as APACHE II score and mean age, except sex, were not significantly different between the two groups. In this study, results were toward shorter ICU stay, less mortality, and better SOFA score in the group receiving appropriate nutrition compared to the other group. However, due to the low number of patients, no significant differences were observed in the two groups.

Our data suggest that nutritional support should be considered as an essential part of the medication during critical illness.

The aim of this study was to evaluate postoperative nutritional status in patients who underwent operations due to congenital gastrointestinal anomalies in surgical neonatal intensive care units (NICUs) and to investigate the role of nutrition support teams (NSTs) on the outcome.

A retrospective clinical study was carried out at two NICUs in Dr. Sheikh Pediatric Hospital, Mashhad, Iran. One of the NICUs was supported by NST and the other was not. A total of 120 patients were included through a non-random simple sampling. Different variables such as age, sex, prematurity, type of anomaly, birth weight, use of vasoactive drugs, weight gain in NICU, length of NICU stay, postoperative enteral nutrition initiation, duration of mechanical ventilation, mortality rate, maximum of blood sugar, the amount of calorie delivered to the calorie requirement ratio, and distribution of energy from enteral or parenteral roots were compared between the patients of two NICUs.

Median weight gain and the amount of calorie delivered during NICU stay in subjects of NST-supported NICU was significantly more than other NICU. There was no significant difference in the length of NICU stay, enteral nutrition initiation after the operation, ventilation days, and percent of mortality between the two groups. The percentage of enteral feeding was also increased by about 2.8%, which was not significant.

NST could increase post-operative weight gain and calorie delivery in patients as well as providing an increase in enteral feeding rather than parenteral.

Nutritional support plays a major role in the management of critically ill patients. This study aimed to compare the nutritional quality of enteral nutrition solutions (noncommercial vs. commercial) and the amount of energy and nutrients delivered and required in patients receiving these solutions.

This cross‑sectional study was conducted among 270 enterally fed patients. Demographic and clinical data in addition to values of nutritional needs and intakes were collected. Moreover, enteral nutrition solutions were analyzed in a food laboratory.

There were 150 patients who fed noncommercial enteral nutrition solutions (NCENS) and 120 patients who fed commercial enteral nutrition solutions (CENSs). Although energy and nutrients contents in CENSs were more than in NCENSs, these differences regarding energy, protein, carbohydrates, phosphorus, and calcium were not statistically significant. The values of energy and macronutrients delivered in patients who fed CENSs were higher (P < 0.001). Energy, carbohydrate, and fat required in patients receiving CENSs were provided, but protein intake was less than the required amount. In patients who fed NCENSs, only the values of fat requirement and intake were not significantly different, but other nutrition delivered was less than required amounts (P < 0.001). CENSs provided the nutritional needs of higher numbers of patients (P < 0.001). In patients receiving CENSs, nutrient adequacy ratio and also mean adequacy ratio were significantly higher than the other group (P < 0.001).

CENSs contain more energy and nutrients compared with NCENSs. They are more effective to meet the nutritional requirements of entirely fed patients.

Malnutrition has been the most prevalent problem in hospitalized patients during recent years which accentuate the importance of comprehensive nutritional support among these patients. The present study aimed to provide a review of the recent literature about ICU inpatients and their nutritional care. This review on energy and nutrient requirements for feeding the ICU inpatients focused on literature in English language. An on-line search using the keywords “nutritional support, malnutrition, ICU inpatients, micronutrient deficiencies, critically ill” in ISI web of science, PubMed, Scopus journals published during the years (Jun1979-Nov2014) was run. The cross sectional and prospective studies as well as the clinical trials were recruited into this investigation. Recent studies propose energy provision with 20-25 Kcal/Kg/day or 25-35 Kcal/Kg/day for critically ill patients. The recommended carbohydrate and protein intakes are 2-4 g/Kg/day, 1.2-1.5 g/Kg/day, respectively. The suggested fat intake is 25-30% of total calorie. Latest studies stressed the need for anti-oxidant vitamins and trace elements like A, C, β-carotin, E, selenium, magnesium and zinc among ICU inpatients. High prevalence of malnutrition among ICU inpatients caution to provide a nutritional health care team including professionals and dietitians who evaluate the effectiveness of treatment and supplementations. Energy requirement should be determined according to their nutritional and clinical status, and then macro and micronutrient needs should be considered for ICU inpatients.

Tube feeding is used for the patients who are not able to feed orally but their digestive system can digest foods. This method is safe and economic for patients. It maintains the functions of digestive system and reduces the risk of infection and sepsis. However, incorrect administration of this type of feeding results in problems such as aspiration, pneumonia, infection, diarrhea, NG tube obstruction, etc. If tube feeding is performed based on its standard procedure, it can have a major role in reducing the complications, providing adaptability and desired lifestyle, reducing the duration of hospitalization as well as reducing the relevant costs. This research is a descriptive-analytic cross-sectional study on 37 nurses who worked in the general surgery and neurology wards and fed patients suffering from gastrostomy. A valid and reliable checklist was used for data collection. To analyze the data, the descriptive statistical method (frequency and mean) and inferential method (paired t test, Spearman Correlation Coefficient and variance Analysis with repetition of observations) were used. The findings showed that the mean score of measures in all the stages (before, during and after administration) was significantly lower than the standard (p<0.001). There was a significant reverse relation between the score of measures in all the three stages (before, during and after performance) and work record and work experience in the ward. Furthermore, the mean score of measures in all the three stages was significantly different between female and male subjects (p value = 0.031), in the manner that the mean score of women was higher than that of men. There was also a significant difference between the mean score of measures in all the three stages and the employment condition of samples, so that the mean score of provisionally employed personnel was higher than that of permanent employed personnel. Considering the findings of the research in which the mean score of measures before, during and after performing feeding through gastrostomy was lower than the standard (p<0.001), a gastroenterology advisor, a clinical nurse and a nutrition specialist should train the patients and their families as well as the personnel about preparation and storage of foods, method of administering food, protection of tube entrance and NG tube by considering the problems and complications arising from this type of feeding. Based on the findings of the present research, it is necessary to re-train the nurses and especially male nurses, nurses with more work experience and permanently employed nurses in terms of correct performance of clinical nursing skills including this type of feeding.