Misconceptions and truths for feeding patients in the intensive care unit: Case studies with practical nursing solutions
ABSTRACT
The Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient published in May 2009 (joint guidelines between the Society of Critical Care Medicine (SCCM) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) have advanced our clinical practice for the nutritional management of critically ill patients. In the current article, we will review how to implement these guidelines using a case study model. Two mechanically ventilated and tube fed patients are discussed, one with pneumonia and the second with severe acute pancreatitis. We address the questions of the feeding timing, method of administration, and management of its complications for these two patients.
The Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient published in May 2009 (joint guidelines between the Society of Critical Care Medicine (SCCM) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) have advanced our clinical practice for the nutritional management of critically ill patients. In the current article, we will review how to implement these guidelines using a case study model. Two mechanically ventilated and tube fed patients are discussed, one with pneumonia and the second with severe acute pancreatitis. We address the questions of the feeding timing, method of administration, and management of its complications for these two patients.
Cite this paper
Hegazi, R. , Cockram, M. and Luo, M. (2012) Misconceptions and truths for feeding patients in the intensive care unit: Case studies with practical nursing solutions. Open Journal of Nursing, 2, 327-331. doi: 10.4236/ojn.2012.223047.
Hegazi, R. , Cockram, M. and Luo, M. (2012) Misconceptions and truths for feeding patients in the intensive care unit: Case studies with practical nursing solutions. Open Journal of Nursing, 2, 327-331. doi: 10.4236/ojn.2012.223047.
References
[1] McClave, S.A., Martindale, R.G., Vanek, V.W., McCarthy, M., Roberts, P., Taylor, B., Ochoa, J.B., Napolitano, L. and Cresci, G. (2009) Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). Journal of Parenteral and Enteral Nutrition, 33, 277-316. doi:10.1177/0148607109335234 [2] Wischmeyer, P.E. and Heyland, D.K. (2010) The future of critical care nutrition therapy. Critical Care Clinics, 26, 433-441. doi:10.1016/j.ccc.2010.04.011 [3] Kattelmann, K.K., Hise, M., Russell, M., Charney, P., Stokes, M. and Compher, C. (2006) Preliminary evidence for a medical nutrition therapy protocol: Enteral feedings for critically ill patients. Journal of the American Dietetic Association, 106, 1226-1241. doi:10.1016/j.jada.2006.05.320 [4] Andersen, H.K., Lewis, S.J. and Thomas, S. (2006) Early enteral nutrition within 24h of colorectal surgery versus later commencement of feeding for postoperative complications. Cochrane Database of Systematic Reviews, CD004080. [5] Khalid, I., Doshi, P. and DiGiovine, B. (2010) Early enteral nutrition and outcomes of critically ill patients treated with vasopressors and mechanical ventilation. American Journal of Critical Care, 19, 261-268. doi:10.4037/ajcc2010197 [6] Artinian, V., Krayem, H. and DiGiovine, B. (2006) Effects of early enteral feeding on the outcome of critically ill mechanically ventilated medical patients. Chest, 129, 960-967. doi:10.1378/chest.129.4.960 [7] Heyland, D.K., Dhaliwal, R., Drover, J.W., Gramlich, L. and Dodek, P. (2003) Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. Journal of Parenteral and Enteral Nutrition, 27, 355-373. doi:10.1177/0148607103027005355 [8] 2009 Clinical Practice Guidelines. The Use of EN vs PN, 8 October 2012. http://www.criticalcarenutrition.com/docs/cpg/1.0envspn_07_FINAL.pdf. [9] Cangelosi, M.J., Auerbach, H.R. and Cohen, J.T. (2011) A clinical and economic evaluation of enteral nutrition. Current Medical Research and Opinion, 27, 413-422. doi:10.1185/03007995.2010.545816 [10] Jensen, G.L., Mirtallo, J., Compher, C., Dhaliwal, R., Forbes, A., Grijalba, R.F., Hardy, G., Kondrup, J., Labadarios, D., Nyulasi, I., Castillo Pineda, J.C. and Waitzberg, D. (2010) Adult starvation and disease-related malnutrition: A proposal for etiology-based diagnosis in the clinical practice setting from the International Consensus Guideline Committee. Journal of Parenteral and Enteral Nutrition, 34, 156-159. doi:10.1177/0148607110361910 [11] Marik, P.E. and Zaloga, G.P. (2004) Meta-analysis of parenteral nutrition versus enteral nutrition in patients with acute pancreatitis. British Medical Journal, 328, 1407. doi:10.1136/bmj.38118.593900.55 [12] Hegazi, R., Raina, A., Graham, T., Rolniak, S., Centa, P., Kandil, H. and O’Keefe, S.J. (2011) Early jejunal feeding initiation and clinical outcomes in patients with severe acute pancreatitis. Journal of Parenteral and Enteral Nutrition, 35, 91-96. doi:10.1177/0148607110376196 [13] Edes, T.E., Walk, B.E. and Austin, J.L. (1990) Diarrhea in tubefed patients: Feeding formula not necessarily the cause. The American Journal of Medicine, 88, 91-93. doi:10.1016/0002-9343(90)90454-L [14] Btaiche, I.F., Chan, L.N., Pleva, M. and Kraft, M.D. (2010) Critical illness, gastrointestinal complications, and medication therapy during enteral feeding in critically ill adult patients. Nutrition in Clinical Practice, 25, 32-49. doi:10.1177/0884533609357565
[1] McClave, S.A., Martindale, R.G., Vanek, V.W., McCarthy, M., Roberts, P., Taylor, B., Ochoa, J.B., Napolitano, L. and Cresci, G. (2009) Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). Journal of Parenteral and Enteral Nutrition, 33, 277-316. doi:10.1177/0148607109335234 [2] Wischmeyer, P.E. and Heyland, D.K. (2010) The future of critical care nutrition therapy. Critical Care Clinics, 26, 433-441. doi:10.1016/j.ccc.2010.04.011 [3] Kattelmann, K.K., Hise, M., Russell, M., Charney, P., Stokes, M. and Compher, C. (2006) Preliminary evidence for a medical nutrition therapy protocol: Enteral feedings for critically ill patients. Journal of the American Dietetic Association, 106, 1226-1241. doi:10.1016/j.jada.2006.05.320 [4] Andersen, H.K., Lewis, S.J. and Thomas, S. (2006) Early enteral nutrition within 24h of colorectal surgery versus later commencement of feeding for postoperative complications. Cochrane Database of Systematic Reviews, CD004080. [5] Khalid, I., Doshi, P. and DiGiovine, B. (2010) Early enteral nutrition and outcomes of critically ill patients treated with vasopressors and mechanical ventilation. American Journal of Critical Care, 19, 261-268. doi:10.4037/ajcc2010197 [6] Artinian, V., Krayem, H. and DiGiovine, B. (2006) Effects of early enteral feeding on the outcome of critically ill mechanically ventilated medical patients. Chest, 129, 960-967. doi:10.1378/chest.129.4.960 [7] Heyland, D.K., Dhaliwal, R., Drover, J.W., Gramlich, L. and Dodek, P. (2003) Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. Journal of Parenteral and Enteral Nutrition, 27, 355-373. doi:10.1177/0148607103027005355 [8] 2009 Clinical Practice Guidelines. The Use of EN vs PN, 8 October 2012. http://www.criticalcarenutrition.com/docs/cpg/1.0envspn_07_FINAL.pdf. [9] Cangelosi, M.J., Auerbach, H.R. and Cohen, J.T. (2011) A clinical and economic evaluation of enteral nutrition. Current Medical Research and Opinion, 27, 413-422. doi:10.1185/03007995.2010.545816 [10] Jensen, G.L., Mirtallo, J., Compher, C., Dhaliwal, R., Forbes, A., Grijalba, R.F., Hardy, G., Kondrup, J., Labadarios, D., Nyulasi, I., Castillo Pineda, J.C. and Waitzberg, D. (2010) Adult starvation and disease-related malnutrition: A proposal for etiology-based diagnosis in the clinical practice setting from the International Consensus Guideline Committee. Journal of Parenteral and Enteral Nutrition, 34, 156-159. doi:10.1177/0148607110361910 [11] Marik, P.E. and Zaloga, G.P. (2004) Meta-analysis of parenteral nutrition versus enteral nutrition in patients with acute pancreatitis. British Medical Journal, 328, 1407. doi:10.1136/bmj.38118.593900.55 [12] Hegazi, R., Raina, A., Graham, T., Rolniak, S., Centa, P., Kandil, H. and O’Keefe, S.J. (2011) Early jejunal feeding initiation and clinical outcomes in patients with severe acute pancreatitis. Journal of Parenteral and Enteral Nutrition, 35, 91-96. doi:10.1177/0148607110376196 [13] Edes, T.E., Walk, B.E. and Austin, J.L. (1990) Diarrhea in tubefed patients: Feeding formula not necessarily the cause. The American Journal of Medicine, 88, 91-93. doi:10.1016/0002-9343(90)90454-L [14] Btaiche, I.F., Chan, L.N., Pleva, M. and Kraft, M.D. (2010) Critical illness, gastrointestinal complications, and medication therapy during enteral feeding in critically ill adult patients. Nutrition in Clinical Practice, 25, 32-49. doi:10.1177/0884533609357565