Background: In mechanically ventilated ICU patients enteral nutrition started 24 to 48 hours of ICU admission, shown to reduce infectious complications and duration of hospitalization. Due to acute respiratory failure 30% of patients admitted to ICUs require mechanical ventilation. Delayed weaning increases costs, risks of nosocomial pneumonia, cardiac-associated morbidity, and death. Early weaning often results in reintubation, and associated complications due to prolonged ventilation. Nutritional management poses a vital challenge to the intensivist in the ICU. Malnutrition causes widespread organ dysfunction, associated with poor healing, reduce immune competence & poor weaning from ventilator (decreasing the diaphragmatic contractility and depressing the hypoxic drive & ventilatory drive to CO2). The extent of muscle wasting and weight loss in the ICU is inversely correlated with long-term survival of the patients. In this thesis will be discussed the role of the nutritional support in the critical care setting when associated to weaning from mechanical ventilation. Objectives: 1. Assessment of Clinical And Anthropometric nutritional status. 2. Differences in outcomes measuring weaning duration, harm (adverse events) and resource use (ICU and hospital length of stay, cost). Material and methods: Patients >18 y-o, admitted to the ICU from November 2016 to November 2018 were enrolled. Anthropometrics, nutritional status such as BMI and weight, nutritional support such as enteral or parenteral nutrition, albumin and total proteins levels, clinical parametrs such as P/F were recorded for the entire ICU stay. Results: 30 consecutive patients (12 female) were enrolled. The average duration of each admission to the ICU was 24.58 ± 14.7 days. The 84% of patients was enterally fed. Albumine and total proteins were not significantly different throughtout the ICU stay. Different enteral nutrition mixtures influence clinical response (better P/F). Calories estimated and provided were adequate to the ventilatory phase associate. The nutritional support was adequate, since BMI and weight were the same at admission and discharge from the ICU. Conclusions: through an optimal planning of the nutritional supply, in our ICU days of hospitalization were not increased, avoiding the incidence of difficult or prolonged weaning conditions and the consequences associated with it.
Background: In pazienti ventilati meccanicamente, la nutrizione enterale, iniziata entro 24-48 ore dal ricovero in terapia intensiva, ha dimostrato ridurre le complicanze infettive e la durata dell’ospedalizzazione. A causa dell’insufficienza respiratoria associata, il 30% dei pazienti ricoverati nelle terapie intensive richiede ventilazione meccanica. Lo svezzamento ritardato dalla ventilazione meccanica aumenta i costi, i rischi di polmoniti nosocomiali, comorbidità cardiache associate e morte. Uno svezzamento precoce dalla ventilazione spesso implica reintubazione e complicanze associate allo svezzamento prolungato. La gestione della nutrizione rappresenta una sfida per l’intensivista. La malnutrizione causa la diffusione di patologie associate alla disfunzione d’organo, difficoltà di guarigione, riduce l’efficacia del sistema immunitario e si associa ad uno scarso successo di svezzamento dalla ventilazione. La quantità di tessuto muscolare distrutto e la perdita di peso sono inversamente correlati con la sopravvivenza a lungo termine dei pazienti critici. In questa tesi sarà discusso il ruolo del supporto nutrizionale in un setting di malati critici, in associazione allo svezzamento dalla ventilazione meccanica. Obiettivi: 1. Valutazione dello stato nutrizionale (parametri clinici e antropometrici); 2. Differenza di outcome misurato come durata dello svezzamento dalla ventilazione, eventi avversi e uso delle risorse (durata dell’ospedalizzazione e costi per la terapia intensiva). Materiali e metodi: Sono stati arruolati pazienti > 18 anni, ricoverati tra novembre 2016 e novembre 2018. Sono stati raccolti dati antropometrici, dati relativi allo stato nutrizionale come BMI e peso, tipo di nutrizione somministrata (enterale o parenterale), livelli di albumina, proteine totali, parametri clinici come il P/F. Risultati: Sono stati analizzati 30 pazienti (12 femmine). La durata media di ogni degenza è stata 25.6 ± 14.7 giorni. L’84% di pazienti è stato nutrito per via enterale. Non ci sono state alterazioni statisticamente significative nei livelli di albumina e proteine totali durante l’intera degenza in terapia intensiva. Diverse miscele nutrizionali influenzano le risposte cliniche (migliori P/F tra i pazienti alimentati con queste ultime). Le calorie stimate e somministrate sono state adeguate alla fase ventilatoria associata. Il supporto nutrizionale era appropriato, dal momento che BMI e peso sono rimasti invariati nel confronto tra inizio e fine degenza in terapia intensiva. Conclusioni: Applicando una strategia di supporto nutrizionale adeguato alla nostra terapia intensiva non si aumentano i giorni di ospedalizzazione, riducendo l’incidenza di condizioni associate ad uno svezzamento dalla ventilazione difficile o prolungato e le complicanze associate ad esso.
Impact of protein intake on weaning from mechanical ventilation in ICU patients / Rauseo, Michela. - (2020). [10.14274/rauseo-michela_phd2020]
Impact of protein intake on weaning from mechanical ventilation in ICU patients
RAUSEO, MICHELA
2020-01-01
Abstract
Background: In mechanically ventilated ICU patients enteral nutrition started 24 to 48 hours of ICU admission, shown to reduce infectious complications and duration of hospitalization. Due to acute respiratory failure 30% of patients admitted to ICUs require mechanical ventilation. Delayed weaning increases costs, risks of nosocomial pneumonia, cardiac-associated morbidity, and death. Early weaning often results in reintubation, and associated complications due to prolonged ventilation. Nutritional management poses a vital challenge to the intensivist in the ICU. Malnutrition causes widespread organ dysfunction, associated with poor healing, reduce immune competence & poor weaning from ventilator (decreasing the diaphragmatic contractility and depressing the hypoxic drive & ventilatory drive to CO2). The extent of muscle wasting and weight loss in the ICU is inversely correlated with long-term survival of the patients. In this thesis will be discussed the role of the nutritional support in the critical care setting when associated to weaning from mechanical ventilation. Objectives: 1. Assessment of Clinical And Anthropometric nutritional status. 2. Differences in outcomes measuring weaning duration, harm (adverse events) and resource use (ICU and hospital length of stay, cost). Material and methods: Patients >18 y-o, admitted to the ICU from November 2016 to November 2018 were enrolled. Anthropometrics, nutritional status such as BMI and weight, nutritional support such as enteral or parenteral nutrition, albumin and total proteins levels, clinical parametrs such as P/F were recorded for the entire ICU stay. Results: 30 consecutive patients (12 female) were enrolled. The average duration of each admission to the ICU was 24.58 ± 14.7 days. The 84% of patients was enterally fed. Albumine and total proteins were not significantly different throughtout the ICU stay. Different enteral nutrition mixtures influence clinical response (better P/F). Calories estimated and provided were adequate to the ventilatory phase associate. The nutritional support was adequate, since BMI and weight were the same at admission and discharge from the ICU. Conclusions: through an optimal planning of the nutritional supply, in our ICU days of hospitalization were not increased, avoiding the incidence of difficult or prolonged weaning conditions and the consequences associated with it.File | Dimensione | Formato | |
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