ABSTRACT
Enteral nutrition plays an irreplaceable role in the nutritional treatment of critically ill patients. In order to help clinical medical staff to manage the common complications during the implementations of enteral nutrition for critically ill patients, the consensus writing team carried out literature retrieval, literature quality evaluation, evidence synthesis. Several topics such as diarrhea, aspiration, high gastric residual volume, abdominal distension, etc. were assessed by evidence-based methodology and Delphi method. After two rounds of expert investigations, Expert consensus on prevention and management of enteral nutrition therapy complications for critically ill patients in China (2021 edition) developed, and provided guidance for clinical medical staff.
ABSTRACT
Objective:To investigate the difference between the concentration of the peripheral ionized calcium (iCa) monitored at different blood collection points and the target concentration of anticoagulant efficacy in patients with continuous renal replacement therapy (CRRT), so as to provide scientific basis for the best blood collection point in clinical practice.Methods:Taking patients of department of critical care medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology receiving CRRT therapy with 4% citrate anticoagulation as research objects. Type of Prisma-FlexV8CRRT as well as department self-made substituate and dialyzate were adopted for all patients receiving CRRT therapy. Patients were divided into continuous veno- venous hemofiltration (CVVH) group ( n=10) and continuous veno- venous hemodialysis (CVVHD) group ( n=30) depending on their actual conditions and treatment needs. Blood collection was conducted at specific sites for extracorporeal peripheral ionized calcium concentration determination before and after the filter at the time of 2, 4, 8, 14, 20 hours following CRRT therapy for patients from both groups. Target concentration of extracorporeal peripheral ionized calcium was set as 0.2-0.4mmol/L for ensuring the efficacy of extracorporeal citrate anticoagulation. Results:Totally 400 testing results were obtained from 40 included patients during their treatment. In CVVH group, 100 testing results were obtained at the time of 2, 4, 8, 14, 20 hours following CRRT therapy and no significant statistical difference was shown ( P>0.05). In CVVHD group, 300 testing results were obtained at the time of 2, 4, 8, 14, 20 hours following CRRT therapy. The iCa concentration before the filter were (0.53±0.01), (0.50±0.01), (0.52±0.01), (0.53±0.01), (0.53±0.02) mmol/L while the iCa concentration after the filter were (0.41±0.01), (0.40±0.01), (0.39±0.02), (0.41±0.01), (0.40±0.01) mmol/L accordingly, and the difference was statistically significant ( t values were 75.24-103.41, P<0.01). Conclusions:For patients receiving CRRT treatment with citrate anticoagulation in different CRRT mode, testing results obtained from blood collection sites before and after the filter could not reflect the efficacy of citrate anticoagulation correctly and simultaneously to ensure the secure use of the extracorporeal pipelines and filter. In CVVH mode, iCa concentration determined from blood samples collected from sites before and after the filter could refelct the efficacy of citrate anticoagulation equally, while in CVVHD mode, blood collection and determination are suggested to conduct at the site before the filter to faciliate the assessment of the citrate anticoagulation efficacy.
ABSTRACT
Objective:To study the feasibility of using bedside ultrasound in evaluating gastric residual volume in critical ill patients with enteral nutrition support.Methods:From May 2019 to August 2019, 60 patients were selected to receive enteral nutrition via gastric tube in ICU of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology. Patients were divided into the experimental group and the control group according to the odd and even number of beds, 30 patients in the experimental group with odd number of beds and 30 patients in the control group with even number of beds. Gastric residual volume was evaluated at 0, 4, 8, 12, 16, 20, 24 h of enteral nutrition. In the experimental group, the gastric residual volume was evaluated by bedside ultrasound and syringe suction at each time point. In the control group, only bedside ultrasound was used to evaluate gastric residual volume. The results of operation time, monitoring results at different time points, diarrhea and the utilization rate of gastrointestinal motility drugs target feeding time, vomiting, were compared between the two groups.Results:There was no statistical difference between the gastric residual amount monitored by ultrasound and the gastric residual amount monitored by suction ( P>0.05). The operating time of bedside ultrasound monitoring was (62.40 ± 4.00) s, the operating time of suction monitoring was (78.39 ± 12.15) s, and the operating time of bedside ultrasound monitoring was less than that of suction ( t value was 6.633, P<0.01). There was no significant difference in the rate of vomiting, diarrhea and gastrointestinal motility drugs between the two groups( P>0.05). The time to reach the target feeding amount in the control group was (3.04 ± 0.31) d, and the time to reach the target feeding amount in the experimental group was (4.19 ± 0.33) d. The time to reach the target feeding amount in the control group was less than that in the experimental group ( t value was 13.42, P<0.01). Conclusions:Bedside ultrasound can be used to evaluate the residual gastric volume of enteral nutrition support patients, guide the implementation of enteral nutrition, shorten the operation time, reduce the workload of nurses, and avoid the contamination of enteral nutrition preparation.