What is the nutritional status of patients with prolonged disorders of consciousness? A retrospective cross-sectional study.

BACKGROUND: Nutritional status of patients with disorders of consciousness (DoC) is poorly studied. OBJECTIVES: To evaluate the relationship between nutritional status (body mass index, daily calories intake) and clinical variables (level of consciousness, time since injury, diagnosis, etiology and spastic muscle overactivity; SMO,) in patients with prolonged DoCor emerging. Our main hypotheses are i) patients with lower level of consciousness (UWS) have worse nutritional status compared to patients in minimally conscious state (MCS) and ii) SMO could influence nutritional status. METHODS AND RESULTS: Among the 80 patients included in the study (19 UWS, 47 MCS, 14 emerging MCS; 43 ± 15 yo; 3 ± 4 years post-injury, 35 traumatic etiology, 34 females), 9% were at risk to be undernourished, with no differences between UWS and MCS. Patients without SMO had a higher BMI compared to patients with severe SMO. Compared to the recommended daily calories intake, patients with the highest BMI received less calories and patients with the lowest BMI received more calories. We observed a negative correlation between SMO (in lower limbs) and BMI. CONCLUSION: Our study shows that most patients are well nourished, independently from the level of consciousness. SMO may require additional calories in patients' daily needs; however, longitudinal studies are needed to explore the causal relationship between these variables.

Adequacy of Nutritional Intakes during the Year after Critical Illness: An Observational Study in a Post-ICU Follow-Up Clinic.

Whether nutritional intakes in critically ill survivors after hospital discharge are adequate is unknown. The aims of this observational study were to describe the energy and protein intakes in ICU survivors attending a follow-up clinic compared to empirical targets and to explore differences in outcomes according to intake adequacy. All adult survivors who attended the follow-up clinic at 1, 3 and 12 months (M1, M3, M12) after a stay in our intensive care unit (ICU) ≥ 7 days were recruited. Average energy and protein intakes over the 7 days before the face-to-face consultation were quantified by a dietician using food anamnesis. Self-reported intakes were compared empirically to targets for healthy people (FAO/WHO/UNU equations), for critically ill patients (25 kcal/kg/day and 1.3 g protein/kg/day). They were also compared to targets that are supposed to fit post-ICU patients (35 kcal/kg/day and 1.5 g protein/kg/day). Blood prealbumin level and handgrip strength were also measured at each timepoint. A total of 206 patients were analyzed (49, 97 and 60 at the M1, M3 and M12, respectively). At M1, M3 and M12, energy intakes were 73.2 [63.3-86.3]%, 79.3 [69.3-89.3]% and 82.7 [70.6-93.7]% of healthy targets (p = 0.074), respectively. Protein intakes were below 0.8 g/kg/day in 18/49 (36.7%), 25/97 (25.8%) and 8/60 (13.3%) of the patients at M1, M3 and M12, respectively (p = 0.018), and the protein intakes were 67.9 [46.5-95.8]%, 68.5 [48.8-99.3]% and 71.7 [44.9-95.1]% of the post-ICU targets (p = 0.138), respectively. Prealbumin concentrations and handgrip strength were similar in patients with either inadequate energy intakes or inadequate protein intakes, respectively. In our post-ICU cohort, up to one year after discharge, energy and protein intakes were below the targets that are supposed to fit ICU survivors in recovery phase.

Protecting clinical trials in cystic fibrosis during the SARS-CoV-2 pandemic: risks and mitigation measures.

The SARS-CoV-2 pandemic has disrupted clinical trials worldwide. The European Cystic Fibrosis Society-Clinical Trials Network (ECFS-CTN) has tracked clinical trial disruption by surveying its 58 trial sites across 17 European countries and collated information on measures to mitigate the impact of the pandemic and ensure trial continuity. Here, we present recommendations on how to reduce the risk of SARS-CoV-2 exposure to patients and trial staff by implementing remote trial visits where possible, using home assessments, video and phone calls, electronic consent, and home delivery of study drugs. We discuss the practicalities of remote source data verification, protocol amendments, changing trial site location, and staff absences and home working. We outline recommendations on how to protect trial outcomes, including home assessments, safety reporting, protocol deviations, and recruitment challenges. Finally, we discuss the importance of continued access to study drugs via extension trials for some patients. This guidance was co-created from the shared knowledge and experience of sites in our network and was re-distributed directly to all ECFS-CTN sites to help mitigate the impact of further waves of the SARS-CoV-2 pandemic. We will also use this guidance to assist companies, academia, and consortia with future protocol design and risk mitigation plans. This guidance can be applied to clinical trials in other diseases and could help sites that are not supported by clinical trial networks.

Nutrition During Critical Care: An Audit on Actual Energy and Protein Intakes.

INTRODUCTION: Oral nutrition is delivered frequently in intensive care units (ICUs) but rarely studied. The primary objective of this study was to quantify nutrition intakes in patients exclusively orally fed (OF) and in those receiving medical nutrition solutions or both. METHODS: Adults who stayed in a mixed ICU for ≥3 days were studied. Nutrition deficits were calculated as the difference between estimated energy or protein targets (determined by weight-based formulas) and actual intakes (recorded on a daily basis by nurses). Total volumes of enteral or parenteral nutrition solutions, propofol, and glucose infused over 24 hours were collected and energy and protein amounts were calculated. In OF patients, food intake at each meal (breakfast, lunch, and dinner) was estimated using the "one-quarter portion" method. RESULTS: Among the 289 included patients aged 67 (57-75.5) years, 253 were fed and received, on average, 14.3 (7.8-19) kcal/kg/d and 0.53 (0.27-0.8) g/kg/d protein. In OF patients (n = 126), intakes were 9.7 (5.8-19) kcal/kg/d and 0.35 (0.17-0.57) g/kg/d protein. In the subset of OF patients with ICU stay ≥ 7 days (n = 37), respectively, 51% and 94% never received ≥80% of their energy and protein targets. CONCLUSION: Nutrition intakes were lower by oral feeding compared with other exclusive or combined medical nutrition. Compared with the prescribed amounts, the deficit was larger for proteins than for energy.

Oral Nutrition during and after Critical Illness: SPICES for Quality of Care!

Malnutrition is associated to poor outcomes in critically ill patients. Oral nutrition is the route of feeding in less than half of the patients during the intensive care unit (ICU) stay and in the majority of ICU survivors. There are growing data indicating that insufficient and/or inadequate intakes in macronutrients and micronutrients are prevalent within these populations. The present narrative review focuses on barriers to food intakes and considers the different points that should be addressed in order to optimize oral intakes, both during and after ICU stay. They are gathered in the SPICES concept, which should help ICU teams improve the quality of nutrition care following 5 themes: swallowing disorders screening and management, patient global status overview, involvement of dieticians and nutritionists, clinical evaluation of nutritional intakes and outcomes, and finally, supplementation in macro-or micronutrients.

[Nutritional aspects of the management of the severely burned patient]. / Aspects nutritionnels de la prise en charge du patient brûlé grave.

The nutrition of the severely burned patient is one of the pillars of his or her care, from the first few hours after the accident to rehabilitation. When properly conducted, there is a recognized beneficial effect on morbidity and even mortality.