Jomyaku Keicho Eiyo

Show abstractHide abstract

Background & Purpose: Constipation and/or diarrhea may disturb early enteral feeding in critically ill patients. We developed a protocol for management of fecal evacuation depending on feces volume only. We also evaluated the efficacy of this protocol in critically ill patients.
Patients and Methods: Fifty-three critically ill patients who received enteral feeding for a period of 7 days in the intensive care unit of our hospital during the past three years were included in this study. Patients were divided in a pre-protocol group (n=24) and a post-protocol group (n=29). Daily volume of feces was measured for 7 days from the initiation of enteral feeding, and was retrospectively compared between two groups. Diarrhea and constipation were defined as more than 300 g/day of feces and no evacuation for 48 hours, respectively.
Results: Daily volume of feces in the post-protocol group was significantly decreased compared with that in the pre-protocol group. Frequency of diarrhea showed no significant difference between the two groups. Frequency of constipation and frequency of both diarrhea and constipation in the postprotocol group were significantly lower than those in the pre-protocol group (1.5±0.3 vs 0.7±0.2 days and 4.0±0.3 vs 2.6±0.3 days, respectively).
Conclusion: We introduced a protocol for management of defecation using daily fecal volume. This protocol decreased fecal volume and incidence of diarrhea and constipation in critically ill patients. Appropriate management of evacuation of feces using this protocol may facilitate enteral nutrition, resulting in improvement of prognosis in critically ill patients.

View full abstract

Download PDF (590K)

Purpose: Overfeeding is known to induce metabolic problems in critical ill patients as well as malnutrition. In this study, we have determined the effect of overfeeding on protein catabolism as nutritional stress.
Subjects and Methods: Analyses were evaluated for metabolic status. 30 patients in a hospital ICU and receiving mechanical ventilation were measured energy expenditure by using indirect calorimetry. Patients were divided into 3 groups: underfeeding (U), adequate feeding (A), overfeeding (O). Energy expenditure, 3-methyl-histidine, creatinine, blood urea nitrogen, noradrenalin, C-reactive protein, prealbumin levels were assessed.
Results: The assessment of protein catabolism using 3-methyl-histidine/creatinine indicated that patients with overfeeding were prompt catabolism. BUN, CRP and prealbumin were not different among each group. The patients with overfeeding showed high level of urea noradrenalin significantly compared with other groups. However, length of ICU stay and ventilated duration were not changed between each group. Feeding routes; enteral nutrition, parental nutrition or both of those, did not make significant difference of protein catabolism and nutritional stress.
Conclusion: Overfeeding induced protein catabolism since it might be from nutrition stress.

View full abstract

Introduction: Protein-energy malnutrition (PEM) is common in the elderly and leads to increased risk of postoperative complications. The nutrition support team (NST) investigated the influence of the intensive nutritional management with immunonutrients on short-term results after hip fracture surgery.
Patients and methods: A retrospective review was conducted in 60 consecutive patients (age≥75 years) who underwent hip fracture surgery at our hospital from December 2009 to April 2011. The patients were divided into two groups; one group underwent the NST treatment [NST (+), n=30] and the other group was not under the NST treatment [NST (-),n=30]. Serum albumin levels, body mass index (BMI), food intake, duration from the acute stage until rehabilitation, total duration of hospital stay, and postoperative complications were compared between the two groups.
Results: No statistically significant differences were observed in the preoperative characteristics of age, male-to- female ratio, serum albumin values, BMI, and food intake among the two groups. Duration of the acute stage until rehabilitation [NST (-) : NST (+) = 11.3±5.4 days : 8.9±9.4 days] and serum albumin values on the 28th postoperative day [NST (-) : NST (+) = 3.20±0.39g/dL : 3.52±0.31g/dL] demonstrated statistically significant differences.
Conclusion: The nutritional status of the patients under NST treatment recovered earlier after surgery than that of patients not under NST treatment. But it is necessary to perform the randomized control study to verify these results.

View full abstract

Register with J-STAGE for free!