Search

Between 42 and 60% of critically ill patients have disordered swallowing (dysphagia) following extubation, with duration of endotracheal intubation recognized as a risk factor [[2]]. 1 Swallow Risk Index (SRI) identifies disordered swallowing and aspiration risk in ICU patients without the need for radiology. a Radiological images (frames 1-5) of a 10-ml liquid swallow (pink) with manometry catheter in situ. 42% (8/19) of critically ill patients had an abnormal I SRI i , with two patients demonstrating an SRI above the predictive threshold for aspiration risk (SRI > 15), with aspiration being subsequently confirmed. [Extracted from the article]

Background: This study aimed to determine the agreement between the modified Nutrition Risk in Critically ill Score (mNUTRIC) and the Subjective Global Assessment (SGA) and compare their ability in discriminating and quantifying mortality risk independently and in combination. Methods: Between August 2015 and October 2016, all patients in a Singaporean hospital received the SGA within 48 hours of intensive care unit admission. Nutrition status was dichotomized into presence or absence of malnutrition. The mNUTRIC of patients was retrospectively calculated at the end of the study, and high mNUTRIC was defined as scores ≥5. Results: There were 439 patients and 67.9% had high mNUTRIC, whereas only 28% were malnourished. Hospital mortality was 29.6%, and none was lost to follow-up. Although both tools had poor agreement (κ statistics: 0.13, P<.001), they had similar discriminative value for hospital mortality (C-statistics [95% confidence interval (CI)], 0.66 [0.62-0.70] for high mNUTRIC and 0.61 [0.56-0.66] for malnutrition, P = .12). However, a high mNUTRIC was associated with higher adjusted odds for hospital mortality compared with malnutrition (adjusted odds ratio [95% CI], 5.32 [2.15-13.17], P < .001, and 4.27 [1.03-17.71], P = .046, respectively). Combination of both tools showed malnutrition and high mNUTRIC were associated with the highest adjusted odds for hospital mortality (14.43 [5.38-38.78], P < .001). Conclusion: The mNUTRIC and SGA had poor agreement. Although they individually provided a fair discriminative value for hospital mortality, the combination of these approaches is a better discriminator to quantify mortality risk. (JPEN J Parenter Enteral Nutr. 2018;42:872-876) [ABSTRACT FROM AUTHOR]

This study examined the effects of critical illness on the relationship between proximal and distal gastric motor activity during fasting and duodenal nutrient stimulation. Prospective, case-controlled study. Ten critically ill patients and ten healthy volunteers. Concurrent proximal gastric (barostat) and antro-pyloro-duodenal (manometry) motility were recorded during fasting and during two 60-min duodenal nutrient infusions (Ensure at 1 kcal/min and 2 kcal/min) in random order, separated by a 2-h wash-out period. Baseline proximal gastric volumes were similar between the two groups. At 10 min nutrient-induced fundic relaxation was lower in patients than healthy subjects (45 ± 26 vs. 196 ± 29 ml). In patients the frequency and volume amplitude of fundic waves were also lower. There were fewer propagated antral waves in patients than in healthy subjects during both fasting and nutrient infusion. These were more retrograde, shorter in length and associated with a pyloric contraction. The proportion of fundic waves followed by a distally propagated antral wave was significantly less in patients (0%, 0–8%) than controls 36% (11–44%). In critical illness, in addition to impairment of proximal and distal gastric motor activity, the association between the two gastric regions is abnormal. This disturbance may interfere with meal distribution and further contribute to slow gastric emptying in these patients. [ABSTRACT FROM AUTHOR]

The article reports on the results of a study of the impact of delaying enteral feeding on gastric emptying (GE), plasma cholecystokinin and peptide YY concentrations in critically ill patients. A description of the experimental set-up and measurement methods is presented. The study concluded that delayed enteral feeding has little impact on either GE or the enterogastric feedback hormones.

To determine the incidence of Clostridium difficile (CD) diarrhoea in feed-intolerant, critically ill patients who received erythromycin-based prokinetic therapy. Prospective observational study in a mixed intensive care unit. The development of diarrhoea (> 3 loose, liquid stool per day with an estimated total volume ≥ 250 ml/day) was assessed in 180 consecutive critically ill patients who received prokinetic therapy (erythromycin only, n = 53; metoclopramide, n = 37; combination erythromycin/metoclopramide, n = 90) for feed intolerance. Stool microscopy, culture and CD toxin assay were performed in all patients who developed diarrhoea during and after prokinetic therapy. Diarrhoea was deemed to be related to CD infection if CD toxin was detected. Demographics, antibiotic use and admission diagnosis were similar amongst the three patients groups. Diarrhoea developed in 72 (40%) patients, 9.9 ± 0.8 days after commencement of therapy, none of whom was positive for CD toxin or bacterial infection. Parasitic infections were found in four aboriginal men from an area endemic for these infections. Diarrhoea was most prevalent in patients who received combination therapy (49%) and was more common than in those who received erythromycin alone (30%) and metoclopramide alone (32%). Diarrhoea was short-lasting with a mean duration of 3.6 ± 1.2 days. In critical illness, diarrhoea following the administration of erythromycin at prokinetic doses is not associated with CD but may be related to pro-motility effects of the agent. Prokinetic therapy should be stopped at the onset of diarrhoea and prophylactic use should be strictly avoided. [ABSTRACT FROM AUTHOR]

The article presents a study on the effects of exogenous glucagon-like peptide-1 (GLP-1) on gastric emptying, glucose absorption and plasma insulin, and glucagon concentrations in nondiabetic critically ill patients. The study involves 25 diabetes-free mechanically ventilated patients. Furthermore, it shows that exogenous glucagon-like peptide-1 lowers postprandial glycemia in the critically ill, which may occur by slowing gastric emptying when it is normal but not when it is delayed.

The article compares the efficacy of combination therapy, with erythromycin and metoclopramide, to erythromycin alone in the treatment of feed intolerance in critically ill patients in the U.S. It stated that slow gastric emptying and subsequent intolerance of nasogastric (NG) feeding occur in up to 50% of critically ill patients. It concludes that the combination therapy is more effective than erythromycin alone in improving the delivery of nasogastric nutrition.

The article presents a study on the effects of critical illness on sucrose absorption, permeability and mucosal morphology. The study covered patients receiving mechanical ventilation and 20 healthy subjects. Results of the study revealed critically ill patients had significantly reduced cumulative carbon dioxide recovery compared with healthy subjects. Patients also showed increased lactulose/rhamnose ratio which was greater in feed-intolerant patients.

The article discusses a study on the relationship of small intestinal glucose absorption and duodenocecal transit with glycemia in critically ill people. The study subjects included 28 patients who were admitted to tertiary mixed medical-surgical adult intensive care units (ICU) and 16 healthy subjects. The study procedure included the infusion of liquid feed into the duodenum, the measurement of glucose absorption, and the measurement of duodenocecal transit.

The article discusses an observational comparative study which investigated the association between plasma erythromycin levels and feeding outcomes in feed-intolerant critically ill patients. The feed-intolerant mechanically ventilated patients received intravenous erythromycin. The study showed that there is an inverse relationship between plasma erythromycin level and the time to loss of clinical motor effect in the feed-intolerant critically ill patients.