Tolerancja żywienia dojelitowego wśród pacjentów w-starszym wieku na oddziale intensywnej terapii

Introduction. The health problems of old age are a generalized decline of organ efficiency, neuromuscular conduction and metabolic processes. Content of water in the body decrease while the occurrence of malnutrition increase. The percentage of people admitted to hospital wards including intensive care also increases. The aim of this study was to evaluate the tolerance of the industrial diets in patients over 60 years old treated in the Intensive Care Unit.Material and methods. A retrospective analysis of medical and nursing documentation of 134 patients over 60 years old hospitalized in the years 2009–2010, who was fed at least for 5 days by industrial enteral diets administered by nasogastric tube continuous infusion of 20 h/day. Feeding tolerance was assessed in the 1st, 3rd and 5th day of feeding. Analysed: diet infusion rate, signs of intolerance from the gastrointestinal tract (residual and the number of defecations).Results. Enteral Nutrition was implemented average on the 4th day of stay. Previously, 84 patients were fed parenterally. On the first day the average speed of infusion was 33 ml/h, on the third day-55 ml/h, and on thefifth day-66 ml/h (p < 0.05). Residuals occurred on the first day in 37 patients, on the third day in 26, and on the fifth day in 18 patients. In d1 diarrhea occurred in 2 patients, on the 3rd day-in 7 patients, on the fifth day-in 4 patients. Enteral nutrition was abandoned in 9 patients (total) because of: intense residuals of gastric content, gastrointestinal bleeding, vomiting, surgical treatment of the underlying disease. The level of CRP in patients with residuals was significantly higher in the d1 and d3 as compared to patients without residual.Conclusions. Feeding with enteral industry diets implemented gradually in the ICU is well tolerated by patients over 60 years old. Symptoms from gastrointestinal tract require modifications of planned enteral nutrition therapy, while the lack of tolerance and the need to stop nutritional treatment are usually associated with deterioration of general condition and progress of the underlying disease.Wstęp. Problemy zdrowotne osób w wieku podeszłym to uogólniony spadek: wydolności narządowej, przewodnictwa nerwowo-mięśniowego, procesów metabolicznych. Zmniejsza się zawartość wody w organizmie oraz zwiększa się występowanie niedożywienia. Wzrasta także liczba osób przyjmowanych na oddziały szpitalne, między innymi oddziały intensywnej terapii (OIT). Celem pracy była ocena tolerancji diet przemysłowych u pacjentów powyżej 60. roku życia leczonych na OIT.Materiał i metody. Metodą badań była retrospektywna analiza dokumentacji lekarsko-pielęgniarskiej 134 pacjentów powyżej 60. roku życia, u których co najmniej przez 5 dni stosowano żywienie dojelitowe dietami przemysłowymi podawanymi przez zgłębnik nosowo-żołądkowy wlewem ciągłym 20 h/dobę. Tolerancję żywienia oceniano w 1., 3. oraz 5. dobie żywienia. Analizowano: prędkość wlewu diety, objawy nietolerancji ze strony przewodu pokarmowego (zaleganie oraz liczbę wypróżnień).Wyniki. Żywienie enteralne wdrażane było średnio w 4. dobie pobytu; 84 pacjentów żywionych było wcześniej parenteralnie. Średnia prędkość wlewu w pierwszej dobie wynosiła 33 ml/godzinę, w 3. — 55 ml/godzinę, a w 5. — 66 ml/godzinę; (p < 0,05). Zaleganie w żołądku wystąpiło w 1. dobie u 37 chorych, w dobie 3. u 26 chorych,a w dobie 5. u 18. W dobie 1. biegunka wystąpiła u 2 pacjentów, w 3. — u 7 pacjentów, w 5. — u 4. Od żywienia dojelitowego odstąpiono łącznie u 9 pacjentów z powodu: intensywnych zalegań treści żołądkowej, krwawienia z przewodu pokarmowego, wymiotów, operacyjnego leczenia choroby podstawowej. Poziom białka C-reaktywnego (CRP) u pacjentów z zaleganiami był istotnie statystycznie wyższy w d1 i d3 w porównaniu z pacjentami bez zalegań.Wnioski. Żywienie dojelitowe dietami przemysłowymi wdrażane stopniowo na OIT jest dobrze tolerowane przez pacjentów powyżej 60. roku życia. Występujące objawy ze strony przewodu pokarmowego wymagają modyfikacji zaplanowanej terapii żywieniowej dojelitowej, natomiast brak tolerancji i konieczność przerwania leczenia żywieniowego związane są najczęściej z pogorszeniem stanu ogólnego i postępem choroby podstawowej

Occurrence of gastrointestinal side effects associated with early use of commercial diets in ITU patients

BACKGROUND: The purpose of this retrospective study was to analyse the occurrence of gastrointestinal side effects in enterally fed ICU patients.METHODS: We analysed the records of 195 ITU patients fed enterally, over at least five days, with commercial mixtures administered as 20-h infusions. Gastric retention, the number of defecations, and incidents requiring discontinuation of enteral feeding, were noted during the first 3 days of nutrition.RESULTS: Enteral nutrition was usually started during the first week of treatment (median 4, range: 1–33). In 118 patients receiving parenteral nutrition, the median day of implementing enteral feeding was day 5; some received enteral mixtures much earlier (day 2). The mean infusion rates of enteral mixtures were: 33 mL h –1 on day 1, 58 mL h –1 on day 2, and 68 mL h –1 on day 3. Gastric retention was observed in 49 (25.1%) patients during the first day, in 37 (19.0%) on day 2, and in 25 (12.8%) on day 3. Discontinuation of enteral nutrition was necessary in 6 patients due to: surgery (1), high gastric retention (4), gastrointestinal bleeding (1). A statistically significant correlation was found between the occurrence of gastric retention, infusion rates and CRP, and between the number of defecations and infusion rates.CONCLUSIONS: Enteral feeding with commercial diets is well tolerated when implemented gradually. Intolerance and the need for the discontinuation of enteral feeding were usually associated with a worsening of the patient’s general condition and progression of the underlying disease.BACKGROUND: The purpose of this retrospective study was to analyse the occurrence of gastrointestinal side effects in enterally fed ITU patients.METHODS: We analysed the records of 195 ITU patients fed enterally, over at least five days, with commercial mixtures administered as 20-h infusions. Gastric retention, the number of defecations, and incidents requiring discontinuation of enteral feeding, were noted during the first 3 days of nutrition.RESULTS: Enteral nutrition was usually started during the first week of treatment (median 4, range: 1–33). In 118 patients receiving parenteral nutrition, the median day of implementing enteral feeding was day 5; some received enteral mixtures much earlier (day 2). The mean infusion rates of enteral mixtures were: 33 mL h–1 on day 1, 58 mL h–1 on day 2, and 68 mL h–1 on day 3. Gastric retention was observed in 49 (25.1%) patients during the first day, in 37 (19.0%) on day 2, and in 25 (12.8%) on day 3. Discontinuation of enteral nutrition was necessary in 6 patients due to: surgery (1), high gastric retention (4), gastrointestinal bleeding (1). A statistically significant correlation was found between the occurrence of gastric retention, infusion rates and CRP, and between the number of defecations and infusion rates.CONCLUSIONS: Enteral feeding with commercial diets is well tolerated when implemented gradually. Intolerance and the need for the discontinuation of enteral feeding were usually associated with a worsening of the patient’s general condition and progression of the underlying disease