Nutrition Therapy in the Hospital
News Release: SCOFF Trial Confirms Fasting Not Necessary Before Cardiac Catheterisation Procedures
7 Sep, 2024 | 10:10h | UTC1 September 2024 – London, United Kingdom – New findings from the SCOFF trial, presented at ESC Congress 2024, suggest that fasting prior to minimally invasive cardiac catheterisation procedures under conscious sedation does not increase the risk of complications. The trial supports reconsidering current guidelines on pre-procedural fasting.
Key Points for Physicians:
– No increased complications: The SCOFF trial found no significant difference in adverse outcomes, such as aspiration pneumonia or hypoglycemia, between patients who fasted and those who ate normally before cardiac catheterisation.
– Improved patient satisfaction: Patients who did not fast reported higher satisfaction, with fewer complaints of discomfort and hunger.
– Potential guideline change: These findings, in line with previous studies like CHOW-NOW and TONIC, challenge the necessity of fasting before such procedures.
The trial’s lead investigator, Dr. David Ferreira (John Hunter Hospital, Australia), emphasized that avoiding fasting may improve patient experience without increasing risks, making it time to reconsider fasting guidelines for these procedures.
Study Overview:
– Trial design: Prospective, randomized, open-label, with blinded endpoint assessment.
– Participants: 716 patients undergoing coronary angiography, coronary intervention, or cardiac implantable electronic device procedures.
– Primary endpoint: Composite of hypotension, aspiration pneumonia, hyperglycemia, and hypoglycemia, showing a lower event rate in the non-fasting group (12.0%) compared to the fasting group (19.1%).
These results are likely to influence future clinical practice, providing greater flexibility for both patients and healthcare systems.
Systematic Review: Nasogastric Feeding Increases Diarrhea and Pain Compared to Nasojejunal Feeding in Acute Pancreatitis – BMC Gastroenterol
18 Aug, 2024 | 19:23h | UTCStudy Design and Population: This systematic review and meta-analysis compared the safety and efficacy of nasogastric (NG) versus nasojejunal (NJ) feeding initiated within 48 hours of hospital admission in patients with moderate to severe acute pancreatitis. The analysis included four randomized controlled trials (RCTs) involving a total of 217 patients.
Main Findings: The review found no significant difference in mortality between NG and NJ feeding groups. However, NG feeding was associated with a higher incidence of diarrhea (RR 2.75, P = 0.02) and pain (RR 2.91, P = 0.002). The risk of infection was also higher in the NG group (6.67% vs. 3.33%, P = 0.027). No significant differences were observed in the need for surgical intervention, the requirement for parenteral nutrition, or the success rates of feeding procedures.
Implications for Practice: The findings suggest that while NG feeding does not increase mortality in acute pancreatitis, it is associated with higher rates of certain complications, particularly diarrhea and pain. Clinicians should consider these risks when choosing a feeding strategy for patients with acute pancreatitis, especially within the critical early 48-hour period post-admission.
RCT: Free Access to Water vs. Fasting Pre-Cesarean Reduces Vomiting and Increases Maternal Satisfaction
25 Mar, 2024 | 11:17h | UTCStudy Design and Population: This randomized controlled trial was carried out at the Obstetric Unit, Universiti Malaya Medical Center from October 2020 to May 2022. A total of 504 women scheduled for planned cesarean delivery under spinal anesthesia were randomized into two groups: 252 were allowed free access to water up until being called to the operating theater, and 252 were required to fast from midnight before the procedure. The study primarily aimed to evaluate the effects of these preoperative oral intake policies on perioperative vomiting and maternal satisfaction.
Main Findings: The results demonstrated significant benefits for the group with free access to water. Specifically, perioperative vomiting was observed in 3.6% of women with water access compared to 9.5% of those fasting, indicating a relative risk reduction. Maternal satisfaction scores were notably higher in the water access group, with median scores of 9 versus 5 for the fasting group. Additional findings included lower reports of thirst, fewer instances of preoperative intravenous hydration, reduced ketone presence in urine, and a lower average number of vasopressor doses needed. Significantly, 95.2% of participants in the water access group would recommend their regimen to a friend, compared to only 39.7% in the fasting group.
Implications for Practice: Allowing free access to water up until the time of surgery for women scheduled for cesarean delivery under spinal anesthesia significantly reduces the risk of perioperative vomiting and improves maternal satisfaction, without adversely affecting post-cesarean recovery or neonatal outcomes. These findings support revising current preoperative fasting guidelines to improve patient experience and potentially enhance clinical outcomes.
ESPEN guideline on nutritional support for polymorbid medical inpatients
7 Aug, 2023 | 14:52h | UTCESPEN guideline on nutritional support for polymorbid medical inpatients – Clinical Nutrition
ESPEN Updated Guideline | Clinical nutrition in the intensive care unit
1 Aug, 2023 | 14:27h | UTC
Personalized nutrition therapy in critical care: 10 expert recommendations
10 Jul, 2023 | 13:36h | UTCPersonalized nutrition therapy in critical care: 10 expert recommendations – Critical Care
How to avoid harm with feeding critically ill patients: a synthesis of viewpoints of a basic scientist, dietitian and intensivist
10 Jul, 2023 | 13:34h | UTC
M-A | Optimizing enteral nutrition delivery by implementing volume-based feeding protocol for critically ill patients
24 May, 2023 | 13:13h | UTC
M-A | Prevalence and outcomes of frailty in unplanned hospital admissions
9 May, 2023 | 14:45h | UTC
Review | What the clinician needs to know about medical nutrition therapy in critically ill patients in 2023
26 Apr, 2023 | 13:59h | UTC
Review | Refeeding Syndrome: diagnostic challenges and the potential of clinical decision support systems
10 Apr, 2023 | 13:28h | UTC
RCT | Low-calorie, low-protein feeding improves recovery time in ventilated adults with shock
22 Mar, 2023 | 13:42h | UTCSummary: The NUTRIREA-3 study aimed to determine the optimal calorie and protein intakes during the acute phase of severe critical illness. The study was a randomized, controlled, multicenter, open-label, parallel-group trial conducted in 61 French intensive care units (ICUs) involving 3044 adults receiving invasive mechanical ventilation and vasopressor support for shock. During the first seven ICU days, participants were randomly assigned to early nutrition with either low or standard calorie and protein targets. The primary endpoints were time to readiness for ICU discharge and day 90 all-cause mortality, while key secondary outcomes included secondary infections, gastrointestinal events, and liver dysfunction.
The study found that early calorie and protein restriction did not decrease mortality. However, it was associated with faster recovery and fewer complications compared to standard calorie and protein targets. The low-calorie, low-protein group had a shorter median time to readiness for ICU discharge and lower proportions of patients with vomiting, diarrhea, bowel ischemia, and liver dysfunction. The proportions of patients with secondary infections did not differ significantly between the two groups.
In conclusion, the NUTRIREA-3 study provides evidence that patients may benefit from restricted calorie and protein intakes during the acute phase of critical illness, as it expedites recovery and reduces the risk of complications.
Article: Low versus standard calorie and protein feeding in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group trial (NUTRIREA-3) – The Lancet Respiratory Medicine (free registration required)
Commentary on Twitter
NEW Research—Early calorie & protein restriction did not decrease mortality but was associated w/ faster recovery & fewer complications than standard intake targets
NUTRIREA-3 from Prof Jean Reignier & co https://t.co/VCS72qxLPD
Being presented @ISICEM today! #ISICEM23 pic.twitter.com/TpoJnwHP8P
— The Lancet Respiratory Medicine (@LancetRespirMed) March 21, 2023
Review | Nutritional management of the infant with chronic kidney disease stages 2–5 and on dialysis
9 Mar, 2023 | 14:18h | UTC
RCT | Caffeine did not reduce time to first bowel movement after laparoscopic colectomy
1 Mar, 2023 | 13:41h | UTCCaffeine for intestinal transit after laparoscopic colectomy: randomized clinical trial (CaCo trial) – British Journal of Surgery (link to abstract – $ for full-text)
Commentary on Twitter
In BJS' December issue: Caffeine for intestinal transit after laparoscopic colectomy: randomized clinical trial (CaCo trial) https://t.co/6z1cboAxi0 @bplwijn @des_winter @ksoreide @MalinASund @evanscolorectal @nfmkok @paulo_sutt @robhinchliffe1 @young_bjs pic.twitter.com/yGtXiIwgq0
— BJS (@BJSurgery) December 28, 2022
Review | (Mal)nutrition in critical illness and beyond
28 Feb, 2023 | 13:28h | UTC(Mal)nutrition in critical illness and beyond: a narrative review – Anaesthesia
ESPEN practical guideline | Home parenteral nutrition
20 Feb, 2023 | 12:21h | UTCSummary: Home parenteral nutrition (HPN) is a form of nutrition support where a patient receives intravenous nutrition at home. It is used for patients who cannot receive adequate nutrition through oral or enteral routes, such as those with intestinal failure, severe inflammatory bowel disease, or other gastrointestinal disorders. HPN can be a life-saving therapy, but it requires careful patient selection, as well as ongoing monitoring and management by a multidisciplinary team. The ESPEN guideline aims to provide practical guidance on the use of HPN, including the nutritional and metabolic aspects of care and the practical considerations of administering HPN at home. The guideline also emphasizes the importance of patient-centered care and shared decision-making, highlighting the need for regular assessment and monitoring of patients.
Article: ESPEN practical guideline: Home parenteral nutrition – Clinical Nutrition
M-A | The rate and assessment of muscle wasting during critical illness
17 Feb, 2023 | 12:55h | UTC
Commentary on Twitter
A Review published in @Crit_Care analyzes the data of ICU muscle wasting studies and reports that critically ill patients lose nearly 2% of skeletal muscle per day during the first week of ICU admission.https://t.co/qW5jzbWRSk
— BMC (@BioMedCentral) January 8, 2023
Review | Preoperative frailty screening, assessment and management
16 Feb, 2023 | 14:37h | UTCPreoperative frailty screening, assessment and management – Current Opinion in Anaesthesiology
Position Paper | Enteral nutrition in preterm infants
30 Jan, 2023 | 00:54h | UTC
Toward nutrition improving outcome of critically ill patients: how to interpret recent feeding RCTs?
30 Jan, 2023 | 00:42h | UTC
RCT | Higher protein dosing did not improve outcomes in critically ill patients with high nutritional risk
27 Jan, 2023 | 12:24h | UTCThe effect of higher protein dosing in critically ill patients with high nutritional risk (EFFORT Protein): an international, multicentre, pragmatic, registry-based randomised trial – The Lancet (link to abstract – $ for full-text)
Commentary on Twitter (thread – click for more)
Researchers aimed to test the hypothesis that a higher dose of protein provided to critically ill patients would improve clinical outcomes.
Here's what they found ? /4 https://t.co/C5JswTr82o
— The Lancet (@TheLancet) January 26, 2023
RCT | Continued enteral nutrition until extubation was noninferior to a 6-h fasting strategy before extubation in patients in the ICU
26 Jan, 2023 | 12:49h | UTCContinued enteral nutrition until extubation compared with fasting before extubation in patients in the intensive care unit: an open-label, cluster-randomised, parallel-group, non-inferiority trial – The Lancet Respiratory Medicine (free registration required)
Invited Commentary: Continuation of enteral nutrition until extubation in critically ill patients – The Lancet Respiratory Medicine
Commentary on Twitter
NEW Research—Continued enteral nutrition until extubation in critically ill patients in the ICU is a practice that could be safe to implement and be associated with potential benefits
Read the trial from Mickaël Landais & colleagues here: https://t.co/iAvet2DNjN #SCCM2023 pic.twitter.com/SBal9qkAyQ
— The Lancet Respiratory Medicine (@LancetRespirMed) January 21, 2023
Evidence-Based Guidance | Medical nutrition therapy in ECMO patients
26 Jan, 2023 | 12:28h | UTC
RCT | In patients undergoing cardiac surgery, intravenous high-dose selenium did not reduce morbidity or mortality
15 Jan, 2023 | 20:00h | UTC
Commentary on Twitter
In this study, high-dose sodium selenite was not effective in reducing the development of organ dysfunction and death in high-risk cardiac surgery patients. @CStoppe @CriticalCa https://t.co/H3HR1u1HhU
— JAMA Surgery (@JAMASurgery) January 12, 2023
Review | Intermittent feeding and circadian rhythm in critical illness.
12 Dec, 2022 | 12:20h | UTCIntermittent feeding and circadian rhythm in critical illness – Current Opinion in Critical Care