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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Effects of enteral nutrition on clinical outcomes among mechanically ventilated and sedated patients in the pediatric intensive care unit

Abstract

Objective. To analyze the effects of enteral nutrition on outcomes and complications of critically ill children in the pediatric intensive care unit (PICU).

Design. Retrospective cohort study.

Setting. PICU in a tertiary care academic medical center.

Patients. Patients up to age 17 years who were admitted to the PICU between January 1, 2011, and December 31, 2013.

Interventions. Intubation for more than 48 hours and requiring any sedative medications. Patients with surgical contraindications to feeding were excluded.

Measures and Main Results. A total of 165 patients met inclusion criteria. Both manual review of the electronic health record and automated data capture (whenever technically feasible) were conducted. Data were collected in REDCap software and analyzed using a statistical discovery program. The mean (SD) calorie intake within the first 10 days of PICU admission was 40% (31.9%) of the prescribed calories. Only 67% of the patients had feeding initiated within 48 hours of admission. No significant difference in hospital or PICU length of stay or ventilator-free days was observed in patients who met one-third of their nutritional goals (50.3%) compared with patients who did not (49.7%). Mortality was nonsignificantly higher among patients who did not meet nutritional goals (P=.07). No association was found between higher doses of opioids or benzodiazepines and nutrition tolerance or gastrointestinal complications.

Conclusions. Early adequate enteral nutrition had no statistically significant impact on the short-term clinical outcomes of PICU patients.

Key words: critical illness, deep sedation, energy intake, pediatric intensive care unit, pediatrics, respiration, artificial

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Spontaneous breathing during anaesthesia: first, do no harm

Abstract

Controlled respiration and mechanical ventilation have long been part of anaesthetic practice. Modern surgery, anaesthetic techniques, and new agents require a reappraisal of this established habit. In many circumstances the adverse effects of mechanical ventilation can be avoided by the use of the laryngeal mask and allowing spontaneous ventilation. In addition to the more prominent advantages, such as less sore throat, reliable assessment of anaesthetic depth, and good recovery, there may be more subtle advantages such as improved cardiopulmonary interaction, better distribution of ventilation, and reduced mechanically induced lung damage. Some of these advantages may be also applied during mechanical ventilation, by allowing continued muscle activity or continuously varying the size of the tidal breaths.Mechanical ventilation is often unnecessary and may be harmful.

Key words: respiration, neuromuscular blockade, artificial respiration, pul-monary gas exchange

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