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Clinical severity scores do not predict tolerance to enteral nutrition in critically ill children

  • César Sánchez (a1), Jesús López-Herce (a2), Santiago Mencía (a2), Javier Urbano (a2), Angel Carrillo (a2) and José María Bellón (a3)...

Abstract

The objective of the present study was to analyse whether there is a relationship between the clinical severity at the time of starting transpyloric enteral nutrition (TEN) and the onset of digestive tract complications in critically ill children. Between May 2005 and December 2007, we performed a prospective, observational study with the participation of 209 critically ill children aged between 3 d and 17 years and who received TEN. The characteristics of the nutrition and its tolerance were compared with the paediatric risk of mortality (PRISM), the paediatric index of mortality (PIM) and the paediatric logistic organ dysfunction index (PELOD) at the time of starting the nutrition. Higher PRISM and PELOD scores correlated with a later time of starting enteral nutrition, a longer time to reach the maximum daily energy delivery and a longer duration of the TEN. However, the severity scores did not correlate with the maximum energy delivery achieved. Abdominal distension or excessive gastric residues were observed in 4·7 % of the patients and diarrhoea in 4·3 %. The ability of the severity scores to predict diarrhoea was of 0·67 for PRISM, 0·63 for PELOD and 0·60 for PIM-2.The severity scores were not able to predict other digestive tract complications. Higher scores of clinical severity at the time of starting enteral nutrition correlate with a later initiation of the nutrition, a longer time to reach the maximum energy delivery and a longer duration of TEN. However, their ability to predict digestive tract complications is low.

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Corresponding author

*Corresponding author: Dr Jesús López-Herce, fax +34 91 5290107, email pielvi@ya.com

References

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1Major, K, Lefor, AT & Wilson, M (2002) Route of nutrition support. Nutrition 18, 445446.
2Galbán, C, Montejo, JC, Mesejo, A, et al. (2000) An immune-enhancing enteral diet reduces mortality rate and episodes of bacteremia in septic intensive care unit patients. Crit Care Med 28, 643648.
3Chellis, MJ, Sanders, SV, Webster, H, et al. (1996) Early enteral feeding in the pediatric intensive care unit. JPEN J Parenter Enteral Nutr 20, 7173.
4Dunham, CM, Frankenfield, D, Belzberg, H, et al. (1994) Gut failure – predictor of or contributor to mortality in mechanically ventilated blunt trauma patients? J Trauma 37, 3034.
5Panadero, E, López-Herce, J, Caro, L, et al. (1998) Transpyloric enteral feeding in critically ill children. J Pediatr Gastroenterol Nutr 26, 4348.
6Pollack, MM, Ruttimann, UE & Getson, PR (1988) The pediatric risk of mortality (PRISM) score. Crit Care Med 16, 11101116.
7Shann, F, Pearson, G, Slater, A, et al. (1997) Pediatric index of mortality (PIM). A mortality prediction model for children in intensive care. Intensive Care Med 23, 201207.
8Slater, A, Shann, F & Pearson, G (2003) PIM II:a revised version of the Paediatric Index of Mortality. Intensive Care Med 29, 278285.
9Leteurtre, S, Martinot, A, Duhamel, A, et al. (2003) Validation of the paediatric logistic organ dysfunction (PELOD) score: prospective, observational, multicentre study. Lancet 362, 192197.
10Chellis, MJ, Sanders, SV, Dean, M, et al. (1996) Bedside transpyloric tube placement in the pediatric intensive care unit. JPEN J Parenter Enteral Nutr 20, 8890.
11Pettignano, R, Heard, M, Davis, R, et al. (1998) Total enteral nutrition versus total parenteral nutrition during pediatric extracorporeal membrane oxygenation. Crit Care Med 26, 358366.
12De Lucas, C, Moreno, M, López-Herce, J, et al. (2000) Transpyloric enteral nutrition reduces the complication rate and cost in the critically ill child. J Pediatr Gastroenterol Nutr 30, 175180.
13Martha, VF, Ramos García, PC, Piva, JP, et al. (2005) Comparison of two prognostic scores (PRISM and PIM) at a pediatric intensive care unit, (article in Portuguese). J Pediatr (Rio J) 81, 259264.
14Leclerc, F, Leteutre, S, Duhamel, A, et al. (2005) Cumulative influence of organ dysfunctions and septic state on mortality of critically ill children. Am J Resp Crit Care Med 171, 348353.
15Proulx, F, Fayon, M, Farell, CA, et al. (1996) Epidemiology of sepsis and multiple organ dysfunction syndrome in children. Chest 109, 10331037.
16Polderman, KH, Thijs, LG & Girbes, AR (1999) Interobserver variability in the use of APACHE II scores. Lancet 353, 380.
17Briassoulis, G, Filippou, O, Kanariou, M, et al. (2005) Comparative effects of early randomized immune or non-immune-enhancing enteral nutrition on cytokine production in children with septic shock. Intensive Care Med 31, 851858.
18Briassoulis, G, Zavras, N & Hatsis, T (2001) Malnutrition, nutritional indexes, and early enteral feeding in critically ill children. Nutrition 17, 548557.
19Watters, JM, Kirkpatrick, SM, Norris, SB, et al. (1997) Immediate postoperative enteral feeding results in impaired respiratory mechanics and decreased morbility. Ann Surg 226, 369380.
20Sánchez, C, López-Herce, J, Carrillo, A, et al. (2007) Early transpyloric enteral nutrition in children. Nutrition 23, 1622.
21Taylor, RM, Preedy, VR, Baker, AJ, et al. (2003) Nutritional support in critically ill children. Clin Nutr 22, 365369.
22Briassoulis, G, Venkataraman, S & Thompson, AE (2000) Energy expenditure in critically ill children. Crit Care Med 28, 11661172.
23Mentec, H, Dupont, H, Bochetti, M, et al. (2001) Upper digestive intolerance during enteral nutrition in critically ill patients: frequency, risk factors and complications. Crit Care Med 29, 19551961.
24Pupelis, G, Selga, G, Austrums, E, et al. (2001) Jejunal feeding, even when instituted late, improves outcomes in patients with severe pancreatitis and peritonitis. Nutrition 17, 9194.
25López-Herce, J, Santiago, MJ, Sánchez, C, et al. (2008) Risk factors for gastrointestinal complications in critically ill children with transpyloric enteral nutrition. Eur J Clin Nutr 62, 395400.

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Clinical severity scores do not predict tolerance to enteral nutrition in critically ill children

  • César Sánchez (a1), Jesús López-Herce (a2), Santiago Mencía (a2), Javier Urbano (a2), Angel Carrillo (a2) and José María Bellón (a3)...

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