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| 1 | Implementation of enteral feeding protocol in an intensive care unit: Before-and-after study显示文摘AIM To determine the effects of implementing an enteral feeding protocol on the nutritional delivery and outcomes of intensive care patients.METHODS An uncontrolled, observational before-and-after study was performed in a tertiary mixed medical-surgical intensive care unit(ICU). In 2013, a nurse-driven enteral feeding protocol was developed and implemented in the ICU. Nutrition and outcome-related data from patients who were treated in the study unit from 2011-2012(the Before group) and 2014-2015(the After group) were obtained from a local electronic database, the national Population Registry and the hospital's Infection ControlService. Data from adult patients, readmissions excluded, who were treated for at least 7 d in the study unit were analysed. RESULTS In total, 231 patients were enrolled in the Before and 249 in the After group. The groups were comparable regarding demographics, patient profile, and severity of illness. Fewer patients were mechanically ventilated on admission in the After group(86.7% vs 93.1% in the Before group, P = 0.021). The prevalence of hospitalacquired infections, length of ICU stay and ICU, 30-and 60-d mortality did not differ between the groups. Patients in the After group had a lower 90-d(P = 0.026) and 120-d(P = 0.033) mortality. In the After group, enteral nutrition was prescribed less frequently(P = 0.039) on day 1 but significantly more frequently on all days from day 3. Implementation of the feeding protocol resulted in a higher cumulative amount of enterally(P = 0.049) and a lower cumulative amount of parenterally(P < 0.001) provided calories by day 7, with an overall reduction in caloric provision(P < 0.001). The prevalence of gastrointestinal symptoms was comparable in both groups, as was the frequency of prokinetic use. Underfeeding(total calories < 80% of caloric needs, independent of route) was observed in 59.4% of the study days Before vs 76.9% After(P < 0.001). Inclusion in the Before group, previous abdominal surgery, intraabdominal hypertension and the sum of gastrointestinal symptoms were found to be independent predictors of insufficient enteral nutrition.CONCLUSION The use of a nurse-driven feeding protocol improves the delivery of enteral nutrition in ICU patients without concomitant increases in gastrointestinal symptoms or intra-abdominal hypertension. | Martin Padar Gerli Uusvel Liis Starkopf Joel Starkopf Annika Reintam Blaser | 2017 | World Journal of Critical Care Medicine2017，6，1： | 22 |
| 2 | Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems显示文摘 | Annika Reintam Blaser Manu L. N. G. Malbrain Joel Starkopf Sonja Fruhwald Stephan M. Jakob Jan Waele Jan-Peter Braun Martijn Poeze Claudia Spies | 2012 | Intensive Care Medicine2012，，3： | 4 |
| 3 | Mild to moderate intra-abdominal hypertension: Does it matter?显示文摘This review summarizes the epidemiology, pathophysiological consequences and impact on outcome of mild to moderate(Grade Ⅰ to Ⅱ) intra-abdominal hypertension(IAH), points out possible pitfalls in available treatment recommendations and focuses on tasks for future research in the field. IAH occurs in about 40% of ICU patients. Whereas the prevalence of abdominal compartment syndrome seems to be decreasing, the prevalence of IAH does not. More than half of IAH patients present with IAH grade Ⅰ and approximately a quarter with IAH grade Ⅱ. However, most of the studies have addressed IAH as a yes-or-no variable, with little or no attention to different severity grades. Even mild IAH can have a negative impact on tissue perfusion and microcirculation and be associated with an increased length of stay and duration of mechanical ventilation. However, the impact of IAH and its different grades on mortality is controversial. The influence of intra-abdominal pressure(IAP) on outcome most likely depends on patient and disease characteristics and the concomitant macro- and microcirculation. Therefore, management might differ significantly. Today, clear triggers for interventions in different patient groups with mild to moderate IAH are not defined. Further studies are needed to clarify the clinical importance of mild to moderate IAH identifying clear triggers for interventions to lower the IAP. | Liivi Maddison Joel Starkopf Annika Reintam Blaser | 2016 | World Journal of Critical Care Medicine2016，5，1： | 4 |
| 4 | Gastrointestinal symptoms during the first week of intensive care are associated with poor outcome: a prospective multicentre study显示文摘 | Annika Reintam Blaser Martijn Poeze Manu L. N. G. Malbrain Martin Bj?rck Heleen M. Oudemans-van Straaten Joel Starkopf | 2013 | Intensive Care Medicine2013，，5： | 3 |
| 5 | Protective effect of antioxidants on pulmonary endothelial function after cardiopulmonary bypass显示文摘 | Monika A Settergten G Starkopf J | 2003 | J Cardiothorac Vasc Anesth2003，17，3： | 1 |
| 6 | Defining gastrointestinal failure显示文摘 | Reintam A Kern H Starkopf J | 2007 | ActaClinBelg Suppl2007，62，1： | 1 |
| 7 | Hyperoxia elicits preconditioning through a NFkB-dependent mechanism in the rat heart显示文摘 | Tahepold P Starkopf J Dumitrescu A | 2001 | J Thorac Cardiovasc Surg2001，125，： | 1 |
| 8 | Hyperoxia elicits myocardial protection through a nuclear factor kappaB-dependent mechanism in the rat heart显示文摘 | Tahepold P Vaage J Starkopf J | 2003 | J Thorac Cardiovasc Surg2003，125，3： | 1 |
| 9 | Definition, prevalence, and outcome of feeding intolerance in intensive care: a systematic review and meta-analysis 显示文摘 | Blaser AR Starkopf J Kirsimagi U | 2014 | Acta Anaesthesiol Scand2014，58，8： | 1 |
| 10 | Defining gastrointestinal failure显示文摘 | Reintam A Kern H Starkopf J | 2007 | Acta Clin Belg Suppl2007，1，1： | 1 |
| 11 | Defining gastrointestinal failure 显示文摘 | Reintam A Kern H Starkopf J | 2007 | Acta Clin Belg Suppl2007，62，1： | 1 |
| 12 | Hyperoxia elicits myocardial protection through a nuclear factor kappaB-dependent mechanism in the rat heart显示文摘 | Tahepold P Vaage J Starkopf J | 2003 | J Thorac Cardiovasc Surg2003，125，3： | 1 |
| 13 | Defining gastrointestinal failure 显示文摘 | Reintam A Kern H Starkopf J | 2007 | Aeta Clin Belg Suppl2007，，1： | 1 |
| 14 | Hyperoxia elicits myocardial protection through a nuclear factor kappaB dependent mechanism in the rat heart显示文摘 | Tahepold P Vaage J Starkopf J | 2003 | J Thorac Cardiocvasc Surg2003，125，3： | 1 |
| 15 | Gas- trointestinal function in intensive care patients:terminolo- gy definitions and management recommendations of theesiem working group on abdominal problems显示文摘 | Reintam Blaser A Malbrain ML Starkopf J | 2012 | Inten- sive Care Med2012，38，3： | 1 |
| 16 | Defining gastrointestinal failure显示文摘 | Reintam A Kern H Starkopf J | 2007 | Acta Clin Belg Suppl2007，，1： | 1 |
| 17 | Gastrointestinal failure in the ICU显示文摘 | Reintam Blaser A Jakob SM Starkopf J | 2016 | Curr Opin Crit Care2016，22，2： | 1 |
| 18 | Gastro- intestinal function in intensive care patients: terminology, definitions and management, recommendations of the esiem working group on abdominal problems 显示文摘 | Reintam Blaser A Malbrain ML Starkopf J | 2012 | Intensive Care Med2012，38，3： | 1 |
| 19 | Defining gastrointestinal failure显示文摘 | REINTAM A KERN H STARKOPF J | 2007 | Acta Clin Belg Suppl2007，，： | 1 |
| 20 | Hyperoxia elicits preconditioning through a NFkB-dependent mechanism in the rat heart显示文摘 | Tahepold P Starkopf J Dumitrescu A | 2001 | J Thorac Cardiovase Surg2001，125，： | 1 |
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