Purpose
The purpose of this study was to identify the incidence and risk factors associated with the unplanned removal of nasogastric (NG) tubes in neurocritical patients.
Methods
Data were collected retrospectively from the medical records of 479 patients admitted to the tertiary hospital's neuro-intensive care units (NCU). Subjects were divided into two groups depending on whether there was unplanned NG tube removal. Multivariate logistic regression analysis was used to identify risk factors.
Results
Unplanned removal of NG tubes occurred in 35.9% of patients. The incidence of unplanned NG tube removal was 47.2 per 1,000 patient days. Intubated time of the NG tube was 3.96 days in patients with unplanned removal. Risk factors associated with unplanned removal were men (Odds Ratio [OR]=2.19), epilepsy (OR=9.99), traumatic brain injury (OR=5.50), stroke (OR=4.42), improvement of Glasgow Coma Scale (GCS) (OR=1.08), delirium (OR=1.88), physical restraint (OR=2.44), and drainage or decompression purpose (OR=1.67).
Conclusion
Unplanned removal of NG tubes occurred very frequently in neurocritical patients. Care should be taken for patients with neurological diseases who show improvement in their level of consciousness but are still confused due to brain lesions or delirium to reduce it. The application of physical restraints cannot guarantee the prevention of unplanned NG tube removal. Therefore, nurses need to assess the condition of patients and NG tubes frequently.In particular, more attention should be paid to using NG tubes for decompression or drainage purposes. It is also proposed to actively review the NG tube removal plan through periodic evaluation.

Citations

• Impact of the restraint decision tree for physical restraint use in South Korean neurointensive care units
  Jaejin Kang, Sol Kim, Minji Lee, Hyunjoo Na
  Nursing in Critical Care.2024; 29(5): 1110.     CrossRef

PURPOSE
The purpose of this study was to investigate the nutritional support, gastric residual volume, and nutritional status of the intensive care unit (ICU) patients on enteral feeding.
METHODS
A descriptive longitudinal design was used to collect 5 day data on enteral nutrition of 52 ICU patients in an university hospital. Nutritional support was calculated with actual caloric intake compared to individual caloric requirement. Residual volumes were measured prior to routine feedings, and the serum albumin levels and the total lymphocyte counts were checked to evaluate nutritional status. The data were analyzed using one group repeated measures ANOVA, paired t-test, and Spearman's bivariate correlation analysis.
RESULTS
The subjects received their first enteral feeding on the 5.75th day of ICU admission. The mean nutritional support rate was 49.1% of the requirement, however prescription rate and support rate were increased as time goes by. Gastric residual volumes were less than 10 cc in 95% cases. A significant negative correlation was found between nutritional support and nutritional status.
CONCLUSION
The nutritional support for ICU patient was low compared to the requirement, and their nutritional status was worse than at the time of ICU admission. Further studies are necessary to develop nursing interventions for improving nutritional support for ICU patients.

Citations

• Comparison of the nutritional indicators of critically Ill patients on extracorporeal membrane oxygen (ECMO)
  Nah-Mee Shin, Suk Yeon Ha, Yoon Soo Cho
  Journal of Nutrition and Health.2021; 54(5): 489.     CrossRef
• The effect of nutritional supply on clinical outcomes and nutritional status in critically ill patients receiving continuous renal replacement therapy
  Ju Yeun Kim, Ji-Myung Kim, Yuri Kim
  Journal of Nutrition and Health.2015; 48(3): 211.     CrossRef

PURPOSE
The purpose of this study was to describe the differences between early and delayed enteral nutrition on nutritional intake.
METHODS
A pilot cohort study was conducted with 45 critically ill adult patients who had a primary medical diagnosis. Energy prescribed and received were collected during the four days after initiation of enteral nutrition. Adequate feeding was defined as the energy intake more than 90% of required energy.
RESULTS
A total of 23 patients (52%) were received early enteral nutrition (within 48 hours of admission). Energy intake of early enteral nutrition was less than intake of delayed enteral nutrition during the four days of the study. Although the difference on day one was significantly greater than the differences on day two, the differences on day two were not different from days three or four. No statistical differences in the adequacy of nutritional intake were found between patients in the early and the delayed group.
CONCLUSION
In critically ill patients receiving early enteral nutrition, more aggressive administration from the beginning will improve the nutritional intake. Additional studies including a large multi-centre, randomized clinical trial are recommended.

Citations

• A Case Report about Diarrhea of Soeumin Caused by Tube Feeding Treated with Korean Medicinal Treatment
  Jeong-been Ha, Su-jung Lee, Jae-hwan Lew
  The Journal of Internal Korean Medicine.2020; 41(2): 150.     CrossRef

PURPOSE
The purpose of the study were to examine the nutritional status of severe brain injury adult patients in critical period, and to compare the nutritional states before and after tube feeding.
METHODS
Data from 19 patients admitted to the SICU in a university hospital due to severe brain injury were analyzed. Nutritional states were measured by anthropometric and blood biochemical indicators.
RESULTS
MAC and MAMC were significantly decreased only at 7 days after admission compared with those on the day of admission. TSF was significantly decreased from 7 days to 14 days after admission. Fat rate was significantly decreased from 3 days to 14 days after admission. Hb was significantly decreased only at 3 days after admission. Albumin was significantly decreased from 3 days to 14 days after admission. However, lymphocyte was significantly increased at 14 days after admission. TSF and Albumin became significantly worse even after initiating tube feeding.
CONCLUSIONS
Nutritional status of severe brain injury patients in SICU became worse after admission whichever indicators were adopted to evaluate nutritional status, anthropometric or blood biochemical indicators, and became worse even after initiating tube feeding.