Hypoenergetic feeding does not improve outcomes in critically ill patients with premorbid obesity: a post hoc analysis of a randomized controlled trial.

Optimal energy goals for adult, obese critically ill surgical patients are unclear. To date, there has been little data comparing feeding regimens for obese and non-obese critically ill surgical patients and the effect on outcomes. The objective was to compare the effect of hypoenergetic and euenergetic feeding goals in critically ill obese patients on outcomes, including infection, intensive care unit length of stay, and mortality.

Physician opinions on decision making for percutaneous endoscopic gastrostomy (PEG) feeding tube placement.

Background: Percutaneous endoscopically placed gastrostomy (PEG) tubes are useful for long-term enteral nutrition; however, they are associated with lack of benefit for patients with advanced dementia, at end of life, and for some stroke patients with early regain of swallowing function. We surveyed physician opinions on decision making with the aim to identify factors that can lead to inappropriate PEG placement, as a first step of a quality improvement initiative to prevent inappropriate PEG placements at our facility.

Methods: A survey was distributed to 231 physicians, with questions about discussion topics, contraindications, responsibilities, and practices in decision making for PEG placement.

Early Oral Feeding as Compared With Traditional Timing of Oral Feeding After Upper Gastrointestinal Surgery: A Systematic Review and Meta-analysis.

Objective: To compare the effects of early oral feeding to traditional (or late) timing of oral feeding after upper gastrointestinal surgery on clinical outcomes.

Background: Early postoperative oral feeding is becoming more common, particularly as part of multimodal or fast-track protocols. However, concerns remain about the safety of early oral feeding after upper gastrointestinal surgery.

Hypocaloric compared with eucaloric nutritional support and its effect on infection rates in a surgical intensive care unit: a randomized controlled trial.

Background: Proper caloric intake goals in critically ill surgical patients are unclear. It is possible that overnutrition can lead to hyperglycemia and an increased risk of infection.

Objective: This study was conducted to determine whether surgical infection outcomes in the intensive care unit (ICU) could be improved with the use of hypocaloric nutritional support.

Does enteral glutamine supplementation decrease infectious morbidity?

Background: Although some studies have demonstrated lower infectious morbidity in patients receiving supplemental glutamine, there remains no consensus on the utility of such treatment. This study was designed to investigate the effects of supplemental enteral glutamine on the rate and outcomes of infection in critically ill surgical patients.

Methods: All 185 surgical and trauma patients admitted to a single university surgical trauma intensive care unit (STICU) over an approximately three-year period who were to receive enteral nutrition support were assigned sequentially to one of three diets: standard 1-kCal/mL feedings with added protein (Group 1), standard feedings with glutamine 0.

Does the addition of glutamine to enteral feeds affect patient mortality?

Objective: Studies have failed to consistently demonstrate improved survival in intensive care unit (ICU) patients receiving immune-modulating nutrient-enhanced enteral feeds when compared with standard enteral feeds. The objective was to study in a prospective fashion the effects of adding glutamine to standard or immune-modulated (supplemented with omega-3 fatty acids, beta-carotene, and amino acids such as glutamine and arginine) tube feeds.

Design: Prospective, unblinded study using sequential allocation.