Türkiye'deki çocuk yoğun bakım ünitelerinde enteral beslenme uygulamalarının değerlendirilmesi
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2022
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Open Access Color
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Araştırma, Türkiye'de bulunan çocuk yoğun bakım ünitelerindeki enteral beslenme uygulamalarını değerlendirmek amacıyla tanımlayıcı tipte gerçekleştirilmiştir. Araştırma, Şubat 2021- Haziran 2021 tarihleri arasında online surveey veri tabanı üzerinden Sağlık Bakanlığı 2019 verilerine göre toplam 93 Çocuk Yoğun Bakım Ünitesi (ÇYBÜ)'nin 73'üne ulaşılarak yapılmıştır. Veriler araştırmacı tarafından hazırlanan 'Katılımcı ve ünite değerlendirme formu' ve 'Enteral beslenme uygulamalarını değerlendirme formu' kullanılarak elde edildikten sonra, SPSS 21.0 programı ile analiz edilmiştir. Araştırmaya katılan ÇYBÜ'lerinde yazılı 'pediatrik enteral beslenme protokolü' kullananların oranı yalnızca % 24,7 olup, en sık kullanılan pediatrik nutrisyon risk değerlendirme ölçeği de Strong kids ölçeğidir. Standart olarak ilk tercih edilen yol ve yöntem, gastrointestinal yol ile aralıklı beslenme yöntemidir. Enteral beslenme tolerasyonunu değerlendirmede en sık kullanılan kriterler sırasıyla; GRV (Gastrik Rezidüel Volüm) miktarı, abdominal basınç artışı, kusma ve ishaldir. ÇYBÜ'lerinin % 61,6'sı rutin olarak enteral beslenmeye başlanan her hastada GRV ölçmekte ve % 31,5'i ise rutin olarak bakmayıp sadece intolerasyon belirti/bulgusu olan hastalarda GRV ölçmektedir. GRV ölçüm sıklığı aralıklı beslenme yönteminin kullanıldığı hastalarda en fazla % 50,7 oranıyla her beslenme öğünü öncesinde yapılırken, sürekli beslenme yönteminin kullanıldığı hastalarda ise en fazla % 38,4 oranıyla sadece çocuk kusuyorsa yapılmaktadır. ÇYBÜ'lerinin % 58,9'u GRV miktarına göre beslenmenin durdurulması için herhangi bir eşik değer veya formül kullanmazken, en fazla kullanılan eşik değer ise 'bir önceki beslenme miktarının en az yarısı kadar içeriğin gelmesi' olarak tanımlanmıştır. Araştırmada elde edilen bulgular doğrultusunda katılan üniterde yazılı enteral beslenme protokolünün az sayıda ünitede kullanıldığı, enteral beslenen hastalarda rutin GRV kontrolünü yapan ünite sayısının yüksek olduğu, ilk tercih edilen enteral beslenme yönteminin aralıklı gastrik yol olduğu belirlendi. Bu sonuçlar doğrultusunda enteral beslenme konusunda kaliteli bir sunum için her kurumun güncel literatür bilgileri eşiliğinde hazırlanmış yazılı protokol oluşturması, düzenli olarak hizmet içi eğitimler yapılması, beslenme destek ekiplerinin oluşturulması ve randomize kontrollü çalışmalar yapılması önerilmektedir.
This descriptive study aims to evaluate enteral feeding practices in pediatric intensive care units (PICU) across Turkey. According to the 2019 data of the Turkish Ministry of Health, there were 93 PICUs in Turkey. Seventy three of these PICUs were contacted, and an online survey filled out by senior nurses in the participating centers. Data were recorded on the 'participant and unit evaluation form' and 'enteral feeding practices form' and analyzed on Statistical Package for Social Sciences Software (version 21.0, IBM, Armonk, New York). Pediatric enteral feeding protocols were used in 24.7% of participating units only, with the most commonly used nutritional risk evaluation tool being the STRONGkids scale. Intermittent feeding through the gastrointestinal tract was the most common initial method for feeding. Most commonly used criteria employed to evaluate feeding tolerance were gastric residual volumes (GRV), abdominal distension, vomiting and diarrhea. Routine measurement of GRV was performed in 61.6% of the units while 31.5% of the units measured GRV when other signs suggestive of intolerance were noted. Measurement of GRV was performed before every feed in 50.7% of the units. In patients on drip feeding, GRV was measured in 38.4% of the patients and only when vomiting was noted. There was no particular GRV threshold that would require withholding feeds in 58.9% of participating centers, while the most commonly used threshold was 'half or more of the volume of the last feed'. In this study, we found that written enteral feeding protocols were used in a minority of participating units, many units measured GRV routinely and the most common route for feeding was the enteral route. In light of these findings, we suggest that each unit prepare a written protocol based on recent evidence, conduct continuous training, compose nutritional support teams so that appropriate enteral nutrition can be provided. More randomized controlled trials on enteral feeding practices should be conducted.
This descriptive study aims to evaluate enteral feeding practices in pediatric intensive care units (PICU) across Turkey. According to the 2019 data of the Turkish Ministry of Health, there were 93 PICUs in Turkey. Seventy three of these PICUs were contacted, and an online survey filled out by senior nurses in the participating centers. Data were recorded on the 'participant and unit evaluation form' and 'enteral feeding practices form' and analyzed on Statistical Package for Social Sciences Software (version 21.0, IBM, Armonk, New York). Pediatric enteral feeding protocols were used in 24.7% of participating units only, with the most commonly used nutritional risk evaluation tool being the STRONGkids scale. Intermittent feeding through the gastrointestinal tract was the most common initial method for feeding. Most commonly used criteria employed to evaluate feeding tolerance were gastric residual volumes (GRV), abdominal distension, vomiting and diarrhea. Routine measurement of GRV was performed in 61.6% of the units while 31.5% of the units measured GRV when other signs suggestive of intolerance were noted. Measurement of GRV was performed before every feed in 50.7% of the units. In patients on drip feeding, GRV was measured in 38.4% of the patients and only when vomiting was noted. There was no particular GRV threshold that would require withholding feeds in 58.9% of participating centers, while the most commonly used threshold was 'half or more of the volume of the last feed'. In this study, we found that written enteral feeding protocols were used in a minority of participating units, many units measured GRV routinely and the most common route for feeding was the enteral route. In light of these findings, we suggest that each unit prepare a written protocol based on recent evidence, conduct continuous training, compose nutritional support teams so that appropriate enteral nutrition can be provided. More randomized controlled trials on enteral feeding practices should be conducted.
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Hemşirelik, Nursing
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