Evaluation the Efficacy and Complication of Nutrika Supplement in Intensive Care Unit of Ghaem Hospital-Mashhad

<!DOCTYPE html> <html lang="en"> <head> <meta charset="utf-8" /> <title>Evaluation the Efficacy and Complication of Nutrika Supplement in Intensive Care Unit of Ghaem Hospital-Mashhad</title>  <link rel="shortcut icon" type="image/ico" href="./data/psj/coversheet/favicon.ico" />  <meta name="viewport" content="width=device-width, maximum-scale=1, initial-scale=1, user-scalable=0" />   <meta name="keywords" content="Nutrika supplement,Intensive Care Unit,Enteral Nutrition" /> <meta name="description" content="Introduction: Malnutrition is a general problem in hospitalized patients. Enteral feeding in Intensive Care Unit (ICU) has been stated to decrease the metabolic response to stress, decline bacterial translocation, and preserve gut mucosal integrity. To assess the efficacy and complications of Nutrika supplement for enteral feeding in Intensive Care unit. Materials and Methods: Nutrika is an enteral nutritional supplement. 12 patients (six male, six female) who received Nutrika supplement through Nasogastric Tube (NGT) in ICU department of Ghaem Hospital were studied. Evaluating gastrointestinal tolerance, biochemical tests, daily calorie intake and the measurement of arm circumference were done daily. Mean admission duration of these hospitalized patients was ten days and it should be noted that the average amount of received gavage was 200 ml/2h. Results: four patients (two male, two female) had diarrhea when they received this supplement in consecutive meals. Two patients (female) experienced abdominal pain after consuming this supplement; however the prevalence of all gastrointestinal intolerance symptoms among patients were not statistically significant (P=0.25, P=0.50, P=0.50). Albumin and Urea level alter significantly during supplementation (P=0.001, P=0.002). Rest of the laboratory values did not change significantly. In two patients (one male, one female) who were completely intolerant to this solution, arm circumference had two cm decrease. Conclusion: Although this supplement has some complication including distension and diarrhea, however it is strongly suggested to use due to severe malnutrition in ICU ward and plays a significant role in improving general condition of these patients." /> <meta name="title" content="Evaluation the Efficacy and Complication of Nutrika Supplement in Intensive Care Unit of Ghaem Hospital-Mashhad" /> <meta name="googlebot" content="NOODP" /> <meta name="citation_title" content="Evaluation the Efficacy and Complication of Nutrika Supplement in Intensive Care Unit of Ghaem Hospital-Mashhad" /> <meta name="citation_author" content="Rezaie, Peyman" /> <meta name="citation_author_institution" content="Biochemistry and Nutrition Research Center, Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran." /> <meta name="citation_author" content="Ayoubi, Samaneh Sadat" /> <meta name="citation_author_institution" content="Biochemistry and Nutrition Research Center, Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran." /> <meta name="citation_author" content="Mazidi, Mohsen" /> <meta name="citation_author_institution" content="Institute of Genetics and Developmental Biology, International College, University of Chinese Academy of Science (IC-UCAS), Beijing, China." /> <meta name="citation_author" content="Norouzy, Abdolreza" /> <meta name="citation_author_institution" content="Biochemistry and Nutrition Research Center, Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran" /> <meta name="citation_abstract" content="Introduction: Malnutrition is a general problem in hospitalized patients. Enteral feeding in Intensive Care Unit (ICU) has been stated to decrease the metabolic response to stress, decline bacterial translocation, and preserve gut mucosal integrity. To assess the efficacy and complications of Nutrika supplement for enteral feeding in Intensive Care unit. Materials and Methods: Nutrika is an enteral nutritional supplement. 12 patients (six male, six female) who received Nutrika supplement through Nasogastric Tube (NGT) in ICU department of Ghaem Hospital were studied. Evaluating gastrointestinal tolerance, biochemical tests, daily calorie intake and the measurement of arm circumference were done daily. Mean admission duration of these hospitalized patients was ten days and it should be noted that the average amount of received gavage was 200 ml/2h. Results: four patients (two male, two female) had diarrhea when they received this supplement in consecutive meals. Two patients (female) experienced abdominal pain after consuming this supplement; however the prevalence of all gastrointestinal intolerance symptoms among patients were not statistically significant (P=0.25, P=0.50, P=0.50). Albumin and Urea level alter significantly during supplementation (P=0.001, P=0.002). Rest of the laboratory values did not change significantly. In two patients (one male, one female) who were completely intolerant to this solution, arm circumference had two cm decrease. Conclusion: Although this supplement has some complication including distension and diarrhea, however it is strongly suggested to use due to severe malnutrition in ICU ward and plays a significant role in improving general condition of these patients." /> <meta name="citation_id" content="3808" /> <meta name="citation_publication_date" content="2015/01/01" /> <meta name="citation_date" content="2015-01-01" /> <meta name="citation_journal_title" content="Journal of Patient Safety & Quality Improvement" /> <meta name="citation_issn" content="2345-4482" /> <meta name="citation_volume" content="3" /> <meta name="citation_issue" content="1" /> <meta name="citation_firstpage" content="175" /> <meta name="citation_lastpage" content="178" /> <meta name="citation_publisher" content="Mashhad University of Medical Sciences" /> <meta name="citation_doi" content="10.22038/psj.2015.3808" /> <meta name="DC.Identifier" content="10.22038/psj.2015.3808" /> <meta name="citation_abstract_html_url" content="https://psj.mums.ac.ir/article_3808.html" /> <meta name="citation_pdf_url" content="https://psj.mums.ac.ir/article_3808_39446b56d651e166e39af8dc46df8ae5.pdf" /> <meta name="DC.Title" content="Evaluation the Efficacy and Complication of Nutrika Supplement in Intensive Care Unit of Ghaem Hospital-Mashhad" /> <meta name="DC.Source" content="Journal of Patient Safety & Quality Improvement" /> <meta name="DC.Date" content="01/01/2015" /> <meta name="DC.Date.issued" content="2015-01-01" /> <meta name="DC.Format" content="application/pdf" /> <meta name="DC.Contributor" content="Rezaie, Peyman" /> <meta name="DC.Contributor" content="Ayoubi, Samaneh Sadat" /> <meta name="DC.Contributor" content="Mazidi, Mohsen" /> <meta name="DC.Contributor" content="Norouzy, Abdolreza" /> <meta name="og:title" content="Evaluation the Efficacy and Complication of Nutrika Supplement in Intensive Care Unit of Ghaem Hospital-Mashhad" /> <meta name="og:description" content="Introduction: Malnutrition is a general problem in hospitalized patients. Enteral feeding in Intensive Care Unit (ICU) has been stated to decrease the metabolic response to stress, decline bacterial translocation, and preserve gut mucosal integrity. To assess the efficacy and complications of Nutrika supplement for enteral feeding in Intensive Care unit. Materials and Methods: Nutrika is an enteral nutritional supplement. 12 patients (six male, six female) who received Nutrika supplement through Nasogastric Tube (NGT) in ICU department of Ghaem Hospital were studied. Evaluating gastrointestinal tolerance, biochemical tests, daily calorie intake and the measurement of arm circumference were done daily. Mean admission duration of these hospitalized patients was ten days and it should be noted that the average amount of received gavage was 200 ml/2h. Results: four patients (two male, two female) had diarrhea when they received this supplement in consecutive meals. Two patients (female) experienced abdominal pain after consuming this supplement; however the prevalence of all gastrointestinal intolerance symptoms among patients were not statistically significant (P=0.25, P=0.50, P=0.50). Albumin and Urea level alter significantly during supplementation (P=0.001, P=0.002). Rest of the laboratory values did not change significantly. In two patients (one male, one female) who were completely intolerant to this solution, arm circumference had two cm decrease. Conclusion: Although this supplement has some complication including distension and diarrhea, however it is strongly suggested to use due to severe malnutrition in ICU ward and plays a significant role in improving general condition of these patients." /> <meta name="og:url" content="https://psj.mums.ac.ir/article_3808.html" />   <link href="./themes/base/front/assets/plugins/bootstrap/css/bootstrap.min.css?v=0.02" rel="stylesheet" type="text/css" /> <link href="./inc/css/ju_css.css" rel="stylesheet" type="text/css" /> <link href="./themes/old/front/assets/css/header.css?v=0.015" rel="stylesheet" type="text/css" />  <link href="./themes/base/front/assets/plugins/bootstrap/css/bootstrap-ltr.min.css" rel="stylesheet" type="text/css" /> <link href=" ./themes/base/front/assets/css/gfonts-OpenSans.css" rel="stylesheet" type="text/css" />  <link href="./data/psj/coversheet/stl_front.css?v=0.12" rel="stylesheet" type="text/css" />  <link rel="alternate" type="application/rss+xml" title="RSS 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<li class="padding-3"> <a href="./?_action=article&au=34359&_au=Peyman++Rezaie">Peyman Rezaie</a> <sup><a href="#aff1" >1</a></sup> </li> <li class="padding-3"> <a href="./?_action=article&au=31447&_au=Samaneh+Sadat++Ayoubi">Samaneh Sadat Ayoubi</a> <sup><a href="#aff1" >1</a></sup> </li> <li class="padding-3"> <a href="./?_action=article&au=34360&_au=Mohsen++Mazidi">Mohsen Mazidi</a> <sup><a href="#aff2" >2</a></sup> </li> <li class="padding-3"> <a href="./?_action=article&au=26934&_au=Abdolreza++Norouzy">Abdolreza Norouzy</a> <sup><a href="mailto:norouzya@mums.ac.ir" data-toggle="tooltip" data-placement="bottom" title="Email to Corresponding Author"><i class="fa fa-envelope-o" ></i></a></sup> <sup><a href="#aff3" >3</a></sup> </li> </ul> <p class="margin-bottom-3 ltr" id="aff1"> <sup>1</sup> Biochemistry and Nutrition Research Center, Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran. </p> <p class="margin-bottom-3 ltr" id="aff2"> <sup>2</sup> Institute of Genetics and Developmental Biology, International College, University of Chinese Academy of Science (IC-UCAS), Beijing, China. </p> <p class="margin-bottom-3 ltr" id="aff3"> <sup>3</sup> Biochemistry and Nutrition Research Center, Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran </p> <div class="margin-bottom-3 ltr" id="ar_doi" title="DOI"><i class="ai ai-doi size-25 text-orange"></i> <span dir="ltr"><a href="https://doi.org/10.22038/psj.2015.3808">10.22038/psj.2015.3808</a></span></div> <p style="margin:12px -2px 0 -2px"><strong>Abstract</strong></p> <div class="padding_abstract justify ltr">Introduction: Malnutrition is a general problem in hospitalized patients. Enteral feeding in Intensive Care Unit (ICU) has been stated to decrease the metabolic response to stress, decline bacterial translocation, and preserve gut mucosal integrity. To assess the efficacy and complications of Nutrika supplement for enteral feeding in Intensive Care unit. <br/>Materials and Methods: Nutrika is an enteral nutritional supplement. 12 patients (six male, six female) who received Nutrika supplement through Nasogastric Tube (NGT) in ICU department of Ghaem Hospital were studied. Evaluating gastrointestinal tolerance, biochemical tests, daily calorie intake and the measurement of arm circumference were done daily. Mean admission duration of these hospitalized patients was ten days and it should be noted that the average amount of received gavage was 200 ml/2h. <br/>Results: four patients (two male, two female) had diarrhea when they received this supplement in consecutive meals. Two patients (female) experienced abdominal pain after consuming this supplement; however the prevalence of all gastrointestinal intolerance symptoms among patients were not statistically significant (P=0.25, P=0.50, P=0.50). Albumin and Urea level alter significantly during supplementation (P=0.001, P=0.002). Rest of the laboratory values did not change significantly. In two patients (one male, one female) who were completely intolerant to this solution, arm circumference had two cm decrease. <br/>Conclusion: Although this supplement has some complication including distension and diarrhea, however it is strongly suggested to use due to severe malnutrition in ICU ward and plays a significant role in improving general condition of these patients.</div> <p class="padding-0" style="margin:12px -2px 0 -2px"><strong>Keywords</strong></p> <ul class="block list-inline list-inline-seprator margin-bottom-6 ltr"> <li class="padding-3"> <a class="tag_a" href="./?_action=article&kw=9670&_kw=Nutrika+supplement" >Nutrika supplement</a> </li> <li class="padding-3"> <a class="tag_a" href="./?_action=article&kw=1485&_kw=Intensive+Care+Unit" >Intensive Care Unit</a> </li> <li class="padding-3"> <a class="tag_a" href="./?_action=article&kw=5955&_kw=Enteral+Nutrition" >Enteral Nutrition</a> </li> </ul> </div> <hr> <div class="page_break"></div> <div class="panel"> <div class="panel-heading card-header"> <h4 class="panel-title"> <a data-toggle="collapse" data-parent="#accordions" href="#collapsesFT"><i class="fa fa-minus"></i> Full Text</a> </h4> </div> <div id="collapsesFT" class="panel-collapse collapse in"> <div class="panel-body"> <div class="ltr" ><div class="WordSection1"> <p><strong>Introduction</strong></p> </div> <p>Malnutrition is a general problem in hospitalized patients. About (40%) of adult patients are extremely malnourished at the time of their admission, and two thirds of all patients experience deterioration of their nutritional status during their hospital stay (1).</p> <p>Moreover, malnutrition has been linked with poor consequences among hospitalized patients, including prolonged mechanical ventilation, increased risk for infection, and higher mortality (2, 3). Critically ill patients commonly receive insufficient nutritional support during their Intensive Care Unit (ICU) stay because doctors underestimate the nutritional requirements of patients and the initiation of nutritional support is frequently postponed (4). Furthermore, nutritional care has a vital role in prevention and management of nutritional deficiencies in ICU patients (5). Enteral feeding has been stated to decrease the metabolic response to stress, decline bacterial translocation, and preserve gut mucosal integrity; nutritional intake through the digestive tract has been strongly suggested (6). However, enteral and parenteral nutritional support in ICU patients may be problematic due to gastrointestinal intolerance and fluid overload, respectively, and they are linked with severe iatrogenic complications including aspiration pneumonia and catheter-related infections (7).</p> <p>Nutrika is a nutritional supplement that has been specialized for enteral feeding. This supplement has been produced by Chika Sepahan Company in Isfahan-Iran. This solution contains lactose-free pasteurized milk, pureed chicken, water, lactose-free milk powder, hydrated rice, pureed apple, malt dextrin, pureed potato, vegetable oil, pureed banana, pureed carrot, pureed tomato and inulin. The osmolality of this solution is 350mOsmol/kg and it is unusable as parenteral nutrition. It should be noted that this solution is lactose and gluten free. Nutritional value in one serving of this solution (260ml/270gram) is shown in tabale-1.</p> <p>The aim of this study was evaluating the efficacy and complications of Nutrika supplement in Intensive Care unit.</p> <p><strong>Materials and Methods</strong></p> <p>In this study, 12 patients (six male, six female) who received Nutrika supplement in Neurosurgery ICU of Ghaem Hospital were studied. These patients were recruited under the supervision and permission of medical staff including specialists and nurses. They hospitalized due to brain stroke, Subarachnoid Hemorrhage (SAH), guillain-barre syndrome, Myasthenia gravis, seizure and status epilepticus.</p> <p>Nutrika solution was administered by means of Nasogastric Tube (NGT) as a daily hospital gavage under the supervision and advice of nutritionist.</p> <p>Evaluating gastrointestinal tolerance, biochemical tests, daily calorie intake and the measurement of arm circumference were done daily and evaluation forms were completed every day. Mean admission duration of these hospitalized patients was ten days and it should be noted that the average amount of received gavage was 200 ml/2h.</p> <p>The evaluation forms contained assessment of prevalence of gastrointestinal intolerance to the Nutrika solution including diarrhea, Gastero Intenstinal (GI) residue over (60%), abdominal pain, nausea and distension, also evaluating biochemical tests (Albumin, Total Protein, Calcium, Phosphor, Magnesium, Urea, and Creatinine), evaluating arm circumference, the mean of daily received calorie and its comparison with required calorie. The gathered data were analyzed by SPSS Version 22 Bootstrap paired samples T-Test and McNemar Test were used to assess quantitative and non-parametric data respectively.</p> <p>P-value less than (0.05) was considered significant.</p> <p><em>Ethical consideration:</em>The informed consent was obtained from the medical staff particularly specialists as well as each patient’s family.</p> <p><strong>Results</strong></p> <p>These results were obtained from the follow-up of these 12 patients (six male, six female) who consumed Nutrika supplement in Intensive Care Unit of Ghaem Hospital.</p> <p>The mean age of these patients were 52 years old. Glasgow Coma Scale (GCS) median of these patients were 12. It should be stated that the GCS is a <a title="Neurology" href="http://en.wikipedia.org/wiki/Neurology">neurological</a> <a title="Scale (ratio)" href="http://en.wikipedia.org/wiki/Scale_(ratio)">scale</a> that aims to give a reliable, objective way of recording the conscious state of a person for initial as well as subsequent assessment (8).</p> <p><em>Evaluation of</em><em> the prevalence of gastrointestinal intolerance:</em> In this follow-up, two male patients had gastrointestinal residue over (60%), so they were not able to consume this supplement.</p> <p>Three patients (one male, two female) had diarrhea when they received this supplement in consecutive meals; however limited gavage of this supplement (four times a day) resolved this problem.</p> <p>Two patients (female) experienced abdominal pain after consuming this supplement; moreover they complained about the smell and taste of Nutrika thus they were not able to continue consuming this solution.</p> <p>Rest of the patients consumed and tolerated this solution well in desired volume.</p> <p>McNemar Test was performed in order to statistically compare these intolerance symptoms before and after the supplementation table 2.</p> <p>As it shown in table 1, the prevalence of all gastrointestinal intolerance symptoms among patients were insignificant.</p> <p><em>Evaluation of nutritional status: </em>The gathered data from biochemical indices during this study was analyzed by Bootstrap paired samples T-test (Table 3).</p> <p>As it represented in table 3, Albumin and Urea level alter significantly during supplementation (P=0.001, P=0.002). Rest of the laboratory values did not change significantly.</p> <p>Evaluation<em> of arm circumference and calorie requirement and intake:</em>In two patients (one male, one female) who were completely intolerant to this solution, arm circumference had two cm decrease. The mean energy requirement of these patients were 1750Kcal, however the average calorie intake of these patients in ICU was 1020Kcal. The mean energy intake from Nutrika supplement was 50% during a day.</p> <p><strong>Discussion</strong></p> <p>The main finding was that nutritional supplementation in ICU patients plays a significant role in improvement of general condition of the patients due to severe malnutrition that has been seen in this department. This supplement helps these patients to meet their daily energy and calorie requirement.</p> <p>Barr's stated that the implementation of an evidence-based nutritional management protocol rise the likelihood of ICU patients receiving enteral nutrition and reduces their duration use of mechanical ventilation.</p> <p>Moreover, this strategies help patient to meet their energy requirement. Furthermore, Patients receiving enteral nutrition had a (56%) reduction in their risk of death compared to patients receiving parenteral nutrition or no nutritional support (9).</p> <p>Inconsistency with our finding, Krishnan's reported that ICU patients were inadequately fed in comparison to goals set by American College of Chest Physicians (ACCP) guidelines. However, the relationships between caloric intake and clinical outcomes measured in this study suggest that daily ACCP caloric targets may overestimate needs since caloric intake of (65%) of recommendations (approximately 18kcal/kg/d) was associated with excess morbidity and mortality (10-13).</p> <p>It can be conferred from this study, that Nutrika Supplementation maintain lean mass and prevent weight loss. Steven stated that data supporting their use to augment lean mass and strength gains in these patients (14). However, there are some complications besides using this solution and these problems are unavoidable due to patients’ diseases.</p> <p>Another aspects that should be taken into account in nutritional supplementation in hospital is the cost effectiveness of these solutions. Several studies have been carried out in this field in order to evaluate this aspect (15-18). <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Pradelli%20L%5BAuthor%5D&cauthor=true&cauthor_uid=24345520">Pradelli</a>'s reported that supplementation of omega-3 fatty acids would be cost effective in hospitals especially in European countries; moreover they reported that alanyl-glutamine dipeptide supplementation is more effective and less costly than standard Total Parenteral Nutrition (TPN) in ICU patients (15, 17). Furthermore, Jolliet P revealed that enteral nutrition should be preferred to parenteral nutrition whenever possible due to lower costs. They also strongly suggested that these enteral solutions are more cost effective according to the beneficial effects of enteral nutrition supplementation (18).</p> <p>However, the price of Nutrika supplement in this study is more than other routine hospital solutions, therefore the cost of this solution can be considered as a negative point for providing and consuming this product for hospitalized patients. It would be suggested that one of the main issues that health authorities should consider in improving the nutritional condition of Iranian patients in hospitals is assessment of producing cost effective supplements in order to use and consume routinely in health centers particularly Intensive Care Units.  </p> <p><strong>Conclusion</strong></p> <p>Although this supplement has some complications including distension and diarrhea, it is suggested to use it due to severe malnutrition in ICU and its’ significant role in improving general condition of these patients.</p></div> </div> </div> </div> <div class="page_break"></div> <div class="panel"> <div class="panel-heading card-header"> <h4 class="panel-title "> <a data-toggle="collapse" data-parent="#accordions" href="#collapsesRef"><i class="fa fa-plus"></i> References</a> </h4> </div> <div id="collapsesRef" class="panel-collapse collapse"> <div class="panel-body justify"> <div class="padding-3 margin-top-3 ltr justify">1- McWhirter JP, Pennington CR. Incidence and recognition of malnutrition in hospital. BMJ (Clinical research ed). 1994 Apr 9;308(6934):945-8. </div> <div class="padding-3 margin-top-3 ltr justify">2- Bassili HR, Deitel M. Effect of nutritional support on weaning patients off mechanical ventilators. JPEN Journal of parenteral and enteral nutrition. 1981 Mar-Apr;5(2):161-3. </div> <div class="padding-3 margin-top-3 ltr justify">3- Larca L, Greenbaum DM. Effectiveness of intensive nutritional regimes in patients who fail to wean from mechanical ventilation. Critical care medicine. 1982 May;10(5):297-300. </div> <div class="padding-3 margin-top-3 ltr justify">4- Heyland D, Cook DJ, Winder B, Brylowski L, Van deMark H, Guyatt G. Enteral nutrition in the critically ill patient: a prospective survey. Critical care medicine. 1995 Jun;23(6):1055-60. </div> <div class="padding-3 margin-top-3 ltr justify">5- Klein S, Kinney J, Jeejeebhoy K, Alpers D, Hellerstein M, Murray M, et al. Nutrition support in clinical practice: review of published data and recommendations for future research directions. Clinical nutrition (Edinburgh, Scotland). 1997 Aug;16(4):193-218. </div> <div class="padding-3 margin-top-3 ltr justify">6- Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN Journal of parenteral and enteral nutrition. 2002 Jan-Feb;26(1 Suppl):1SA-138SA. </div> <div class="padding-3 margin-top-3 ltr justify">7- Montejo JC. Enteral nutrition-related gastrointestinal complications in critically ill patients: a multicenter study. The Nutritional and Metabolic Working Group of the Spanish Society of Intensive Care Medicine and Coronary Units. Critical care medicine. 1999 Aug;27(8):1447-53. </div> <div class="padding-3 margin-top-3 ltr justify">8- Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974 Jul 13;2(7872):81-4. </div> <div class="padding-3 margin-top-3 ltr justify">9- Barr J, Hecht M, Flavin KE, Khorana A, Gould MK. Outcomes in critically ill patients before and after the implementation of an evidence based nutritional management protocol. Chest. 2004 Apr;125(4):1446-57. </div> <div class="padding-3 margin-top-3 ltr justify">10- Krishnan JA, Parce PB, Martinez A, Diette GB, Brower RG. Caloric intake in medical ICU patients: consistency of care with guidelines and relationship to clinical outcomes. Chest. 2003 Jul;124(1):297-305. </div> <div class="padding-3 margin-top-3 ltr justify">11- Elamin EM. Nutritional care of the obese intensive care unit patient. Current opinion in critical care. 2005 Aug;11(4):300-3. </div> <div class="padding-3 margin-top-3 ltr justify">12- McClave SA, Sexton LK, Spain DA, Adams JL, Owens NA, Sullins MB, et al. Enteral tube feeding in the intensive care unit: factors impeding adequate delivery. 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Clinical nutrition (Edinburgh, Scotland). 2014 Oct;33(5):785-92. </div> <div class="padding-3 margin-top-3 ltr justify">16- Koethe JR, Marseille E, Giganti MJ, Chi BH, Heimburger D, Stringer JS. Estimating the cost-effectiveness of nutrition supplementation for malnourished, HIV-infected adults starting antiretroviral therapy in a resource-constrained setting. Cost effectiveness and resource allocation: C/E. 2014;12:10. </div> <div class="padding-3 margin-top-3 ltr justify">17- Pradelli L, Iannazzo S, Zaniolo O, Muscaritoli M, Eandi M. Effectiveness and cost-effectiveness of supplemental glutamine dipeptide in total parenteral nutrition therapy for critically ill patients: a discrete event simulation model based on Italian data. International journal of technology assessment in health care. 2012 Jan;28(1):22-8. </div> <div class="padding-3 margin-top-3 ltr justify">18- Jolliet P, Pichard C, Biolo G, Chiolero R, Grimble G, Leverve X, et al. Enteral nutrition in intensive care patients: a practical approach. Working Group on Nutrition and Metabolism, ESICM. European Society of Intensive Care Medicine. 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S. , Mazidi, M. and Norouzy, A. (2015). Evaluation the Efficacy and Complication of Nutrika Supplement in Intensive Care Unit of Ghaem Hospital-Mashhad. <em>Journal of Patient Safety & Quality Improvement</em>, <em>3</em>(1), 175-178. doi: 10.22038/psj.2015.3808</p> </div> </div> </div> </div> <div id="cite-mla" class="modal fade" tabindex="-1" role="dialog" aria-labelledby="myModalLabel" aria-hidden="true"> <div class="modal-dialog"> <div class="modal-content">  <div class="modal-header"> <button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">×</span></button> <h4 class="modal-title" id="myModalLabel">MLA</h4> </div>  <div class="modal-body"> <p> Rezaie, P. , , Ayoubi, S. S. , , Mazidi, M. , and Norouzy, A. . "Evaluation the Efficacy and Complication of Nutrika Supplement in Intensive Care Unit of Ghaem Hospital-Mashhad", <em>Journal of Patient Safety & Quality Improvement</em>, 3, 1, 2015, 175-178. doi: 10.22038/psj.2015.3808</p> </div> </div> </div> </div> <div id="cite-harvard" class="modal fade" tabindex="-1" role="dialog" aria-labelledby="myModalLabel" aria-hidden="true"> <div class="modal-dialog"> <div class="modal-content">  <div class="modal-header"> <button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">×</span></button> <h4 class="modal-title" id="myModalLabel">HARVARD</h4> </div>  <div class="modal-body"> <p>Rezaie, P., Ayoubi, S. S., Mazidi, M., Norouzy, A. (2015). 'Evaluation the Efficacy and Complication of Nutrika Supplement in Intensive Care Unit of Ghaem Hospital-Mashhad', <em>Journal of Patient Safety & Quality Improvement</em>, 3(1), pp. 175-178. doi: 10.22038/psj.2015.3808</p> </div> </div> </div> </div> <div id="cite-chicago" class="modal fade" tabindex="-1" role="dialog" aria-labelledby="myModalLabel" aria-hidden="true"> <div class="modal-dialog"> <div class="modal-content">  <div class="modal-header"> <button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">×</span></button> <h4 class="modal-title" id="myModalLabel">CHICAGO</h4> </div>  <div class="modal-body"> <p> P. Rezaie , S. S. Ayoubi , M. Mazidi and A. Norouzy, "Evaluation the Efficacy and Complication of Nutrika Supplement in Intensive Care Unit of Ghaem Hospital-Mashhad," Journal of Patient Safety & Quality Improvement, 3 1 (2015): 175-178, doi: 10.22038/psj.2015.3808</p> </div> </div> </div> </div> <div id="cite-vancouver" class="modal fade" tabindex="-1" role="dialog" aria-labelledby="myModalLabel" aria-hidden="true"> <div class="modal-dialog"> <div class="modal-content">  <div class="modal-header"> <button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">×</span></button> <h4 class="modal-title" id="myModalLabel">VANCOUVER</h4> </div>  <div class="modal-body"> <p>Rezaie, P., Ayoubi, S. S., Mazidi, M., Norouzy, A. Evaluation the Efficacy and Complication of Nutrika Supplement in Intensive Care Unit of Ghaem Hospital-Mashhad. <em>Journal of Patient Safety & Quality Improvement</em>, 2015; 3(1): 175-178. doi: 10.22038/psj.2015.3808</p> </div> </div> </div> </div> </div> </div>   <section class="alternate padding-xxs"> </section>   <div class="container"> <footer id="footer"> <div class="scrollup" id="scroll" href="#"><span></span></div> <div class="row"> <div class="col-md-2">  <h4 class="">Explore Journal</h4> <ul class="footer-links list-unstyled"> <li id="fli_home"><a href="./">Home</a></li> <li id="fli_about"><a href="./journal/about">About Journal</a></li> <li id="fli_Edb"><a href="./journal/editorial.board">Editorial Board</a></li> <li id="fli_submit"><a href="./author">Submit Manuscript</a></li> <li id="fli_contactus"><a href="./journal/contact.us">Contact Us</a></li> <li id="fli_sitemap"><a href="./sitemap.xml?usr">Sitemap</a></li> </ul>  </div> <div class="col-md-3">  <h4 class="">Latest News</h4> <ul class="footer-posts list-unstyled"> <li> <a href="./news?newsCode=34">The formation of a professional group for translating articles from English to English into the Patient Safety Research Center</a> <small class="ltr">2014-06-25</small> </li> <li> <a href="./news?newsCode=25">Publication License</a> <small class="ltr">2014-02-09</small> </li> </ul>  </div> <div class="col-md-3">  <div></div>  </div> <div class="col-md-4">  <h4 class="">Newsletter Subscription</h4> <p>Subscribe to the journal newsletter and receive the latest news and updates</p> <form class="validate" action="" method="post" data-success="Subscription saved successfully." data-toastr-position="bottom-right"> <input type="hidden" name="_token" value="a2b84d9670520f34664ee3e9e7d90922ee0869fdc0dc88d5"/> <div class="input-group"> <span class="input-group-addon"><i class="fa fa-envelope"></i></span> <input type="email" id="email" name="email" required="required" class="form-control required sbs_email" placeholder="Enter your Email" oninvalid="this.setCustomValidity('Enter a valid email address.')" oninput="this.setCustomValidity('')"> <span class="input-group-btn"> <button class="btn btn-primary mybtn" type="submit">Subscribe</button> </span> </div> </form>   <div class="margin-top-20"> <a class="noborder" href="" target="_blank" class="social-icon social-icon-border social-facebook pull-left block" data-toggle="tooltip" data-placement="top" title="Facebook"> <i class="fa fa-facebook-square" aria-hidden="true"></i> </a> <a class="noborder" href="" target="_blank" class="social-icon social-icon-border social-facebook pull-left block" data-toggle="tooltip" data-placement="top" title="Twitter"> <i class="fa fa-twitter-square" aria-hidden="true"></i> </a> <a class="noborder" href="" target="_blank" class="social-icon social-icon-border social-facebook pull-left block" data-toggle="tooltip" data-placement="top" title="Linkedin"> <i class="fa fa-linkedin-square" aria-hidden="true"></i> </a> <a class="noborder" href="./ju.rss" class="social-icon social-icon-border social-rss pull-left block" data-toggle="tooltip" data-placement="top" title="Rss"><i class="fa fa-rss-square" aria-hidden="true"></i></a> </div> </div> </div> <div class="copyright" style="position: relative"> <ul class="nomargin list-inline mobile-block"> <li>© Journal Management System. <span id='sp_crt'>Powered by <a target='_blank' href='https://www.sinaweb.net/'>Sinaweb</a></span></li> </ul> </div> </footer> </div>  </div>   <a href="#" id="toTop_old"></a>  <div id="preloader"> <div class="inner"> <span class="loader"></span> </div> </div>    <script type="text/javascript"> $('ul.nav li.dropdown').hover(function() { if (window.matchMedia('(max-width: 767px)').matches) return; $(this).find('.dropdown-menu').stop(true, true).delay(200).fadeIn(500); }, function() { if (window.matchMedia('(max-width: 767px)').matches) return; $(this).find('.dropdown-menu').stop(true, true).delay(200).fadeOut(500); }); var btn = $('#toTop_old'); $(window).scroll(function() { if ($(window).scrollTop() > 300) { btn.addClass('show'); } else { btn.removeClass('show'); } }); btn.on('click', function(e) { e.preventDefault(); $('html, body').animate({scrollTop:0}, '300'); }); window.cookieconsent.initialise({ "palette": { "popup": { "background": "#222" }, "button": { "background": "#f1d600" } }, "content": { "message": "This website uses cookies to ensure you get the best experience on our website.", "dismiss": "Got it!", "link": "" } }); </script> </body> </html><div id="actn_modal" class="modal fade" tabindex="-1"> <div id="" class="modal-dialog modal-dialog madal-aw"> <div class="modal-content"> <div class="modal-header"> <button type="button" class="close pull-right" data-dismiss="modal" aria-hidden="true" href="#lost">×</button> <h5 class="modal-title"></h5> </div> <div class="modal-body"></div> <div class="modal-footer"></div> </div> </div> </div>

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Evaluation the Efficacy and Complication of Nutrika Supplement in Intensive Care Unit of Ghaem Hospital-Mashhad