Introduction: Critically-ill patients are commonly fed with EN via open system (OS) or closed system (CS). Several studies showed that patients on CS had received greater volume of EN compared to OS.
Objective: As there was no study conducted in Malaysia, hence this study is conducted to compare the energy and protein adequacy of both systems.
Methodology: This cohort prospective study was conducted in GICU (OS) and NICU/NHDW (CS) in Hospital Kuala Lumpur. Patients aged ≥18 years and fed by feeding pump in OS were included. Patients who were moribund or not given EN were excluded. Patients’ demographic data and disease severity score were collected on day 1 in ICU and followed for 5 days until decease or discharge. Adequacy was determined by percentage of energy/protein received from requirements.
Results: Fifty-five patients were included (25 OS and 30 CS) with mean aged 45.41±17.46 years old, 78.2% male and 65.5% Malay. The mean SAPS II, SOFA score and ICU LOS were 46.47±10.65, 8.60±3.64 and 9.24±7.91 days respectively. The ICU mortality was 20%. EN was started about 2.56±2.89 days after ICU admission and the mean adequacy of energy was 74.56±32.23%, while protein adequacy was and 69.15±35.78%. Compared with the CS, OS were significantly older than CS (51 years old vs 42.5 years old; p=0.035) and had a higher SOFA score (10 vs 7.5; p= 0.014). No difference in ICU LOS and mortality between group were found. Energy (45.64% vs 96.71%; p<0.001) and protein adequacy (38.78% vs 94.12%; p<0.001) were significantly higher in the CS than the OS.
Conclusion: CS as compared with OS may improve nutritional adequacy as CS delivered more 108% energy and 141% protein than OS. The difference in adequacy might be attributed to these factors; feeding method used in the system, patients’ characteristics and condition rather than the feeding system itself.
Keywords: enteral nutrition, critically-ill patients, open system, closed system, adequacy
Global pollution from toxic metal waste has resulted in increased research on toxic metal adsorption. A cellulose acetate-polyurethane (CA-PU) film adsorbent was successfully prepared in this research. The cellulose acetate-polyurethane film adsorbent was prepared with a polycondensation reaction between cellulose acetate and methylene diphenyl diisocyanate. The CA-PU bond formation was confirmed by functional group analysis obtained from Fourier transform infrared (FTIR) spectroscopy. The obtained film was characterized for improved tensile and thermal properties with the addition of methylene diphenyl diisocyanate (MDI). The adsorption ability of the obtained film was evaluated with laser-induced breakdown spectroscopy (LIBS). The best film adsorbent from the LIBS was selected and studied for adsorption isotherm. The FTIR analysis confirmed the formation of the CA-PU bond from the polycondensation between cellulose acetate and the methylene diphenyl diisocyanate. The result showed that the addition of methylene diphenyl diisocyanate (MDI) resulted in the urethane network's growth. The characterization result showed an improvement in the morphology, thermal stability, and tensile strength of the film. The LIBS studies showed improvement in the adsorption of Pb2+ with CA-PU compared with the neat CA. The isotherm studies revealed that Pb2+ adsorption by cellulose acetate-polyurethane film adsorbent was heterogeneously dependent on the Freundlich isotherm model (R2 = 0.97044). Overall, the polycondensation method proposed by this study enhanced the Pb2+ removal, and was comparable to those reported in previous studies.